HomeMy WebLinkAboutA011 - Real Estate Transfer - Groundwater Hazard Statement REAL ESTATE TRANSFER -GROUNDWATERHAZARD STATEMENT
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)
TRANSFERORName Best Buy Stores;L.P.
Address 7075 Flying Cloud Drive,Eden Prairie,Minnesota 55344
Number and Street or RR City,Town or P.O. State zip
TRANSFEREE. Name Daniels Subdivision First Addition
Address Ames, Iowa
Number and Street or RR City.Town or P.O. State tip
Address of Property Transferred Ames,Iowa
Nwubrr and Street or RR city,Town,or P.O. State zip
Legal Description of Property See Exhibit"A" attached hereto.
1. Wells (check one)
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)
IN 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(check.one)
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)
ff 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.
5.Private Burial Site(check one)
lK There 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 DEC BARE THAT THE INFORMATION CONTAINED IN PART 1 OF THIS STATEMENT IS TRUE AND CORRECT
l..
Signature: — Telephone Number: 5157279-9059
Trsoderor or Agent
Timothy C.Hogan, Attorney for Developer
r PART 11 -TO BE COMPLETED BY RECORDER
Date of Instrument l D I D Book/I.D. Page® f 167
27
Date of Recordii g 0 D Township Ames
�hContract ❑ County Y
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DNR form (July 99) 1-1 LE WITH RECORDER 542-0960
(See Instruction 96)
EXHIBIT "A"
LEGAL DESCRIPTION
Parcel X in the N 1/4 of the SW 1/4 of the SE 1/4 of
Section 11, Township 83 North, Range 24 West of the 5th
P.M. , Ames, Iowa, as shown on the Plat of Survey filed
in the office of the Recorder of Story County, Iowa, on
the 23rd day of May, 2002, and recorded as Instrument
No. 02-07579, Slide 134 Page 3 , corrected on the 24th
day of May, 2002, and recorded as Instrument No. 02-
07666, Slide 134 Page 5.