HomeMy WebLinkAboutA012 - Real Estate Transfer - Groundwater Hazard Statement I �
REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT
PART I - TO BE COMPLETED BY TRANSFEROR
(Please type or print legibly)
TRANSFEROR: S rl — PA R I/Y E92 6%0) 1 LC SSN/FID I1I
Address: j1606 elrCUmAC .C'T_ /�
`�nodstreel or RR ,town,p.o. state zlp
TRANSFEREE: S, RA CA)tRS aDG✓k LL e- SSN/FID _ M
Address: I1606 MCLbbd
n0street or RR" city,town,p.o. state zlp
Address of Property Transferred:
no./street or RR city,town,.p.o. state zip
Legal Description of Property: _ (AJ �lQn40 S E UEDI1I Sl Q YVJ�-Sw � A
1. Wells.
There are no known wells situated on this property.
Q There is a well or wells situated on this property. The type(s), location(s),and legal status are shown below.
2. Solid Waste Disposal.
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 potentially 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.
There is no known hazardous waste on this property.
There is hgazardous waste on this property and it is being managed in accordance with Department of Natural
Resources rules.
4. Underground Storage Tanks.
K] There are no 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.)
0 There is an underground storage tank or tanks on this property. The type(s), size(s) and any know substance(s)
contained are described below.
Information,if any, required by,statements checked above:
Attedpent for Additional Information? QYes ONo If so, no. of pages
I HEREBY DECLARE THAT THE INFORMATION CONTAINED IN PART I OF THIS.STATEMENT IS TRUE AND CORRECT..
f "r or A ent '
'PARTCOMPLETED
9 9
Date of Instrument !01 �19,9 Book/I.D. Page/I.D.[) 6448
Date of Recording City
Deed
Contract r! County s