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M.S.B.A. Real Property Form No, 14 (Adopted April, 1998) <br />DISCLOSURE OF SEWAGE TREATMENT SYSTEM <br />PAGE 4 <br />5 <br />Is the system, including all drainfields, located within the setback lines' yes! no /unknown <br />If "no," describe encroachment: <br />F. INFORMATION REGARDING GOVERNMENTAL NOTICES AND <br />SELLER'S /TRANSFEROR'S KNOWLEDGE. <br />1 <br />Have you received any notices regarding your system from any governmental unit? <br />yesJnD <br />If "yes," explain: <br />2 <br />Do you know of any defects in the sewer system? yes Limp If "yes," describe: <br />3 <br />Is there enough useable land area on the property to construct a new drainfield? <br />yes / no Onknown _ <br />� Novi! �G, /c <br />/,r co,, L{ <„ ,,. ,„bry -/. SYS %., <br />4 <br />Do you have any other information about repairs or maintenance of the system that has <br />not already been disclosed in this form? yes no7 If "yes," describe: <br />G. SELLER'S /TRANSFEROR'S ADDRESS INFORMATION. <br />Seller's /Transferor's name and address <br />before sale or transfer: city or Little Canada <br />515 E. Little Canada Road <br />Little Canada, MN 55117 <br />Seller's /Transferor's address after <br />sale or transfer: Same as above <br />STATEMENT BY SELLER /TRANSFEROR: To my knowledge, the information on this <br />Supplemental Disclosure is true, accurate, and complete. <br />Signature of Seller /Transferor <br />Print Name of Seller /Transferor Date <br />Signature of Seller /Transferor Print Name of Seller / fansferor Date <br />ACKNOWLEDGMENT AND RECEIPT BY BUYER /TRANSFEREE: I have received this <br />Supplemental Disclosure on [date] l/ <br />._„, 47(- -1s- <br />,Sigruiture of Buyer/ Transferee Signature of Buyer /Transferee <br />