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HomeMy WebLinkAboutA022 - Real Estate Transfer - Groundwater Hazard Statement ItIFAL ESTATE 'I'llANSFGIt - GIt0UN1.)WATUR IIAZAIt1) S 'A I E M E N'1' F " Please rcad the filing instructions on the reverse side BEFORE completing this form. PAIlT I - TO 11E CO NI PI,F,TE1) BY 'I'll ANSFE110It (Please 'Type or Print Legibly) TRANSFEROR Name Uthe Development Company, L.L.C. Address 105 S. 16th Street, Ames, Iowa 50010 Number an treet or—Rit-- (Ity,'I own oiT.O. State Zip TRANSFEREE Name Northridge Heights Subdivision Second Addition Address Number an Street or -- --- —l-ty, 'own or '.�.----- .tale Zip Address of Property Transferred um er an ,beet or if ---- State Zip Legal,Description of Property See attached 1. Wells(check one) XX 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 (check one) XX"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. U Them 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) XX 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) XX There are no known underground storag, 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. 5. Private Burial Site(check one) XXThere are no known private burial sites on this property. ❑ There is a private burial site on this property. The location(s) of the site(s) is stated below. The known identifying information of the decedent is stated below. Information, if any, required by statements checked above: Attachment for Additional Information? Y/N If so, number of pages 1-' I HEREBY DECLARE TIIAT I'IIE INFORMATION CONTAINED IN PART 1 OF THIS STATEMENT IS TRUE AND CORRECT IS Z� —gq ure: --T. _( Signature: ------- 'I'clephone Number: S' )_ _ ---------^ I ART-- -'--- -1 ,�IVI I r N II�F I)i3 ----------------------------------------------------------------- ' , RECORDER ® � Date of Instrument I w I o I _ Book/ Page/I.D. Date of Recording ( ' �((/ ( O J _ _ _ City o ownship Deed glecontract (1 County --- ------------------------------------------------------------------------------------------------- DNR form(July 99) FILE IVVITII RECORDER 542-0960 (Sec Instruction #6) INSTRUCTiONS FOR COMPLETING GROUNDWATER HAZARD STATEMENT The transferor of real property is required to complete Part 1 of this 3. Hazardous Wastes - "llazardous waste" is defined in loN form. The purpose of the statement is to satisfy legal requirements Code section 45513.411, 567--141.2 (45513), I.A.C., and fedei for filing instruments of conveyance of real property with the regulations referenced therein. It is generally defined as was county recorder(Iowa Code Section 558.69). The Department of that poses a threat to human health or the environment. Natural Resources does not approve or disapprove of properly includes wastes which are ignitable, corrosive, toxic, explosi% transfers based on these statements. The statement must be signed violently reactive, or specifically listed as hazardous in the Coi by one of the persons transferring the property interest or that of Federal Regulations (40 CPR 261). EXCLUDED- a person's agent. An agent signing this form represents the household wastes, agricultural wastes returned to the soil information from transferor to be correct. fertilizers or soil conditioners, agricultural chemicals applied disposed of by a farmer in accordance with the manufacturer For the most part the information requested is clear (name, instructions, triple-'rinsed agricultural chemical contauie address, etc.). One statement under each of the numbered items disposed of by farmers (where the rinsate is used as makei (1, 2, 3, 4 and 5) must be checked, and if one or more of the water in the tankmix and applied at appropriate rates), and oth statements checked requires the transferor to provide additional specific materials. Persons are legally required to be aware information,that information is to be provided in part I. Relate the hazardous waste laws. additional information to the specific category of facility (well, etc.) by numbering it with the corresponding number (1, 2, 3,.4, 4. Underground Storage Tanks - "Underground storage tanl 5). If additional- space is.needed,.type or print it legibly oll.'a means .one-or a combination of tanks, including undergrour separate sheet or sheets, complete the statements at the end of Part piping connected to the tanks, used to contain an accumulation I and attach the additional information to all copies of the firm. regulated substances, and the volume of which is 10 percent When describing the location of a facility on the property, be more beneath the surface of the ground. "Regulated substance; reasonably precise, such as a specific distance and general include petroleum products and hazardous or toxic materia direction from a landmark or corner of the property. A identified in 567--135.2(455B), I.A.C. Underground storaf professional survey is not necessary. The following definitions are tank does not include: for use in completing the form. a. Farm or residential tanks of 1,100 gallons or less capacil 1. Wells - A "well" is any excavation that is drilled, cored, bored, used for storing motor fuel for noncommercial purposes. Bt augered, washed, driven, dug,jetted or otherwise constructed for See 45513.473(4)) accessing groundwater or for diverting surface water into the b. 'tanks used for storing healing oil for consumptive use on°Ili ground, including abandoned wells. "Well" does not include an premises where stored. open ditch or drainage tiles which discharge to the surface. c. Residential septic tanks. d. Pipeline facilities regulated by state or federal law. If a well is an"abandoned well"or an"agricultural drainage well," e. A surface impoundment, pit pond, or lagoon. this must be identified and the status of the well with respect to f. A storm water or wastewater collection system. Iowa Code sections 45513.190 and 159.29, respectively, must be g. A flow-through process tank. stated. An "abandoned well" is a well no longer in use or in such li, 'A liquid trap or associated gathering lines directly related t state of disrepair that continued use is unsafe or impracticable. oil or gas production and gathering operations. Abandoned wells are to be properly plugged ill accordance with i. A tank in an underground area such as a basement or mine, chapter 39-of--the rifles--of the Depart►ient-of-NauraI-Rr=sifmrccs:- - tire-rank-is-on.r-ab-otie tire surface-of the floor:- -- (567 Iowa Administrative Code, Chapter 39) j. Pipes connected to the above exclusions. An "agricultural drainage well" is a well constructed for the ""Tank type" means the material of construction (steel, fiberglas purpose of draining, or which drains, water from agricultural land rciufcrced plastic [FRP], or other [specify]), and any internal o to an aquifer.(underground), excluding drainage tile intakes which external protection such as a protective coating or wrapping, o outlet to the surface: Agricultural drainage wells are required to cathodic protection. be registered with the department by September 30, 1988, and the owner of the well and of the land drained by the well are to Identify the capacity in gallons and the substance stored in earl develop a plan proposing alternatives to the use of [lie well by tank. July 1, 1998 (See Iowa Code Section 159.29.) 5. Private Burial Sites - "Private Burial Site" means one o 2. Solid Waste - "Solid waste" means garbage, refuse, rubbish more graves containing human remains. For each site (Ili and other similar discarded solid or semisolid material. It does not transferor shall state lire location of the site. For each deceden include dirt,stone,brick, or similar inorganic material used for fill, buried on the property the transferor shall state all knows as long as no other solid waste is included. See 567--100.2(455B), identifying information of that decedent including name, date o Iowa Administrative Code (I.A.C.) for further definitions. A death, and date of birth. "disposal site" is any area on the properly on, in, or under which solid waste has been disposed, whether or not the disposal is or 6. Filing - The original of this form must be p{esented to the was regulated by the department. county recorder when.the document to be recorded is tiled. Tht Recorder sliall forward the original to the transferee when tht If the transferor or agent has not received notice from -tlf —'recorded instrument is-returned. Tho recorder is not required_11 Department of Natural Resources that the disposal site has been keep any copies. deemed to be potentially hazardous, there is no duty to inquire to the department. *Note Tire land application of sludges or soils resulting from the remediation of underground storage tank releases accomplished in ® ' compliance with Department of Natural Resources rules without a permit is not required to be reported as the disposal of solid waste or hazardous waste. (See Iowa Code Section 558.69) C17 ' 00 0) 0 DNR form(July 99) 543-0960 I A tract of land located in the South Half of the Northwest Quarter (SV2 NW1/4) of Section Twenty-eight (28), Township Eighty-four (84) North, Range Twenty-four (24) West of the 5t' P.M., City of Ames, Story County, Iowa, described as follows: Commencing at the Center of said Section 28, thence S89°50'58"W, 367.06 feet along the Southerly line of the NW'/4 of said Section 28; thence N00009'05"W, 60.00 feet to a point on the Northerly right- of-way line of Bloomington Road, the Point of Beginning; thence S89050'58"W, 1018.31 feet along said Northerly right-of-way line and parallel to said Southerly line to a point on the Easterly line of Northridge Heights --- Subdivision,--First-Addition;-Thence N00°07'-32"W-,-89.91 - --- -- - - feet along said Easterly line; thence N89°52'28"E, 129.00 feet along said Easterly line; thence N00°07'32"W, 630.67 feet along said Easterly line; thence S82009'32"E, 675.00 feet; thence N89°45'57"E, 220.55 feet; thence S00009'05"E, 627.00 feet to the Point of Beginning; containing 13.78 acres subject to easements of record.