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M.S.f3.A. Real Property Form No. 14 (Adopted April, 1998) <br />DISCLOSURE OF SEWAGE TREATMENT SYSTEM <br />PAGE 2 <br />ABANDONED <br />[Check <br />INDIVIDUAL ON -SITE SEWAGE TREATMENT SYSTEM: <br />either 6 or 7: ] <br />____ 6. Seller /Transferor has no knowledge whether there is an abandoned <br />individual sewage treatment system on the property. <br />_'___ f <br />7. Seller /Transferor knows that there [strike one: are / gg2Snap abandoned <br />individual sewage treatment systems on the property. If Seller /Transferor <br />discloses the existence of an abandoned individual sewage treatment <br />system on the property, then Minnesota law requires that the location of the <br />system be disclosed to Buyer /Transferee with a map. I. Complete the map <br />below in Section C.] <br />C. <br />INDIVIDUAL SEWAGE TREATMENT SYSTEMS (IN -USE OR ABANDONED) ON THE <br />PROPERTY. Describe all in -use and abandoned systems on the property. <br />For each sewage treatment system in use, state the type of System: <br />_Septic Tank with: ____ standard drainfield mound system drainfield <br />___Sealed System (holding tank or contained cesspool) <br />__Other (describe) ____seepage tank _X_cesspool well pit <br />___dry ___leaching <br />2 <br />SKETCH MAP <br />Sketch the location of the house, garage, accessory buildings, well, septic tank, drainfield, <br />mound, or other components of the sewer system. Also show the location of the <br />components of any abandoned sewage treatment systems (tanks, pipes, drainfields, pits, <br />etc.) Include estimated distances from all roads, streets and buildings. Use additional <br />sheets of paper, if necessary. <br />/ <br />i C' L, C <br />I,I ; <br />3 <br />STATEMENT BY SELLER /TRANSFEROR: To my knowledge, the property [strike one] is <br />Pisiniecin compliance with all applicable sewage treatment laws and rules. <br />Signature of Seller /Transferor Print Name of Seller /Transferor Date <br />Signature of Seller /Transferor Print Name of Seller /Transferor Date <br />4 <br />ACKNOWLEDGMENT AND RFyCEIPT BY BUYER /TRANSFEREE: I have received this <br />disclosure on [date) /i 10 I o 9 <br />Signaure of Buyer/Transferee 4 Signature of Buyer /Transferee <br />