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Authentisign ID:16706484-ACC8-47DF-8.0D7-E7DEFF933E7F <br /> 1'6"f I'--e-,- WELL DISCLOSURE STATEMENT <br /> '.11fitntelt At This form approved by the MinnesotaAssociation of REALTORS', <br /> -V...';'.'•:';-117:2'.'L.. .,..:'%.:; wtNchdisclaims any liisbetyarisingout01use ormIsuseofOils loin. <br /> lBURNET[' 02007.11curesota Association of REALTORS',Edina,MN <br /> C1BBBURNEET.eoLm 1. Date August I,2012 <br /> s'a'"•.1lei Wm.,Ti`i°t 2. Page 1 of pages:THE REQUIRED MAP IS <br /> 3. ATTACHED HERETO AND MADE A PART HEREOF. <br /> 4. Minnesota Statute 1031.235 requires that,before signing an agreement to sell or transfer real property,Seller must <br /> 5. dIsclose Information In vatting to Buyer about the status and location of all known wells on the property.This requirement <br /> 6. is satisfied by delivering to Buyer either a statement by Seller that Seiler does not know of any wells on the property, <br /> 7. or a disclosure statement Indicating the legal description end county,and a map shoving the location of each well.In <br /> 8. the disclosure statement Seller must indicate,for each well,Whether the well is in use,not In use or sealed. <br /> 9. Unless Buyer and Seller agree to the contrary In writing,before the closing of the sale,a Seller who falls to disclose <br /> 10. the existence or known status of a Well at the lime of sale,and knew or had reason to know of the existence or known <br /> 11. status of the watt,is liable to Buyer for costs relating to sealing of the welt and reasonable attorneys'fees for collection <br /> 12. of costs from Seiler,if the action is commenced within six years after the date Buyer closed the purchase of the real <br /> 13. property where the welt Is located. <br /> 14. Legal requirements exist relating to various aspects of location and status of wads.Buyer Is advised to contact the <br /> 16. local unit(s)of government,state agency or qualified professional Which regulates wells for further informallon about <br /> 16. these issues, <br /> 17. Instructions for completion of Ibis form are on the reverse side. <br /> 18. PROPERTY DESCRIPTION:Street Address: 4550 Wolverton Place <br /> 19. Orono 55359 Hennepin <br /> - -- (City) (Sp) (Com•r) <br /> 20. LEGAL DESCRIPTION: <br /> 21. _ <br /> 23, <br /> 23. - - <br /> 24. ------------ - <br /> 25. <br /> 26. WELL DISCLOSURE STATEMENT: <br /> 27. (Check appropriate box.) <br /> 28. ❑ Seller certifies that Seller does not know of any wells on the above described real properly. <br /> 29. a this option is checked,then skip to the last lino and sign and date this Statement.) <br /> 30. raSeller certifies that the following wells are located on the above described real property. <br /> 31. MN Unlque Well Year of Well IN USE NOT IN SEALED <br /> 32, Well No. Depth Const. Type USE <br /> 33. Wella V - g- [) ❑ <br /> 34. Well 2 -- ❑ ❑ ❑ <br /> 35, Well3 ❑ ❑ ❑ <br /> 36. NOTE: See definition of terms"IN USE,"'NOT IN USE;'and"SEALED"on lines 89-100.11a welt Is not in use, <br /> 37. It must be scaled by a licensed well oontraotor or a well owner must obtain a maintenance permit <br /> 38. from the Minnesota Department of Health and pay an annual maintenance fee. Maintenance <br /> 39. permits are not transferable.It a well Is operable and properly maintained,a maintenance permit <br /> 40. Is not required. <br /> 41. ORIGINAL COPY TO LISTING BROKER;COPIES TO SELLER,BUYER,SELLING BROKER, <br /> ?,?t,ewoc•1(8107) <br /> WOiForms.NovrtW2 <br />