450ColumbusBlvd,Suite901Hartford,CT06103
RESIDENTIALPROPERTYCONDITIONREPORT
TheUniformPropertyConditionDisclosureAct(ConnecticutGeneralStatutesSection20-327b)requiresthesellerofresidential propertytoprovidethisreporttotheprospectivepurchaserpriortotheprospectivepurchaser’sexecutionofanybinder,contract topurchase,option,orleasecontainingapurchaseoption.Theseprovisionsapplytothetransferofresidentialrealpropertyof fourdwellingunitsorless,includingcooperativesandcondominiums,madewithorwithouttheassistanceofalicensedbrokeror salesperson.Thesellerwillberequiredtocreditthepurchaserwiththesumof$500atclosingifthesellerfailstofurnishthis report(ConnecticutGeneralStatutesSection20-327c).
INSTRUCTIONSTOSELLERS:
1.Youmustanswerallquestionstothebestofyourknowledge.
2.Youarerequiredtoidentifyanddiscloseanyproblemsregardingthesubjectproperty.
3.Yourrealestatelicenseecannotcompletethisformonyourbehalf.
4.“UNK”meansUnknown,“N/A”meansNotApplicable.
5.Ifyouneedadditionalspacetocompleteanyanswerorexplanation,attachadditionalpage(s)tothisform.Include subjectpropertyaddress,seller’snameandthedate.
PursuanttotheUniformPropertyConditionDisclosureAct,thesellerisobligatedtoanswerthefollowing questionsandtodisclosehereinanyknowledgeofanyproblemregardingthefollowing:
A.SUBJECTPROPERTY
1)Nameofseller(s):
2)Streetaddress,municipality,zipcode:
B.GENERALINFORMATION
3)Whatyearwasthestructurebuilt?
4)Howlonghaveyouoccupiedtheproperty?_______________Ifnotapplicable,indicatewithN/A.
5)Doesanyoneelseclaimtoownanypartofyourproperty,including,butnotlimitedto,any encroachments?Ifyes,explain:
6)Doesanyoneotherthanyouhaveorclaimtohaveanyrighttouseanypartofyourproperty, including,butnotlimitedto,anyeasementorrightofway?Ifyes,explain:
7)Isthepropertyinafloodhazardareaoraninlandwetlandsarea?Ifyes,explain:
8)Areyouawareofthepresenceofadamonthepropertythathasbeenorisrequiredtoberegistered withtheDepartmentofEnergyandEnvironmentalProtection?Ifyes,explain:
9)Doyouhaveanyreasontobelievethatthemunicipalityinwhichthesubjectpropertyislocatedmay imposeanyassessmentforpurposessuchassewerinstallation,sewerimprovements,watermain installation,watermainimprovements,sidewalksorotherimprovements?Ifyes,explain:
10)Isthepropertylocatedinamunicipallydesignatedvillagedistrict,municipallydesignatedhistoric district,orlistedontheNationalRegisterofHistoricPlaces?Ifyes,explain:
Note:Informationconcerningvillagedistrictsandhistoricdistrictsmaybeobtainedfromthe municipality’svillagedistrictcommission,ifapplicable.
11)Isthepropertylocatedinaspecialtaxdistrict?Ifyes,explain:
12)Isthepropertysubjecttoanytypeoflanduserestrictions,otherthanthosecontainedwithinthe property’schainoftitleorthatarenecessarytocomplywithstatelawsormunicipalzoning?Ifyes, explain:
13)Isthepropertylocatedinacommoninterestcommunity?Ifyes,isitsubjecttoanycommunityor associationduesorfees?Pleaseexplain:
14)Doyouhaveanyknowledgeofpriororpendinglitigation,governmentagencyoradministrative actions,ordersorliensonthepropertyrelatedtothereleaseofanyhazardoussubstance?Ifyes, explain:
15)Doesthepropertyincludeanyleasedorrentedequipmentthatwouldnecessitateorobligeeitherof thefollowing:theassignmentortransferoftheleaseorrentalagreement(s)tothebuyerorthe replacementorsubstitutionoftheequipmentbythebuyer?Ifyes,indicatebycheckingallitemsthat apply:
Propanefueltank
Waterheater
Securityalarmsystem
Firealarmsystem
Satellitedishantenna
Watertreatmentsystem
Solardevices
Majorappliances
Other:
16)Fueltypes?_____________________Areyouawareofanyheatingsystemproblems?Ifyes, explain:
17)Hotwaterheatertype?__________________________Age:__________Areyouawareofanyhot waterproblems?Ifyes,explain:
18)Isthereanundergroundstoragetank?Ifyes,listtheageoftank___________andlocation:
19)Areyouawareofanyproblemswiththeundergroundstoragetank?Ifyes,explain:
20)Duringthetimeyouhaveownedtheproperty,hasthereeverbeenanundergroundstoragetank locatedontheproperty?Ifyes,hasitbeenremoved?YesNo Ifyes,whatwasthedateofremoval_________________________andwhatwasthenameand addressofthepersonorbusinesswhoremovedsuchundergroundstoragetank?
Provideanyandallwrittendocumentationofsuchremovalwithinyourcontrolorpossessionby attachingacopyofsuchdocumentationtothisform.
21)Airconditioningtype:Central;Window;Other: Areyouawareofanyairconditioningproblems?Ifyes,explain:
22)Plumbingsystemproblems?Ifyes,explain:
23)Electricalsystemproblems?Ifyes,explain:
24)Electronicsecuritysystemproblems?Ifyes,explain:
25)Aretherecarbonmonoxideorsmokedetectorslocatedinthedwellingontheproperty?Ifyes,state thenumberofdetectors_____andwhethertherehavebeenproblemswithsuchdetectors:
26)Firesprinklersystemproblems?Ifyes,explain:
E.WATERSYSTEM
27)Domesticwatersystemtype:Public;Privatewell;Other:
28)Ifpublicwater:
a)Isthereaseparateexpense/feeforwaterusage?Ifyes,istheexpense/feeforwaterusageflator metered?________Providetheamountoftheexpense/fee_____________andexplain:
b)Arethereunpaidwatercharges?Ifyes,stateamountunpaid:
29)Ifprivatewell:
Hasthewellwaterbeentestedforcontaminants/volatileorganiccompounds?Ifyes,attacha copyofthereport.Ifnoreportisavailable,providenameofentitythatperformedtestingand describeresultsofsuchtesting:
30)Ifpublicwaterorprivatewell:Areyouawareofanyproblemswiththewellorwiththewater quality,quantity,recovery,orpressure?Ifyes,explain:
YESNOUNKN/AF.SEWAGEDISPOSALSYSTEM
31)Sewagedisposalsystemtype:Public;Septic;Cesspool;Other:
32)Ifpublicsewer:
a)Isthereaseparatechargemadeforseweruse?Ifyes,isitflatormetered?
b)Ifitisaflatamount,stateamount__________________andduedates:
c)Arethereanyunpaidsewercharges?Ifyes,statetheamount:
33)Ifprivate:
a)Nameofservicecompany:
b)Datelastpumped:_________________________Frequencyofpumpingduringownership:
c)Foranysewagesystem,arethereproblems?Ifyes,explain: YESNOUNKN/AG.ASBESTOS/LEAD
34)Areasbestosinsulationorbuildingmaterialspresent?Ifyes,location:
35)Isleadpaintpresent?Ifyes,location:
36)Isleadplumbingpresent?Ifyes,location: YESNOUNKN/AH.BUILDING/STRUCTURE/IMPROVEMENTS
37)Isthefoundationmadeofconcrete?Ifno,explain:
38)Foundation/slabproblemsorsettling?Ifyes,explain:
39)Basementwaterseepage/dampness?Ifyes,explainamount,frequencyandlocation:
40)Sumppumpproblems?Ifyes,explain:
41)Doyouhaveknowledgeofanytestingorinspectiondonebyalicensedprofessionalrelatedtoa foundationontheproperty?Ifyes,disclosethetestingorinspectionmethod,theareasorlocations thatweretestedorinspected,theresultsofsuchtestingorinspectionandattachacopyofthereport concerningsuchtestingorinspection.Ifnoreportisavailable,providenameofentitythatperformed testinganddescriberesultsofsuchtesting:
42)Doyouhaveknowledgeofanyrepairsrelatedtoafoundationontheproperty?Ifyes,describesuch repairs,disclosetheareasrepairedandattachacopyofthereportconcerningsuchrepairs:
43)Doyouhaveanyknowledgerelatedtothepresenceofpyrrhotiteinafoundationontheproperty?If yes,explain:
44)Rooftype:________________________________;Age:
45)Roofleaks?Ifyes,explain:
46)Exteriorsidingproblems?Ifyes,explain:
47)Chimney,fireplace,woodorcoalstoveproblems?Ifyes,explain:
48)Patio/deckproblems?Ifyes,explain:
49)Ifpatio/deckisconstructedofwood,isthewoodtreatedoruntreated?
50)Drivewayproblems?Ifyes,explain:
51)Waterdrainageproblems?Ifyes,explain:
52)Interiorfloor,walland/orceilingproblems?Ifyes,explain:
53)Fireand/orsmokedamage?Ifyes,explain:
54)Termite,insect,rodentorpestinfestationproblems?Ifyes,explain:
55)Rotorwaterdamageproblems?Ifyes,explain:
56)Is(Are)thestructure(s)insulated?Ifyes,type:_______________________;location:
57)Hasatestforradonbeenperformed?Ifyes,attachcopyofthereport.Ifnoreportisavailable, providethenameofentitythatperformedthetestinganddescribetheresultsofsuchtesting:
58)Istherearadoncontrolsysteminplace?Ifyes,explain:
59)Hasaradoncontrolsystembeeninplaceintheprevious12months?Ifyes,explain: YESNOUNKN/A
I.FLOODRISKAWARENESS
60)IsthepropertylocatedinaFederalEmergencyManagementAgencydesignatedfloodplain?Ifyes, whichzone:
61)Duringthetimethatthesellerhasownedtheproperty,hasthesellerreceivedassistanceoristhe sellerawareofanypreviousownersreceivingassistancefromtheFederalEmergencyManagement Agency,theUnitedStatesSmallBusinessAdministrationoranyotherfederalorstatedisaster assistanceprogramforflooddamagetotheproperty?
62)Isthereacurrentfloodinsurancepolicyineffectontheproperty?
63)IsaFederalEmergencyManagementAgencyelevationcertificateavailable?
64)Hasthesellereverfiledaclaimforflooddamagetotheproperty?
65)Ifthereisastructureontheproperty,hasthestructureexperiencedanywaterpenetrationordamage duetoseepageoranaturalfloodevent?
Thesellershouldattachadditionalpages,ifnecessary,tofurtherexplainanyitem(s)above.Indicateherethenumberof additionalpagesattached:______
QuestionsorComments?ConsumerProblems?VisittheDepartmentofConsumerProtectionwebsiteat: www.ct.gov/dcp
IMPORTANTINFORMATION
(A)ResponsibilitiesofRealEstateBrokers
Thisreportinnowayrelievesarealestatebrokerofhisorherobligationundertheprovisionsofsection20-328-5aofthe RegulationsofConnecticutStateAgenciestodiscloseanymaterialfacts.Failuretodosocouldresultinpunitiveactiontaken againstthebroker,suchasfines,suspensionorrevocationoflicense.
(B)StatementsNottoConstituteaWarranty
Anyrepresentationsmadebytheselleronthewrittenresidentialpropertyconditionreportshallnotconstituteawarrantytothe buyer.
(C)NatureofReport
ThisResidentialPropertyConditionReportisnotasubstituteforinspections,tests,andothermethodsofdeterminingthe physicalconditionoftheproperty.
(D)InformationontheResidenceofConvictedFelons
Informationconcerningtheresidenceaddressofapersonconvictedofacrimemaybeavailablefromlawenforcementagencies ortheDepartmentofPublicSafety.
(E)BuildingPermitsandCertificatesofOccupancy
Prospectivebuyersshouldconsultwiththemunicipalbuildingofficialinthemunicipalityinwhichthepropertyislocatedto confirmthatbuildingpermitsandcertificatesofoccupancyhavebeenissuedforworkontheproperty.
(F)HomeInspection
Buyersshouldhavethepropertyinspectedbyalicensedhomeinspector.
(G)ConcreteFoundation
Prospectivebuyersmayhaveaconcretefoundationinspectedbyalicensedprofessionalengineerwhoisastructuralengineerfor deteriorationofthefoundationduetothepresenceofpyrrhotite.
(H)Dam
InformationconcerningtheregistrationandcategorizationofadamonthepropertymaybeobtainedfromtheDepartmentof EnergyandEnvironmentalProtection.
(I)FloodInsurance,FloodMapsandFloodRisk
Federallawrequiresownerstoobtainandmaintainfloodinsuranceforpropertiesfinancedwithafederallyregulatedorinsured mortgageinaSpecialFloodHazardArea,alsoknownasahigh-riskzoneonFEMA’sfloodinsuranceratemaps.Inaddition,for propertiesthathavepreviouslyreceivedfederaldisasterassistance,ownersarerequiredtoobtainandmaintainfloodinsuranceas aconditiontobeeligibleforfutureassistance.Thisrequirementaffixestothepropertyandappliestoallfutureowners.FEMA floodmapsarenotdesigned,norintendedtobe,areliabletoolforbuyerstoassessaproperty’sfloodrisk.Apropertydoesnot havetobenearwaterorinafloodzonetoflood.Foradditionalinformationonobtainingimportantfloodinsurance,contactan insuranceprofessional.
Buyer’sCertification
Thebuyerisurgedtocarefullyinspectthepropertyand,ifdesired,tohavethepropertyinspectedbyanexpert.Thebuyer understandsthatthereareareasofthepropertyforwhichthesellerhasnoknowledgeandthatthisreportdoesnotencompass thoseareas.Thebuyeralsoacknowledgesthatthebuyerhasreadandreceivedasignedcopyofthisreportfromtheselleror seller’sagent.
Seller’sCertification
Totheextentoftheseller’sknowledgeasapropertyowner,theselleracknowledgesthattheinformationcontainedaboveistrue andaccurateforthoseareasofthepropertylisted.Intheeventarealestatebrokerorsalespersonisutilized,thesellerauthorizes thebrokersorsalespersonstoprovidetheaboveinformationtoprospectivebuyers,sellingagentsorbuyers’agents.
DateSellerSeller
LeadWarningStatement
Everypurchaserofanyinterestinresidentialrealpropertyonwhicharesidentialdwellingwasbuiltpriorto1978isnotifiedthatsuchpropertymay presentexposuretoleadfromlead-basedpaintthatmayplaceyoungchildrenatriskofdevelopingleadpoisoning.Leadpoisoninginyoungchildren mayproducepermanentneurologicaldamage,includinglearningdisabilities,reducedintelligencequotient,behavioralproblems,andimpaired memory.Leadpoisoningalsoposesaparticularrisktopregnantwomen.Thesellerofanyinterestinresidentialrealpropertyisrequiredtoprovide thebuyerwithanyinformationonlead-basedpainthazardsfromriskassessmentsorinspectionsinthepossessionandnotifythebuyerofany knownlead-basedpainthazards.Ariskassessmentorinspectionforpossiblelead-basedpainthazardsisrecommendedpriortopurchase.
Disclosure(initial)
(a)Presenceoflead-basedpaintand/orlead-basedpainthazards(initial(i)or(ii)below):
(i)Knownlead-basedpaintand/orlead-basedpainthazardsarepresentinthehousing(explain):
(ii)Sellerhasnoknowledgeoflead-basedpaintand/orlead-basedpainthazardsinthehousing.
(b)Recordsandreportsavailabletotheseller(initial(i)or(ii)below):
(i)Sellerhasprovidedthepurchaserwithallavailablerecordsandreportspertainingtolead-basedpaintand/orleadbasedpainthazardsinthehousing(listdocumentsbelowwithdocumentname/author/date):
(ii)Sellerhasnoreportsorrecordspertainingtolead-basedpaintand/orlead-basedpainthazardsinthehousing.
Acknowledgment(initial)
(c)Purchaserhas(initial(i)or(ii)below):
(i)receivedcopiesofallrecordsandreportspertainingtolead-basedpaintand/orlead-basedpainthazardsinthe housinglistedabove.
(ii)notreceivedanyrecordsorreportsregardinglead-basedpaintand/orlead-basedpainthazardsinthehousing.
(d)PurchaserhasreceivedthepamphletProtectYourFamilyfromLeadinYourHome
(e)Purchaserhas(initial(i)or(ii)below):
(i)receiveda10-dayopportunity(ormutuallyagreeduponperiod)toconductariskassessmentorinspectionforthe presenceoflead-basedpaintand/orlead-basedpainthazards;or
(ii)waivedtheopportunitytoconductariskassessmentorinspectionforthepresenceoflead-basedpaintand/orleadbasedpainthazards.
Acknowledgment(initialonebelow)
(f)__________enthasinformedtheselleroftheobligationsunder42U.S.C.4852(d)andisawareoftheir responsibilitytoensurecompliance.
(g)__________Thesellerisnotrepresentedbyanagentand hasinformedtheselleroftheobligations under42U.S.C.4852(d)andisawareoftheirresponsibilitytoensurecompliance.
CertificationofAccuracy
Thefollowingpartieshavereviewedtheinformationaboveandcertify,tothebestoftheirknowledge,thattheinformationtheyhaveprovided istrueandaccurate.
