Real Estate Environmental Hazard Disclosure Form

This Real Estate Environmental Hazard Disclosure Form is provided to inform potential buyers of known environmental hazards associated with the property. Sellers must complete the form accurately, disclosing any known hazards such as lead-based paint, asbestos, mold, or radon gas. Please review and sign accordingly to acknowledge the disclosed information.

Property Information

Property Address:
County:
Parcel Number:
Legal Description:

Seller Information

Seller Name(s):
Contact Information:
Agent/Broker Name:
Agent/Broker Contact:

Disclosure of Environmental Hazards

Lead-Based Paint

Presence of lead-based paint on the property (if built before 1978).
Known lead hazards (if applicable).

Explanation: The property was built in 1965 and may contain lead-based paint. No specific hazards have been identified.

Asbestos

Presence of asbestos-containing materials (ACMs) on the property.

Explanation: Asbestos-containing materials were identified in the attic insulation during a recent inspection. No known hazards have been reported.

Mold

Past or present mold infestations within the property.
History of water damage leading to mold growth.

Explanation: The basement experienced minor water intrusion in 2019, resulting in isolated mold growth. Remediation was conducted, and no further issues have been reported.

Radon Gas

Presence of radon gas in the property.
Previous radon testing results (if applicable).

Underground Storage Tanks (USTs)

Existence of underground storage tanks on the property.
Status of UST removal or compliance with regulations.

Explanation: An underground storage tank was removed from the property in 2008 in accordance with state regulations. No leakage or contamination was reported.

Contaminated Soil or Groundwater

Known contamination of soil or groundwater on the property.

Explanation: Soil contamination was identified near the southwest corner of the property boundary due to historic industrial activities in the area. No impacts to groundwater have been reported.

Hazardous Substances

Storage or use of hazardous substances on the property.
Compliance with regulations regarding hazardous materials.

Explanation: The property does not store or use hazardous substances. Compliance with all relevant regulations is maintained.

Acknowledgment and Signature

I, or we, who have duly signed below as the seller or sellers, do hereby declare and certify that all the information we have provided in this document, which is the Real Estate Environmental Hazard Disclosure Form, is accurate and true to the best of my, or our, knowledge and understanding.

Seller Signature

[Date]

Seller Signature

[Date]

Agent/Broker Signature

[Date]