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Purhcase of Property_1401 and 1421 Elm Street_Angie's BarTHE CITY OF Dui Masterpiece on the Mississippi TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: Acquisition of 1401 -1421 Elm Street DATE: November 12, 2013 Dubuque band AI- America City 'I'll®, r 2007 • 2012 • 2013 Housing and Community Development Department Director Alvin Nash recommends City Council authorization for the City of Dubuque to enter into a purchase agreement with Angela Mangeno to acquire 1401 -1421 Elm Street, which consists of a single family detached home and small wooden structure known as "Angie's Tavern ". The total assessed value of the property is $70,280. The house and tavern is up for sale by the owner for $80,000. The City would acquire the property for $80,000 under the Neighborhood Revitalization Program as part of the Washington Neighborhood plan. The reuse of the property will consist of subdividing the lot, rehabbing and selling the single family home, deconstructing the Tavern and developing a Washington Community Gateway. The Washington Neighborhood will be engaged to determine final design, but some options for the Washington Community Gateway development would consist of: • A three pole flag presentation plus lighting • Two or three park benches • One three tier water fountain • A Welcome sign to the "Washington Neighborhood" • A bike rack • Landscaping /rain garden plot • A paved public sidewalk • Two street lights /poles • Three /quarter fencing around alley and north side to limit cars from alley and prevent irregular foot traffic Including development of the site, the net costs are $101,449 and a funding source has been identified. I concur with the recommendation and respectfully request Mayor and City Council approval. Michael C. Van Milligan MCVM:jh Attachment cc: Barry Lindahl, City Attorney Cindy Steinhauser, Assistant City Manager Teri Goodmann, Assistant City Manager Alvin Nash, Housing & Community Development Department Director 2 Masterpiece on the Mississippi Dubuque herd All-Amenca City 2007 • 2012 • 2013 TO: Michael C. Van Milligen, City Manager FROM: Alvin Nash, Housing & Community Development Director SUBJECT: Acquisition of Lot 142 in East Dubuque Addition 1401 -1421 Elm Street DATE: November 12, 2013 Introduction The purpose of this memorandum is to request City Council approval of a resolution authorizing the City of Dubuque to enter into a purchase agreement with Angela Mangeno to acquire Lot 142 in East Dubuque Addition 1401 -1421 Elm Street. Background Lot 142 in East Dubuque Addition 1401 -1421 Elm Street consists of a single family detached home and a small wooden structure known as "Angie's Tavern. The total assessed value is $70,280. The Tavern used to be three stories high before a fire destroyed the top two floors. The house and Tavern is up for sale by owner, the sale price is $80,000. I believe it is in the best interest of the neighborhood for the city to purchase this property, deconstruct the Tavern, subdivide the lot, and develop a "Washington Community Gateway" and sell the single family house. The owner is in a must sell situation and cannot afford to continue to operate the Tavern. After confirming with staff to see how these properties would fit into the Washington Neighborhood Plan, we believe they will contribute to Washington's revitalization campaign. Discussion The deconstruction of the Tavern and the development of a Washington Community Gateway will beautify the area, appeal to the business across the street and create a rest area for joggers and persons walking their animals or taking a break from work. We are suggesting the "Washington Neighborhood Community Gateway" because the area is too small to be considered a park and cannot offer Park amenities and there is no sign leading into or welcoming people to the Washington Community. This is an entrance point into the Washington Neighborhood for traffic coming from the south and east, plus a lot of traffic coming through the Washington Neighborhood from the West down Loras Blvd. Great place to display a Washington Neighborhood Sign. The Dubuque Bike Route that runs between the Mill Work District and the 16th Street Detention Basin passes this area, so this could be a valuable resting point for bikers and pedestrians for water and a break. This may then become a marked spot along the Bike Map. Opportunity to re -use existing stock of Purrington Brick Pavers, thousands of these out at the landfill that came out of the Mill Work District, these can be tricky to work with for ADA compliance because of needing the perfect flat surface, but we could at least use them as the border around the paths and seating areas. This will fit right into the Sustainability Theme. Rain Garden area is an item on all city projects to control run -off, pretty easy to have all areas of this lot drain to a couple areas where Rain Gardens could be planted. Budget /summary Asking price: $80,000 Deconstruction of Tavern: $15,500 Rehab of House: $12,930 Washington Community Gateway $70,000 $178,430 The owner has two rehab loans with the City, totaling $21,981 which is due at sale. Re -Sale of house: Payoff of loans at sale $55,000 $21,981 $76,981 Budget Director Jennifer Larson has identified funding sources from savings from the Fire Mobile Data Terminals project which was completed in Fiscal Year 2014 ($60,000) and savings from the new management lease negotiated with Platinum Hospitality for the Grand River Center which eliminated payment of 50% of the hotel /motel tax paid by the Grand Harbor Hotel ($21,449). Recommendation I recommend that the City Housing Department acquire the property under our Neighborhood Revitalization Program as part of the Washington Neighborhood plan; we will rehab and sell the house as a single family structure, deconstruct the Tavern and provide a Washington Community Gateway. To improve the corner lot upon which the Tavern sits would create a much cleaner view of the area. There are other benefits to purchasing the property: • The building is an eye sore and does not contribute to the esthetic value of the area and is not conducive to the sustainability of the area. • The Tavern is not considered a contribution to the neighborhood by surrounding residents. • Parking is a serious problem for patrons of the Tavern and on evenings and weekends the alley is used for parking which causes problems for neighbors across the alley. • There is no real financial value to the Tavern and the facade is very poor. • At nights and weekends activity around the Tavern does not contribute to the peace and quiet of the neighborhood. • The owner must sell and does not want someone to purchase the Tavern and continue to operate as a Tavern or a less than desirable establishment. The reuse of the property will consists of subdividing the lot, selling the single family home, deconstructing the Tavern and developing a Washington Community Gateway. The Washington Neighborhood will be engaged to determine final design, but some options for the Washington Community Gateway development would consist of: • A three pole flag presentation plus lighting • Two or three park benches • One three tier water fountain • A Welcome sign to the "Washington Neighborhood" • A bike rack • Landscaping /rain garden plot • A paved public side walk • Two street lights /poles • Three /quarter fencing around alley and north side to limit cars from alley and prevent irregular foot traffic Action Step The action requested of the City Council is to approve the attached resolution authorizing the purchase of Lot 142 East Dubuque Addition 1401 -1421 Elm Street, property owned by Angela Mangeno. Prepared by Maureen A. Quann 300 Main Street Suite 330 Dubuque IA 52001 563 583-4113 Return to Kevin S. Firnstahl, 50 W. 13th Street, Dubuque IA 52001 563-589-4121 RESOLUTION NO. 324-13 APPROVING THE ACQUISITION OF REAL ESTATE KNOWN AS LOT 142 IN EAST DUBUQUE ADDITION 1401-1421 ELM STREET IN THE CITY OF DUBUQUE, IOWA WHEREAS, the City of Dubuque, Iowa intends to acquire certain property located in the Washington Street Neighborhood Revitalization Program area; 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; and WHEREAS, a purchase agreement has been finalized with the owner of the property scheduled for acquisition and an Acknowledgment of Voluntary Negotiation and Purchase of Property Affidavit has been executed by the owner. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF DUBUQUE, IOWA AS FOLLOWS: Section 1. That the City of Dubuque, Iowa hereby approves the acquisition of the following legally described property: Lot 142 in East Dubuque Addition 1401-1421 Elm Street, in the City of Dubuque, Iowa, according to the recorded plat thereof At the cost of Eighty Thousand and 00/100 Dollars ($80,000.00). 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 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 18 to day of November, 2013. Attest: Kevin S. Firnstahl,City Clerk Roy D. Buol, Mayor OFFER TO BUY REAL ESTATE AND ACCEPTANCE TO: Angela Mangeno, Seller. SECTION 1. REAL ESTATE DESCRIPTION. The City of Dubuque, Iowa (Buyer) offers to buy real estate in Dubuque County, Iowa, described as follows: Parcel Number 1024427014: Lot 142 in East Dubuque, an Addition in the City of Dubuque, Iowa, according to the recorded plat thereof — 1421 Elm Street legal description to be confirmed per continued abstract per Section 9, with any easements and appurtenant servient estates, but subject to the following: a) any zoning and other ordinances; b) any covenants of record; and c) any easements of record for public utilities, roads and highways. SECTION 2. PRICE. The purchase price shall be eighty thousand dollars ($80,000.00), payable in cash at the Closing. SECTION 3. REAL ESTATE TAXES. Seller shall pay any unpaid real estate taxes payable for fiscal year 2012 -2013 and prior years. Seller shall also pay real estate taxes for fiscal year 2013 -2014 prorated through the date of closing. Buyer shall pay all subsequent real estate taxes after the date of closing. SECTION 4. SPECIAL ASSESSMENTS. Seller shall pay all special assessments, if any, which are a lien as of the date of closing, prorated to the date of closing. SECTION 5. RISK OF LOSS AND INSURANCE. Sellers shall bear the risk of loss or damage to the Real Estate prior to closing or possession, whichever first occurs. Sellers agree to maintain existing insurance and Buyer may purchase additional insurance. In the event of substantial damage or destruction prior to closing, this Agreement shall be null and void; provided, however, Buyer shall have the option to complete the closing and receive insurance proceeds regardless of the extent of damages. The Real Estate shall be deemed substantially damaged or destroyed if it cannot be restored to its present condition on or before the closing date. SECTION 6. CARE AND MAINTENANCE. The Real Estate shall be preserved ibts present condition and delivered intact at the time possession is delivered to Buy r; provided, however, if there is loss or destruction of all or any part of the Real Estate from causes covered by the insurance maintained by Seller, Buyer agrees to accept such damaged or destroyed Real Estate together with such insurance proceeds in lieu of the Real Estate in its present condition and Seller shall not be required to repair or replace same. SECTION 7. POSSESSION. If Buyer timely performs all obligations, possession of the Real Estate shall be delivered to Buyer by December 31, 2013, or such earlier date as 10302013maq the parties may agree in writing, with any adjustments of rent, insurance, and interest to be made as of the date of transfer of possession. SECTION 8. FIXTURES. All property that integrally belongs to or is part of the buildings on the Real Estate, whether attached or detached, such as light fixtures, shades, rods, blinds, awnings, windows, storm doors, screens, plumbing fixtures, water heaters, water softeners, automatic heating equipment, wall -to -wall carpeting, built -in items and electrical service cable, outside television towers and antenna, fencing, gates and landscaping shall be considered a part of Real Estate and included in the sale. SECTION 9. ABSTRACT AND TITLE. Seller shall promptly obtain an abstract of title to the Real Estate. At Buyer's expense, the abstract will be continued through the date of acceptance of this offer, and delivered to Buyer for examination. 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. Seller shall pay the costs of any additional abstracting and title work due to any act or omission of Seller, including transfers by or the death of Seller or its assignees. SECTION 10. 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 11. TIME IS OF THE ESSENCE. Time is of the essence in this contract. SECTION 12. REMEDIES OF THE PARTIES. 12.1 If Buyer fails to timely perform this Offer, Seller may forfeit it as provided in the Code of Iowa, and all payments made shall be forfeited or, at Seller's option, upon thirty (30) days written notice of intention to accelerate the payment of the entire balance because of such failure (during which thirty (30) days such failure is not corrected) Seller may declare the entire balance immediately due and payable. Thereafter this Offer may be foreclosed in equity and the Court may appoint a receiver. 12.2 If Seller fails to timely perform this contract, Buyer has the right to have all payments made returned to it. 12.3 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 13. CONTRACT BINDING ON SUCCESSORS IN INTEREST. This Offer shall apply to and bind the successors in interest of the parties. 2 SECTION 14. CONSTRUCTION. Words and phrases shall be construed as in the singular or plural number, and as masculine, feminine or neuter gender, according to the context. SECTION 15. TIME FOR ACCEPTANCE. If this Offer is not accepted by Seller on or before December 1, 2013 it shall become void and all payments shall be repaid to the Buyer. SECTION 16. OTHER PROVISIONS. 16.1 The Offer is subject to final approval of the City Council of the City of Dubuque, Iowa in its sole discretion. If the City Council of the City of Dubuque, Iowa does not approve this Offer, it shall become automatically void and neither party shall be bound by the terms and conditions set forth herein. 16.2 After execution of this Offer by Seller and Buyer and final approval of the City Council of the City of Dubuque, Iowa, Buyer shall deliver a copy of the executed Offer to Buy Real Estate and Acceptance executed by Michael C. Van Milligen, City Manager, along with a copy of the Resolution of the City Council authorizing the purchase of this Real Estate. 16.3 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 for the purpose of 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 or the Donated 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 Buyer considers appropriate. 16.4 Seller warrants that the rights of all tenants shall be terminated by Seller prior to closing and that there will be no tenants whose rights in the Real Estate survive the closing. This covenant shall survive the closing. 16.5 Until ten (10) days prior to closing, Buyer shall have the right to terminate this Offer if environmental issues exist on the Real Estate that Buyer determines in its sole discretion do not permit Buyer to use the Real Estate for its intended use. Prior to terminating this Offer pursuant to this Section, Buyer shall offer Seller the opportunity to remediate the Real Estate to the satisfaction of Buyer in its sole discretion and at Seller's sole cost. 16.6 The Real Estate is sold /purchased "as is" and "with all faults ". 3 THIS OFFER IS ACCEPTED Dated: /( /3 CITY OF DUBUQUE, IOWA By: Michael C. Van Milligen City Manager 4 Dated: A21} / 3 By: Angela Mangeno ACKNOWLEDGMENT OF VOLUNTARY NEGOTIATION AND PURCHASE OF PROPERTY Project: Bee Branch Restoration and Gateway Project Parcel Numbers: 1024427014 As owner(s) of real estate needed for the above referenced project and parcel, we acknowledge this is a voluntarily negotiated purchase by the City of Dubuque, Iowa under Section 6B.1A of the Code of Iowa, and is not an acquisition by the City of Dubuque, Iowa through an exercise of the power of eminent domain under Chapter 6B of the Code of Iowa. This voluntarily negotiated sale to the City of Dubuque, Iowa was made without any coercive action of any nature. Angela angeno 7f�U �Pi Date Date Nofary Public in and for Dubu e County, Iowa 11111M111811111G1111 lii Doc ID: 007951460003 TyPe• N Kind: DEED WITH RESOLUTION 10 Recorded: Amt: $149.20 Page 2a1 o0f 3 '43 AM Fee Revenue Tax: $127.20 Dubuque County Iowa Kathy Flynn014 00002530 File20 ©THE IOWA STATE BAR ASSOCIATION Maureen A. Quann FOR THE LEGAL EFFECT OF THE USE OF Official Form No. 101 - August 2013 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, Towa 50 West 13th Street Dubuque, Towa 52001 P BTAT� ' 7s`s°CIAtv., For the consideration Angela Mangeno, WARRANTY DEED of one Dollar(s) and other valuable consideration, a single person do hereby Convey to City of Dubuque, Iowa the following described Lot 142 in thereof. Grantors title in fee simple; is free and clear Warrant and Each of the real estate. or plural number, Dated: real estate in Dubuque County, Iowa: recorded Plat the real estate by the real estate Covenant to above stated. in and to the as in the singular. East Dubuque, an Addition in the do Hereby Covenant with grantees, that they have good and lawful of all liens and encumbrances Defend the real estate against the undersigned hereby relinquishes Words and phrases herein, including an as m sculine or feminine 2125i2Ii' City of Dubuque, Iowa, according to the - and successors in interest, that grantors hold authority to sell and Convey the real estate; that except as may be above stated; and grantors lawful claims of all persons except as may be all rights of dower, homestead and distributive share acknowledgment hereof, shall be construed gender, according to the context. >< , Angela Mangeno (Grantor) STATE OF IOWA COUNTY OF Dubu ue (Grantor) by Angela This record was acknowledged before me Mangeno, a single person this . Ihday of ,tl (L1 W1,. 2.014, Q i 01 ,r (i1. -EN A_ OLIANN AA / (n rnts ,on Num ler 76401 • p,- .,, „;, :',1m, rxp. $ 25 Signature of Notary (This form of acknowledgment for individual Public grantor(s) only) Prepared by Maureen A. Quann 300 Main Street Suite 330 Dubuque IA 52001 563 583-4113 Return to Kevin S. Firnstahl, 50 W. 13th Street, Dubuque IA 52001 563-589-4121 RESOLUTION NO. 324-13 APPROVING THE ACQUISITION OF REAL ESTATE KNOWN AS LOT 142 IN EAST DUBUQUE ADDITION 1401-1421 ELM STREET IN THE CITY OF DUBUQUE, IOWA WHEREAS, the City of Dubuque, Iowa intends to acquire certain property located in the Washington Street Neighborhood Revitalization Program area; 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; and WHEREAS, a purchase agreement has been finalized with the owner of the property scheduled forr acquisition and an Acknowledgment of Voluntary Negotiation and Purchase of Property Affidavit has been executed by the owner. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF DUBUQUE, IOWA AS FOLLOWS: Section 1. That the City of Dubuque, Iowa hereby approves the acquisition of the following legally described property: Lot 142 in East Dubuque Addition 1401-1421 Elm Street, in the City of Dubuque, Iowa, according to the recorded plat thereof At the cost of Eighty Thousand and 00/100 Dollars ($80,000.00). 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 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 18th day of November, 2013. Attest: Kevi► S. Firnsta I, City Clerk Roy D. Buol, Mayor 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. 324-13 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 14th day of March, 2014. IIpIBHA11Y11111aI IHI111111111IN1111111111III1111I1111M Doc ID 007951470002 Type: GWH Kind GROUNDWATER HAZARD Recorded: 03/18/2014 at 10:10:55 AM Fee Amt: $0.00 Page 1 of 2 Dubuque County Iowa Kathy Flynn Thurlow Recorder Fi1e2014-00000308 REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT TO BE COMPLETED BY TRANSFEROR TRANSFEROR: Name Angela Mangeno Address 1401 Elm Street Dubuque Iowa 52001 Number and Street or RR City, Town or P.O. State Zip TRANSFEREE: Name City of Dubuque, Iowa Address 50 West 13th Street Dubuque Iowa 52001 Number and Street or RR City, Town. or P.O. State Zip Address of Property Transferred: 1401 Elm Street Dubuque Iowa 52001 Number and Street or RR City, Town or P.O. State Zip Legal Description of Property: (Attach if necessary) Lot 142 in East Dubuque, an Addition 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) al 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) ,. 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) ,0/y-a?531i 5. Private Burial Site (check one) it 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) AlI 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: (TransferoAgent) FILE WITH RECORDER Telephone No.: 51,A i 541. DNR form 542-0960 (July 18, 2012)