STATE OF COI\I\ECTICUT
DEPARTMENT OF CONSUMER PROTECTION
4fl1 Columbus Blvd, Suite 901 o Hertford, CT 06103
RESIDENTIAL PROPERTY CONDITION R"EPORT
Tbc Uniform Property Condition Disclosr.ue Act (Connecticut Gcncral Statutes Section 2O-327b') requires the seller of rcsidcnrial property to providc this rcport to the prospectivc purchaser prior to dre prosp€ctivc purclraser's execution of any binder, conbacr 1o purchase, option, or lease containing a purchasc option. These provisions apply to the hansfer ofresidential real property of four dwelliag uaits or lass, including coopcrativcs and condominiulDs, madc with or without the assistaocc of a licensed bioker or salesperson. Thc scllcr will be required to crcdit thc purchaser with the sum of 3500 at closing if the seller fails to fumish this repon (Connectiort Gcncral Satutes Section 2U327c}
INSTRUCTIONS TO SELLERS:
l. You must answer all questions to the best of your knowledge.
2. You are required to identift and disclose any problems regarding the subjecr properry.
3. Your real estete licensee cannot complete this form on your behalf.
4. "tfNK" means Unknown, "N/A'r means Not Applicable.
5. lf you need additional spacc to complete any answer or explanation, anach additional page(s) ro this form. Include subject propcrty address, seller's name and thc datc.
Pursuant to the Uniform Property Condition Disclosure Act, the seller is obligated to answer the followlng questlons and to disclose herein any knowledge of eny problem regerding the following:
A. STJEIECT PROPERTY
l) Namcofselle(s): MAorL€eu rvtarySz<..p€E-r rrca<vc<-AF.r€ rn-osii-r(<z?-*.=4- fi\rutv<? F r^>(.v r fi/$s(=E
2, Snca addrcss, municipality, zip code: I qe F{ f r-urr: a_ LA (> C
GENERAL INFORIUATION
3) What year was the structurc built? \ 1't o
4) How long have you occupicd thc 9€(EAS€r) Y=.+K:t inilicate with N/A.
5) Docs anyonc clsc claim lo own ny per.tofyourpropcrty, including, bur not tinitcd to. any encroachments? lf yes, A
D T Is thc property in a flood hazard arca or an inland wctlands area? Ifyes. W fitl nous
6) Does anyone other than you havc or claim to have any right to use any part of your propcrty, including bul not limited to, any easement or rigbt of waf If 1rcs, explain p / tt exolain: ?(Lo?.;n-<t .-? vv,\S L A5 LAFr>) n^ro 5.rr35sQo*+ttt--1 5orN6gOrrur*.G r THe Z<hV PnQ.<-Er- / f crtSre.u rS rrlDr(r.r€-g nS &;ruc. tr*l Fr-ocp 7oxta./ W€'TUANO \^/}{rr;; T}r= hous,6- Sf(ao<jr.qp-€ eA"_<{=L rg HOf
E) Do you have any reason to belicve that the municipality in which the subject propen)' is locared may imposc any assessment for purposcs such as scwer installation, sewcr improvcmcnts, water main installalion, watcr main improvernents, sidc*alks or other improvcmcnts? If ycs. il/a
r - 9) ls the property locatcd in a municipally designated villagc disrict, municipally designared historic district, or listcd on thc National Register of Historic Placcs? If yes. explain:
Note: Inforrnation concerning villagc districts and historic disrrics may bc' obraincd from rhe municipaliry's villagc district comrnission, if applicable. i t f, I t0) ls thc propcrty located in a special rax disrrict? Ifycs, explain: rr ,/A
I I ) ls thc propcrty subject to any t)?e of land usc rcstrictions, other than those contained within thc propeny's chain of titlc or lhat are necessary to comply wilh skte laws or municipal zoning? lf yes,
u 12) Is the property located in a common intcrcs communiqd If yes is it subjcct to any communiqv or association ducs or fees? Please explain: P/,4
! I
l3) Do you have any knowlcdgc of prior or pending litigation. govcrnmcnt sgcncy or adrninistrative actions, orders or liens on the properry rclatcd to thc rclcase of any hazardous subsance? lf yes. explain: t-r/A
l4) Does thc propcrty include any leased or rented quipmcnt that would necessitate or oblige either of thc following: the assignment or transfer of thc lcasc or rcntal agrecment(s) ro the buyer or the rcplacemcnt or subsdrudon of the eguiprnent by the buyer? lf yes. indicate by chccking all itenrs that apply:
/ eropane fuel tank
Watcr trestmcnt sysrem -i Water hcatcr
Solar deviccs -i Security alarm slstcm
Major appliances
Other
SYSTEMS
?O-oeAFr€ C (' e,ses-r\{o C. d O D 15) Fuel tlPes? oru t*vc^lr'"O) Are 1ou aware of any heating s)€tcm problems? If yes,
n { ! 16) Hot nntcr hcatcr type? egc: -f o V€^tfp you aware of any I LrCr hot water problems? If yes, explain: N /e. oF D O lf Is rherc an undctground storage tank? If yes. list the agc of N lmr+iar. o.t /A
D/ D D 18) Are you aware of any problcms with thc underground storage ank? lfyes, A and
E A
n
19) During thc limc you have ovmed the property, has there cver bce! an underground storage tank locared on tbe propeq/? lfycs, has ir bccn rernovcdf y'yes :: No lf yes, wlrat was dre darc of removat-lA- and what was the name and address of the pcrson or busincss who rcmoved such underground storagc tank? xr/r 'E.SrrnrrLry€ Tl{G rArrL C-&!tov'-Fr rlr Tan-c 9C>' 5
Providc any and all wrinen documentation of strch remowl within pur contFol or possession by attaching a copy of such documentstion to this fonn" *t/ *
20) Air conditioning tlpe: I Ccntral; I Window; Other OrlcrL€Si s"u.r 3y6f €n olr \ f 5 ,( Lt
Are 1ou aware of any air conditioning problems? lf ye.s, explain: N,/l F\o
! { 2l) Plumbingsystcmproblems?Ifyes,exptain: N /A
22) Electrical s'4stcm problcms? If ycs, */*
D 23) Elecoonic security systcm problcms? If ps, cxplain: p/a
{ ! 24) Arc Ocrc carbon monoxide or smoke &tecrors located in thc drvelling on thc propefly? If )rcs, state rhe number of detectors-l and rvhethcr there hsve been problems with such
tr il tr 25) Ffu,e sprinkler system problems? If yes, explaia
26) Domcstic rvatcr s)6tem
27) lf public water: ,ypr2/VrVti"; :--'r Privatc $el h Other-
a) Is there a sep:uate e.:{pensefec for watcr usrge? lfyes, is the expenscr'fec for rvater usage flat or mctcred , neree?e ide rhe amoun, orri. cxpense./fee and cxprain:
b) Arc there unpaid water chargcs? If ycs, state amounr unpaid: r,.t Z/*
28) If privatc wcll:
Has thc wcll water been te$ed for connminants/volatile organic compounds? lf yes. attach a copy of thc rcport. If no rcport is available, provide namc of cntity that pcrformed tesring and describe F\ la results of such tcsting:
lf public water or private well: Are you awsrc of any problems u.ith rhe well or with rhe watcr quality, qusntity, recovcry, or pressure? lfyes. N
N/A F. SEWAGE DISPOSAL SYSTEM
I .i i:
29) Scwagc dispcsal system qpe: hrblic; )/Sqtic; - Ccsspool; Other:
30) lf public sewer:
a) Is there a sepanile charge madc for scwcr usc? tf yes, is it flat or metered?-5[_
b) If it is a flat amount state and due
c) Arc there any unpaid server charges? If ps, statc thc smounr:L
3l) lfprivate:
a) Name of service company: Lor<=t g-.=tt
b) Date last pumned: r o 1 tt / z < Frequency of pumping dwing ownership:
c) Foranyseuragesystem,arerhereproblcms?Ifycs.cxplainr il /rl
O g n E 32) tueasbcstosinsulationorbuildingrnateriatsprescnr?lfycs, t{
33) Is leadpaintpresen0 lfycs, location: */rt / 34) Is lcad plumbing present? lf yes tocation: p/n
NO UNK N/A II. BIJILDING/ STRUCTUREX IMPROVEMENTS
n n 35) ls thc foundation made of concrete? If no, explain:
o n 36) Foundation/slab problenrs or seuling? lfyes, cxplain: fo)E: eoNitcclrrc.:r AA e sya){€wrs
37) waEr seepage/dampness? emounl, 6tl.
38) Sump pump problerns? lf yes, cxplain:
39) Do you havc knowledge of any lesting or inspoction done by a licenscd professional rclatcd to a foundation on tbc property? lfycs, disclosc tbc tcsting or inspccrion metho4 the areas or locations that were tesled or inspected, the renrlts ofnrch testing or inspcction and anach a copy ofthe repon conceming such lesting or inspcction. lf no r€port is arrailable. provide name of entity tlut performed testing and describc results of such tcsting:
40) Do you havc knowledge ofany repairs related to a foundation on the propefif lfycs, dcscribc stch repairs, disclosc thc arcas rcpaired and attach a copy of the report concerning such 6e4 Agov€ R€er,r4€o A Cjarlctz- frAA,r +-\Ag Sfof C-A€6€D Pttg\-r'..{t AaD (-COo\g,ar, A€<<aren1 \u??nr€ -_
4l) Do you have any knowledge retared o the prxencc of pyrrhodrc in a foundation on tbc propcrty? n"€'Dr r lfyes,cxplail: r{o , l-r/a
42) Roof ?vrALf fue: ) 2o Y€rt-S
a3) Roof lcaks? If lrcs, Nr
Address: t18 q rrrvrB?e- tA
44) Exterior siding problcrns? If ycs" cxptain: sr /a
45) Cbimnen freplace, wood orcoal stove problerns? Ifycs, cxplein: N ,/A
4Q Patio/dcck problcms? If ycs, o 5/<bee€o
UNK N/A H. BUILDING/ STRUCTURE/ IMPROVEMENTS (Condnued)
n a?) If puio/dcck is conshucrcd of woo4 is the wood rrearcd or trnrcatcd? N / A
48) Driveway problcms? lf yes,
D 49) Water drainage problens? If ycs,
E 50) lntcriorfloor, walland/orceilingproblerns? lfyes, explaint A / A U D D D D 5l) Fire and/orsrnoke &mage? lf yes,
52) Termitc, insect, rodcat or pcst infesation problems? If yes, explain: $/ A
53) Rot or water damagc problems? If yes,
D 54) Is thc shrcun{s) insulatcd? If ps, tlAc: €iG.za-lgt-^4 locgtior: ArrA lrr<-s
55) Has e tcst for radon bccn pc,rforrnod? If yes, aftach copy of the r?on. tf no report is availablc, pmvide the name of entity that performcd thc tcsting and describe the resulrs of such
tr il 56) ts tbcrc a radoo conbot system in place? lfyes, explaint e / h
I 57) Has a ndon control s)lstcm bcen in place in the prcviors l2 monrhs? lf ycs, cxnlain: Nr/A
The seller should anach additional pagcs, ifncccssary, to frrther explain any item(s) above. lndicarc hcre thc numbcr of additional pages attached:
Qllgstions or Comments? Consumcr Problems? Visit the Department of Consumer Protectionwebsite at: www.ct.oou/dcp
Address: tqg h\ Ttrltg-crL u
(A) Resoonsibtlltics of Real Estetc Brokcrs
rM PORTAIYT INF'ORIITATION
This rcport in no xray relieves a real cstatc broker of his or her obligation undcr the provisions of secrion 2G328-5a of the Regulations of Connecticut Ststc Agcncics to disclose any matcrial f8cts. Faihrrc to do so could result in punitivc action laken against the broker, such as fincg suspension or revocalion ofliccrsc.
(B) St.temenls Not to Constiffie r War8ntv
Any representations made by thc scllcr on the wrinen residendal propcrty condition report shall not constitutc a warranty to the buyer.
(C) Nsture of Reoort
This Rcsidcntial Property Condition Report is not a substitute for irspecions, tesrs. and orhcr mcthods of determining the physical condition of the property.
(D) Informetion on tbe Resldcnce of Convlcted Felons
Infonnation conccming thc rcsidcncc address of a person convictcd of a crimc may be available from law enforccmcnt agencies or tbe Depanmcnt of Public Safery.
(E) Buildiae Pcrmits end Certillcetes of Occuoencr
Prospective buyers should consult with the municipal buitding official in rhe municipality in which rhe property is locatcd to confirm that buildiqg pcrmits and certificates ofoccupancy have bcen issucd for work on the property.
(F) Home Insocction
Buyea sbould bavc thc propcny inspected by a licensed homc inspccor.
(G) Concrete Foundrtiou
Prospective buycrs may havc a concrete foundation inspe+tcd by a licenscd profcssional engineer who is a shlcrural engineer for detcrioration of the foundation due to the prcsence ofpyrrhotitc.
(II) Buver's Certift cetion
The buyer is urgod to carcfully inspoct tbe property ur4 if desired, to have thc pmpcrty inspected by an expert. The buler understands dnt thete ane areas of thc propcrty for wtrich ttre seller has no knowledgc and &st this ncport does not encompass those areas. The buyer also acknowledgcs that thc buyer has read and reoeived a signed mpy of this report from the seller or scllcr's agent.
Dtte_Euyer Buyer
Slgneture
Signeturc
Prlnt Neme
Print Neme
(I) Seller's Ccrtificrtion
To thc cxtcnt of the seller(s) knowledge as a propcfiy omcr, thc scllcr acknowledges rhat rhe information containcd abovc is true and accuralc for those areas of the property listed. In thc cvcnt a real cstate broker or salesperson is utitize{, thc scller authorizcs thc brokcrs or salespersons to to prospcctive buyers, selling agena or buyer's agcnts. qHgtsr sZa\^lslat all-re5KEE
Prlnt Neme
Sigoature
Prlnt NeE€
STATE OF CONIYECTICUT
DEPARTMENT OF CONSUMER PROTECTION
450 Columbus Blvd, Suite 90I o Hartford, CT 06103
RESIDENTIAL FOTJNDATION CONDITION REPORT
This report must bc filled out for the tans r of residcntial prop€rty located in a toun dctcrmincd by the Capirol Region Council of Governmcnts to be affected, or potenlially afrfectcd, by crumbling foundations g! rhat was acquired bf (l ) a poiiricat subdivision of this state; (2) a judgment of srict foreclosure; (3) forectosurc by salc; or (4) a deed in lieu of fcreclosurc. Thc owner or political suMivision shatl mske the disclosues below to thc prospcctive purchaser of such property prior to thc prospective purchascr's exccution of any binder, contract to purchasc, optioq or lease cutaining a purchasc optioD. Thc scller is rcquired !o credit thc purchascr with the sum of $500 at closing if thc scllcr fails to fumish this repon (C.G.S. Scction 2O-327c).
A list of afiected or potendally alfected towns may be found at httn://crcos.orslcrumblins-fou ndationVrealestatemao/.
INSTRUCTIONS TO SELLERS:
l. You must answer all questions to the best of your knowledge.
2. You are not required to undertake investigations or inspeaions of the foundation to veriS your ans\r,ers.
3. Your real estate licensec cannot complete this form on your behalf.
4. "IJNK'nrcans Unknown,'N/A" means Not Applicable.
5. lf you need additional space to complete any answer or explanation, anach additional pag{s) to this form. Include the subject property address, seller's name and the &re on all additional pages.
Punuant to the Uniform Property Conditlon Disclosure Act, the seller is obtigated to answer the following questions snd to disclose eny knowledge of any problem regarding the following:
A. SUB.'ECT PROPERTY
l) Nameof MAr>n-€aFt n^AT y5,Z€,oi*r (rrLr <f oex= ? (Liz€Yo (,A s{ SZ,crr><rir fet)sf at
2) Street address. municipality, zip tQ<e rt <r^^ " (a -c5D-f <rG'l t o
B. INFORMATION ABOUT THE FOUNDATION
3) Do you have any knowlodge related to thc prescncc ofpyrrhotite in any concrerc foundation on rhc subjcct propcrtf If ycs, explain: o
! dr tr 4, Arc you aware ofany darnage or deterioration in any concrctc foundation on the subject prope(y. including, but not limitcd to, any damage or deterioration caused by thc prcscncc of pyrrhotitc in any co[crqtc foundation on the property? If yes, explain f-ro Pv RCf{-r1 ra .rt-n^*ae , ^{ /^ €e. *
NO UNK N/A B. IIIFORMATION
ABOUT THE FOUNDATION (Continued)
F D D 5)
Are you aware of any rcpairs or rcrncdiation !o any concrcte foundation on the subjcct propcrry? If
The seller should anach additional pagcs, if ncccssary, to further explain any ircm(s) above. lndicatc hcrc thc numbcr of additional
Pages
Ouestions? Vbit the Depannent of Consumer Protection vebsite at: wwr.ct.eou/dcp
IMPORTANIT INFORMATION
(A) Resooosibilitles of Real Esurc Broken
This repon in no way rclicvcs a rcal cstate brokcr ofthe broker's obligation under the provisions of section 2G328-5a of thc Regtlations ofConnccticut Ststc Agcncics to disclosc any material facrs. Failure to do so could result in punitivc 8crion takcn against thc broker, such 8s fines, suspension or revocation oflicense.
(B) Stetements Not to Constitute e Werrsntv
Any reprcscnadons madc by tbc seller on this residential foun&tion condition repon shall not constiture a waranty to rhe buyer.
(C) Nrture of Reoort
This repon is not a srbsirute for inspcctions, tcsts, and othcr mcthods of detcrmining the phpical condition of rhe foun&tion. Prospective buyers may havc a concrctc foundation inspcctcd by a licenscd professional engirrer who is a structural eagineer for deterioratioo ofthe foundation due to the prcscncc ofpyrrhotite.
(D) Buver's Certilicetion
The buyer is urgcd to carcfully inspcct the foundation and, if desired, to have the foun&tion inspected by an expen. The buyer understands that there arc parts of thc propcrty, including thc foundation, for which the seller has no krnwledge and that this r€port does not eoconpass tbo6e parts. Tbe buyer also acknowledges that the buyer bas r€ad 8nd received a sigrred copy of this rcport from lhc scllcr or sellcr's
(E) Seller's Certillcrtion
To lhe extent of the seller(s) knowledge as an owner of a property acquircd through forcclosure or decd in ticu of forcclosure. thc seller acknowledges that 6e infonnation containd above is tnre and accurate. ln thc cvcot a rcal cstatc brokcr or salcspcnson is utilize4 the seller auhorizes the broker or salcsperson to provide thc abovc information to prospcctivc buycrs, sclling agcnts or buyers'a8,ents.
