HomeMy WebLinkAboutA008 - Real Estate Transfer - Groundwater Hazard Statement REAL ESTATE TRANSFER - GROUNDWATER HAZARD 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)
TRANSFEROR Name 121 BEACH LLC
Address 54643 282ND STREET,AMES,IOWA
Number and Street m RR City,Town or P.O. State ZIP
TRANSFEREE Name �� J
i
Address
Number and Street or RR City,Town or P.O. State Zip
Address of Property Transferred 121 BEACH,AMES,IOWA
Number and Street or RR City,Town_a P.O. - - -----state—- ---Zip-- —--
Legal DescriptionofProperly COLLEGE HEIGHTS THIRD ADDITION,CITY OF AMES,IOWA
1.Wells(check one)
® There are no known wells situated on this property.
❑ There isawellorwells situated onthisproperty.The type(s),location(s)andlegal status are statedbelow.
2.Solid Waste Disposal(check one)
® 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)ofthe site(s)is stated below.
3.Hazardous Wastes(check one)
® There isno knownhazardouswaste onthis 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)
CK There are no known underground storage tanks on this property.(Note exclusions such as small farm and residential motor fuel tanks,
mostheating 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)
® There are no known private burial sites on this property.
❑ There is a private burial site on this property.The location(s)ofthe site(s)is stated below.The known identifying information ofthe
decedent is stated below.
Information,if any,required by statements checked above:
AttachmentforAdditionallnformation9®/N If so,number of pages
I HEREBY DE rl;7
E IN -0 ATIO ONTAINED IN PART 1 OF THIS STATEMENT IS TRUE AND CORRECT
Signature: Telephone Number:(515)597-38I0
(r infer r or Agent)
PART 11 -TO BE COMPLETED BY RECORDER
�J Date of Instrument %'I�1 � Book/I.D. Page/I:DQ .3 - ®692 9
Date of Recording I QTownship
Ljk----
Deed ❑ Contract ❑ County S-T-
------------------------------------- ——————————————————————--———————
DNR form (July 99) FILE WITH RECORDER 1am 0960