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Home My WebLink AboutA016 - Real Estate Transfer - Groundwater Hazard Statement REA1, FSTATE TRANShF,il - (WOUNDWA'IT',R iIAZARD STA1IiM1iN'1' Please read the filing inslruc•lions on the revcrse side BEFORE: completing This form. PART i - TO 13F, CO INIVVH,'1'F,1) It 'I'llANShi;ROIt (]'lease 'Type or Print Vegibly) TRANSFEROR Name Erbe_n Hunziker & Margaret Hunziker Development, L.L,C.-; D&R Furman. L.L.C. ; & R. Friedrich & Sons, Inc. Address 105 S. 16th Street, Ames, Iowa 50010 rp TRANSFEREE Name—Somerset Subdivision Ninth Addition Address IT, an SIrcct )r 1L�.._.._--...------_.___.._..._...----_- ._. ....-_-�-.... r uy,T6iiii Address of-Properly Tr-ansferrc(l- - -- mFr rarTJ�frccr or rF (rty.Ymvn,or T.7t. - - ----- ,tare Zip Legal Description of Property_An official re-plat of Outlot S in Somerset Subdivision Third Addition, an official plat; all now included in and forming a part of the City of Ames,• Story County, Iowa. r 1..Wells(check one) IX There are no known wells situated on this property. n There is a well or wells situated on this property. The Iypc(s), location(s) and legal status are staled below. 2. Solid Waste Disposal (check one) iX"]'here is no known solid waste disposal site on this property. 1.1 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. I 1 There is a solid waste disposal site on (his properly which has been (Icelned to be potentially hazardous by the Department of Natural Resources. The location(s)of the site(s) is staled below. i. 112zartlous Wastes(check one) [X There is no known hazardous waste on this properly. [I There is hazardous waste on this property and it is being managed in accordance with Department of Natural Resources rules. I. Underground Storage Tanks(check one) EXThere are no known underground storag : tanks on this properly. (Note exclusions such as small farm and residential motor fuel tanks, most heating oil tanks, cisterns and septic tanks, in instructions.) t I Theic is an underground storage tank or tanks on this property. 'I'hc lype(s), size(s) an(1 any known substance(s)contained are described below. .Private Burial Site(check one) CNThere are no known private burial sites on this property. ❑ There is a private burial site on this property. The location(s)of"the sites) is stated below. The known identifying information of the decedent is slated below. iforrnation, if any, required by statements checkc(I above: a ttachment for Additional information? Y/N if so, nuniber of pages U Ri?i3Y DF,Ci,ARE TI 'Ili, INF 2111ATION CON'I'AiNED IN PAIU' i OF TIIIS STA'1'I RIENT ISA RUE AND CORRECT' gnahrrc: Telephone Number: (515) 233-4450 ILmrsi ------------------------------------------------------------------------------------------------------------------------------ i'AR7 iI -TO BE COMPLF,'IT I) BY RECORDF•It ite of instrument--L_ �O l 1 Page/I.D. ite of Recording � _. C'.ity it"township_-- ----- -- ed Ix Contract I i Comity— ---------------------------------------------------- ---- - - ---------------------------------------------------------- --------------------------------------------- IR form(July 99) FILE 1N'1'i'iI RI,CORi)I?Il 542-0960 (Sec Instruction !!G) INSTRUCTIONS FOR COMPLETING GROUNDWATER HAZARD STATEMENT The transferor of real property is required to complete Part I of Ibis 3. lIazardous \'hasles - "I lazardous waste" is defiucd illloci form. The purpose of the statement is to satisfy legal requirements Code section 45513.41 I, 567--141.2 (45511), I.A.C., and Feder� for tiling inslrun►enls of conveyance of real properly with [Ile regulalions referenced therein. It is generally defined as was Section 558.69). The DeparUncnt of that poses a threat to human health or the enviromueut. county recorder (Iowa Code Se Natural Resources (foes not approve or disapprove of property includes wastes which are ignitable, corrosive, toxic, expl is transfers based on these statements. `I'Ire statement must be signed violently reactive, or specifically listed as hazardous in the Cot by one of the persons t•ansferring ti►e property interest or that of I-ederal Regulations (40 CFR 26.1). EXCLUDED ar person's agent. An agent signing this form represents the household wastes, agricultural wastes returned to the soil a information from transferor to be correct. ferlilizers or soil conditioners, agricultural chemicals applied disposed of by a farmer in accordance with (Ile manufacturer' For tfte most part (lie information requested is clear (name, illstrucIioIs, triple-rinsed agricultural (heroical container address, etc.).- One statement under each of tile m e nubere(l iletns ., disposed of by Farmers (w1jere Ilre rinsale is used as n►akeu (1, 2, 3, 4 and 5) mast be cliecked, and if one or more of the water in IIle lankutix and applied at appropriate rates), and olilt 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 par( 1. Relate the hazarrdous waste laws. additional information to lire specific category of facility (well, etc.) by nunrhering it Willi the corresponding number (1, 2, 3, 4, 4. I luderground Slor':rge 'faults - "IJudergrouu(1 storage lank 5). If additional.space is needed, type Or prim it legibly on a ureans one or a ainrbinalior► of .tanks, _including _undergroun separate sheet or shcels, complete the statements at the cod of,fart piping connected to the lacks, usul to contain an uccuuwlaliou o I and allach lire additional information to all copies of the form. regulated substances, and the volume of which is 10 perceul o� When describing the location of a futility on the property, be more beneath the surface of Ibe ground. Iltegtilated substances reasonably precise, such as a specific distance and general include petroleum producls and hazardous or toxic, material direction from a landmark or corner of the property. A identified in 567--135.2(455B), I.A.C. Underground storag professional survey is not necessary. The following definitions are lank clues not include: for use in completing the form. a. Farm or residential tanks of 1,100 gallons or less capacit 1. Wells - A "well" is any excavation that is drilled, cored, bored, used fix'storing motor filel for noncommercial purposes. 13u angered, washed, (Iriven, dug,jelled 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 tlr ground, including abandoned wells. "Well" (foes not include an premises where stored. open ditch or drainage tiles which discharge to the surface. c. Riesiden(ial septic lacks. d. Pipeline facilities regulated by slate or federal law.. Ira well is an"abandoned well"or an"agricultural drainage well," e. A surface impouudnlent, pit pond, or lugoon. this nulst be identilie(I and the status of the well will' respect to I. A stone water or wastewater collection system. Iowa Code sections 45511.190 and 159.29, respeclively, must be g. A flow-through process lank. stated. An "abandoned well" is a well no longer in use or in such h. A liquid trap or associated gathering lines directly related I state of disrepair (flat continued use ;is u,psafe or impracticable. oil or gas production and gathering operations. Abandoned wells are to be properly plugged in accordance with i. A tank in an underground area such as a basement or mine, i cbapter_ 9_of lh�rulc_s__c�l,llie_ )cparl'lle'rl A►f_NaluraLRcsmlrcces. _.__ _—the tank-is-on-or_above the-surface-of-_lhe-floor._ (567 Iowa Administrative Code, Chapter 39) j. Pipes connected to the above exclusions. An "agricultural drainage Well" is a well cuus[nrcled for the "Tank type" means the material of construction (steel, liberglas purpose of draining, or which drains, water from agricultural land rciuli,rcc(f plastic [FRI'I, or other [specifyl), and any internal c to an aquifer(underground), excluding drainage file intakes which external protection such as a protective coaling or wrapping, c outlet to the surface. Agricultural drainage wells are required to cathodic protection. be registered with the department by Seplentbcr 30, 1988, and the owner of the well and of the land i drained by the well are to IdenliFy the capacity in gallons and the substance stored in eac develop a plan proposing allernalives to the use of the well by tank. July 11 1998 (See Iowa Cole Section 159.29.) 5. 1'rivale Burial Sites - "Private Burial Site" means one ( 2. Solid NVasle - "Sufid waste" means garbage, refn5e, rubbish more graves containing human remains. For each site tl and other similar discarded solid or semisolid material. Il does not transferor shall stale the location of the site. For each deceder include dirt,-stone, brick, or similar inorganic material used for fill, buried on the properly the transferor shall state all know as long as no other solid waste is included. See 567--100.2(45513), - identifying information of that decedent including uarne, (late Iowa Administrative Lode (I.A.C.) for blether definitions. A death, and date of birlll. "disposal site" is any area on the property on, in, or under which solid waste has been disposed, whether or not the disposal is or 6. Wiling - The original of this form must be presented to tl. was regulated by the department. county recorder when lire document to be recorded is filed. TI Recorder shall Forward the original to the transferee when if If the transferor or agent has not recziy(_d VIOG-Ce finny_the- _rcco:xfetl-instru+:►eel-is-returrae(1— 1'he�recor(ler is-not-required I Department of Natural Resources [flat the disposal site has been keep any copies. deemed to be potentially hazardous, there is no duty to inquire to the department. ' *Note The land application of sludge, or soils resulting from the remediation of undergr"uluid storage lank releases accomplished in compliance will► Department of Natural Resources rules without a h permit is not required to be reported as the disposal ol'solid waste or hazardous waste. (See Iowa Code Section 558.69) 543•09 DNR form(July 99)