Ga. Comp. R. & Regs. 620-6-.03
OFFICIAL GEORGIA WOOD INFESTATION INSPECTION REPORT
COMPANY NAME ___________________
LICENSE NO. _______________________
ADDRESS _______________________________________
TELEPHONE NO. ____________________
DATE OF ISSUANCE ________________
SELLER ____________________________
INSPECTOR ________________________
FILE NO. ___________________________
PURCHASER(S) ____________________
SCOPE OF INSPECTION
AN INSPECTION OF THE BELOW LISTED STRUCTURE(S) WAS PERFORMED BY A QUALIFIED INSPECTOR EMPLOYED BY THIS FIRM TO DETERMINE THE PRESENCE OR PREVIOUS PRESENCE OF AN INFESTATION OF THE LISTED ORGANISMS AND IS NOT INTENDED TO BE A STRUCTURAL REPORT. NEITHER IS THIS A WARRANTY AS TO ABSENCE OF WOOD DESTROYING ORGANISMS. THIS REPORT IS SUBJECT TO ALL CONDITIONS ENUMERATED ON THE REVERSE SIDE AND IS ISSUED WITHOUT WARRANTY OR GUARANTEE EXCEPT AS PROVIDED IN RULE 620-6-.03 OF THE RULES OF THE GEORGIA STRUCTURAL PEST CONTROL ACT OR SUBJECT TO ANY TREATMENT GUARANTEE SPECIFIED BELOW.
MAIN STRUCTURE __________________________________________________
OTHER STRUCTURES (SPECIFY) ______________________________________
ADDRESS OF STRUCTURE(S) _________________________________________
FINDINGS
INSPECTION REVEALS VISIBLE EVIDENCE OF: | ACTIVE INFESTATION | PREVIOUS INFESTATION | ||
Yes | No | Yes | No | |
SUBTERRANEAN TERMITES | ____ | ____ | ____ | ____ |
POWDER POST BEETLES | ____ | ____ | ____ | ____ |
WOOD BORING BEETLES | ____ | ____ | ____ | ____ |
DRY WOOD TERMITES | ____ | ____ | ____ | ____ |
WOOD DECAYING FUNGUS (Not Molds and Mildews) | ____ | ____ | ____ | ____ |
WHERE ANY AREAS OF THE STRUCTURE OBSTRUCTED OR INACCESSIBLE?
____ YES ____ NO
IF YES, LIST THESE AREAS (SEE ITEM 3 ON REVERSE SIDE OF FORM)
____________________________________
THE FOLLOWING CONDITIONS CONDUCIVE TO INFESTATION FOR WOOD DESTROYING ORGANISMS WERE FOUND AT THE TIME OF INSPECTION. THE LOCATION OF THESE CONDITIONS CONDUCIVE TO INFESTATION ARE INDICATED ON THE ATTACHED DIAGRAM:
____________________________________
____________________________________
REMARKS/ADDITIONAL FINDINGS:
____________________________________
____________________________________
NOTE: IF VISIBLE EVIDENCE OF ACTIVE OR PREVIOUS INFESTATION IS REPORTED IT SHOULD BE ASSUMED THAT SOME DEGREE OF DAMAGE IS PRESENT AND A DIAGRAM IDENTIFYING THE STRUCTURE(S) INSPECTED AND SHOWING THE LOCATION OF SUCH EVIDENCE MUST BE ATTACHED TO THIS FORM. EVALUATION OF DAMAGE AND ANY CORRECTIVE ACTION SHOULD BE PERFORMED BY A QUALIFIED INSPECTOR IN THE BUILDING TRADE APPROVED BY THE PURCHASER AND LENDING AGENCY.
TREATMENT
THE ABOVE DESCRIBED STRUCTURE(S) WAS TREATED BY THIS COMPANY AS FOLLOWS:
ORGANISM | TREATMENT DATE | CONTRACT EXPIRATION | TYPE TREATMENT (CHEMICAL BARRIER, BAIT, WOOD TREATMENT) |
SUBTERRANEAN TERMITES | ______ | ______ | ______ |
POWDER POST BEETLES | ______ | ______ | ______ |
WOOD BORING BEETLES | ______ | ______ | ______ |
DRY WOOD TERMITES | ______ | ______ | ______ |
WOOD DECAYING FUNGUS | ______ | ______ | ______ |
THE PRESENT TREATMENT WARRANTY(IES) IS:
__________TRANSFERABLE TO ANY SUBSEQUENT OWNER OF THE PROPERTY UPON PAYMENT OF A FEE ON OR BEFORE THE EXPIRATION DATE.
__________NOT TRANSFERABLE TO ANY SUBSEQUENT OWNER OF THE PROPERTY.
__________THE ABOVE STRUCTURE(S) ARE NOT COVERED BY A TREATMENT CONTRACT WITH THIS COMPANY.
THIS STRUCTURE HAS A CURRENT OFFICIAL WAIVER FORM ISSUED BY THIS COMPANY ______ Yes ______ NO
IF YES, A COPY MUST BE ATTACHED AS PART OF THIS REPORT.
CERTIFICATION
THIS IS TO CERTIFY THAT NEITHER I NOR THE COMPANY HAS HAD OR CONTEMPLATES HAVING ANY INTEREST IN THE PROPERTY INVOLVED, NOR IS ACTING IN ANY ASSOCIATION WITH ANY PARTY TO THE TRANSACTION.
____________________________________
SIGNATURE OF DESIGNATED CERTIFIED OPERATOR
____________________________________
SIGNATURE OF PURCHASER OR LEGAL REPRESENTATIVE ACKNOWLEDGING RECEIPT OF REPORT
COPIES TO:
_____ PURCHASER _____ MORTGAGEE _____ REALTOR _____ SELLER
Revised 04/14 - Replaces all previous editions
CONDITIONS GOVERNING THIS REPORT
Ga. Comp. R. & Regs. R. 620-6-.03
O.C.G.A. § 43-45-8.