HomeMy WebLinkAboutA007 - Groundwater Hazard Statement REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT
y Please read the filing instructions on the reverse side BEFORE completing this form.
PART I - TO BE COMPLETED BY TRANSFEROR
(Please Type or Print Legibly)
TRANSFEROR Name Hunziker Development Co. , L.C. Social Security No.(or Federal I.D. No.) Ud -13 94a$ f
Address 803 - 24th Street Ames IA 5001C
Number and Street or RR City,Town or P.O. State Zip
First Addition, Hillside Subdivision, in Social Security No.
TRANSFEREE Name (or Federal I.D. No.)
Ames, Iowa
Address
Number and Street or RR City, Town or P.O. State Zip
Address of Property Transfered
Number and Street or RR City,Town or P.O. State Zip
Legal Description of Property SEE ATTACHED SCHEDULE A.
1. Wells (check one)
i2§ There are no known wells situated on this property.
❑ There is a well or wells situated on this property. The type(s), location(s) and legal status are stated below.
2. Solid Waste Disposal
s check one
P ( )
X There is no known solid waste disposal site on this property.
❑ There is a solid waste disposal site on this property, but no notice has been received from the Department
of Natural Resources that the site is deemed to be oten i p tally hazardous.
❑ There is a solid waste disposal site on this property which has been deemed to be potentially hazardous
by the Department of Natural Resources. The location(s) of the site(s) is stated below.
3. Hazardous Wastes (check one)
IR There is no known hazardous waste on this property.
❑ There is hazardous waste on this property and it is being managed in accordance with Department of
Natural Resources rules.
4. Underground Storage Tanks (check one)
IR There are no known underground storage tanks on this property. (Note exclusions such as small farm
and residential motor fuel tanks, most heating oil tanks, cisterns and septic tanks, in instructions.)
❑ There is an underground storage tank or tanks on this property. The type(s), size(s) and any known
substance(s) contained are described below.
Information, if any, required by statements checked above:
Attachment for Additional Information? Y / N If so, number of pages
I HEREBY DECLARE THAT THE INFORMATION CONTAINED IN PART I OF THIS STATEMENT IS TRUE
AND CORRECT.
Signature: A Telephone Number:
Christine A. Hunziker— (Transferor or Agent)--Attorney
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PART II - TO BE COMPLETED BY RECORDER
Date of Instrument S�Z S"�� Boo I. ! Pag I.
Q
Date of Recording -3d - ( City Township Ame
Deed ❑ �a�
Contract ❑ P County
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DNR form (JAN. 91) FILE WITH RECORDER 542-0960
(See Instructions, #5)
SCHEDULE A
PROPERTY DESCRIPTION
Beginning at a point 339 . 00 feet North of the East 1/4
Corner of Section 7 , Township 83 North, Range 24 West of the
5th P.M. , Story County, Iowa on the East Line of the
Northeast Quarter of said Section 7; thence, North
00'-00 ' -00" East along the East Line of the Northeast 1/4 of
said Section 7 , a distance of 997 . 80 feet; thence,
S89°-3l ' -25"W, a distance of 2634 . 96 feet, thence,
S00°-11 ' -33"W, a `distance of 975 . 90 feet; thence,
N90°-00 ' -00"E, a distance of 2638 . 20 feet to the Point of
Beginning.
Said tract of land being subject to and together with any
and all easements of record.
Said tract of land contains 59 . 66 acres which includes 1 . 03
acres of road Right-of-Way.