Van Buren St vacate - BastenMEMORANDUM
July 9, 2002
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Vacating Petition -A Portion of Van Buran Street
(Formerly Lenox Avenue)
In response to a request from Michael W. and Sally A. Basten, Public Works Director
Mike Koch is recommending the vacation of a portion of Van Buren Street (formerly
Lenox Avenue) at Isborn Avenue. He further recommends that the purchase price be
established at $573.78, plus platting, publication and filing fees.
The City has no plans for the utilization of this Portion of Van Buren Street, except for
reserving a perpetual easement for utilities as noted.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Michael. C. Van Milligen
MCVM/jh
Attachment
cc: Barry Lindahl, Corporation Counsel
Cindy Steinhauser, Assistant City Manager
Michael A. Koch, Public Works Director
CITY OF DUBUQUE, IOWA
MEMORANDUM
July 8, 2002
TO: Michael C. Van Milligen, City Manager
FROM: Michael A. Koch, Public Works Director
SUBJECT: Vacating Petition -A Portion of Van Buren Street
(Formedy Lenox Avenue)
A public hearing was set by the City Council for July 1, 2002, to approve the
vacating of a portion of Van Buren Street (formerly Lenox Avenue).
Michael W. and Sally A. Basten are requesting the vacating of a portion of Van
Buren Street (formerly Lenox Avenue) at Isbom Avenue for building an attached
garage. Perpetual easement rights will be reserved on a portion of Lot 119A for
maintenance of the existing sanitary sewer and other utilities.
Therefore, it is recommended that the area indicated by Lot 119A of Lenox
Addition be vacated, and that the purchase price be established at $573.78, plus
platting, publication and filing fees.
MAK/vjd
MEMORANDUM
June 22, 2002
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Vacating Petition -A Portion of Van Buren Street
(Formerly Lenox Avenue)
In response to a request from Michael W. and Sally A. Basten, Public Works Director
Mike Koch is recommending the vacation of a portion of Van Buren Street (formerly
Lenox Avenue) at Isborn Avenue. He further recommends a public hearing be set for
the disposition of the City's interest in the subject area on July 15, 2002, and further
recommends that the purchase price be established at $573.78. plus platting,
publication and filing fees.
The City has no plans for the utilization of this portion of Van Buren Street, except for
reserving the utility easements as noted.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Michael C. Van Milligen
MCVM/jh
Attachment
cc: Barry Lindahl, Corporation Counsel
Cindy Steinhauser, Assistant City Manager
Michael A. Koch, Public Works Director
CITY OF DUBUQUE, IOWA
MEMORANDUM
June 24, 2002
TO: Michael C. Van Milligen, City Manager
FROM: Michael A. Koch, Public Works Director
SUBJECT: Vacating Petition- A Portion of Van Buren Street
(Formerly Lenox Avenue)
INTRODUCTION
This is in response to a request from Michael W. and Sally A. Basten for the
vacating of a portion of Van Buren Street (formerly Lenox Avenue) at Isborn
Avenue.
DISCUSSION
The attached plat shows the proposed portion of Van Buren Street (formerly
Lenox Avenue) to be vacated. The abutting property is owned by Michael W.
and Sally A. Basten, who plan on building an attached garage. The area
proposed to be vacated is excess right-of-way due to a realignment of Van Buren
Street when a longer curve was constructed at Isbom Avenue.
The area to be vacated is divided into one lot numbered Lot 119A of Lenox
Addition in the City of Dubuque, Iowa. Perpetual easement rights will be
reserved on a portion of Lot 119A for maintenance of the existing sanitary sewer
and other utilities as indicated on the plat.
The area outside the easement has been valued at $1.22 per square foot.
Giving credit for the surveying costs, the purchase pnce was established at
$573.78.
RECOMMENDATION
The City has no plans for the utilization of this portion of Van Buren Street
(formerly Lenox Avenue), except for reserving the utility easements as noted.
I would recommend that the area indicated by Lot 119A of Lenox Addition on the
attached plat be vacated, and that a public hearing be set for the disposition of
the City's interest in the subject area on July 15, 2002. I would further
recommend that the purchase price be established at $573.78, plus platting,
publication and filing fees.
ACTION TO BE TAKEN
The recommendation of the City Manager should be approved and a public
hearing should be scheduled on the vacate of the property through adoption of
the enclosed resolutions and ordinance.
MAK/vjd
Prepared by Ronald J. Turner, P.L.S.
MICHAEL W. BASTEN
28~4 Van Buren
Dt~buque, Io~x*. 52001-5439
563-583-9578
April 11, 2002
Honorable Mayor Terry Duggan and City Comncil
50 W. 13th Street
Dubuque, Iowa 52001
Honorable Mayor Terry Duggan and City Council,
I am interested to see if I could acquire a portion of City property in accordance with the City of
Dubuque vacating procedures.
I have coordinated this with the City Engineer's office to have the area checked for sewer utilities
and was given a preliminary indication that the vacating is favorable. The property is located at
2804 Van Buren Ave. at the comer of Isbom Ave.,
The reason for my purchase of this land is to add on a garage. I have already added to the house
that I originally paid seventeen thousand dollars for and now is appraised over one hundred
thousand dollars. I will build the garage to blend into my existing house. My wife and I have cared
for this City property for 24 years. We have over 100 feet of well groomed hedges with hosta
plants bordering the house side, and a huge rock garden in the center of this property which you are
welcome to come and see. This will not be affected with my addition, as I will work closely with
the City Engineer's Office to obtain written consent of the contiguous property owners. Thank you
for your consideration in this matter.If there is any further information I can provide, please
contact me at the above address and phone number.
Sincerely,
Michael W. Basten
pENNSYLVANIA AVE
PURPOSE:
VAN BUREN
STREET VACATE
NORTH
Prepared by: Ronald J. Turner. City of Dubuque, 50 W. 13th Street. Dubuque, Iowa (563) 589-4270
RESOLUTION NO.
RESOLUTION APPROVING PLAT OF THE PROPOSED VACATED
PORTION OF VAN BUREN STREET (FORMERLY LENOX AVENUE)
Whereas, there has been presented to the City Council of the City of
Dubuque, Iowa, a plat dated the 19th day of June. 2002, prepared by Buesing &
Associates, describing the proposed vacated portion of Van Buren Street
(formerly Lenox Avenue); and
Whereas, said plat conforms to the laws and statutes pertaining thereto.
NOW. THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF DUBUQUE, IOWA:
Section 1. That the plat dated the 19th day of June, 2002, prepared by
Buesing & Associates, relative to the real estate hereinabove described be and
the same is hereby approved, and the Mayor and City Clerk be and they are
hereby authorized and directed to execute said plat for and on behalf of the City
of Dubuque, Iowa.
Section2. The City of Dubuque reserves unto itself a perpetual
easement including the right of ingress and egress thereto, for the purpose of
erecting, installing, constructing, reconstructing, repa~dng, owning, operating, and
maintaining water, sewer, drainage, gas, telephone, television cable, fiber optics,
and electric lines as may be authorized by the City of Dubuque, Iowa, as shown.
on the Plat of Survey of Lot 119A of Lenox Addition in the City of Dubuque, Iowa.
Section 3. That the City Clerk be and is hereby authorized and directed
to file said plat and certified copy of this resolution in the office of the Recorder ih
and for Dubuque County, Iowa.
Passed, approved and adopted this
2002.
day of
Terrance M. Duggan, Mayor
Attest:
Jeanne F. Schneider, CMC, City Clerk
Plat of Survey: for Right of Way Vacation, described as
LOT 119A OF LENOX ADDITION, AS COMPRISED OF A VACATED PORTION OF
VAN BUREN STREET (formerly Lenox Avenue) RIGHT OF WAY IN TH E CITY OF
DUBUQUE, iOWA.
DETAil ~ NO SCALE
/
/
LOT '~2} 13.37
-OT 120
LOT 122
LOT2 OF 11
LOT 123
LOT124
LOT 125
9.50' FROM BOO
TO PROPER~Y LINE
NEW ROW
LINE
LOT 1 OF
LOT I18
LOT ? 17
/
LOT 116
LOT 126
~ LOT?IS
NOTES
DETAIL- N( SCALE
9.50' FROM BOO
TO PROPERTY LINE
C UTILITY
/
P'O'Bt CURVE DATA:
0 25 50 lC
ORDINANCE NO.
ORDINANCE VACATING A PORTION OF VAN BUREN STREET (FORMERLY
LENOX AVENUE)
Whereas, Michael W. and Sally A. Basten have requested the vacating of a portion
of Van Buren Street (formerly Lenox Avenue); and
Whereas, Buesing & Associates has prepared and submitted to the City Council a
plat showing a vacated portion of Van Buren Street (formerly Lenox Avenue) and assigned
a lot number thereto, which hereinafter shall be known and described as Lot 119A of Lenox
Addition, in the City of Dubuque, Dubuque County, Iowa; and
Whereas, the City Council of the City of Dubuque, Iowa has determined that a
portion of Van Buren Street (formerly Lenox Avenuel is no longer required for public use.
except for utility easements as noted, and vacating of said portion of Van Buren Street
(formerly Lenox Avenue) known as Lot 119A of Lenox Addition, in the City of Dubuque,
Dubuque County, Iowa should be approved.
NOW, THEREFORE, BE IT RESOLVED BYTHE CITY COUNCIL OF THE CITY OF
DUBUQUE, IOWA:
Section I That the real estate described as Lot 119A of Lenox Addition in the
City of Dubuque, Iowa, be and the same is hereby vacated.
Section 2. The City of Dubuque reserves unto itself a perpetual easement
including the right of ingress and egress thereto, for the purpose of erecting, installing,
constructing, reconstructing, repairing, owning, operating, and maintaining water, sewer.
drainage, gas, telephone, television cable, fiber optics, and electric lines as may be
authorized by the City of Dubuque, Iowa, as shown on the Plat of Survey of Lot 119A of
Lenox Addition in the City of Dubuque, Iowa.
Passed, approved and adopted this
day of ,2002.
Terrance M. Duggan, Mayor
Attest:
Jeanne F. Schneider, CMC, City Clerk
RESOLUTION NO,
RESOLUTION OF INTENT TO DISPOSE OF CITY INTEREST IN LOT
119A OF LENOX ADDITION IN THE CITY OF DUBUQUE, IOWA
Whereas. Michael W. and Sally A. Basten have requested the vacating of
a portion of Van Buren Street (formerly Lenox Avenue); and
Whereas, Buesing & Associates has prepared and submitted to the City
Council a plat showing the vacated portion of Van Buren Street (formerly Lenox
Avenue) and assigned lot number thereto, which hereina~er shall be known and
described as Lot 119A of Lenox Addition in the City of Dubuque, Iowa; and
Whereas, the City Council of the City of Dubuque, Iowa has determined
that this portion of Van Buren Street (formerly Lenox Avenue) is no longer
required for public use, except for utility easements as noted, and vacating and
sale of said portions of Van Buren Street known as Lot 119A of Lenox Addition in
the City of Dubuque, Dubuque County, Iowa should be approved.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF DUBUQUE, IOWA:
Section 1. That the City of Dubuque intends to dispose of its interest in
Lot 119A of Lenox Addition in the City of Dubuque, Iowa
Section 2. That the conveyance of Lot 119A of Lenox Addition in the
City of Dubuque, Iowa to Michael W. and Sally A. Basten be contingent upon the
payment of $573.78. plus platting, publication and filing fees.
Section 3. The City of Dubuque reserves unto itself a perpetual
easement including the dght of ~ngress and egress thereto, for the purpose of
erecting, installing, constructing, reconstructing, repairing, owning, operating, and
maintaining water, sewer, drainage, gas, telephone, television cable, fiber optics,
and electric lines as may be authorized by the City of Dubuque, iowa, as shown
on the Plat of Survey of Lot 119A of Lenox Addition in the City of Dubuque, Iowa.
Section 4. That the City Clerk be and is hereby authorized and directed
to cause a notice of intent to dispose of said real estate to be published in the
manner as prescribed by law.
Passed, approved and adopted this
day of ., 2002.
Attest:
Terrance M Duggan, Mayor
Jeanne F. Schneider, CMC, City Clerk
Prepared by: Ronald J. Turner, City of Dubuque, 50 W. 13th Street, Dubuque, Iowa (563) 589-4270
RESOLUTION NO. 364-02
RESOLUTION DISPOSING OF CiTY INTEREST IN LOT 119A OF
LENOX ADDITION IN THE CITY OF DUBUQUE, IOWA
Whereas, pursuant to resolution and published notice of time and place of
hearing, published in the Telegraph Herald, a newspaper of general circulation
published in the City of Dubuque, Iowa on this 5th day of July, ,2002,
thC C~ty Council of the City of Dubuque, Iowa met on the 15th day of
July ,2002, at 6:30 p.m. in the Public Library Auditorium, 360 West 11
'Street,-Dubuque, Dubuque County, Iowa to consider the proposal for the sale of
real estate described as:
Lot 119A of Lenox Addition in the City of Dubuque, Dubuque County, Iowa
Whereas, the City Council of the City of Dubuque, Iowa overruled any and
all objections, oral or written to the proposal to sell such real estate, except for
easement as noted.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF DUBUQUE, IOWA:
Section 1. That the sale of City of Dubuque real properly described as
Lot 119A of Lenox Addition in the City of Dubuque, Iowa to Michael W. and Sally
A. Basten be and the same is hereby approved for the sum of $573.78 plus cost
of publication, platting and filing fees. Conveyance shall be by Quit Claim Deed.
Section 2. The City of Dubuque reserves unto itself a perpetual
easement including the right of ingress and egress thereto, for the purpose of
erecting, installing, constructing, reconstructing, repairing, owning, operating, and
maintaining water, sewer, drainage, gas, telephone, television cable,fiber optics,
and electric lines as may be authorized by the City of Dubuque, Iowa, as shown
on the Plat of Survey of Lot 119A of Lenox Addition in the City of Dubuque, Iowa.
Section 3. That the Mayor be authorized and directed to execute a Quit
Claim Deed, and the City Clerk be and is hereby authorized and directed to
deliver said deed of conveyance to Michael W. and Sally A. Basten upon receipt
of the purchase price in full.
Section 4. That the City Clerk be and is hereby authorized and directed
to record a certified copy of this resolution in the offices of the City Assessor,
Dubuque County Recorder and Dubuque County Auditor.
Passed, approved and adopted this 15th
Attest: ,
J'eanne F. Schneider, CMC, City Clerk
day of July, 2002.
Terrance M. Duggan, Mayor
RESOLUTION NO. 345-02
RESOLUTION OF INTENT TO DISPOSE OF CITY INTEREST IN LOT
119A OF LENOX ADDITION IN THE CITY OF DUBUQUE, IOWA
Whereas, Michael W. and Sally A. Basten have requested the vacating of
a portion of Van Buren Street (formerly Lenox Avenue); and
Whereas, Buesing & Associates has prepared and submitted to the City
Council a plat showing the vacated portion of Van Buren Street (formerly Lenox
Avenue) and assigned lot number thereto, which hereinafter shall be known and
described as Lot 119A of Lenox Addition in the City of Dubuque, Iowa; and
Whereas, the City Council of the City of Dubuque, Iowa has determined
that this portion of Van Buren Street (formerly Lenox Avenue) is no longer
required for public use, except for utility easements as noted, and vacating and
sale of said portions of Van Buren Street known as Lot 119A of Lenox Addition in
the City of Dubuque, Dubuque County, Iowa should be approved.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF DUBUQUE, IOWA:
Section 1. That the City of Dubuque intends to dispose of its interest in
Lot 119A of Lenox Addition in the City of Dubuque, Iowa.
Section 2. That the conveyance 'of Lot 119A of Lenox Addition in the
City of Dubuque, Iowa to Michael W. and Sally A. Basten be contingent upon the
payment, of $573.78, plus platting, publication and filing fees.
Section 3. The City of Dubuque reserves unto itself a perpetual
easement including the right of ingress and egress thereto, for the purpose of
erecting, installing, constructing, reconstructing, repairing, owning, operating, and
maintaining water, sewer, drainage, gas, telephone, television cable, fiber optics,
and electric lines as may be authorized by the City of Dubuque~ Iowa, as shown
on the Plat of Survey of Lot 119A of Lenox Addition in the City of Dubuque, Iowa.
Section 4. That the City Clerk be and is hereby authorized and directed
to cause a notice of intent to dispose of said real estate to be published in the
manner as prescribed by law.
Passed, approved and adopted this. 1st day of ~]ul.v ,2002.
Attest:
e F. Schneider, CMC, City Clerk
Prepared by: Ronald J. Turner, City of Dubuque, 50 W. 13th Street, Dubuque, Iowa (563) 589-4270
RESOLUTION NO. 344-02
RESOLUTION APPROVING PLAT OF THE PROPOSED VACATED
PORTION OF VAN BUREN STREET (FORMERLY LENOX AVENUE)
Whereas, there has been presented to the City CoUncil of the City of
Dubuque, Iowa, a plat dated the 19~h day of June, 2002, prepared by Buesing &
Associates, describing the proposed vacated portion of Van Buren Street
(formerly Lenox Avenue); and
Whereas, said plat conforms to the laws and statutes pertaining thereto.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF DUBUQUE, IOWA:
Section 1. That the plat dated the 19th day of June, 2002, prepared by
Buesing & Associates, relative to the real estate hereinabove described be and
the same is hereby approved, and the Mayor and City Clerk be and theY are
hereby authorized and directed to execute said plat for and on behalf of the City
of Dubuque, Iowa.
Section 2. The City of Dubuque reserves unto itself a perpetual
easement including the right of ingress and egress thereto, for the purpose of
erecting, installing, constructing, reconstructing, repairing, owning, operating, and
maintaining water, sewer, drainage, gas, telephone, television cable, fiber optics,
and electric lines as may be authorized by the City of Dubuque, Iowa, as shown
on the Plat of Survey of Lot 119A of Lenox Addition in the City of Dubuque, Iowa.
Section 3. That the City Clerk be and is hereby authorized and directed
to file said plat and certified copy of this resolution in the office of the Recorder in
and for Dubuque County, Iowa.
Passed, approved and adopted this
2002.
Attest:
~-Jeanne F. Schneider, CMC, City Clerk
1st
day of Juls ,
T~rr~nce M. Du/g~ Mayor
ORDINANCE NO. 54-02
ORDINANCE VACATING A PORTION OF VAN BUREN STREET (FORMERLY
LENOX AVENUE)
Whereas, Michael W. and Sally A. Basten have requested the vacating of a portion
of Van Buren Street (formerly Lenox Avenue); and
Whereas, Buesing & Associates has prepared and submitted to the City Council a
plat showing a vacated portion of Van Buren Street (formerly Lenox Avenue) and assigned
a lot number thereto, which hereinafter shall be known and described as Lot 119A of Lenox
Addition, in the City of Dubuque, Dubuque County, Iowa; and
Whereas, the City Council of the City of Dubuque, Iowa has determined that a
portion of Van Buren Street (formerly Lenox Avenue) is no longer required for public use,
except for utility easements as noted, and vacating of said portion of Van Buren Street
(formerly Lenox Avenue) known as Lot 119A of Lenox Addition, in the City of Dubuque,
Dubuque County, Iowa should be approved.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
DUBUQUE, IOWA:
Section 1. That the real estate described as Lot 119A of Lenox Addition in the
City of Dubuque, Iowa, be and the same is hereby vacated.
Section 2. The City of Dubuque reserves unto itself a perpetual easement
including the right of ingress and egress thereto, for the purpose of erecting, installing,
constructing, reconstructing, repairing, owning, operating, and maintaining water, sewer,
drainage, gas, telephone, television cable, fiber optics, and electric lines as may be
authorized by the City of Dubuque, Iowa, as shown on the Plat of Survey of Lot 119A of
Lenox Addition in the City of Dubuque, Iowa.
Passed, approved and adopted this 1st
Attest:
day of July ,2002.
T~rance M. Du~g/~ayor
e F. Schneidler, CMC, City Clerk
Prepared by: Ronald J. Turner, City of Dubuque, 50 W. 13th Street, Dubuque, Iowa (319) 589~270
Address Tax Statement: Michael W. & Sally A. Basten, 2804 Van Buren Street, Dubuque, IA 52001
QUIT CLAIM DEED
The City of Dubuque, Iowa, a municipal corporation of Dubuque County, Iowa, for Five
Hundred Seventy Three and 78/00 Dollars (8573.78) does hereby Quit Claim unto:
Michael W. & Sally A. Basten
2804 Van Buren Street
Dubuque, IA 52001
ali its rights, title, and interest in the following described real estate situated in Dubuque
County, Iowa, to wit:
Lot 119A of Lenox Addition in the City of Dubuque, Dubuque County, Iowa
The City reserves unto itself a perpetual easement including the right of ingress and egress
thereto, for the purpose of erecting, installing, constructing, reconstructing, repairing,
owning, operating; and maintaining water, sewer, drainage, gas, telephone, television cable,
fiber optics, and electric lines as may be authorized by the City of Dubuque, Iowa, as shown
on the plat of said Lot 119A of Lenox Addition.
No declaration of value is required according to Iowa Code Section 428A.1.
This deed is given pursuant to the authority of Resolution No. of the City of
Dubuque, adopted , 2002, the terms and conditions thereof, if any, having
been fulfilled.
Signed this day of ., 2002.
CITY OF DUBUQUE, IOWA
By:
Terrance [vi. Duggan, Mayor
Attest:
By:
Jeanne F. Schneider, City Clerk
STATE OF IOWA
DUBUQUE COUNTY
)
) ss
)
On this __ day of , 2002, before me, the undersigned, a Notary
Public in and for the State of Iowa, personally appeared Terrance M. Duggan and Jeanne F.
Schneider, to me personally known, who being by me duly sworn, did say that they are the
Mayor and City Clerk, respectively, of the City of Dubuque, Iowa, a municipal corporation;
that the seal affixed to the foregoing instrument is the corporate seal of said corporation, by
the authority of its City Council, as contained in Ordinance No. 2-5 of the City of Dubuque
Code of Ordinances, passed by Resolution of the City Council under Resolution No. of
the City Council on the __ day of , 2002; and Terrance M. Duggag and
Jeanne F. Schneider acknowledged the execution of the instrument to be their voluntary act
and deed and the voluntary act and deed of the corporation, by it voluntarily executed.
Notary Public In and For Said State.
TRANSFEROR Name
REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT
Please read the filing instructions on the reverse s/de BEFORE completing this form.
PART I - TO BE COMPLETED BY TRANSFEROR
(Please Type or Print Legibly)
Address 50 W. 13th Street
Ti~NSFEKEE Name
Michael W. & Sally A. Basten
Dubuque IA 52001-4864
Address 2~)4 V~ 8Uren Street
Dubuque
IA 52001
Zip
Address of Property Transfe~ed
Legal Description of Property
Lot"119A of' Lenox Addition in the City of Dubuque, Du. buque County, Iowa
1. Wells (check one) [] There are no known wells situated on this property.
[2 There is a well or wells situated on this property. The type(s), Iocatiun(s) and legal status are stated below.
2. Solid Waste Disposal (check one)
t~ There is no known solid waste disposal site on ttfis property.
0 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
0 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 DeparUnent of Natural Resources roles.
4. Underground Storage Tan'ks (check one)
[~ There are no known underground storage tanks on this proper[y. (Note exclusions such as small farm and residential motor fuel tank&
most heating oil tanks, cisterns and septic tanks, in instructions.)
U There is an underground storage tank or tanks on this property. The type(s), size(s) and any known substance(s) contained are describer
below.
5. Private Burial Site (check one) O~ 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 infon'nat/on of the
decedent is stated below.
Information, if any, required by statements checked above:
Attac,hment for Additions Information? y/(~) If so, number of pages
I HEREBY DECLARE THAT THE hNFOR~MATION CONTAINED IN PA2RT 1 OF THIS STATEMENT IS TRUE AND CORJ>.ECT
Signature: ~~ Telephone Number: __(563)_ 589-4270 Michael A. Koch '
PART II - TO BE COMPLETED BY RECORDER
Date of Insamment
Date of Recording
Deed [] ConU'uct []
Book/I.D. Page&D.
City or Township
Cottnty
DNR form (July 99) FILE WITH RECORDER
(See Instruction #6)
INSTRUCTION'S FOR COMPLETING GROUNDWATER H.&ZARD STATEN[ENT
The transferor of real property is required to complete Part I of this
form. The purpose of the statement is to satisfy legal requirements
for filing instruments of conveyance of real property with the
county recorder (Iowa Code Section 558.69). The Department of
Natural Resources does not approve or disapprove of property
transfers based on these statements. The statement must be signed
by one of the persons transferring the property interest or that
person's agent. An agent signing this form represents the
information from transferor to be correct.
For the most part the information requested is clear (name,
address, etc.). One statement under each of the numbered items
(1, 2, 3, 4 and 5) must be checked, and if one or more of the
statements checked requires the transferor to provide additional
information, that information is to be provided in part I. Relate the
additional information to the specific category of facility (well,
etc.) by numbering it with the .¢prresponding number (1, 2, 3, 4,
5). If additional space is needed, type or print it legibly on a
separate sheet or sheets, complete the statements at the end of Parr
I and attach the additional information to all copies of the form.
~en describing the location of a facility on the property, be
reasonably precise, such as a specific distance and general
direction from a landmark or comer of the property. A
professional survey is not necessary. The following def'mitions are
for use in completing the form.
1. Wells - A "well" is any excavation that is drilled, cored, bored,
au'gered, washed, driven, dug, jetted or otherwise constructed for
accessing groundwater or for diverting surface water into the
ground, including abandoned wells. "Well" does not include an
open ditch or drainage tiles which discharge to the surface.
If a well is an "abandoned ,,veil" or an "agricultural drainage well,"
this must be identified and the status of the well with respect to
Iowa Code sections 455B.190 and 159.29, respectively, must be
stated. An "abandoned well" is a ,,veil no longer in use or in such
state of disrepair that continued use is unsafe or impracticable.
Abandoned wells are to be properly plugged in accordance with
chapter 39 of the rules of the Deparrrnent of Natural Resources.
(567 Iowa Administrative Code, Chapter 39)
An "agricultural drainage well" is a well constructed for the
purpose of draining, or which drains, water from agricultural land
to an aquifer (underground), excluding drainage tile intakes which
outlet to the surface. Agricultural drainage wells are required to
be registered with the department by September 30, 1988, and the
o~,rner of the well and of the land drained by the well are to
develop a plan proposing alternatives to the use of the well by
July 1, 1998 (See Iowa Code Section 159.29.)
2. Solid Waste - "Solid waste" means garbage, refuse, rubbish
and other similar discarded solid or semisolid material. It does not
include dirt, stone, brick, or similar inorganic material used for fill,
as long as no other solid ~vaste is included. See 567--I00.2(455B),
Iowa Administrative Code (I.A.C.) for fur[her definitions. A
"disposal site" is any area on the property on, in, or under which
solid waste has ~een disposed, whether or not the disposal is or
was regulated by the department.
If the transferor or agent has not received nonce from the
Department of Natural Resources that the disposal site has oeen
deemed to be potentially hazardous, there is no duty to inquire to
the department.
3. Hazardous Wastes - "Hazardous waste" is def'me~l in Iowa
Code section 455B.411, 567--141.2 (455B), LA.C, aud federal
regulations referenced therein. It is generally defined as waste
that poses a threat to human health or the enviromment. It
includes wastes which are igrdtable, corrosive, toxic, explosive,
violently reactive, or specifically listed aa hazardous in the Code
of f.ederal Regulations (40 CFR 261). EXCLUDED are
household wastes, agricultural wastes rem.rned to the soil ~
fertilizers or soil conditioners, agricultural chemicals applied or
disposed of by a farmer in accordance with the manufact~-er's
instructions, triple-rinsed agricultural chemical containers
disposed of by farmers (where the r/nsate is used as makeup
water in the tankmix and applied at appropriate rates), and other
specific materials. Persons are legally required to be aware of
hazardous waste lawsl
4. Underground Storage Tanks - "Underground storage
means one or a combination of tanks, including undergroancl
piping connected to the tanks, used to contain an accumulation of
regulated substances, and the volume of which is I0 pemenr or
more beneath the surface of the ground. "Regulated substances"
include petroleum products and hazardous or toxic rnate~s~
identified in 567--I35.2(455B), I.A.C. Underground storage
tank does not include:
a. Farm or residential tanks of 1,100 gallons or less capac/w
used for storing motor fuel for noncommercial purposes. But
See 455B.473(4)) - '
b. Tanks used for storing heating oil for consumptive use on the
premises where stored.
c. Residential septic tanks.
d. Pipeline facilities regulated by state or federal taw.
e. A surface impoundment, pit pond, or lagoon.
f. A storm water or wastewater collection system.
g. A flow*t_hxough process tank.
h. 'A liquid trap or associated gathering lines directly related to
oil or gas production and gathering operations.
i. A tank in an underground area such as a basement or mine, if
the tank is on or above the surface of the floor.
j. Pipes connected to the above exclusions.
"Tank type" means the material of construction (steel, fiberg!~s
reinforced plastic [FPP], or other [specify]), and any interrm! or
external protection such as a protective coating or wrapping, or
cathodic protection.
Identify the capacity in gallons and the subst,~nce stored in each
tank.
5. Private Burial Sites - "Private Burial Site" me~s one or
more graves containing human remains. For each site the
transferor shall state the location of the site. For each decedent
buried on the property the transferor shall state ail
identi~'ing information of that decedent including name, date of
death, and date of birth.
6. Filing - The original of this form must be presented to the
counW recorder when the document to be recorded is filed. ~'~e
Recorder shall forward the original to the transferee when fine
recorded instrument is returned. The recorder is not required to
keeF any copies. --
*Note The land application o~' sludges or soils resulting from the
remediation of underground storage tank releases accomplished tn
compliance wilh Department of Natural Resources rules without a
pemut m not required to be reported as the disposal of solid waste
or hazardous waste. (See Iowa Code Section 558.69)
DNR form (July 99)