Residential Property Disclosure And Disclaimer Statement Page 3
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6(5) How many bedrooms was the system approved for?
E. Do all plumbing fixtures, including laundry drain, go to the septic/sewer system?
Yes
No
Unknown
If no, explain:
F. Are you aware of any changes or repairs to the septic system?
Yes
No
Unknown
If yes, explain:
G. Is the septic system, including drainage field, located entirely within the property’s boundaries?
Yes
No
Unknown
If no, explain:
4. STRUCTURAL
A. How old is the current roof? ____ years. (If unknown, mark Unknown.)
Unknown
Roof is constructed of:
Asphalt Shingle,
Wood Shingle,
Slate,
Metal,
Tile,
Asbestos,
Unknown,
Other:
B. Has the roof leaked during your ownership?
Yes
No
Unknown
If yes, has it been repaired?
Yes
No
Explain any roof repairs of which you are aware:
C. Has the house undergone any conversions, additions, or remodeling?
Yes
No
Unknown
1. If yes, were all building permits obtained?
Yes
No
Unknown
2. If yes, were all final inspections obtained?
Yes
No
Unknown
Explain any conversions/additions/remodeling:
D. Do you know the age of the house?
Yes
No
If yes, give year of original construction (if approximation, indicate such):
E. Are you aware of:
Yes
No
(1) Any movement, shifting, deterioration or other problems with walls, foundation, crawl space or slab?
Yes
No
(2) Any cracks or flaws in the walls, ceilings, foundations, concrete slab, crawl space, basement, floors or garage?
Yes
No
(3) Any water leakage or dampness in the crawl space or basement?
Yes
No
(4) Any dry rot on the property?
Yes
No
(5) Any repairs or other attempts to control the cause or effect of any problem described above?
Yes
No
Explain any ‘Yes’ answer(s) to 1-5 above. When describing repairs or control efforts, describe the location, extent, date, and name of
person/company who did the work. Attach any reports and/or other documentation:
F. If you know of any defect(s) regarding the following items, mark the defective item with a check:
1. Foundation
6. Fire Alarm
11. Slab Floors
16. Sidewalks
21. Balconies
2. Deck
7. Doors
12. Driveways
17. Outbuildings
22. Wood Stoves
3. Exterior walls
8. Door locks
13. Attic Stairs
18. Fireplaces
4. Chimneys
9. Patio
14. Windows
19. Garage Floors
5. Interior walls
10. Ceilings
15. Window locks
20. Walkways
If you checked any of the above items, explain the defect(s):
G. In the last 4 years, was a pest, dry rot, structural or "whole house" inspection done?
Yes
No
Unknown
If yes, which test(s), when, and by whom was the inspection done? (Attach documentation)
H. Has the property had a problem with pest control, infestations, or vermin?
Yes
No
Unknown
If yes, explain:
I. Are you aware of:
(1) Any termites, wood destroying insects or pests on or affecting the property?
Yes
No
(2) Property damage by termites, wood destroying insects or pests?
Yes
No
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