Fillable Residential Property Disclosure Form (Page 2 of 4) in pdf

Property Address________________________________________________________________________________________________________

B) SEWER SYSTEM: The nature of the sanitary sewer system servicing the property is (check appropriate boxes):

Public Sewer

Private Sewer

Septic Tank

Leach Field

Aeration Tank

Filtration Bed

Unknown

Other _______________________

If not a public or private sewer, date of last inspection: ___________________________________________________________________________

Do you know of any current leaks, backups or other material problems with the sewer system servicing the property?

Yes

If “Yes”, please describe: __________________________________________________________________________________________________

________________________________________________________________________________________________________________________

If owner knows of any leaks, backups or other material problems with the sewer system since owning the property (but not longer than the past 5

years), please describe and indicate any repairs completed: ________________________________________________________________________

________________________________________________________________________________________________________________________

Information on the operation and maintenance of the type of sewage system serving the property is available from the department of health or the

board of health of the health district in which the property is located.

C) ROOF: Do you know of any current leaks or other material problems with the roof or rain gutters?

Yes

If “Yes”, please describe: ___________________________________________________________________________________________________

________________________________________________________________________________________________________________________

If owner knows of any leaks or other material problems with the roof or rain gutters since owning the property (but not longer than the past 5 years),

please describe and indicate any repairs completed: ______________________________________________________________________________

________________________________________________________________________________________________________________________

D) WATER INTRUSION: Do you know of any previous or current water leakage, water accumulation, excess moisture or other defects to the

property, including but not limited to any area below grade, basement or crawl space?

Yes

If “Yes”, please describe and indicate any repairs completed: _____________________________________________________________________

________________________________________________________________________________________________________________________

Do you know of any water or moisture related damage to floors, walls or ceilings as a result of flooding; moisture seepage; moisture condensation;

ice damming; sewer overflow/backup; or leaking pipes, plumbing fixtures, or appliances?

Yes

If “Yes”, please describe and indicate any repairs completed: ______________________________________________________________________

________________________________________________________________________________________________________________________

Purchaser is advised that every home contains mold. Some people are more sensitive to mold than others. If concerned about this issue, purchaser is

encouraged to have a mold inspection done by a qualified inspector. Have you ever had the property inspected for mold by a qualified inspector?

Yes

If “Yes”, please describe and indicate whether you have an inspection report and any remediation undertaken:

________________________________________________________________________________________________________________________

E) STRUCTURAL COMPONENTS (FOUNDATION, BASEMENT/CRAWL SPACE, FLOORS, INTERIOR AND EXTERIOR WALLS):

Do you know of any movement, shifting, deterioration, material cracks/settling (other than visible minor cracks or blemishes) or other material

problems with the foundation, basement/crawl space, floors, or interior/exterior walls?

Yes

If “Yes”, please describe: ___________________________________________________________________________________

________________________________________________________________________________________________________________________

If owner knows of any repairs, alterations or modifications to control the cause or effect of any problem identified above, since owning the property

(but not longer than the past 5 years), please describe: ____________________________________________________________________________

________________________________________________________________________________________________________________________

Do you know of any previous or current fire or smoke damage to the property?

Yes

If “Yes”, please describe and indicate any repairs completed: ______________________________________________________________________

________________________________________________________________________________________________________________________

F) MECHANICAL SYSTEMS: Do you know of any current problems or defects with the following mechanical systems? If your property does

not have the mechanical system, mark N/A (Not Applicable).

YES

N/A

YES

N/A

1) Electrical

8) Water softener

2) Plumbing (pipes)

a. Is water softener leased?

3) Central heating

9) Security System

4) Central Air conditioning

a. Is security system leased?

5) Sump pump

10) Central vacuum

6) Fireplace/chimney

11) Built in appliances

7) Lawn sprinkler

12) Other mechanical systems

If the answer to any of the above questions is “Yes”, please describe and indicate any repairs to the mechanical system since owning the property (but

not longer than the past 5 years). _____________________________________________________________________________________________

_______________

_______________________________________________________________________________________________________

Owner’s Initials ______/______ Date ______/______

Purchaser’s Initials ______/______ Date ______/______

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