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DISCLOSURE REGARDING VALIDITY OF SEPTIC SYSTEM

OPERATING PERMIT

The Virginia Association of REALTORS® gratefully acknowledges the Northern Virginia Association of REALTORS®

with the creation of this form and is used with its permission.

PROPERTY:

("Property")

OWNER/SELLER:

("Seller")

PROPOSED BUYER:

("Buyer")

The following disclosure ("Disclosure") is made specifically in accordance with and pursuant to the requirements of Section

32.1-164.1:1 of the Virginia Code (as amended, the "Code Section"):

The onsite sewage system ("Septic System") which serves the Property is presently subject to certain repair

and/or maintenance requirements ("Requirements") imposed by the Virginia State Board of Health

("Board")[, as further described below]. Seller has obtained a valid waiver ("Waiver") of such

Requirements from the Board. Such waiver is not transferable, and shall be null and void upon

Closing hereunder, and at such time the Buyer shall be required to comply with the Requirements,

and such other requirements as may be imposed by the Board, before an operating permit for the

Septic System may be reinstated.

[The Requirements, as described in the Waiver, are as follows: _____________________________________

________________________________________________________________________________________

_______________________________________________________________________________________]

Pursuant to the Code Section, the Seller is required to deliver the Disclosure to the Buyer prior to the acceptance of a real

estate purchase contract ("Contract") in respect of the Property. If the Disclosure is delivered to the Buyer after the

acceptance of the Contract, the Buyer's sole remedy shall be to terminate the Contract at or prior to the earliest of the

following: (i) three (3) days after delivery of the Disclosure in person; (ii) five (5) days after the postmark if the Disclosure is

deposited in the United States mail, postage prepaid, and properly addressed to the Buyer; (iii) settlement upon purchase of

the Property; (iv) occupancy of the Property by the Buyer; (v) the execution by the Buyer of a written waiver of the Buyer's

right of termination under the Code Section, as amended, contained in a writing separate from the Contract; or (vi) the Buyer

making written application to a lender for a mortgage loan where such application contains a disclosure that the right of

termination shall end upon the application for the mortgage loan.

In order to terminate the Contract when permitted by the Code Section, the Buyer shall, within the time required, give written

notice to the Seller either by hand delivery or by United States mail postage prepaid, and properly addressed to the Seller. If

the Buyer terminates the Contract in compliance with the Code Section, the termination shall be without penalty to the Buyer,

and any deposit made by Buyer to Seller or an escrow holder in connection with such Contract shall be promptly returned to

the Buyer. Any rights of the Buyer to terminate the Contract provided by the Code Section shall end if not exercised prior to

the earlier of (i) the making of a written application to a lender for a mortgage loan where the application contains a

disclosure that the right to terminate shall end upon the application for a mortgage loan or (ii) settlement or occupancy by the

Buyer, in the event of a sale of the Property, or occupancy of the Property, in the event of a lease with option to purchase.

IN WITNESS WHEREOF, Seller has executed this disclosure and Buyer has acknowledged receipt of the Disclosure as of

the ___day of ____________, 20__. The Buyer has executed this Disclosure as of the ___day of ____________, 20__.

SELLER:

BUYER:

____________________________

________________________

NVAR FORM 1400

REV. 08/05

PAGE 1 OF 1

Virginia Association Of Realtors - Varbuzz

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