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M.S.B.A. Real Property Form No. 14 (Adoptecl April, 1998) <br />DISCI SIRE 0r SEWAGE TREATMENT SYSTEM PAGE 3 <br />SUPPLEMENTAL DISCLOSURE REGARDING INDIVIDUAL ON -SITE SYSTEM. <br />This supplemental disclosure asks for information that is not required as part of the statutory disclosure. <br />Completion of this Sunolement is voluntary <br />D, INFORMATION REGARDING PERFORMANCE AND USE. Seller's answers to these <br />questions might assist a state - licensed inspector in evaluating the performance of <br />the individual on -site sewage treatment system. [See MINN. RULES, chapter 7080.] <br />1 <br />a. The property is [check one] x in full time residential use - /.4r £'c - V,Cnar /', i '..-7<s <br />in part -time, seasonal, or recreational use (lake <br />___ cabin, etc.) <br />b. What is the average number of people who have used the system during the past two <br />years? - _est.4__------ <br />2 <br />Flow many toilets flush into the system? _2____ ____ <br />3 <br />Does a dishwasher empty into the systemty -a)/ no If "yes," how many times per week? <br />12!_11.1._. <br />4 <br />Does a garbage disposal empty into the system •)/ no <br />If "yes," how many times per week? yes_ o___ _ _ <br />5 <br />Does a clothes washer empty into the system ?Ce.h no <br />If "yes," how many Toads of wash per week? 0 <br />6 <br />Are there any other sources of water which drain into the system ?�yeno If "yes," <br />describe: Bathrooms - 2, floor drains <br />7 <br />Has the system malfunctioned while you have owned the property? ves Kpj If "yes," <br />describe: No <br />8 <br />Describe the work performed on the system while you have owned the property, including <br />routine maintenance and pumping: The City eliminated the old, unused cesspool by collapsing and <br />properly filling it. We also removed an obstruction from the sanitary sewer service line located on the properly, and <br />installed a clean -out on the line as depicted on the attached diagram. <br />E. INFORMATION REGARDING LOCATION. If Seller /Transferor is unable to provide <br />answers to these questions, Buyer should obtain this information from other sources. <br />Minnesota law and local ordinances restrict the ability to build or to rebuild <br />improvements within flood plains, shorelands, and wetlands. You might also be <br />restricted from using the property if the property does not have enough land area to <br />install a new drainfield. These restrictions affect wells and individual on -site sewage <br />treatment systems. If the individual on -site sewage treatment system fails, you might <br />not be allowed to rebuild in its present location. <br />1 <br />Is any part of the system, including all drainfields, located in a Flood Plain? yes yrio ?h <br />unknown <br />2 <br />Is any part of the system, including ail drainfields, located in a Shoreland Zone? <br />yes (no- Punknown <br />3 <br />Is any part of the system, including all drainfields, located in or near a wetland or low lying <br />area? ves L96) unknown <br />If "yes," describe: <br />4 <br />Is the system, including all drainfields, located within the property lines? (_es bno / <br />unknown <br />If "no," describe encroachment or easement: <br />- 1 5 - <br />