Loading...
HomeMy WebLinkAboutA013 - Groundwater Hazard Statement RE,%I, ESTATE TR,%NSVI-:I1 - (iROHNI)WA'1'I:R HAZARD STA VIease lead the riling insltuctions on the tc%etst. side BEFORE completing this loan. PART I - TO RE COINII'I.ETED nil' '1'RANSFh,ROR (Please 'Type of Print Legibly) Erben Hunziker and Margaret Hunziker Development, L.L.C. ; TRANSFEROR Name D & R Furman, L.L.C. ; and R. Friedrich & Sons, Inc. Address 105 S. 16th Street Ames Iowa__ 50010 WUIIIT)caml Street J F R R --- - - ---' - c;ty.row ni P.i) - - —`------St�lc .rp - TRANSFEREE Name Tenth Addition, Somerset Subdivision Address ATirudier gird 5tieet or f(R--- - _ - i'iiy,' r(l. Address of Property Transferred 9-1wlici 3f41.Ctwei n_RR itv. 1 Legal Description of Property An official replat of Outlot E in Block Three (3) of Somerset Subdivision, Fifth Addition, an official replat now included in and forming a-part of the City_of_Ames, Story County, Iowa. 1. Wells(check one) M 'mere are no known wells situaled on Ibis property. f I "I'hcre is a well or wells situated on this properly. 'Pile lype(s), location(s)and legal stales arc stated below. 2. Solid Waste Disposal (check one) N 'I'here is no known solid waste disposal site on this property. I I 'There is a solid waste disposal site on this property, hul no notice has been received fioln the Department of Nalural Resources that the site is deemed to be potentially hazardous. I.l Tliere.is a solid waste disposal site on this properly which Ilas been dcenned to he potentially hazardous by the Depar(new of Nalural Resources. The localion(s)of the site(s) is staled below. 3. Ilazar(lons Wastes(check one) M There is no known Iazardous waste on this property. I I 'I here is hazardous waste on this properly and it is being managed in accordance will) Department of Natural Resources rules. 4. Ifnder�roand Slorage Tanks(check one) N There are no known underground storag : tanks on this property. (Note exclusions such as small farm and t'Csiticntlal inotor flrcl (auks, most heating oil tanks, cisterns and septic tanks, in ins(uc(ions.) I 1 'I'here is an underground storage tank of tanks on this propely. The type(s), size(s)and any known subslance(s)contained are(lescribe(I below. 5. Private Burial Site(check one) M "There are no known private burial sites on this property. H Therc is a private burial site on This property. 'The localion(s) of the site(s) is slated below. The known i(lentifying information of the decedent is stated below. Information, if any, regniie(1 by statements chocked above: Attachment for Additional b►ti►rn►alion7 Y/N If'so, number of pages 1 IIFIIEIIY l,,% Ei111A'llON CONT,kINED IN P %RT 1 OF TIIIS S I'ATERIENT IS TRITE AND CORREC T Signature: Tclepbone Nun►ber: (515 233-4450 ITransT -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- PART 11 -'TO lip; CORIPl,E TED BY RECORDIA1 0 D _ 1 1 571 Date of Instrun►ent 0`1.? 6'c7 13uok/I.I). Page/I.D. _ p Date of Recording ©,1Z. e'Q ('ily or' ownsbip Deed I I Contract I I County -----„----------------------------------------------- ------------ --- ------ ---------- --------------- DNR fornt(hily ')t)) 1 11,14; 1Y1'1'Il RECORDER s(z o'ir,n (Sec Inspection //0) INSTRUCTIONS FOIt C(MIITh'I'ING GIto I INI)WATER IIA%AItD STA'I'1?1111. 'r The nansleroI oI,ICaI property is required to ctnnpleIC Pahl I of this 3. Ilazardous Wastes - "llazaidous waste" is defined in Iowa lirrnl. The purpose ofllie statement is to satisfy legal reyuirclncllts Code section 15511.41 I, 567--1.11.2 (45513), FAA',, and federal fin filing insllunlents of conveyance of real properly with the regulalions rclereuced IherciM. It is generally (dined as waste county recorder (Iowa Code Section 558.69). 'the Oepartntent of that Doses it 1111CA to bonnet health or the envirouulcnt. It Natural Resources does not approve or disapprove of" property includes wastes which ale ignitable, corrosive, toxic, explosive, Iransl'ers hased on these statements. The stalcntcul must be signed violently Ieactive, or specifically listed as hazanlous ill the Code by one of Ile persons transferring the property interest or that of Federal Regulations (40 C'FR 261). EACLUDIA) are person's agent_ An agent signing this I'min represents the household wastes, agricultural wastes Ielmned to the soil as inliaMlalioM I'ronl Iranslefor to be Correct. Icrtilizers or soil conditioners, agricultural chemicals applied or disposed of by it Earner in accordance with the luanufaclurcl's For (lie most pall the information requesled is clear (name, insLtuclions, ifiplc-rinsed agricultural chemical containers address, ere.). One statement under each of the numbered items disposed of by far►ners (where Ile rinsale is used as makeup (1, 2, 3, 4 and 5) must he checked, and if one or morc of the water in life (ankntix and applied at appropriate rates), and other statements checked requires the Iransfcror to provide additional specific ntalciials. Persons are legally relluired to be aware of infiunlalion, that infornrltion is to be provided in pall 1. Relate the hazardous wasic laws. additional inlinntatioM to file specific category of facility (well, etc.) by numbering it \%ilh the corresponding number (I, 2, 3, 4, 4. I hider-ground Storage Tanks - "I h0ciground storage (ank" 5). If additional space is needed, type or plinl it legibly on it means One or it Coll rbinalion of tanks, including underground separate sheet or sheds, complete the SIMCIIlenls at the end ol'Pall piping connected to the tanks, used to contain all accunnlalion of- I and attach Ile additional information to all copies of Ile form. regulated substances, and Ile volume of which is 10 percent or When describing the location of a facility on the property, he more beneath the surface of the ground. "Regulated substances" reasonably precise, such as a specific distance and general include petroleum products and hazardous or toxic materials direction from a landmark or corner of Ile property. A idcutificd in 567--135.2(45513), 1.A.C. Underground storage prolcssional survey is not necessary. The following definitions are lank dues not include: I'm Ilse in completing the fonrt. a. Faint or residential tanks of 1,100 gallons or less capacity I. Wells - A "well" is any excavation that is drilled, cored, bored, used fur storing Motor fuel tilt- noncommercial purposes. But atlgered, washed, (liven, dug, jetted or Otherwise constructed for See 45513.473(4)) accessing groundwater or for diverting surface water into the h. 'tanks used lilt- slot ing healing oil lilt-constlmplive use on the ground, including abandoned wells. "Well" does not include an premises where stored. open ditch or drainage files which discharge to the surface. c. Residential septic tanks. d. Pipeline facilities regulated by stale or federal law. If a well is an"abandoned well"or all "agricultural drainage well," c. A surface impoun(hnent, pit pond, or lagoon. this must he identified and the status ol, file well Willi respect to f. A storm water or wastewater collection system. Iowa Code sections 45513.190 and 159.29, respeclively, rntrsl he g. A flow-through process lank. stated. An "abandoned well" is a well Mo longer in Ilse or in such If. A litluid trap or associated gathering lines directly related to stale of, disrepair I11a1 continued Ilse is unsalc or impracticable. oil or gas production and Bathei ing operations. Abandoned wells are to he properly plugged in accordance with i. A lank iu an underground area such as a basement or mine, if clrtptcr 39 of, file miles of Ile I)cpailrltcilt c.f Nalltral Resources. the lank is On OI above Ole surface of the floor. (507 Iowa Administrative Code, Chapter 39) j. Pipes connected to Ile above exclusions. An "agricIlllural drainage well" is if well constructed for fie "Taulk type" means the material of conshuction (stect, fiberglass purpose ol,draining, or which (rains, watct from agricultural land reinforced plastic IFRPI, or other [specifyl), and any internal or to an aquifer (underground), excltttiimg drainage file intakes which external protection such as a protective coating or wrapping, or outlet to Ilse surface. Agricullural drainage wells arc required to cathodic protection. he legislered will the depail ment by September 30, 1988, and the owner of file well and of the land drained by Ile well arc to Identify the capacity in gallons and the substance stored in each develop a plan proposing alternatives to tie use of Ile well by tank. hily I, 1998(See Iowa Code Section 159.29.) 5. Private Burial Sites - "Private Burial Site" means one of- 2. Solid Waste - „Solid waste" means galhage, refilse, rubbish store graves containing human remains. For each site the and other similar discarded solid or semisolid Inalcrial. It does not transferor shall slate the location of the site, For each decedent include dire, stone, prick, or similar inorganic material used for fill, buried oil the properly the transferor shall slate all known as long as Ito other solid waste is included. See 567--100.2(45513), identifying inllrrnlation of that decedent including Maine, date of Iowa A(minislralive Code (I.A.C.) for further definitions. A death, and(dale of bird. .'disposal site" is any area on the property oil, in, or under which solid waste has been disposed, whether or not the disposal is of 6. Filing - The original of this form must be presented to the %vas regulated by the department_ county recorder when the document to he recorded is filed. The Recorder shall linward the original to Ile hanslcrec when the If Ow lraw.fLrul Of Wenl h(!s li,il received notice fiom dw lccoldcel !!"rah'!!1!lCttl !S retm-ned. The !'eeottle! is not !'cquired io Department of Natural Resources thal tie disposal site has been keep any copies. deemed to be potentially hazardous, Ibere is Ito duty to inquire to file department. *Note The land application of'sludges or soils resulting front the remediation of underground storage lank releases accomplished ill compliance Willi Department of Natural Resources rules without a permit is not required to Ile repotted as the disposal of solid waste or hazardous waste. (Sec Iowa Code Section 558.09) UNR form(July 99) 543-0960