120658
13-479
NOTE: Pursuant to: ARS§32-2321 (B) (1) (10), ARS§32-2324 (A) This form must be completed only by an Active Licensed Applicator or Qualifying Party.
NONE
6B. LIST ALL UN-INSPECTED STRUCTURES
Attic Joist Wall interiors
Pellets Describe evidence observed:
None
9. DAMAGE OBSERVED, IF ANY
See photos and graph addendum Proposal 10. ADDITIONAL COMMENTS(ALSO SEE PAGE 2.)
11. STATEMENT OF INSPECTOR
A. The inspection covered the readily accessible areas of the above listed structures, including attics and crawl spaces which permited entry. B. Special attention was given to those areas which experience has shown to be particularly susceptible to attack by wood destroying insects. C. Non-destructive probing and/or sounding of those areas and other visible accessible wood members showing evidence of infestation was
performed.
D. The inspection did not include areas which were obstructed or inaccessible at the time of the inspection.
E. Neither I, nor the company for which I am acting, have had, presently have, or contemplate having any interest in this property. I do further state that neither I, nor the company for which I am acting, is associated in any way with any party to this transaction.
12.A. SIGNATURE OF INSPECTOR 12B. INSPECTOR’S LICENSE NUMBER 12C. DATE
STATEMENT OF PURCHASER
I HAVE RECEIVED THE ORIGINAL OR A LEGIBLE COPY OF THIS FORM AND HAVE READ PAGE (1,2,3) OF THIS FORM.
6/19/2013 1B.
2. READ CAREFULLY PRIOR TO COMPLETING THIS OFFICE OF PEST MANAGEMENT (OPM) FORM
A. Visible evidence of wood-destroying insects was observed.
Type of Wood-Destroying Insects observed:
B. No visible evidence of infestation from wood-destroying insects was observed.
C. Visible evidence of infestation as noted in 8A. Proper control measures were performed on (date):
(Number of additional attachments to this report.) 11 Page(s) 3A. NAME OF INSPECTION COMPANY
Sample
5A. NAME OF PROPERTY OWNER/SELLER
340 Ranch
5B. PROPERTY ADDRESS (Street, City, ZIP) Sedona AZ 86336
House Crawl/ Slab Garage Slab 6A. INSPECTED STRUCTURES 3B. ADDRESS OF INSPECTION COMPANY (Street, City, ZIP)
3C. TELEPHONE NUMBER(Include Area Code) 8437
4. BUSINESS LICENSE # Alternative Pest & Termite Control LLC
P O Box 1865 Cottonwood AZ 86326 Office: (928) 567-7332
D. Visible damage due to was observed in the following areas: E. Visible evidence of previous treatment was observed. List evidence. (See also Item 20, page 2.):
Water Damage
I UNDERSTAND THAT THIS IS NOT A STRUCTURAL DAMAGE, FUNGI/MOLD REPORT, OR A WARRANTY AS TO THE ABSENCE OF WOOD-DESTROYING INSPECTSION AND CAN CONSIDER ASSESSMENT BY A LICENSED STRUCTURAL CONTRACTOR OR FUNT/MOLD INSPECTOR FOR ANY STRUCTURAL DAMAGE OR FUNGI/MOLD CONCERN.
CONDITIONS CONDUCIVE TO INFESTATION
15. WOOD TO EARTH CONTACT (EC) Yes No (If YES, check mark and explain conditions conducive)
Comments:
16. EXCESSIVE CELLULOSE DEBRIS (CD) Yes No
Evidence of surface water draining toward house Floor level or planters at or below grade Wood siding below grade
Stucco at or below grade
Joists in crawl space less than 18" above grade Other
17. FAULTY GRADES (FG) Yes No
Comments:
18. EXCESSIVE MOISTURE (EM) Yes No
19. INACCESSIBLE AREAS (IA)
Pest Control Inspector’s Additional Comments: 20. EVIDENCE OF PREVIOUS TREATMENT
BY THE INSPECTING COMPANY: Previous treatment is recorded for this property. At the Buyer's discretion, treatment records can be viewed at the inspecting company's local office with the property owner's permission.
Account Number: Target Pest:
Other:
Date of Initial Treatment: Warranty Expiration Date:
BY ANOTHER COMPANY: While evidence of previous treatment does exist, it is impossible for the inspecting company to ascertain if such treatment was properly performed. Further investigation is left to the Buyer's discretion to determine if such treatment was done properly and if a valid warranty exists against the target pest of such treatment.
6/19/2013 DATE OF INSPECTION Sample
PROPERTY NAME/ADDRESS
340 Ranch Sedona AZ 86336
AT THE TIME OF THE INSPECTION THE PROPERTY WAS:
(If YES, check mark and explain conditions conducive)
(If YES, check mark and explain conditions conducive)
Comments:
(If YES, check mark and explain conditions conducive) Standing Water
Sprinklers Hitting Structure Crawl Space/Water Leaking
Water Damage Water Stain
Improper Condensate Drainage
Bath/Shower/Toilet Leaking Plumbing Leaks Attic/Roof Leak Inadequate Ventilation Other Comments:
(If YES, check mark and explain conditions conducive)
Comments: Yes No Page 2 Attic -- All Attic -- Joists Attic -- Partial Plumbing Traps Floors Wall Interiors Enclosed Stairwell Dropped Ceilings
Sub/Crawl Space -- Clearance Sub Area/Crawl Space No Access
Areas Obstructed By Furniture or Stored Articles Other
Fence Abutting Structure Concrete Form Boards Porch Post
Pier Posts Porch Stairs Trellis
Plants/Trees Contacting Structure Other
(*) Other Wood Destroying Insects
(Note: Graph Not To Scale)
SU Subterranean Termites DR Drywood Termites DA Dampwood Termites BE Wood Destroying Beetles CA Carpenter Ants
OW Other Wood Destroying Insects (*) FG Faulty Grade
EC Wood To Earth Contact CD Cellulose Debris
PA Plantings Abutting Structure
OB Obstructions IA Inaccessible Areas IV Inadequate Ventilation PL Plumbing Leaks
SP Sprinkler Hitting Structure
WD Water Damage WS Water Stains RL Roof Leaks EM Excessive Moisture FI Further Inspection Needed X CODE SEE GRAPH PAGE (3) X CODE SEE GRAPH PAGE (3) X CODE SEE GRAPH PAGE (3)
X X CODE SEE GRAPH PAGE (3) X X X
Page 3
6/19/2013 Sample 340 Ranch Sedona AZ 86336
FINDING:(WS) Water stains noted on ceiling of Shed also on wood siding and fascia’s also
under patio. See Graph and Photo # 2,3,5,6,11,13
FINDING: (FG) (EC) Wood siding below grade. See Graph & Photo # 4,13
RECOMMEND: The soil be pulled away from the siding to expose the foundation
FINDING: (FG) Planter against home above floor level: See Graph and Photo #1
Recommend this be evaluated by a home inspector as whether this is a condition for moisture
problems no moisture condition found on inside wall at time of this inspection
FINDING: (WD) Water Damage to the wood patio. Bio Organic Growth found See Graph
and Photo # 8,9 RECOMMEND: That damaged wood be removed or cut back to clean wood
to correct this conditions small amounts of damaged wood may re infest the new wood in the
future
FINDING:(DR) Evidence of Drywood Termites noted in crawl.
RECOMMENDATION: That a Full home treatment for Termites be made by Alternative
Pest & Termite Control LLC. This comes with a 1 year guarantee with annual renewals to
be picked up by the buyer next year See Alternative Method Form for more options
Arizona Wood Destroying Insect Inspection Addendum
6/19/2013 DATE OF INSPECTION Sample
PROPERTY NAME/ADDRESS
