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M.S.13A.Reel Property Form No.14(1898,Rev.2009) <br /> (]1S�E.C3SURE OF SEWAGE TR R YsTEM _ PACE 2 of 5 <br /> ABANDONED SUBSURFACE ONSITE SEWAGE TREATMENT SYSTEM:(Check either 6 or 7: <br /> = 6. SellerrrrensNror has no knowledge whether there is an abandoned <br /> subsurface sewage treatment system on the property. <br /> 7. Setfer[Transferor knows that there[strike one:fare/ re no bandoned <br /> subsurface sewage treatment systems on the grope ellerfrransferor <br /> discloses the existence of an abandoned subsurface sewage treatment <br /> system on the property,then Minnesota law requires that the location of the <br /> system be disclosed to Buyerffran0aree with a map.[Complete the map <br /> below in Section C.] <br /> C. SUBSURFACE SEWAGE TREATMENT SYSTEMS(IN-USE OR ABANDONED)ON THE <br /> PROPERTY. Describe all in-use and abandoned systems on Ow property. <br /> 1 For each sewage treatment system in use,state the type of System: <br /> =Septic Tank with:jEg�standard drainfield =mound system drainfield <br /> =Sealed System(holding tank or contained cesspool) <br /> =C?ther(describe)=seepage tank =cesspool=dry well[Teaching pit <br /> 2 SKETCH MAP:Sketch the location of the house,garage,acoessory buildings,well,septic <br /> tank,drainfield,mound,or other components of the sewer system. Also show the location <br /> of the components of any abandoned sewage treatment systems(tanks,pipes,drainfields, <br /> pits, etc.) include estimated distances from all roads, streets and buildings. Use additional <br /> sheets of paper,if necessary. <br /> ty'0.c, <br /> 3 SELLERiTRANSFEROR DISCLOSURE: Pursuant to Minnesota Statutes Section 115.55, <br /> Subdivision 6,the SellerfTransferor shall disclose to the Buyer/Transferee what the <br /> Seilerl"Transferor has knowledge of relative to the compliance status of the subsurface <br /> treatment system,and whether,to the best of the Seller'slFransferorrs knowledge,a <br /> straight-pipe system exists. A Sellerfrransferor who has in their possession a previous <br /> inspection report completed by a licensed inspection business or certified local government <br /> inspector in accordance with Section 115.55,Subdivision 5 or 5a,shall attach a copy to the <br /> disclosure statement that is provided to the Buyerfrransferee. <br /> STATEMENT BY SELLER/TRANSFEROR: To my knowledge,the property[strike one <br /> min compliance with all applicable sewagement laws and rules. To the best of <br /> knowledge,a straight-pipe cyst ke one[ t w-mg,not exist. A previous Inspection <br /> report[strike onejI st <br /> � and if OT-exists,it is attached to this Disclosure. <br /> C&Ocebon:I cer*that none of the pubro;hed text of this form has teen deleted or altered except as indicated by SOM out or by <br /> additional text shorn In a$pence different than bxe published Tam. <br /> Name of lawyer or other preparer <br /> tore df lawyer ac& er preparer <br /> Signature of Selterlrransferor Print Name of Seller/Transferor Daae <br /> Signature of Sellerfrransferor Print Name of Sellerrrransferor Date <br /> 4 ACKNOWLEDGMENT AND RECEIPT BY BUYERITRANSFEREE: I have received this <br /> disclosure on[date] A-)Co <br /> Sig uyrensferee Signature of Buyerfrransferee <br />