DSS Inspection Report - NCDOT
DSS INSPECTION REPORT (Decent, Safe, and Sanitary)North Carolina Department of Transportation - relocation assistanceWBS Element: FORMTEXT ?????TIP/Parcel: FORMTEXT ?????Comparable No. FORMTEXT ?????Displacee FORMTEXT ?????Displ. No.: FORMTEXT ????? FORMTEXT ?Inspection of replacement dwelling/lot FORMTEXT ?Non-White FORMTEXT ?Owner FORMTEXT ?Inspection of Comparable FORMTEXT ?White FORMTEXT ?TenantProperty Address: FORMTEXT ?????Land Size: FORMTEXT ?????Yes FORMTEXT ?No FORMTEXT ?Is this more than typical land size? FORMTEXT ?????Listed Price:$ FORMTEXT ?????Yes FORMTEXT ?No FORMTEXT ?Is this a retained and moved house from Right of Way?Rent per Month:$ FORMTEXT ?????Rent verified by: FORMTEXT ?????Property listed with: FORMTEXT ?????Telephone FORMTEXT ?????Shown by Agent: FORMTEXT ?????Telephone FORMTEXT ?????INSPECTION DATAneighborhoodarea priceyesnoare following requirements satisfactory? FORMTEXT ?Residential FORMTEXT ?Upper FORMTEXT ? FORMTEXT ?Adequate heating system FORMTEXT ?Commercial FORMTEXT ?Middle FORMTEXT ? FORMTEXT ?Adequate habitable floor space FORMTEXT ?Industrial FORMTEXT ?Lower FORMTEXT ? FORMTEXT ?Adequate potable drinking water supplyDistance to schools FORMTEXT ? FORMTEXT ?Meets all State and local codesbuildingconstructioncondition FORMTEXT ? FORMTEXT ?Adequate, safe electrical wiring system FORMTEXT ?Single Family FORMTEXT ?Frame FORMTEXT ?Good FORMTEXT ? FORMTEXT ?Safe unobstructed means of egress FORMTEXT ?Duplex FORMTEXT ?Brick FORMTEXT ?FairKITCHEN FORMTEXT ?Apartment FORMTEXT ?Mixed FORMTEXT ?Poor FORMTEXT ? FORMTEXT ?Sink in good working condition FORMTEXT ?Mobile Home FORMTEXT ?Other FORMTEXT ? FORMTEXT ?Hot and cold water connectionsNumber of Rooms FORMTEXT ?????Age FORMTEXT ?????Years FORMTEXT ? FORMTEXT ?Connection to drainage systemLiving Area FORMTEXT ?????Square Feet FORMTEXT ? FORMTEXT ?Space for installing appliancesBedrooms FORMTEXT ?????Storage FORMTEXT ????? FORMTEXT ? FORMTEXT ?Utility service connectionBathrooms FORMTEXT ?????Basement FORMTEXT ?????BATHROOMSize of Garage FORMTEXT ?????Exterior Appurtanances FORMTEXT ????? FORMTEXT ? FORMTEXT ?Well-lightedHeatingElec. FORMTEXT ?Oil FORMTEXT ?Wood FORMTEXT ?N Gas FORMTEXT ?B.Gas FORMTEXT ? FORMTEXT ? FORMTEXT ?Vent fan (or window)Air ConditioningCentral FORMTEXT ?Or # of Window Units FORMTEXT ? FORMTEXT ? FORMTEXT ?Tub or ShowerCookingElectric FORMTEXT ?Natural Gas FORMTEXT ?Bottled Gas FORMTEXT ? FORMTEXT ? FORMTEXT ?Hot and cold waterWater HeatingElec. FORMTEXT ?Nat. Gas FORMTEXT ?Bottled Gas FORMTEXT ? FORMTEXT ? FORMTEXT ?Flush water closetWater SystemPublic FORMTEXT ?Private FORMTEXT ?Well and Pump FORMTEXT ? FORMTEXT ? FORMTEXT ?Connected to sewage disposalSewer SystemPublic FORMTEXT ?Private FORMTEXT ?Septic Tank FORMTEXT ? FORMTEXT ? FORMTEXT ?Affords privacy (solid door)Repairs FORMTEXT ????? FORMTEXT ? FORMTEXT ?does dwelling appears to meet d.s.s. standards? FORMTEXT ????? FORMTEXT ? FORMTEXT ?If NO, could the structure be made to meet the FORMTEXT ?????Standards with reasonable repairs FORMTEXT ????? FORMTEXT ? FORMTEXT ?If rental, are utilities included in rentcomments: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????This house was inspected and to the best of my knowledge does FORMTEXT ?does not FORMTEXT ?INSPECTION CERTIFICATION:meet requirements for D.S.S. The sole purpose of this inspection is to determine eligibility for replacement housing payment and does not constitute further warranties or guarantees by the Department of Transportation. You should have a home inspection made by a professional inspector. FORMTEXT ?????Inspector's SignatureDate: ................
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