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163. <br />VACANT LAND <br />DISCLOSURE STATEMENT <br />Page 5 <br />164. THE INFORMATION DISCLOSED IS GIVEN TO THE BEST OF SELLER'S KNOWLEDGE. <br />165. Property located at 6203 Rivlyn Ave, Ramsey, 55303 <br />166. D. UTILITIES: <br />167. (1) Have any percolation tests been performed? <br />Yes <br />168. When? By whom? <br />169. Attach copies of results, if in your possession. <br />170. (2) Subsurface Sewage Treatment System Disclosure: (A subsurface sewage treatment system <br />171. required by MN Statute 115.55.) (Check appropriate box.) <br />172. Seller certifies that Seller DOES ❑ DOES NOT know of a subsurface sewage treatment system <br />(Check one.) <br />173. the above -described real property. (If answer is DOES, and the system does not require a stat <br />174. Subsurface Sewage Treatment System Disclosure Statement.) <br />175. <br />176. <br />177. <br />178. <br />There is a subsurface sewage treatment system on or serving the above -described real pro <br />(See Subsurface Sewage Treatment System Disclosure Statement.) <br />There is an abandoned subsurface sewage treatment system on the above -described real <br />(See Subsurface Sewage Treatment System Disclosure Statement.) <br />disclosure is <br />on or serving <br />e permit, see <br />perty. <br />property. <br />179. (3) Private Well Disclosure: (A well disclosure and Certificate are required by MN Statute 1031.235. <br />180. (Check appropriate box.) <br />181. Seller certifies that Seller does not know of any wells on the above -described real property. <br />182. X Seller certifies there are one or morel wells located on the above -described real property. <br />183. (See Well Disclosure Statement.) i s <br />184. Are there any wells serving the above -described property that are not located on the <br />185. land? <br />186. To your knowledge, is the land in a Special Well Construction Area? <br />187. (4) To your knowledge, are any of the following presently existing within the land: <br />188. (a) connection to public water? <br />189. (b) connection to public sewer? <br />190. (c) connection to private water system off -property? <br />191. (d) connection to electric utility? <br />192. (e) connection to pipelines (natural gas, petroleum, other)? <br />193. (f) connection to communication, power or utility lines? <br />194. (g) connection to telephone? <br />195. (h) connection to fiber optic? <br />196. (i) connection to cable? <br />197. (5) <br />198. <br />199. <br />200. <br />201. <br />202. <br />203. <br />204. <br />205. <br />206. <br />207. <br />To your knowledge, are any of the following existing at the boundary of the land: <br />(a) public water system access? <br />(b) private water system access? <br />(c) co-op water system access? <br />(d) shared water system access? <br />(e) electric service access? <br />(f) pipeline (natural gas, petroleum, other) access? <br />(g) communication, power or utility line access? <br />(h) telephone access? <br />(i) fiber optic access? <br />(j) cable access? <br />II <br />(I <br />Yes <br />Yes <br />Yes <br />'es <br />Li Yes <br />Yes <br />Yes <br />7C Yes <br />L_1 Yes <br />['Yes <br />fYes <br />NYes <br />Yes <br />EI Yes <br />fYes <br />es <br />Yes <br />Yes <br />.Yes <br />Yes <br />iYes <br />No <br />No <br />INo <br />No <br />No <br />No <br />No <br />n No <br />No <br />0 <br />No <br />is <br />n No <br />No <br />/c No <br />XI No <br />❑ No <br />n No <br />No <br />[- No <br />No <br />n No <br />MN:VLDS-5 (10/12) <br />Izrm� s <br />