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RESIDENTIAL
SELLER’S PROPERTY DISCLOSURE STATEMENT
Property Address or Tax ID # ______________________________________________________________________________________________ 66 ________________________________________________________________________________________________________ (the “Property”) 67 69210 Harness, Sisters, OR 97759
2.WATER
68
69
A.Household water
70
Public
Community
Private
Other ( specify ) ____________________
(1) The source of the water is ( select ALL that apply ):
4
71
(2) Water source information:
72 73 74 75 76 77 78 79 80
a. *Does the water source require a water permit?.......................................................................... Yes* No If yes, do you have a permit? .................................................................................................. Yes No b. Is the water source located on the Property? .............................................................................. Yes No *If not, are there any written agreements for a shared water source?...................................... Yes* No 4 4 4
Unknown Unknown Unknown Unknown
N/A
4
N/A
N/A
c. *Is there an easement (recorded or unrecorded) for your access to or
maintenance of the water source? .............................................................................................. Yes* No 4
Unknown
d. If the source of water is from a well or spring, have you had any of the
following in the past 12 months? ................................................................................................. Yes No 4
Unknown
N/A
Flow test
Bacteria test
Chemical contents test
81
e. *Are there any water source plumbing problems or needed repairs?........................................... Yes* No 4
Unknown
82 83
(3) Are there any water treatment systems for the Property? ................................................................ Yes No 4
Unknown
Leased
Owned
84
B. Irrigation
85
other irrigation rights for the Property? .................................... Yes
No
Unknown
(1) Are there any water rights or
4
86
(2) *If any exist, has the irrigation water been used during the last five-year period?............................. Yes* No
Unknown
N/A
4
87 88
(3) *Is there a water rights certificate or other written evidence available? ............................................ Yes* No
Unknown
N/A
4
C. Outdoor sprinkler system (1) Is there an outdoor sprinkler system for the Property?..................................................................... Yes No 4
89
Unknown
90
(2) Has a back flow valve been installed? ............................................................................................. Yes No 4
Unknown
N/A
91
(3) Is the outdoor sprinkler system operable? ....................................................................................... Yes No 4
Unknown
N/A
3. SEWAGE SYSTEM 92 A. Is the Property connected to a public or community sewage system? .................................................. Yes No 93 B. Are there any new public or community sewage systems proposed for the Property? .......................... Yes No 94 C. Is the Property connected to an on-site septic system?........................................................................ Yes No 95 4 4 4
Unknown
Unknown
Unknown
(1) If yes, when was the system installed? ________________________ ....................................................................... See utility list
96
Unknown
N/A
97
(2) *If yes, was the system installed by permit?..................................................................................... Yes* No 4
Unknown
N/A
98
(3) *Has the system been repaired or altered?...................................................................................... Yes* No 4
Unknown
N/A
99
(4) *Has the condition of the system been evaluated and a report issued? ........................................... Yes* No 4
Unknown
N/A
100 101
(5) Has the septic tank ever been pumped?.......................................................................................... Yes No 4
Unknown
N/A
If yes, when? ________________________............................................................................................................................... N/A 2024 by George's Septic
DC
MRD
Buyer Initials ________ / ________ Date __________________
Seller Initials ________ / ________ Date __________________ 09/25/2024
LINES WITH THIS SYMBOL Í REQUIRE A SIGNATURE AND DATE OREF 020 | Released 01/2024 | Page 3 of 7 No portion of this form may be reproduced without the express permission of Oregon Real Estate Forms, LLC | Copyright Oregon Real Estate Forms, LLC 2022 This form has been licensed for use solely by the user named below under the terms of the Oregon Real Estate Forms license agreement located at: https://orefonline.com/oref-forms-license-terms-and-conditions
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