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2. MECHANICAL, ELECTRICAL, APPLIANCES & OTHER SYSTEMS
HEATINGIAIR CONDITIONING/HOT WATER SYSTEMS
Av there wurrently uny underground uel storage tunks on the Property? (d) Is," F'ucl Iype: (e)
(f) When
Heating System (check all that apply): JBase Board Hot Air RadiantHeat Pump Direct Vent Steam
Doher (explain):
Age of Fumace/Boiler:sDon't Know
Primary Fuel Type: Oil ONatural Gas Propane JElectric WoodWood Pellet DCoal Solar Geothermal Dother (explain):
Primary Annual Fuel Usage: 5o0 Gallons (or other measure) Date Rangeucar Provider: Hart t ed
Secondary Fuel Type:oiNatural Gas Propane Electric Wood OWood Pellet Coal
Doher (explain): d's conhecà ThS eae
Secondary Annual Fuel UsageorsGallons (or other measure) Date Range |year
1f propane. who owns propane tank? Owner DPropane Supplier JAssociation Gas rycr stove
Pruperty uscd: Full TimeSeasonally Fuel consumption may vary by user, number of occupants and weather conditions.
AirConditioning:YES VNO If"Yes," describe type and number of units (central, heat pump, window, etc.)
Hot Water System (check all that apply) YHot Water TankDomestic/Off BoilerOn Demand Heat Pump Water
Heater Age of Hot Water System:Sqrs Fuel Type: Doi gElectric JNatural Gas
DDon't Know
Owned Rented If rented, from whom:
(check all that apply):
Electrical System: Electrical service panel has: JFuses MCircuit Breakers|other (explain) Annual electricity usage: S03. Date Range: la3 -aayElectric utility provider:m?
Unknown
Property used: Full TimeSeasonally Electricity consumpion may vary by user, number of occupants,number of appliances and weaher conditions.
Main Breaker Amperes: Amps Don't Know Has a Vermont Home Energy Profile been created? If yes, when?
by whom?
Are you aware of any problems or conditions that affect any of the above systems?YES VNO If"Yes," explain in detail:
(a) (C
Seliers initials
Hot Water Tank is:
UYES UNO Effecuve I1 2023 -Copy nghtC Vermont Assocvation of REALTORS& IYES Solar
YES
Alternative Energy System(3)
Energy retumed to grid:YESNO Owned
or Leased VYES YES Wind YES Page 2/7 VNO
NO
Purchaser's
NO
Initials
NO YES VNO YES KO Propane
NO Provider:
Coal OSolar Wood Pellet Other
JDONT KNOW
|YES DONT KNOW DON'T KNOW DONTKNOW LDON'TKNOW DoNTKNOW pONTKNOW DON'T KNOW DON'T KNOW Monthly rental fee:
S olar Geothermal
nosty conyngfro HydroelectricGeothermal
|DON'T KNOW VR-041 Rev. B
TELEPIONE ZINTERNET/TELEVISION
(h) Is landline telephone serv ice present at the Property? YES NO I"Yes," current provider: Iaiv. Is cellular telephone ser ice available at the Property? ZYES ONO If"Yes," list available providers: (Ne useTACPho Is intemct sern ice availuble at the Property? MYES DNO Ir*Yes", current provider: airoin 1 Ir"Yes,"serv ice is: Dial Up BroudbandCable ISalellite DSL.OFiber (Oplic Is telev ision serv ice available at the Property? YES ONO I"Yes", current provider: Dis NetworkQver fhet Ies" soune is:AntennaCable MSulcllite DSL Fiber Optic
OTHER EQUIPMENT AND APPLANCES
Chok the items that will be included in the salc of' the Property: lwric (Garage Door Opencr - NumberofTransmitters DSecurity Alarm System Jowned JLeased DHumidifier
ODehumiditier DLawn SprinklersAulomatic Timer Smoke Detectors - How Many? Atic Fans)Window A/CMini Split Compost Bin
DWhirlpool Bath
|Suimming Pool Pool Heater OSpa/l lot Tub Poo/Spa Equipment (list): MRetrigerator Stove lood/Fan Microwave OvenDishyasherGarbage Disposal Trash Compactor Rasher Dyer (entral Vacuum Freezer Intercom Cciling Fans MWoodstove Sump Pump Well Pump
Satellite Dish Indoor/Outdoor Grill 1dwood (GasPelkvOther Stove (deseribe):
List additional equipment and appliances, including any AC units, that will be excluded from the sale of the Property:
Are any of the items that will be included in the sale of the Property in need of repair or replacement? UYES VNO If yes", explain in detail:
3. STRUCTURAL COMPONENIS
Dype of construction (check all that apply) DManufactured
Modular
Age of Building(s): Main Bldg.50
Additions to Main Bldg.
Additional Building(s): (a)
Has Seller built or caused to be built any of the buildings on the Property, or made any additions, modifications, alterations or renovations to any building on the Property? DYcs VNo
If"Yes," please explain:
Tyes, did you obtain all necessary permits and approvals lor such work? Yes MNo
Check any of the following items that have significant defects or malfunctions or that need significant repair:
WoodFrame Dother (deseribe): Foundation Windows
Sellers Iniuals Chimney Fireplace Storms/Screens Exterior Walls Other Structures/Components:
Walls Driveway
jCeilings
Ifany of the above items are checked, deseribe the defect, malfunction or item(s)that need significant repair:
Ha_ there ever been damageto the Property or any of the structures from fire, wind, floods, carh movements or landslides? ZYES DNoDONT KNOW If"Yes," explain in detail, including any repairs:
&amage om Wind Slab Doors Outside Retaining Walls
Purchaser's Initials
OTHER:
Dantels FurmaeMeeds Cam ey Otside heezer
Sam
Lsasidated
Tnee
Interior
Effecuve I2023- Copyrgh1c Vermont Associalion of REAL.TORS®
Puge 3/7
]Sidewalks Floors Roof VR-041 Rev. B
BASEMIENT/CELLARICRAWL SPACE:
Maas ther ybeen any water leakage, uccumulation of water, dampness or visible mold within the basement, cellar or any crawl space? OYEs TNO IY'es," explain in detail:
lave therdcen uny repairs orother attempts to control any water or dampness within the basement, cellar or crawl space? DYEs NO DONTKNOW Ir*Yes," explain in detail, including any repairs:
Are any of the above recurring problems?
ROOF: Mshingle slate
|YES CNO 1f "Yes," what are the problems and how often have they recurred?
Metalrileother (describe),
Approximate age of roof? \0 VearS
DDon't Know
NODDON'T KNOW
Has the roof ever leaked since youHave owned the Property? MYEs IrYexplain: WWnd Pleu Shiles pt Meoted Verityed No Qter
Has the roof been replaced or repaired since you haveowned the Proplr YES IfYes"when?\ears Ao
Are there any current prdblems with the roofYES VNODON'T KNOW If"Yes." explain:
4. WATER SUPPLY
Special Notice: Water supplies, especially those that are not public or municipal supplies, are affected by many conditionsabout which Seller may have no knowledge or have any ability to control. These water supply systems can change,deteriorate or fail, often with nowarning signs. Seller makes no warranty or representation whatsoever that the water supply, including quality or quantity, will operate or continue to function for any period of time. Inspection of these systems by a qualified inspector is strongly recommended. As required by law, any seller with a potable water supply that is not served by a public water system shall provide the Purchaser with an informational brochure developed by the Vermont Department of Health regarding Testing Water from Private Water Supplies within 72 hours of the execution of a contract for the purchase of the Property.
TYPE OF WATERSYSTEM The Property is connected to and serviced by (check all applicable boxes): Public or Municipal JCommunity Private Shared DDriven Point Well On-siteorsite
NDrilled Well Dug WellDSpring Lake/Pond ONone Don't Know other Water System Features
:Cistern/Reservoir/HoldingTank Water Softener/Conditioner
DUltraviolet Other:
Water Pipes are: MCopper JGalvanized Metal Lead JPVC(Plastic) JCombination
Age of Water System:3O Yeavs
Reverse Osmosis Infrared Light NoneDon't Know
Don't Know
IfDrilled Well: Drilled by:S0e ovdSons
Gallons Per Minute (at time ofariller's report): 4
What is the annual cost for municipal waterS CONDITION OF WATERAND WATER SYSTEM
Tag #: 5 o Depth:26
Date Range:
Date of driller's report: Well drill ed Metered YES
Has the water been tested for coliform bacteria? MYESNODON'TKNÌW If"Yes," when?-5I)
By whom? V+ Dept dt Iealth Results:
Has any other water quality or water chemistry testing been done?YES MNODON'T KNOW
IfYes." when? By whom?
Waler softener YESNO If"Yes," VOwn Rent If rented, from whom:
Results:
NO
Dekoed Monthly Rental Fee:
Are you aware of low pressure in your water system?YES ENO
Has your water supply ever run out or run low? YES DNO If"Yes," describe:
Does the water have any odor, bad taste, cloudiness or discoloration?YES KNO If Yes,"" describe in detail:
Describe in detail any other problems you have had with your water system, including water quality or quantity:
Seller's Initials
4/7
Purchaser's Initials
FL
Effectuve 1/1/2023 - CopyrnightO Vermont Association of REALTORS® NoDON'T KKOW
Page
34Y
VR-041 Rev. B
Not
5. SEWER/SEPTIC/WASTEWATER SYSTEM
Special Notice: Sener septic and wastewater systems that are not public or municipal systems are not designed to Nrtom indetinitely and are aflected by many conditions about which Seller may have no knowledge or have any ability to contnol. ln addition, the usetul life ofthcse systems is aflectcd by the amount and type of use, soil conditions, maintenance, the inherent design of these systenns and many other lactors. Seller makes no warranty or representation whatsoevrr that these systems will operate or continue to function for any period of time. Inspection of these systems by a qualified inspector is recomnmended. State and local permits may be required for sewer, septic and wastewater systems.
IPE OF STSTEM The Propety is connected tognd serviced by (chcck appropriate boxes): ubic Municial Sewer Sy stem ShardOn-site septic/wastewater system or-site septic/wastewater system
Sie lank New or Altemate T'echnology (explain technology) ting lankskessnolDSewage Pump Dry Well DAGrae oher DDon't Know Ifother, please cxplain:
What is the annual ost of municipal/shared sewer? $
Iate
Conventional disposal arca Mound System disposal area Doehhil
Date Range:
ONDITION QF SISTEM if other than public or municipal sewcr/wastewater system, answer the following: om installed:
1994
If Na where is ir?
Is the system entirely on your Property? MYEs ONo DON'T KNOWw
Has the sy stem been repaired since you have owned the Property? YESs VNO If"Yes," when?
What was done?
Tye of septic tank:
Concrete DMetal
Septic tank capacity (in gallons)
Date Septic Tank Last Inspected? ta4
FiberglassOther(describe)
By whom?
Don't Know
Don't Know
DDon't Know Reports of last inspection/pumping attached: YES DNO
Date Septic Tank Last Pumped? 4 Don't Know By whom? PPeohevia
lf roquircd by a State of Vermont wastewater permit, have required periodic maintenarke/inspections been completed? UYesNo
If so, date of most recent service
Cost: $
By whom:
To your knowiedge. is any portion of the system in need of repair or replacement?DYES NOIf"Yes." describe in detail:
Has the property been occupicd as a primary residence for at least 181 days during any one calendar year between December 31l, 1986 and Docember 31, 2006? NYES NO DONT KNOW
6. ADDITIONAL INFORMATION CONCERNING THE PROPERTY
Is Seller currently occupy ing the Property? If"No," how long has it been since Seller occupicd?
Are any property or development rights (e.g. conservation easements to Land Trusts, ctc.) owned by others? If"Yes," by whom:
Is property enrolled in Vermont's Current Use program?
Has Seller received written notice of any violations of local, state or federal laws, building codes and/or zoning ordinances affecting the Property?
Are there any property tax abatements, land use value appraisal, land use tax stabilization agreements or other specialproperty tax arrangements applicable to the Property ?
If the house was built after December 31, 1997, is a Residential Building Energy Standard (RBES)certification available?
Docs the property have Urca-Formaldehyde Foam Insulation?
Does the Property have Asbestos and/or Asbestos Materials in the siding, walls,
plaster, flooring, insulation, heating system?
Has the Property been tested for Radon Gas?
If-Yes," when?
Has Seller received notice that the Property willbe reassessed by any taxing authority during the next 12 months? By whom?
Has paint containing lead been used on the Property?
Ducs the Property have evidence of mold?
IfYes," what has been done about the mold?
Results:
(e h
Scller s lnitials
Efliecuve l12023 -CoynghtC Vermont Assocaalion of REAL. TORS®
Puge S/7 Purchaser's Initials TMYES OYES YES NO NO JYES NO YES DYES NODON'T KNOW LNO JYES NO DYEs NO YES |O DYEs No |DON'T KNOW DONTKNOW DON'T KNOW DONT KNOW DONTKNOW VR-041 Rev. B
Are youaware of uny ofl-site conditions in your neighborhood/community that could atleet the value or desirability of the Property, such as noisc, proposcd major new devclopment, relocation or m jor construction of rouds or highways, proposcd zoning changes, ctç.? I"Yes."explain in detail: Townwil We droppi roat hight byaleet Is there any intestation by pests that aflect the propcrty? If"Yes," cxplain:
(o) Doou have any knowledge of' any damage to the Property caused by pests? (p)Is the Poperty currently under warranty or other coverage by a pest control company?
() Dyou know of any temite/pest control reports or treatments for the Property in the last tive ycars?
()
(s) Further explanation of answers to any of the above:
(a)
(c) Does the Property have any audio and/or video surveillance or recording equipment? IfYes, willsaid cquipment be active during showings? Yes
7. CONDOMINIUMS/ SUBDIVISIONS/ HOMEOWNERS ASSOCIATIONS
Is the Property part of a condominium or other common interest ownership association or is it subject to covenants, conditions and restrictions (CC&R's)? If"Yes," Condo docs or CC&R'S attached?
(b) Is there any defect, damage, or problem with any common elements or common areas? If "Yes" describe below.
Is there any condition or claim which may result in an increase in assessment or fees? If "Yes" describe below.
(d)|Are pets allowed? If yes, what is allowed?
(e)Are there any rental restrictions?
(0Are there any homeowners' association dues affecting the Property? If"Yes," amount:S
(g)
(i)
Are there any special assessments on the Property? If"Yes." amount: S
Purpose of special assessments: No
Years or term remaining on any outstanding special assessments:
Are there any current actions, disputes or lawsuits pending between the homeowners/ condominium owners' association and any other parties? If *Yes," describe below.
Do you know of any violations of local, state, or federal laws or regulations, condominium rules or CC&R's relating to the Property? If "Yes," describe below.
Contact person/manager for condominium/homeowner association: Name: Phone number/e-mail:
Further explanation of any of the above:
(m) (n)
te
Seller's Initials Monthly Quarterly Yearly OMonthlyJQuarterlyDYcarly
Effective 1/n/2023 -Copy nghtC Vermont Assoc1alion of REALTORSQ Purchaser's Initials Page 6/7 NO OYES UNO DYEsVo YES NO DON'T KNOW OYEsNODON'T KNOW YES MNO DON'T KNOw YESVNO DYESVNO DYEsNO YES OYESNO OYES NO IYESUNO DONTKNOW DON'T KNOW NO IYES NO LYESDNO DDONT KNOW DON'T KNOW DON'TKNOW DON'T KNOV DONT KNOW VR-041 Rev. B
IS THERE ANTTHINGELSE THAT SHOULD BE DISCLOSED AB0UT THE CONDITION OF THE PROPERTY? (In ans ering this quc_Hon, you should be guided by what you would want to know about the condition of the Property if you were buying 1t.)
MDoN'T KNOw OF ANYTHING ELSE. If"Yes," explain:
SELLER'S STATEMENT: Seller is providing the information in this report to reduce the likelihood of DISPUTES Or LEGAL ACTION conceming the sale of the Property. The information provided herein does not constitute any warranty, express or implied, by Seller about the Propery orany featureof the Property. Seller hercby authorizes any real estate agentto providea copy of this report to any prospective buyer. IN DELIVERING THIS REPORT TO ABUYER OR PROSPECTIVE BUYER, NO REPRESENTATION 1S MADE BY ANY REAL ESTATE AGENT THAT THEY HAVE ANY INDEPENDENT OR PERSONAL KNOWLEDGE ABOUT THE CONDITION OF THE PROPERTY, THAT THEY HAVE MADE ANY INQUIRY OR INVESTIGATION ABOUT THE CONDITION OF THE PROPERTY OR ANY OF THE INFORMATION PROVIDED IN THIS REPORT BY SELLER OR THAT THEY HAVE VERIFIED THE
INFORMATION PROVIDED IN THIS REPORT BY THE SELLER. Seller acknowledges that the information provided in this report is correct to the best of Seller's knowledge as of the date signed by Seller.
BUYERPROSPECTIVE BUYER ACKNOWLEDGES RECEIPT OF A COPY OF THIS REPORT ON THE DATE SET FORTH BELOW. BUYERPROSPECTIVE BUYER UNDERSTANDS THAT THIS REPORT PROVIDES INFORMATION ABOUT THE PROPERTY MADE BY THE SELLER AS OF THE ABOVE DATE. IT IS NOT AWARRANTY OF ANY KIND BY SELLER ORANY REAL ESTATE AGENT. THIS REPORT IS NOT A SUBSTITUTE FOR ANY PROPERTY INSPECTION. BUYER/PROSPECTIVE BUYER MAY OBTAIN A PROPERTY INSPECTION, HOWEVER, ANY SUCH INSPECTION MUST BE BY WRITTEN AGREEMENT WITH SELLER. BUYER/PROSPECTIVE BUYER UNDERSTANDS THAT THERE MAY BE MATTERS RELATING TO THE PROPERTY WHICH AR NOT ADDRESSED IN THIS REPORT. Seller:
Seller: "(Signature) (Signature) (Signature) (Signature) 4A9-24
Effective 1/12023 -Copy rightC Vermont Association of REALTORS®
Purchaser: Purchaser: Purchaser:
Purchaser: Page 7/7 (Signature) (Signature) (Signature) (Signature) Date Date Date Date
OVEsDNo
Date Date Date
Seller: Seller:
Date
VR-041 Rev. B
