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Acceptance of Deed for Property at 730 Cody Drive_Roepsch Copyright 2014 City of Dubuque Consent Items # 16. ITEM TITLE: Acceptance of Deed for Property at 730 Cody Drive SUMMARY: City Manager recommending approval of a resolution accepting the deed to property purchased from George E. and Dorothy S. Roepsch located at 730 Cody Drive. RESOLUTION Accepting the Deed to certain real Estate in Dubuque County, Iowa from George E. Roepsch and Dorothy S. Roepsch SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Adopt Resolution(s) ATTACHMENTS: Description Type Roepsch Property Purchase-MVM Memo City Manager Memo Staff Memo Staff Memo Resolution Accepting Deed Resolutions Warranty Deed Supporting Documentation THE CITY OF Dubuque DUB E i" Masterpiece on the Mississippi 2007.2012.2013 TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: Purchase of Property from George E. and Dorothy S. Roepsch 730 Cody Drive DATE: October 24, 2016 Senior Counsel Barry Lindahl recommends City Council approval of a resolution accepting the deed to property purchased from George E. and Dorothy S. Roepsch located at 730 Cody Drive. I concur with the recommendation and respectfully request Mayor and City Council approval. v Mic ael C. Van Milligen MCVM:jh Attachment cc: Crenna Brumwell, City Attorney Cindy Steinhauser, Assistant City Manager Teri Goodmann, Assistant City Manager Barry Lindahl, Senior Counsel THE CITY OF DUB-�6 E MEMORANDUM Masterpiece on the Mississippi BARRY LINDAHL SENIOR COUNSEL To: Michael C. Van Milligen City Manager DATE: October 20, 2016 RE: Purchase of Property from George E. and Dorothy S. Roepsch 730 Cody Drive On July 18, 2016, the City entered into an agreement, as amended, with George E. and Dorothy S. Roepsch to purchase the property located at 730 Cody Drive, legally described as follows: Lot 1 of Roepsch Place No. 2, in the city of Dubuque, Dubuque County, Iowa The City has now acquired the property. Attached is a resolution accepting the deed to the property. I recommend that the resolution be submitted to the City Council for consideration and approval. BAL:tls Attachment cc: Marie Ware, Leisure Services Manager F:\Users\tsteckle\Lindahl\Roepsch Property Acquisition-Property By Valentine Park\MVM_ResolutionAcceptingDeed_102016.doc OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563)583-4113/FAX (563)583-1040/EMAIL balesq@cityofdubuque.org Prepared by Barry A. Lindahl 300 Main Street, Suite 330 Dubuque IA 52001 563 583-4113 Return to Prepared by Barry A. Lindahl 300 Main Street, Suite 330 Dubuque IA 52001 563 583-4113 RESOLUTION NO. 374-16 ACCEPTING THE DEED TO CERTAIN REAL ESTATE IN DUBUQUE COUNTY, IOWA FROM GEORGE E. ROEPSCH AND DOROTHY S. ROEPSCH WHEREAS, the City of Dubuque entered into an Agreement on July 18, 2016 with George E. Roepsch and Dorothy S. Roepsch, as amended by First Amendment dated September 29, 2016, for the purchase of certain real property in Dubuque County, Iowa, described as follows: Lot 1 of Roepsch Place No. 2, in the City of Dubuque, Dubuque County, Iowa AND WHEREAS, the terms of the Agreement have now been met. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF DUBUQUE, IOWA, AS FOLLOWS: 1. The City of Dubuque, Iowa, hereby accepts the Deed from George E. Roepsch and Dorothy S. Roepsch, a copy of which is attached hereto. 2. The City Clerk is hereby authorized and directed to record this Resolution and the Deed with the Dubuque County Recorder. Attest: Passed, approved and adopted this 7t day of November, 2016. Roy D. Bu , Mayor Kevi F. Firnstahl, rk F:\Users\tsteckle\Lindahl\Roepsch Property Acquisition - Property By Valentine Park\Closing\ResolutionAcceptingDeed_101816.doc THE CITY OF DUBJE MEMORANDUM Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL MEMO To: Kevin Firnstahl City Clerk DATE: October 24, 2016 RE: Purchase of Property from George E. and Dorothy S. Roepsch 730 Cody Drive Kevin: As we discussed this morning on the telephone, we closed on the above -referenced property acquisition on Thursday, October 20, 2016. I have entered this item into Novus for the November 7, 2016 agenda. I am forwarding to you the following originals for recording after the November 7, 2016 City Council meeting: 1. Warranty Deed; 2. Groundwater Hazard Statement; 3. Declaration of Value; and 4. George E. Roepsch check no. 5170 dated October 20, 2016 payable to the Dubuque County Recorder for $272.80 for the transfer stamps. Also enclosed for your information are copies of the following: 1. Promissory Note dated October 20, 2016; 2. Closing Statement; and 3. George E. Roepsch check no. 5171 dated October 20, 2016 payable to the Dubuque County Treasurer for $2,592.13 for the prorated property taxes. I appreciate your assistance regarding this matter. Attachment cc: Jean Nachtmann, Finance Director F:\Users\tsteckle\Lindahl\Roepsch Property Acquisition - Property By Valentine Park\Closing\Firnstahl_DocsForRecording_102416.docFirnstahl_DocsForRecording_102416 OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563) 583-4113 / FAX (563) 583-1040 / EMAIL tsteckle@cityofdubuque.org WARRANTY DEED Return to: Barry A. Lindahl, 300 Main Street, Suite 330 Dubuque, Iowa 52001 (563) 583-4113 ' Preparer: Barry A. Lindahl, 300 Main Street, Suite 330 Dubuque, Iowa 52001 (563) 583-4113 'ocixo9 Taxpayer: City of Dubuque, Iowa 50 West 13th Street, Dubuque, Iowa 52001 For the consideration of one Dollar(s) and other valuable consideration, George E. Roepsch and Dorothy S. Roepsch, husband and wife, as joint tenants do hereby Convey to the City of Dubuque, Iowa the following described real estate in Dubuque County, Iowa: Lot 1 of Roepsch Place No. 2, in the city of Dubuque, Dubuque County, Iowa Grantors do Hereby Covenant with grantees, and successors in interest, that grantors hold the real estate by title in fee simple; that they have good and lawful authority to sell and Convey the real estate; that the real estate is free and clear of all liens and encumbrances except as may be above stated; and grantors Covenant to Warrant and Defend the real estate against the lawful claims of all persons except as may be above stated. Each of the undersigned hereby relinquishes all rights of dower, homestead and distributive share in and to the real estate. Words and phrases herein, including acknowledgment hereof, shall be construed as in the singular or plural number, and as masculine or feminine bender, according to the context. ed on . ,, O r` STATE OF S G .rge E. oepsch(Gra or) orothy S. Roepsch (Grantor) IOWA , COUNTY OF Dubuque This record was acknowledged before me on 0 c, 240 , 201(,, Roepsch and Dorothy S. Roepsch, husband and wife, as joint tenants BARRY A. LINDAHL Commission Num My Comm. Exp. 11 8. , by George E. Signature of Notary Public © The Iowa State Bar Association 2016 IowaDocs® Form No. 101, Warranty Deed Revised January 2016 REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT TO BE COMPLETED BY TRANSFEROR TRANSFEROR: Name George E. Roepsch and Dorothy S. Roepsch Address 715 Cody Drive Dubuque Iowa 52003 Number and Street or RR City, Town or P.O. State Zip TRANSFEREE: Name City of Dubuque, Iowa Address 50 West 13th Street Dubuque Iowa 52001 Number and Street or RR City, Town or P.O. State Zip Address of Property Transferred: 730 Cody Drive Dubuque Iowa 52003 Number and Street or RR City, Town or P.O. State Zip Legal Description of Property: (Attach if necessary) Lot 1 of Roepsch Place No. 2, in the city of Dubuque, Dubuque County, Iowa 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 or set forth on an attached separate sheet, as necessary. 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 and information related thereto is provided in Attachment #1, attached to this document. 3. Haz9rdous Wastes (check one) /There is no known hazardous waste on this property. There is hazardous waste on this property and information related thereto is provided in Attachment #1, attached to this document. 4. Underground Storage Tanks (check one) ✓ 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 on this property. The type(s), size(s) and any known substance(s) contained are listed below or on an attached separate sheet, as necessary. FILE WITH RECORDER DNR form 542-0960 (July 18, 2012) 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) of the site(s) and known identifying information of the decedent(s) is stated below or on an attached separate sheet, as necessary. 6. Private Sewage Disposal System (check one) _ All buildings on this property are served by a public or semi-public sewage disposal system. This transaction does not involve the transfer of any building which has or is required by law to have a sewage disposal system. There is a building served by private sewage disposal system on this property or a building without any lawful sewage disposal system. A certified inspector's report is attached which documents the condition of the private sewage disposal system and whether any modifications are required to conform to standards adopted by the Department of Natural Resources. A certified inspection report must be accompanied by this form when recording. There is a building served by private sewage disposal system on this property. Weather or other temporary physical conditions prevent the certified inspection of the private sewage disposal system from being conducted. The buyer has executed a binding acknowledgment with the county board of health to conduct a certified inspection of the private sewage disposal system at the earliest practicable time and to be responsible for any required modifications to the private sewage disposal system as identified by the certified inspection. A copy of the binding acknowledgment is attached to this form. There is a building served by private sewage disposal system on this property. The buyer has executed a binding acknowledgment with the county board of health to install a new private sewage disposal system on this property within an agreed upon time period. A copy of the binding acknowledgment is provided with this form. There is a building served by private sewage disposal system on this property. The building to which the sewage disposal system is connected will be demolished without being occupied. The buyer has executed a binding acknowledgment with the county board of health to demolish the building within an agreed upon time period. A copy of the binding acknowledgment is provided with this form. [Exemption #9] _ This property is exempt from the private sewage disposal inspection requirements pursuant to the following exemption [Note: for exemption #9 use prior check box]: The private sewage disposal system has been installed within the past two years pursuant to permit number Information required by statements checked above should be provided here or on separate sheets attached hereto: I HEREBY DECLARE THAT I HAVE REVIEWED THE INSTRUCTIONS FOR THIS FORM Signature: AN P '� T THE INFORMATION STATED ABOVE IS TRUE AND CORRECT. =fir 2o (Tr.j.'=oro FILE WITH RECORDER Telephone No.: 5/3.5t -ti%9 DNR form 542-0960 (July 18, 2012) CTRL C O Y Y Y Y M M##### REAL ESTATE TRANSFER - DECLARATION OF VALUE Please read the instructions comprised in form 57-011 before completing and filing this form. ■ Part I - TO BE COMPLETED BY BUYER, SELLER OR AGENT Date of Instrument (MMDDYYYY) Enter the number matching your selection in the box at the end of the line: Deed (1) Contract (2) Seller: George E. Roepsch and Dorothy S. Roepsch Seller Address: 715 Cody Drive State: Iowa Buyer: City of Dubuque, Iowa Buyer Address: So West 13th Street State: Iowa ZIP: 52001 ZIP: 52003 Address of Property Conveyed:730 Cody Drive City: Dubuque email: email: State: Iowa Phone Number: (563) 582-4349 City: Dubuque Phone Number: (563) 589-4110 City: Dubuque Legal Description: Lot 1 of Roepsch Place No. 2, in the city of Dubuque, Dubuque County, Iowa ZIP: 52003 Enter the number corresponding to your selection in the box at the end of the line, if applicable. Type of Sale: Sale between related parties/family (1); Sale of partial interest (2); Trade (3); Quit Claim Deed (4); Auction (5) Was this a sale of agricultural land to: Corporation (1); Trust (2); Alien (3); Non-resident Alien (4); Limited Partnership (5) DECLARATION OF VALUE STATEMENT 1. Total Amount Paid 2. Amount Paid for Personal Property 3. Amount Paid for Real Property I hereby declare that the information contained in Part I of this form is true and correct. Printed Nam Signature: e E. Roepsc tive On or Before 07/01/16 Buyer Page 1 Phone Number: (563) 582-4349 or Seller or Agent I or Attorney i ISBA 57-006a (03/15/16) • Real Estate Transfer — Declaration of Value, Page 2 1 Part II - TO BE COMPLETED BY THE ASSESSOR Assessed values must be as of January 1 of the year in which the sale occurred. SECTION A: SINGLE CLASSIFICATION Primary Classification: Residential (4); Commercial (5); Industrial (2); Agricultural (1); Multi -residential (7) City/Township: Primary Parcel Number: Occupancy: Year Built: Class Land Building Building Dwelling Com} Res 1.009' .00 1 I )q ' i I 1.003 j.00 , ', i.00 f� ).00r .00 t i i'rr b: 00 ,Com .00 # t rsC i "'� 3 ray Ind xxr. 3 4 J k ;� vusuv x.00 i I 'un .00 m x.00' '� 1 3 "` Ag ' _. .33 eke. 00 : I x.00 , aha �1�.00 MultiRes �?x,<, I .00 3j ) l ?.00 l 1.00 Subtotal SECTION B: DUAL CLASSIFICATION Primary Classification: Commercial (5); City/Township: Primary Parcel Number: Industrial (2); Multi -residential (7) Occupancy: I Year Built: .00 Class Land Building Dwelling Com} 1.009' _ 1.003 ` Ind f� ).00r t i i'rr b: 00 MultiRes # 1 , t ;. i 00 t , . 1.00 a ) i _ �1 'un .00 Total: Add Subtotal amounts from Sections A and B ,,,,,,,,,,,,;,,,,,, ); Enter amount from line 3, page 1 Ratio: Divide Total amount by the amount on line 3, page 1 Comments: 1 Effective on or before 07/01/16 Page 2 00 ).00 NUTC Jurisdiction ISBA 57-006b (03/15/16) 1 THE IOWA STATE EAR ASSOCIATION Official Form No. 136 Barry A. Lindahl FOR THE LEGAL EFFECT OF THE USE OF THIS FORM, CONSULT YOUR LAWYER iCiAX $ 171,00000 PROMISSORY NOTE C October 20 2016 FOR VALUE RECEIVED, the undersigned, each as principal, jointly and severally, promise(s) to pay to the order of George E. Roepsch and Dorothy S Roepsch at 715 Cody Drive, Dubuque , Iowa, the sum of One Hundred Seventy -One Thousand and 0/100 with interest thereon from October 20, 2016 , payable rate of 3 per cent per annum until payment hereof as follows: See 1 in Addendum DOLLARS annually at the Interest shall first be deducted from the payment and any balance shall be applied on principal. Principal and interest not paid when due shall draw interest at the rate of 3 % per annum. Upon default in payment of any interest, or any installment of principal, the whole amount then unpaid shall become immediately due and payable at the option of the holder without notice. The undersigned, in case of suit on this note, agrees to pay attorney's fees. Makers, endorsers and sureties waive demand of payment, notice of non-payment, protest and notice. Sureties, endorsers and guarantors agree to all of the provisions of this note, and consent that the time or times of payment of all or any part hereof may be extended after maturity, from time to time, without notice. Important. Read Before Signing: The terms of this Agreement should be read carefully because only those terms in writing are enforceable. No other terms or oral promises not contained in this written contract may be legally enforced. You may change the terms of this Agreement only by another written agreement. Borrower acknowledges the receipt of a copy of this document at the time it was signed. Address: 50 West 13th Street Dubuque, Iowa 52001 Phone: (563) 589-4110 City of Du t ique, Iowa by: Michael C. Van Milligen, City Manager Caveat: This form not to be used for a Consumer Credit Transaction. © The Iowa State Bar Association 2005 10WADOCS s 136 PROMISSORY NOTE Revised January 2005 Addendum 1. The terms of this Promissory Note are given pursuant to an Offer to Buy and Acceptance attached hereto between the City of Dubuque (City) and George E. and Dorothy S. Roepsch (Roepsch). The Purchase Price of $171,000.00 (the Principle of this Promissory Note) will be paid as follows: City will apply for a State of Iowa REAP grant in the Fall of 2016 to pay the Principle. If a grant is awarded to Buyer, the Principle will be paid subject to the amount and availability of the grant award funding. If City is not awarded a grant in 2016, City will apply for a State of Iowa REAP grant in the Fall of 2017 to pay the Principle. If a grant is awarded to City, the Principle will be paid subject to the amount and availability of the grant award funding. If City is not awarded a grant by the State of Iowa by December 31, 2017, or if City is awarded a grant but the amount of the grant award is less than the Principle, City will pay the Principle or the balance of the Principle remaining after any payment based on the grant award funding in ten equal annual payments at 3% interest from October 20, 2016, commencing with the first payment on July 15, 2018 and on July 15 of each year thereafter until fully paid. Buyer may prepay all or part of the Principle at any time without penalty. CLOSING CHECKLIST CITY OF DUBUQUE, IOWA (Buyer) AND GOERGE E. ROEPSCH AND DOROTHY S. ROEPSCH (Seller) October 20, 2016 at 1:00 PM 300 Main Street Suite 330, Dubuque IA 52001 Lot 1 of Roepsch Place No. 2, in the City of Dubuque, Dubuque County, Iowa 1. Abstract brought up to date and delivered oepsch for review prior to Closing 2. Property Taxes 'epsch (Parcel no. 1035310024) 3. Warranty Deed y 4. Deed Recording Fee 5. Real Estate Transfer Tax — f epsch 6. Declaration of Value t... -City 7. Groundwater Hazard Statement t.ety 8. Real Estate Taxesepsch 9. First Amendment to Offer to Buy '.City 10. Closing Statement ity/Roepsch 101816ba1 CLOSING STATEMENT CITY OF DUBUQUE, IOWA (Buyer) AND GOERGE E. ROEPSCH AND DOROTHY S. ROEPSCH (Seller) October 20, 2016 at 1:00 PM 300 Main Street Suite 330, Dubuque IA 52001 Lot 1 of Roepsch Place No. 2, in the City of Dubuque, Dubuque County, Iowa Due from Seller Due from Buyer Property Purchase Price $171,000.00 Real Estate Transfer Tax (Payable to Dubuque County Recorder) $272.80 Roepsch check no. S170 Property Taxes (Payable to Dubuque County Treasurer) 2nd Half of FY15-16 $1,608.00 1st Half of FY16-17, $984.13 Prorated $3,2161366 days @ 112 days $2,592.13l ,.1 Roepsch check no. 1 Net Due from Buyer CITY OF DU - QUE, IOWA By: A. Lindahl, City Attorney *Pursuant to October 20, 2016 Promissory Note $171,000.00* GEORGE E. ROEPSCH DOROTHY S. ROEPSCH By:t9c cs GEORGE E. ROEPSCH DOROTHY M. ROEPSCH 715 CODY DR. PH. 563-582-4349 DUBUQUE, IA 52003 TO THE ORDER OF e ' - . - 45-7458/2739 5170 a Y22 U WACO COMMUNITY CREDIT UNION 'N 'ry ':� ',.' r D 3 L D. c o r GEORGE E. ROEPSCH DOROTHY M. ROEPSCH 715 CODY DR. PH. 563-582-4349 DUBUQUE, IA 52003 TO THE ORDER OF Q4.; ' ee 45-7453/2739 .27 5171 D P A CO C QIWMUNJTY CREDIT UNION W old ,N • d u p 3 O c o rn i 0 1111 11 i 0 Y Doc ID: 008546850003 Type: GEN Kind: DEED WITH RESOLUTION Recorded: 11/10/2016 at 01:43:39 PM Fee Amt: $294.80 Page 1 of 3 Revenue Tax: $272.80 Dubuque County Iowa John Murphy Recorder Fiie2016-00015291 WARRANTY DEED 0 1 Return to: Barry A. Lindahl, 300 Main Street, Suite 330 Dubuque, Iowa 52001 (563) 583-4113 Preparer: Barry A. Lindahl, 300 Main Street, Suite 330 Dubuque, Iowa 52001 (563) 583-4113 «tA°' Taxpayer: City of Dubuque, Iowa 50 West 13th Street, Dubuque, Iowa 52001 For the consideration of one Dollar(s) and other valuable consideration, George E. Roepsch and Dorothy S. Roepsch, husband and wife, as joint tenants do hereby Convey to the City of Dubuque, Iowa the following described real estate in Dubuque County, Iowa: Lot 1 of Roepsch Place No. 2, in the city of Dubuque, Dubuque County, Iowa Grantors do Hereby Covenant with grantees, and successors in interest, that grantors hold the real estate by title in fee simple; that they have good and lawful authority to sell and Convey the real estate; that the real estate is free and clear of all liens and encumbrances except as may be above stated; and grantors Covenant to Warrant and Defend the real estate against the lawful claims of all persons except as may be above stated. Each of the undersigned hereby relinquishes all rights of dower, homestead and distributive share in and to the real estate. Words and phrases herein, including acknowledgment hereof, shall be construed as in the singular or plural number, and as masculine or feminine ender, according to the context. ed on �.. 0 G=urge E. '' oepsch(Gra or) STATE OF IOWA , COUNTY OF Dubuque This record was acknowledged before me on S cc, 24 Roe . sch and Doroth S. Roe . sch, husband and wife, as ' oint tenants liv BARRY A. LINDAHL [Commission Num r 1 7515 My Comm. Exp. 1 0.1 S orothy S. Roepsch (Grantor) , by George E. Sign.ture of Notary Public © The Iowa State Bar Association 2016 IowaDocs© Form No. 101, Warranty Deed Revised January 2016 5b% C���j C erK (SO°O Prepared by Barry A. Lindahl 300 Main Street, Suite 330 Dubuque IA 52001 563 583-4113 Return to Prepared by Barry A. Lindahl 300 Main Street, Suite 330 Dubuque IA 52001 563 583-4113 RESOLUTION NO. 374-16 ACCEPTING THE DEED TO CERTAIN REAL ESTATE IN DUBUQUE COUNTY, IOWA FROM GEORGE E. ROEPSCH AND DOROTHY S. ROEPSCH WHEREAS, the City of Dubuque entered into an Agreement on July 18, 2016 with George E. Roepsch and Dorothy S. Roepsch, as amended by First Amendment dated September 29, 2016, for the purchase of certain real property in Dubuque County, Iowa, described as follows: Lot 1 of Roepsch Place No. 2, in the City of Dubuque, Dubuque County, Iowa AND WHEREAS, the terms of the Agreement have now been met. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF DUBUQUE, IOWA, AS FOLLOWS: 1. The City of Dubuque, Iowa, hereby accepts the Deed from George E. Roepsch and Dorothy S. Roepsch, a copy of which is attached hereto. 2. The City Clerk is hereby authorized and directed to record this Resolution and the Deed with the Dubuque County Recorder. Attest: Passed, approved and adopted this 7th day of November, 2016. Roy D. Bu , Mayor Kevi F. Firnstahl, it; rk F:\Users\tsteckle\Lindahl\Roepsch Property Acquisition - Property By Valentine Park\Closing\ResolutionAcceptingDeed_101816.doc CERTIFICATE of the CITY CLERK STATE OF IOWA ) SS: COUNTY OF DUBUQUE ) I, Kevin S. Firnstahl, do hereby certify that I am the duly appointed, qualified, City Clerk of the City of Dubuque, Iowa, in the County aforesaid, and as such City Clerk, I have in my possession or have access to the records of the proceedings of the City Council. I do further state that the hereto attached Resolution No. 374-16 is a true and correct copy of the original. In Testimony Whereof, I hereunto set my hand and official seal of the City of Dubuque, Iowa. Dated at Dubuque, Iowa, on this 8th day of November, 2016. KevirS S. Firnstahl, C C City Clerk 11E1M113111BININIMINN siii IN 11111111 Doc ID: 008546860002 Type GWH Kind: GROUNDWATER HAZARD Recorded: 11/10/2016 at 01:44:11 PM Fee Amt: $0.00 Page 1 of 2 Dubuque County Iowa John Murphy Recorder Fi1e2016-00002038 REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT TO BE COMPLETED BY TRANSFEROR TRANSFEROR: Name George E. Roepsch and Dorothy S. Roepsch Address 715 Cody Drive Dubuque Iowa 52003 Number and Street or RR City, Town or P.O. State Zip TRANSFEREE: Name City of Dubuque, Iowa Address 50 West 13th Street Dubuque Iowa 52001 Number and Street or RR City, Town or P.O. State Zip Address of Property Transferred: 730 Cody Drive Dubuque Iowa 52003 Number and Street or RR City, Town or P.O. State Zip Legal Description of Property: (Attach if necessary) Lot 1 of Roepsch Place No. 2, in the city of Dubuque, Dubuque County, Iowa 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 or set forth on an attached separate sheet, as necessary. 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 and information related thereto is provided in Attachment #1, attached to this document. 3. Hazirdous Wastes (check one) ✓There is no known hazardous waste on this property. There is hazardous waste on this property and information related thereto is provided in Attachment #1, attached to this document. 4. Underground Storage Tanks (check one) ✓ 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 on this property. The type(s), size(s) and any known substance(s) contained are listed below or on an attached separate sheet, as necessary. FILE WITH RECORDER DNR form 542-0960 (July 18, 2012) O 110 (5a,9' I 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) of the site(s) and known identifying information of the decedent(s) is stated below or on an attached separate sheet, as necessary. 6. Private Sewage Disposal System (check one) _ All buildings on this property are served by a public or semi-public sewage disposal system. ‘/This transaction does not involve the transfer of any building which has or is required by law to have a sewage disposal system. _ There is a building served by private sewage disposal system on this property or a building without any lawful sewage disposal system. A certified inspector's report is attached which documents the condition of the private sewage disposal system and whether any modifications are required to conform to standards adopted by the Department of Natural Resources. A certified inspection report must be accompanied by this form when recording. There is a building served by private sewage disposal system on this property. Weather or other temporary physical conditions prevent the certified inspection of the private sewage disposal system from being conducted. The buyer has executed a binding acknowledgment with the county board of health to conduct a certified inspection of the private sewage disposal system at the earliest practicable time and to be responsible for any required modifications to the private sewage disposal system as identified by the certified inspection. A copy of the binding acknowledgment is attached to this form. There is a building served by private sewage disposal system on this property. The buyer has executed a binding acknowledgment with the county board of health to install a new private sewage disposal system on this property within an agreed upon time period. A copy of the binding acknowledgment is provided with this form. There is a building served by private sewage disposal system on this property. The building to which the sewage disposal system is connected will be demolished without being occupied. The buyer has executed a binding acknowledgment with the county board of health to demolish the building within an agreed upon time period. A copy of the binding acknowledgment is provided with this form. [Exemption #9] _ This property is exempt from the private sewage disposal inspection requirements pursuant to the following exemption [Note: for exemption #9 use prior check box]: The private sewage disposal system has been installed within the past two years pursuant to permit number Information required by statements checked above should be provided here or on separate sheets attached hereto: I HEREBY DECLARE THAT I HAVE REVIEWED THE INSTRUCTIONS FOR THIS FORM Signature: AN ! /i T THE INFORMATION STATED ABOVE IS TRUE AND CORRECT. O or 0 FILE WITH RECORDER Telephone No.: 5`63.5242 -1/34// DNR form 542-0960 (July 18, 2012)