Residential Property Disclosure And Disclaimer Statement Page 2
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61. TITLE
YES
NO
UNKNOWN
J. Are the property’s boundaries marked?
If yes, explain:
K. Are there fences on the property?
If yes, were the fences put up by the property owner?
L. Are any trees or other flora on the property diseased, dead or damaged?
If yes, explain:
M. Are there any covenants, conditions, or restrictions which affect the property?
If yes, explain:
N. Is the property accessed by public or private road?
PUBLIC
PRIVATE
UNKNOWN
If private, what yearly upkeep amount is paid by the property owner?
If private, explain road upkeep in detail:
2. WATER
A. Household Water
(1) The source of the water is:
Public
Community
Private
Shared
(2) Water source information:
YES
NO
UNKNOWN
a. Are there any written agreements for shared water source?
If yes, explain:
b. Is there an easement (recorded or unrecorded) for access to and/or maintenance of
the water source?
If yes, explain:
c. Are any known problems or repairs needed?
If yes, explain:
d. Does the source provide an adequate year round supply of potable water?
e. Are there any water treatment systems (softener, purifier, etc.) for the property?
If yes, explain, and state if the system(s) is/are leased or owned:
B. Irrigation
(1) Are there any water rights for the property?
If yes, explain:
(2) If they exist, to your knowledge, have the water rights been used during the last five-
year period?
If yes, explain:
(3) If so, is the certificate available?
Explain:
C. Outdoor Sprinkler System
(1) Is there an outdoor sprinkler system for the property?
(2) Are there any defects in the outdoor sprinkler system?
If yes, explain:
3. SEWER/SEPTIC SYSTEM
A. The property is served by (circle one):
Public Sewer Main
Septic Tank System
Other Disposal System
If other, describe:
B. If the property is served by a public or community sewer main, is the house connected to the main?
Yes
No
Unknown
If no, explain:
C. Is the property currently subject to a sewer capacity charge?
Yes
No
Unknown
If yes, explain:
D. If the property is connected to a septic system:
(1) Was a permit issued for its construction, and was it approved by the city or county following its
Yes
No
Unknown
construction?
(2) On what date was it last pumped:
(3) Are there any defects in the operation of the septic system?
Yes
No
Unknown
If yes, explain:
(4) On what date was it last inspected:
By whom:
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