Loading...
Acquisition of Property_20 W. 18th Street (Sawvell)THE CITY OF Dui Masterpiece on the Mississippi TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: 20 West 18th Street Property Acquisition DATE: June 25, 2013 Dubuque kital All- America City II 111! 2012 City Engineer Gus Psihoyos recommends City Council approval to purchase property at 20 West 18th Street owned by Michael J. And Victoria L. Sawvell for a total price of $75,000. The property purchase will facilitate the repair of the 18th Street retaining wall located at 18th Street and Heeb Street. The purchase price includes the cost to purchase the property, reimbursements for expenses incurred as a result of the retaining wall collapse, and relocation assistance. Repairing the retaining wall after acquiring the house will save the City over $180,000. I concur with the recommendation and respectfully request Mayor and City Council approval. kr,„709,,, Michael C. Van Milligen MCVM:jh Attachment cc: Barry Lindahl, City Attorney Cindy Steinhauser, Assistant City Manager Teri Goodmann, Assistant City Manager Gus Psihoyos, City Engineer Masterpiece on the Mississippi TO: Michael C. Van Milligen, City Manager FROM: Gus Psihoyos, City Engineer DATE: June 24, 2013 SUBJECT: 20 West 18th Street Property Acquisition INTRODUCTION Dubuque ketril All Amedca city 11111 2012 The purpose of this memo is to request approval to purchase the property at 20 West 18th Street owned by Michael J. and Victoria L. Sawvell. The property is legally described as the Westerly 80 feet of Lot 8, and all of Lot 11 except the Southerly 6 feet thereof, in "The Subdivision of City Lots 438, 439 and part of 676 which is not embraced in L. H. Langworthy's Subdivision ". The property purchase will facilitate the repair of the 18th Street retaining wall located at 18th Street and Heeb Street. BACKGROUND Engineering has been monitoring the retaining wall and stairs at 18th and Heeb Streets for some time. The retaining wall partially collapsed in April, 2013. When the collapse occurred, city staff hired local contractors to remove any limestone blocks that could be a hazard to the public. The wall was further stabilized and protected from the weather to reduce the possibility of any further degradation of the wall. Additionally, the Sawvell's were asked to vacate their house until the City could assess the condition of the wall to ensure the safety of the Sawvell's. It was determined that the wall collapse posed a potential threat to the house structure. The Sawvell's stayed at a local hotel while City staff evaluated the situation. Previously, city engineering staff created two cost estimates for the replacement of 18th Street retaining wall. One estimate included the house remaining in place and the other estimate included removing the house. Based on these original estimates, it was determined that removing the house and reconstructing the retaining wall would have the lowest overall cost. DISCUSSION Engineering has reviewed the existing retaining wall along Heeb Street and has formulated two options to address the structural stability of the retaining wall. Option 1 is to purchase and remove the house at 20 West 18th Street, stabilize the Heeb Street Wall, remove the 18th Street stairs, and complete related street repairs on Heeb Street. Option 2 would be to not purchase the property at 20 West 18th Street, reconstruct the Heeb Street retaining wall, remove and replace the 18th Street stairs, and complete the related street repairs on Heeb Street. City staff negotiated with Michael J. and Victoria L. Sawvell to purchase the property at 20 West 18th Street. The City's Legal Services Department reached an agreement with the Sawvell's for a total cash price of $75,000 which includes the cost to purchase the property, reimbursements for expenses incurred as a result of the wall collapse, and relocation assistance. Below is a summary of the agreed upon acquisition price: Item Cost Purchase Price of Home $ 44,800.00 Relocation Allocation $ 22,500.00 Reimbursement of Hotel cost — (April 10 — April 18) $ 461.80 Housing Allocation — (April 18 — Date of Closing) $ 5,238.20 Allowance for Incidental Expenses $ 2,000.00 TOTAL: $75,000.00 Attached is the signed agreement from the Sawvell's with the costs above. BUDGET IMPACT Below are the budget options for the 18th street Retaining Wall and Stairs project. Option 1 includes purchasing the property at 20 West 18th Street. Option 2 does not include buying the property. Option 1 This option would include purchase of the Sawvell property, remove the house, stabilize the 18th /Heeb retaining wall, remove the 18th Street stairs, and complete street repairs and miscellaneous related work. DESCRIPTION AMOUNT Property Acquisition $75,000.00 House Demo 37,250.00 Wall Stabilization 66,990.00 Step Removal 8,000.00 Street Repair 15,116.00 Miscellaneous 38,140.00 Sub -total $240,496.00 Contingency 24,049.00 Engineering 39,682.00 TOTAL $304,227.00 2 Option 2 Repair the 18th /Heeb Street retaining wall and steps. This option includes retaining wall reconstruction, step removal and replacement, street repair and related expenses. DESCRIPTION AMOUNT Wall Reconstruction 178,800.00 Step Removal and Replacement 139,824.00 Street Repair 15,116.00 Miscellaneous 49,740.00 Sub -total $383,480.00 Contingency 38,348.00 Engineering 63,274.00 TOTAL $485,102.00 As seen from the numbers above, Option 1 is the lowest cost to the City. This option mitigates the public safety threat and reduces future liabilities to the City. Available Funding 3602481 (FY14) 18th Street Retaining Wall 3501029 (FY13) Stone Retaining Wall Funding ACTION TO BE TAKEN $368,000.00 $134,150.00 Total $502,150.00 I recommend that the property at 20 West 18th Street be purchased by signing the attached agreement and execution of the attached resolution by the City Council. Prepared By: Jon Dienst, P.E. CC: Jenny Larson, Budget Director, Barry Lindahl, City Attorney Crenna Brumwell, Assistant City Attorney Maureen Quann, Assistant City Attorney Bob Schiesl, Assistant City Engineer Greg Doeden, Civil Engineer 3 RESOLUTION NO.193-13 RESOLUTION APPROVING THE ACQUISITION OF REAL ESTATE OWNED BY MICHAEL J. AND VICTORIA L. SAWVELL IN THE CITY OF DUBUQUE Whereas, the City of Dubuque intends to acquire a certain property located at 20 West 18th Street, Dubuque. Iowa; and Whereas, this certain property is not currently part of or located within the Bee Branch Creek Restoration Project or any other federally funded public improvement project; and Whereas, the acquisition of this property is a voluntarily negotiated purchase by the City of Dubuque under Section 6B.1A of the Code of Iowa, and is not an acquisition by the City of Dubuque through its exercise of the power of eminent domain under Chapter 6B of the Code of Iowa; and Whereas, a purchase agreement has been finalized with the owner of the property scheduled for acquisition. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF DUBUQUE, IOWA: Section 1. That the City of Dubuque, Iowa hereby approves the acquisition of the following legally described property: The Westerly 80 feet of Lot 8, and all of Lot 11 except the Southerly 6 feet thereof, in "The Subdivision of City Lots 438, 439 and part of 676 which is not embraced in L. H. Langworthy's Subdivision" in the City of Dubuque, Iowa, according to the recorded plat thereof. At the cost of Forty -Four Thousand Eight Hundred and 00/100 Dollars ($44,800.00) and reimbursements, not to exceed a total amount of Seventy -Five Thousand and 00/100 ($75,000). Section 2. That the City of Dubuque be and is hereby authorized to accept a Warranty Deed from the owner, conveying the owner's interest to the City of Dubuque, Iowa for the herein described real estate. Section 3. That the City Clerk be and is hereby authorized and directed to cause said Warranty Deed to be recorded in the office of the Dubuque County Recorder, together with a certified copy of this Resolution. Section 4. That the City Clerk be and is hereby directed to forward a copy of this Resolution to the Dubuque County Assessor and the Dubuque County Auditor. Passed, approved and adopted this 1st day of July , 2013 Attest: Kevin . Firnstahl, City Clerk Roy D. BuV*, Mayor Prepared by: Crenna M. Brumwell, Esq. 300 Main Street Suite 330 Dubuque IA 52001 563 583 -4381 Return document to: Crenna M. Brumwell, Esq. 300 Main Street Suite 330 Dubuque IA 52001 OFFER TO BUY REAL ESTATE AND ACCEPTANCE TO: Michael and Victoria Sawvell, Seller SECTION 1. REAL ESTATE DESCRIPTION. The City of Dubuque, Iowa (Buyer) offers to buy real estate in Dubuque County, Iowa, described as follows: The Westerly 80 feet of Lot 8, and all of Lot 11 except the Southerly 6 feet thereof, in "The Subdivision of City Lots 438, 439 and part of 676 which is not embraced in L. H. Langworthy's Subdivision" in the City of Dubuque, Iowa, according to the recorded plat thereof. with any easements and appurtenant servient estates, but subject to the following: a. any zoning and other ordinances; b. any covenants of record; c. any easements of record for public utilities, roads and highways (the Real Estate). SECTION 2. PRICE. The purchase price shall be $44,800.00 payable in cash at closing. The closing shall be on or before July 10, 2013. SECTION 3. REAL ESTATE TAXES. Seller shall pay all real estate taxes payable for the fiscal year in which the closing takes place and prorated to the date of possession and any unpaid real estate taxes for prior years. Buyer shall pay all subsequent real estate taxes. SECTION 4. POSSESSION. If Buyer timely performs all obligations, possession of the Real Estate shall be delivered to Buyer on the date of closing, with any adjustments of rent, insurance, and interest to be made as of the date of transfer of possession. Seller shall have until closing to remove any and all personal property and fixtures from the property. SECTION 5. ABSTRACT AND TITLE. Buyer, at Buyer's expense, shall promptly obtain an abstract of title to the Real Estate continued through the date of acceptance of this offer, and examine said abstract. It shall show merchantable title in Seller in conformity with this agreement, Iowa law and Title Standards of the Iowa State Bar Association. The abstract shall become the property of the Buyer when the purchase price is paid in full. SECTION 6. DEED. Upon payment of the purchase price, Seller shall convey the Real Estate to Buyer by Warranty Deed, free and clear of all liens, restrictions, and encumbrances except as provided in 1 a. through 1 .c. Any general warranties of title shall extend only to the time of acceptance of this offer, with special warranties as to acts of Seller continuing up to time of delivery of the deed. SECTION 7. TIME IS OF THE ESSENCE. Time is of the essence in this Contract. SECTION 8. REMEDIES OF THE PARTIES. 8.1 If Buyer fails to timely perform this Contract, Seller may forfeit it as provided in the Iowa Code, and all payments made shall be forfeited or, at Seller's option, upon thirty days written notice of intention to accelerate the payment of the entire balance because of such failure (during which thirty days such failure is not corrected) Seller may declare the entire balance immediately due and payable. Thereafter this Contract may be foreclosed in equity and the Court may appoint a receiver. 8.2 If Seller fails to timely perform this Contract, Buyer has the right to have all payments made returned to it. 8.3 Buyer and Seller also are entitled to utilize any and all other remedies or actions at law or in equity available to them and shall be entitled to obtain judgment for costs and attorney fees as permitted by law. SECTION 9. CONTRACT BINDING ON SUCCESSORS IN INTEREST. This Contract shall apply to and bind the successors in interest of the parties. SECTION 10. TIME FOR ACCEPTANCE. If this offer is not accepted by Seller on or before 5:00 p.m. on June 25, 2013, it shall become void and all payments shall be repaid to the Buyer. SECTION 11. JOINDER BY SELLER'S SPOUSE. Seller's spouse, if not a titleholder immediately preceding acceptance of this offer, executes this Contract only for the purpose of relinquishing all rights of dower, homestead and distributive shares or in compliance with Section 561.13 of the Iowa Code and agrees to execute the deed or real estate Contract for this purpose. SECTION 12. RIGHTS OF INSPECTION, TESTING AND REVIEW. 12.1. Buyer, its counsel, accountants, agents and other representatives, shall have full and continuing access to the Real Estate and all parts thereof, upon reasonable notice to Seller. Buyer and its agents and representatives shall also have the right to enter upon the Real Estate at any time after the execution and delivery hereof for any purpose whatsoever, including inspecting, surveying, engineering, test boring, performance of environmental tests and such other work as Buyer shall consider appropriate, provided that Buyer shall hold Seller harmless and fully indemnify Seller against any damage, claim, liability or cause of action arising from or caused by the actions of Buyer, its agents, or representatives upon the Real Estate (except for any damage, claim, liability or cause of action arising from conditions existing prior to any such entry upon the Real Estate), and shall have the further right to make such inquiries of governmental agencies and utility companies, etc. and to make such feasibility studies and analyses as it considers appropriate. 2 12.2. Seller warrants to the best of its knowledge and belief that there are no wells, solid waste disposal sites, hazardous wastes or substances, underground storage tanks or burial sites located on the Real Estate, except as set out below. Seller further warrants that with the exception of a former petroleum underground storage tank release(s), Seller has done nothing to contaminate or allow the contamination of the Real Estate and has no knowledge of any contamination other than that from the former petroleum underground storage tank release(s). Seller warrants that the Real Estate is not subject to any local, state, or federal judicial or administrative action, investigation or order regarding its environmental condition or environmental compliance, except as may arise from the former petroleum underground storage tank release(s). Seller shall provide Buyer with a properly executed Groundwater Hazard Statement showing no wells, solid waste disposal sites, hazardous wastes, underground storage tanks and private burial sites on the Real Estate, with the exception of a former petroleum underground storage tank release(s), which shall be considered a warranty and representation by Seller to Buyer. SECTION 13. VIOLATIONS OF REGULATIONS. Seller warrants that there are no notices, orders, suits, judgments or other proceedings relating to fire, building, zoning, air pollution, health violations or other matters that have not been. corrected. Seller has notified Buyer in writing of any past notices, orders, suits, judgments or other proceedings relating to fire, building, zoning, air pollution or health violations as they relate to the Real Estate of which it has actual notice; SECTION 14. ENCUMBRANCES. Seller warrants that the Real Estate will as of the date of closing be free and clear of all liens, security interests, and encumbrances; SECTION 15. UNDERGROUND STORAGE TANKS. Seller warrants and represents that there are no underground storage tanks or piping on or in the Real Estate and that all such tanks and piping have been removed according to applicable state regulations. SECTION 16. TENANTS. The Property is free and clear of any occupants, and no party has a lease to or other occupancy or contract right in the Property which shall in anyway be binding upon the Property. SECTION 17. RELEASE. As a part of the consideration for this Agreement, Seller hereby releases and forever discharges the City of Dubuque, Iowa, and its agents, officers and employees, and all other persons, firms or corporations liable or who might be claimed to be liable, none of whom admit any liability to Seller, but all expressly deny any liability from any and all claims, demands, damages, actions, causes of action or suits of any kind or nature whatsoever, and particularly on account of all injuries, known and unknown, both to person or property, which have resulted or may in the future develop from the collapse of the retaining wall adjacent to the Property which occurred on April 10, 2013. Seller further agrees to defend, indemnify, and hold the City of Dubuque, Iowa, and its agents, officers and employees, and all other persons, firms or corporations liable or who might be claimed to be liable, from and against any and all claims of any kind related to or arising out of the collapse of the retaining wall. 3 Seller declares that the terms of this Release have been completely read and are fully understood and voluntarily accepted for the purpose of making a full and final settlement of any and all claims, disputed or otherwise, on account of the injuries and /or damages above mentioned. The terms of this Release shall in all respects survive the closing. SECTION 18. OTHER PROVISIONS. 18.1 This Offer is subject to the approval of the City Council of the City of Dubuque, Iowa, by not later than July 1, 2013. 18.2 Additional amounts payable to Sellers at closing include: a) Relocation allocation of $22,500.00; b) Reimbursement of $461.80 for expenses incurred at the Holiday Inn from April 10 -April 18, 2013; c) Allocation of $5,238.20 for housing expenses from April 18, 2013 through the date of closing; d) Allowance for incidental expenses of $2,000.00; and e) In no event will a total payout to Sellers, including the property purchase price, exceed $75,000.00 18.3 Seller will provide Buyer with a signed Acknowledgment of Voluntary Negotiation and Purchase of Property at the time of closing. Dated: CITY OF DUBUQUE, IOWA By: Michael C. Van Milligen, City Manager 4 Dated: D ( f MICHAEL SAWVELL VIC ORIA SAWVE L IuIIWI111ItlWlVlll IN111YWMIMWYI011 Doc ID 007749350004 Type: GEN Kind DEED WITH RESOLUTION Recorded: 07/17/2013 at 10:16:47 AM Fee Amt: $98.20 Page 1 of 4 Revenue Tax: $71.20 Dubuque County Iowa Kathy Flynn Thurlow Recorder (� G F11e20 1 3- 000 1 1905 ©THE IOWA STATE BAR ASSOCIATION I Official Form No. 101 - May 2006 Maureen A. Quann I FOR THE LEGAL EFFECT OF THE USE OF THIS FORM, CONSULT YOUR LAWYER Return To: Maureen A. Quann Suite 330, 300 Main Street Dubuque, Iowa 52001 (563) 589 -4381 Preparer: Maureen A. Quann Suite 330, 300 Main Street Dubuque, Iowa 52001 (563) 589 -4381 Taxpayer: City of Dubuque, Iowa 50 West 13th Street Dubuque, Iowa 52001 $TATS, �ssecinzse For the consideration Michael J. Sawvell and Victoria WARRANTY DEED of one Dollar(s) and other valuable consideration, L. Sawvell, husband and wife, as joint tenants with full rights of survivorship and not as tenants in common do hereby Convey to the City of Dubuque, Iowa the following described real estate The Westerly 80 feet of Lot Subdivision of City Lots 438, Subdivision" in the City of Grantors do Hereby estate by title in fee simple; that real estate is free and clear of Covenant to Warrant and Defend stated. Each of the undersigned to the real estate. Words and singular or plural number, and in.:414)0 in Dubuque County, Iowa: 8, and all of Lot 11 except the 439 and that part of 676 which Dubuque, Iowa according to the Covenant with grantees, and successors they have good and lawful authority all liens and encumbrances except the real estate against the lawful hereby relinquishes all rights of phrases herein, including acknowledgment as masculine or feminine gender, Southerly 6 feet thereof, in "The is not embraced in L. H. Langworthy's recorded plat thereof in interest, that grantors hold the real to sell and Convey the real estate; that the as may be above stated; and grantors claims of all persons except as may be above dower, homestead and distributive share in and hereof, shall be construed as in the according to the context. Dated: — r 6 ``3 Michael J. Sa ell (Grantor) ictona L. Sawvell (Grantor) STATE OF IOWA , COUNTY OF Dubuque This instrument was acknowledged before and Victoria L. Sawvell, husband and wife, as me on 11% j 2.013 , by Michael J. Sawvell joint tenants with full rights of survivorship and not as tenants in common . , Notary Public (This form of acknowledgment for individual grantor(s) only) ��P' ' A k04 MAUREEN A. QUANN Comm. Ex RESOLUTION NO.193_13 RESOLUTION APPROVING THE ACQUISITION OF REAL ESTATE OWNED BY MICHAEL J. AND VICTORIA L. SAWVELL IN THE CITY OF DUBUQUE Whereas, the City of Dubuque intends to acquire a certain property located at 20 West 18th Street, Dubuque. Iowa; and Whereas, this certain property is not currently part of or located within the Bee Branch Creek Restoration Project or any other federally funded public improvement project; and Whereas, the acquisition of this property is a voluntarily negotiated purchase by the City of Dubuque under Section 6B.1A of the Code of Iowa, and is not an acquisition by the City of Dubuque through its exercise of the power of eminent domain under Chapter 6B of the Code of Iowa; and Whereas, a purchase agreement has been finalized with the owner of the property scheduled for acquisition. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF DUBUQUE, IOWA: Section 1. That the City of Dubuque, Iowa hereby approves the acquisition of the following legally described property: The Westerly 80 feet of Lot 8, and all of Lot 11 except the Southerly 6 feet thereof, in "The Subdivision of City Lots 438, 439 and part of 676 which is not embraced in L. H. Langworthy's Subdivision" in the City of Dubuque, Iowa, according to the recorded plat thereof. At the cost of Forty -Four Thousand Eight Hundred and 00/100 Dollars ($44,800.00) and reimbursements, not to exceed a total amount of Seventy -Five Thousand and 00/100 ($75,000). Section 2. That the City of Dubuque be and is hereby authorized to accept a Warranty Deed from the owner, conveying the owner's interest to the City of Dubuque, Iowa for the herein described real estate. Section 3. That the City Clerk be and is hereby authorized and directed to cause said Warranty Deed to be recorded in the office of the Dubuque County Recorder, together with a certified copy of this Resolution. Section 4. That the City Clerk be and is hereby directed to forward a copy of this Resolution to the Dubuque County Assessor and the Dubuque County Auditor. Passed, approved and adopted this 1st day of July , 2013 Attest: Kevin . Firnstahl, City Clerk 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. 193 -13 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 3rd day of July, 2013. Kevi S. Firnstahl, C C, City Clerk iIIIIIIIwNmwIIIIIIIuamwIIIIIiIIIImmuIIII Doc ID 007749360002 Type GWH Kind GROUNDWATER HAZARD Recorded: 07/17/2013 at 10:17:01 AM Fee Amt: $0.00 Page 1 of 2 Dubuque County Iowa Kathy Flynn Thurlow Recorder F11e2013- 00001209 REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT TO BE COMPLETED BY TRANSFEROR TRANSFEROR: Name Michael J. Sawvell and Victoria L. Sawvell Address 20 West 18th Street Dubuque Iowa 52001 Number and Street or RR City, Town or P.O. TRANSFEREE: Name City of Dubuque, Iowa Address 50 West 13th Street Dubuque Iowa 52001 State Zip Number and Street or RR City, Town or P.O. State Zip Address of Property Transferred: 20 West 18th Street Dubuque Iowa 52001 Number and Street or RR City, Town or P.O. State Zip Legal Description of Property: (Attach if necessary) The Westerly 80 feet of Lot 8, and all of Lot 11 except the Southerly 6 feet thereof, in "The Subdivision of City Lots 438, 439 and that part of 676 which is not embraced in L. H. Langworthy's Subdivision" in the City of Dubuque, Iowa according to the recorded plat thereof 1. Wells (check one) X 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) X 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. Hazardous Wastes (check one) X 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) X 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) d0/3 - /1 �D^5 5. Private Burial Site (check one) X 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) X 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 AND THAT THE INFORMATION STATED ABOVE IS TRUE AND CORRECT. Signature: (Transferor or Agent) FILE WITH RECORDER Telephone No.: 54 9 - 36 DNR form 542 -0960 (July 18, 2012)