Property Acquistion_1501-1503 Bluff Street_WNDCTHE 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 Property at 1501-1503 Bluff Street
DATE: September 8, 2014
Dubuque
band
AI -America City
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2007 • 2012 • 2013
Housing and Community Development Department Director Alvin Nash recommends
City Council authorization to acquire a duplex located at 1501-1503 Bluff Street from the
Washington Neighborhood Development Corporation for the purpose of rehabbing and
reselling as two separate properties to two qualified homebuyers.
This property was originally owned by Gateways to Home and was sold to the
Washington Neighborhood Development Corporation in 2011. At that time, Washington
Neighborhood Development Corporation applied for rehab funds to completely rehab
the property. Total debt owed to the City is $88,469. The assessed value of the
property is $127,080.
Washington Neighborhood Development Corporation would like to pay the City $30,000
toward the debt owed, give title to the properties to the City, and ask the City to release
the remaining debt balance of $58,469. The City would rehab and sell the properties
with the ultimate goal to recoup the debt owed to the City.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
7.-
Mic ael C. Van Milligen
bc./1144 0/4
MCVM:jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Teri Goodmann, Assistant City Manager
Alvin Nash, Housing and Community Development Department
THE CITY OF
Dui
Masterpiece on the Mississippi
Dubuque
ktratd
All -America City
'1 111!
2012
TO: Michael Van Milligen, City Manager
FROM: Alvin Nash, Housing and Community Development Department
SUBJECT: Acquisition of property at 1501-1503 Bluff Street
DATE: September 8, 2014
Introduction
The purpose of this memorandum is to request City Council authorization to acquire a
duplex located at 1501-03 Bluff Street for the purpose of rehabbing and reselling to two
qualified homebuyers.
Background
This property was originally owned by Gateways to Home (a CHDO), and was sold to
the Washington Neighborhood Development Corporation (WNDC) in 2011. At that time,
WNDC applied for rehab funds to completely rehab the property. Total debt owed to the
City is $88,469. The assessed value of the property is $127,080.
Discussion
WNDC would like to offer the City $30,000 toward the debt owed and ask the City to
release the balance. The debt would then be $58,469. Our ultimate goal would be
divide the property at 1501-03 Bluff Street so that we could sell them as two separate
properties and recoup the debt owed to us.
Action Step
The action requested of the City Council is to authorizing the acquisition of property
located at 1501-03 Bluff Street from the WNDC, as per attached agreement.
KLN/AN
Attach.
RESOLUTION NO. 287-14
RESOLUTION APPROVING THE ACQUISITION OF REAL ESTATE OWNED BY THE
WASHINGTON NEIGHBORHOOD DEVELOPMENT CORPORATION (WNDC) AT
1501-03 BLUFF STREET IN THE CITY OF DUBUQUE
Whereas, the City of Dubuque intends to acquire certain real estate to for the
purpose of rehabbing and reselling to two qualified homebuyers; 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 hereby approves the acquisition of the following
legally described property:
The Easterly 90 feet of the Northerly 40 feet of Lot 3, and the Easterly 100
feet of the Southerly 2 feet of Lot 4 in D.N. Cooley’s Subdivision of Out
Lots 667, 668, and 669 in the City of Dubuque, Iowa, according to the
recorded plat thereof
WNDC would like to offer the City $30,000 toward the debt owed and ask the City to
release the balance. The debt would then be $58,469. Our ultimate goal would be
divide the property at 1501-03 Bluff Street so that we could sell them as two separate
properties and recoup the debt owed to us.
Section 2. That the City of Dubuque hereby approves the acquisition of 1501-03 Bluff
Street owned by WNDC at term listed above.
Section 3. 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 4. 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 certified copy of the Resolution.
Section 5. 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 15th day of September, 2014.
Roy D. Bu, Mayor
ATTEST:
. Firnstahi, C
AGREEMENT BETWEEN
CITY OF DUBUQUE
AND
WASHINGTON NEIGHBORHOOD DEVELOPMENT CORPORATION
WHEREAS, the Washington Neighborhood Development Corporation (the
WNDC) owns real estate situated in Dubuque, Iowa, locally known as 1501-1503 Bluff
Street, Dubuque, IA 52001 and legally described as:
The Easterly 90 feet of the Northerly 40 feet of Lot 3, and the Easterly 100
feet of the Southerly 2 feet of Lot 4, in D.N. Cooley's Subdivision of Out
Lots numbered 667, 668 and 669 in the City of Dubuque, Iowa, according
to the recorded plat thereof
(the Real Estate); and
WHEREAS, the City of Dubuque, Iowa (the City) is the holder of a mortgage on
the Real Estate recorded as (the Mortgage); and
WHEREAS, WNDC desires to convey the Real Estate to City for the
consideration set forth herein.
NOW, THEREFORE, IN CONSIDERATION OF THE MUTUAL COVENANTS SET
FORTH HEREIN, THE PARTIES AGREE AS FOLLOWS:
SECTION 1. CONSIDERATION. WNDC agrees to convey the Real Estate to City
and to pay City thirty thousand dollars ($30,000.00) at closing and in consideration
therefore City agrees to accept the conveyance of the Real Estate and release
Mortgages internally known as 1080 for $12,290 and 1080B for $76,179.
SECTION 2. REAL ESTATE TAXES. WNDC shall pay any unpaid real estate taxes
payable for fiscal year 2013-2014 and prior years. WNDC shall also pay real estate
taxes for fiscal year 2014-2015 prorated through the date of closing. City shall pay all
subsequent real estate taxes due and payable after the date of closing.
SECTION 3. SPECIAL ASSESSMENTS. WNDC shall pay all special assessments
which are a lien on the Real Estate as of the date of acceptance of this offer. All other
special assessments shall be paid by City.
SECTION 4. RISK OF LOSS AND INSURANCE. WNDC shall bear the risk of loss or
damage to the Real Estate prior to closing or possession, whichever first occurs.
WNDC agrees to maintain existing insurance and City may purchase additional
insurance. In the event of substantial damage or destruction prior to closing, this
Agreement shall be null and void; provided, however, City 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
1
cannot be restored to its present condition on or before the closing date.
SECTION 5. CARE AND MAINTENANCE. The Real Estate shall be preserved in its
present condition and delivered intact at the time of possession is delivered to City;
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 WNDC, City 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 WNDC shall not be required to repair or
replace same.
SECTION 6. POSSESSION AND CLOSING.
6.1 If City timely performs all obligations, possession of the Real Estate shall be
delivered to City on or before October 1, 2014, or such earlier date as 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.
6.2 Closing shall occur after the approval of title by City and vacation of the Real
Estate by WNDC, but prior to possession by City. WNDC agrees to permit City to
inspect the Real Estate within seventy-two (72) hours prior to closing to assure that the
premises are in the condition required by this Agreement. If possession is given on a
day other than closing, the parties shall make a separate agreement with adjustments
as of the date of possession.
6.3 This transaction shall be considered closed upon the delivery of the title transfer
documents to City and receipt of all funds then due at closing from City under the
Agreement.
SECTION 7. FIXTURES. Included with the Real Estate shall be all fixtures that
integrally belong to, are specifically adapted to, or are a part of the Real Estate, whether
attached or detached.
SECTION 8. ABSTRACT AND TITLE. WNDC, at its expense, shall promptly obtain
an abstract of title to the Real Estate and deliver it to City's attorney for examination. It
shall show marketable title in WNDC in conformity with this Agreement, Iowa law, and
title standards of the Iowa State Bar Association. WNDC shall make every reasonable
effort to promptly perfect title. If closing is delayed due to WNDC's inability to provide
marketable title, this Agreement shall continue in force and effect until either party
rescinds the Agreement after giving ten (10) days' written notice to the other party. The
abstract shall become the property of City when the consideration is paid in full. WNDC
shall pay the costs of any additional abstracting and title work due to any act or
omission of WNDC, including transfers by or the death of WNDC or WNDC's assignees.
Unless stricken, the abstract shall be obtained from an abstracter qualified by the
Guaranty Division of the Iowa Housing Finance Authority.
SECTION 9. DEED. Upon payment of the consideration, WNDC shall convey the
2
Real Estate to City by Warranty Deed, free and clear of all liens, restrictions, and
encumbrances, except as provided in this Agreement. General warranties of the title
shall extend to the time of delivery of the deed excepting liens and encumbrances
suffered or permitted by City.
SECTION 10. CONTRACT BINDING ON SUCCESSORS IN INTEREST. This
Agreement shall apply to and bind the successors in interest of the parties. This
Agreement shall survive the closing.
SECTION 11. RIGHTS OF INSPECTION, ENVIRONMENTAL TESTING, AND
REVIEW.
11.1 City, 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 WNDC. City 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 City shall consider
appropriate, provided that City shall hold WNDC harmless and fully indemnify WNDC
against any damage, claim, liability, or cause of action arising from or caused by the
actions of City, 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.
11.2 WNDC warrants to the best of WNDC's 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. WNDC
further warrants that WNDC has done nothing to contaminate or allow the
contamination of the Real Estate and has no knowledge of any contamination. WNDC
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. WNDC shall provide City 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 which
shall be considered a warranty and representation by WNDC to City.
11.3 WNDC represents and warrants to City that the Real Estate is not served by a
private sewage disposal system, and there are no known private sewage disposal
systems on the property.
SECTION 12. ENCUMBRANCES. WNDC warrants that the Real Estate will as of the
date of closing be free and clear of all liens, security interests, and encumbrances.
SECTION 13. TENANTS. WNDC warrants that the Real Estate is free and clear of any
3
occupants, and no party has a lease to or other occupancy or contract right in the Real
Estate which shall in anyway be binding upon the Real Estate. WNDC shall hold
harmless and indemnify the City for and against any claims, which may arise or be
based upon any alleged leasehold interest, tenancy, or other right of occupancy or use
for any portion for the Real Estate. This covenant shall survive the Closing.
SECTION 14. NO REAL ESTATE AGENT OR BROKER. Neither party has used the
service of a real estate agent or broker in connection with this transaction.
SECTION 15. CERTIFICATION. City and WNDC each certify that they are not acting,
directly or indirectly, for or on behalf of any person, group, entity, or nation named by
any Executive Order or the United States Treasury Department as a terrorist, "Specially
Designated National and Blocked Person", or any other banned or blocked person,
entity, nation, or transaction pursuant to any law, order, rule, or regulation that is
enforced or administered by the Office of Foreign Assets Control; and are not engaged
in this transaction, directly or indirectly on behalf of, any such person, group, entity, or
nation. Each party hereby agrees to defend, indemnify, and hold harmless the other
party from and against any and all claims, damages, losses, risks, liabilities, and
expenses (including attorney's fees and costs) arising from or related to breach of the
foregoing certification.
SECTION 16. REMEDIES OF THE PARTIES.
16.1 If City fails to timely perform this Agreement, WNDC may forfeit it as provided in
the Iowa Code, and all payments made shall be forfeited or, at WNDC'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) WNDC
may declare the entire balance immediately due and payable. Thereafter this Agreement
may be foreclosed in equity and the Court may appoint a receiver.
16.2 If WNDC fails to timely perform this Agreement, City has the right to have all
payments made returned to it.
16.3 City and WNDC 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 17. WAIVER. Failure to promptly assert rights herein shall not, however, be
a waiver of such rights or a waiver of any existing or subsequent default.
SECTION 18. NOTICE. Any notice under this Agreement shall be in writing and be
deemed served when it is delivered by personal delivery or mailed by certified mail,
addressed to the parties at the addresses given below.
Washington Neighborhood Development Corporation
1690 Elm Street, Suite 110
4
Dubuque, IA 52001
City of Dubuque
Attn: Alvin Nash
50 W. 13th Street
Dubuque, IA 52001
SECTION 19. TIME IS OF THE ESSENCE. In the performance of each part of this
Agreement, time shall be of the essence.
SECTION 20. TIME FOR ACCEPTANCE. When accepted, this Agreement shall
become a binding contract. If this offer is not accepted and delivered to City on or before
5:00 p.m. on September 12, 2014, this Agreement shall be null and void and all payments
shall be returned immediately to the City.
SECTION 21. ENTIRE AGREEMENT. This Agreement contains the entire agreement
of the parties and shall not be amended except by a written instrument duly signed by
WNDC and City.
SECTION 22. PARAGRAPH HEADINGS AND CONSTRUCTION. Paragraph
headings are for convenience of reference and shall not limit or affect the meaning of
this Agreement. Words and phrases herein shall be construed as in the singular or
plural number, and as masculine, feminine, or neuter gender according to the context.
SECTION 23. CITY COUNCIL APPROVAL. This Agreement is subject to the 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 Agreement, it shall
become automatically void and neither party shall be bound by the terms and conditions
set forth herein.
CITY OF DUBUQUE
EIN: 42-6004596
By:
Roy D. BuoljMayor
50 W. 13th Street
Dubuque, IA 52001
Telephone: (563) 589-4120
Dated:
�/rte/r�
THE WASHINGTON NEIGHBORHOOD
DEVELOPMENT CORPORATION
EIN: 27-1383409
By:
Kate Toskey, Board Chair
1690 Elm Street, Suite 110
Dubuque, IA 52001
Telephone: (563) 845-8239
Dated:
5
11
111111 II IY I II'I I I' V II IIII 1
Doc ID 008132580005 Type: GEN
Kind DEED WITH RESOLUTION
Recorded: 10/28/2014 at 02:35:12 PM
Fee Amt: $125.60 Page 1 of 5
Revenue Tax: $93.60
Dubuque County Iowa
Kathy Flynn Thurlow Recorder
F11e2014-00012170
WARRANTY DEED
(CORPORATE GRANTOR)
THE IOWA STATE BAR ASSOCIATION
Official Form No. 104
Recorder's Cover Sheet
Preparer Information: (name, address and phone number)
Crenna Brumwell, 300 Main Street, Suite 330, Dubuque, IA 52001, Phone: (563) 589-4381
Taxpayer Information: (name and complete address)
City of Dubuque, 50 W. 13th Street, Dubuque, IA 52001
Return Document To: (name and complete address)
Crenna Brumwell, 300 Main Street, Suite 330, Dubuque, IA 52001, Phone: (563) 589-4381
Grantors:
Washington Neighborhood Development Corporation, an Iowa non-profit corporation
Grantees:
City of Dubuque, a municipal corporation
Legal Description: See Page 2
Document or instrument number of previously recorded documents:
a1
Ci1-16 C1er 4<
WARRANTY DEED
(CORPORATE GRANTOR)
For the consideration of $1.00 Dollar(s) and other valuable consideration, Washington
Neighborhood Development Corporation, an Iowa non-profit corporation organized and existing
under the laws of Iowa does hereby Convey to City of Dubuque, a municipal corporation the
following described real estate in Dubuque County, Iowa:
The Easterly 90 feet of the Northerly 40 feet of Lot 3, and the Easterly 100 feet of the
Southerly 2 feet of Lot 4 in D.N. Cooleys subdivision of out lots 667, 668 and 669 in the
City of Dubuque, Iowa according to the recorded plat thereof.
The Corporation hereby covenants with grantees, and successors in interest, that it holds
the real estate by title in fee simple; that it has good and lawful authority to sell and convey the
real estate; that the real estate is free and clear of all liens and encumbrances, except as may be
above stated; and it covenants to Warrant and Defend the real estate against the lawful claims of
all persons, except as may be above stated.
Words and phrases herein, including acknowledgment hereof, shall be construed as in the
singular or plural number, according to the context.
2 105
Dated: October, 2014.
Washington Neighborhood Development Corporation, an Iowa corporation
By
STATE OF IOWA, COUNTY OF DUBUQUE
an Starr, WNDC Executive Director
2JCO-
This record was acknowledged before me this 2,nd day of October, 2014, by Megan
Starr, as Executive Director of the Washingto ^ .eighbo _j ood Devel•p t Corporation
L' �`.
ma ture o otary 'u.
RESOLUTION NO. 287-14
RESOLUTION APPROVING THE ACQUISITION OF REAL ESTATE OWNED BY THE
WASHINGTON NEIGHBORHOOD DEVELOPMENT CORPORATION (WNDC) AT
1501-03 BLUFF STREET IN THE CITY OF DUBUQUE
Whereas, the City of Dubuque intends to acquire certain real estate to for the
purpose of rehabbing and reselling to two qualified homebuyers; 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 hereby approves the acquisition of the following
legally described property:
The Easterly 90 feet of the Northerly 40 feet of Lot 3, and the Easterly 100
feet of the Southerly 2 feet of Lot 4 in D.N. Cooley's Subdivision of Out
Lots 667, 668, and 669 in the City of Dubuque, Iowa, according to the
recorded plat thereof
WNDC would like to offer the City $30,000 toward the debt owed and ask the City to
release the balance. The debt would then be $58,469. Our ultimate goal would be
divide the property at 1501-03 Bluff Street so that we could sell them as two separate
properties and recoup the debt owed to us.
Section 2. That the City of Dubuque hereby approves the acquisition of 1501-03 Bluff
Street owned by WNDC at term listed above.
Section 3. 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 4. 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 certified copy of the Resolution.
Section 5. 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 15th day of September, 2014.
Roy D. BU. 1, Mayor
ATTEST:
Kevin S. Firnstahl, C ity Clerk •
STATE OF IOWA
CERTIFICATE of the CITY CLERK
) 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. 287-14 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 24th day of October, 2014.
Kevi Firnstahl, C ity Clerk
rm1n11mri111111miNii1nmu1ri11111uAii1N
Doc ID: 008132590003 Type' GWH
Kind GROUNDWATER HAZARD
Recorded: 10/28/2014 at 02:35:26 PM
Fee Amt: $0.00 Page 1 of 3
Dubuque County Iowa
Kathy Flynn /^Thurlow Recorder i /�
Fi1e2014-000018 14
REAL ESTATE TRANSFER - GROUNDWATER HAZARD STATEMENT
TO BE COMPLETED BY TRANSFEROR
TRANSFEROR:
Name Washington Neighborhood Development Corporation
Address 1690 Elm Street, Suite 110, Dubuque, IA 52001
Number and Street or RR City, Town or P.O. State Zip
TRANSFEREE:
Name City of Dubuque
Address 50 W. 13th Street, Dubuque, IA 52001
Number and Street or RR City, Town or P.O. State Zip
Address of Property Transferred:
1501 Bluff Street, Dubuque, IA
Number and Street or RR City, Town or P.O. State Zip
Legal Description of Property: (Attach if necessary)
The Easterly 90 feet of the Northerly 40 feet of Lot 3, and the Easterly 100 feet of the Southerly
2 feet of Lot 4 in D.N. Cooleys subdivision of out lots 667, 668 and 669 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.
FILE WITH RECORDER DNR form 542-0960 (July 18, 2012)
c�,b- 0110
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.
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:
FILE WITH RECORDER DNR form 542-0960 (July 18, 2012)
I HEREBY DECLARE THAT I HAVE REVIEWED THE INSTRUCTIONS FOR THIS FORM
AND THAT THE INFORMATION STATED ABOVE IS TRUE AND CORRECT.
Signature:
Tr. n -ror or Agent)
Telephone No.: (563) 589-4393
FILE WITH RECORDER DNR form 542-0960 (July 18, 2012)