Ceilings, walls and floors free from serious defects such as severe bulging or leaning, large holes, loose surface materials, severe buckling or noticeable movement under walking stress, missing parts or other serious damage. Roof structure firm.. Roof weathertight. Exterior wall structure and exterior wall surface free from serious defects such as leaning, buckling, sagging, cracks or holes, loose siding, or other serious damage. Condition and equipment of interior and exterior stairways, halls, porches, walkways, etc., such as not to present a danger of tripping or falling.. INTERIOR AIR QUALITY Unit free from dangerous levels of air pollution from carbon monoxide, sewer gas, fuel gas, dust, and other harmful pollutants. Adequate air circulation throughout unit. At least one openable window or other adequate exhaust ventilation of bathroom area.. WATER SUPPLY Unit served by approved public or private sanitary water supply..... Item is ACCESS Unit useable and capable of being maintained without unauthorized use of other private SITE AND NEIGHBORHOOD Site and neighborhood free from serious adverse environmental conditions, natural or manmade, such as dangerous walks, steps, instability, flooding, poor drainage, septic tank back-ups, sewage hazard or mudslides; abnormal air pollution, smoke or dust; excessive noise, vibration or vehicular traffic; excessive accumulations of trash; rodent or vermin infestation; or fire hazards.. SANITARY CONDITION Unit is free of vermin and rodent infestation....... 00 A modified form shall be used if local variations from the Acceptability Criteria have been approved by HUD Name of Family. Address Telephone Name of Owner or Other Entity Authorized to Lease Address ... Telephone ------ INSTRUCTION: Place check mark in appropriate box to indicate presence if the facility or item is present in the dwelling unit, and where applicable, if the facility or item is in proper operating condition. Fill in other blanks and boxes as indicated. 39-082-75- -22 Ceilings, walls and floors free from serious defects such as severe bulging or leaning, large holes, loose surface materials, severe buckling or noticeable movement under walking stress, missing parts or other serious damage. Roof structure firm.. Roof weathertight.. Exterior wall structure and exterior wall surface free from serious defects such as leaning, buckling, sagging, cracks or holes, loose siding, or other serious damage.. Condition and equipment of interior and exterior stairways, halls, porches, walkways, etc., such as not to present a danger of tripping or falling.. INTERIOR AIR QUALITY Unit free from dangerous levels of air pollution from carbon monoxide, sewer gas, fuel gas, At least one openable window or other adequate exhaust ventilation of bathroom area.. WATER SUPPLY Unit served by approved public or private sanitary water supply.. Item is ACCESS Unit useable and capable of being maintained without unauthorized use of other private SITE AND NEIGHBORHOOD Site and neighborhood free from serious adverse environmental conditions, natural or manmade, such as dangerous walks, steps, instability, flooding, poor drainage, septic tank back-ups, sewage hazard or mudslides; abnormal air pollution, smoke or dust; excessive noise, vibration or vehicular traffic; excessive accumulations of trash; rodent or vermin infestation; or fire hazards.. SANITARY CONDITION Unit is free of vermin and rodent infestation. CONGREGATE HOUSING This group of items is applicable only if unit is located in congregate housing, defined as housing connected with which there is a central dining facility to provide meals for the occupants.) Suitable space and equipment in central dining facility to store, prepare and serve food in sanitary manner. Adequate facilities and services in central dining facility for the sanitary disposal of food wastes and refuse, including facilities for temporary storage where necessary, i.e., garbage cans.. LEAD-BASED PAINT I hereby agree that the dwelling unit shall be in compliance with HUD Lead Based Paint Regulations, 24 CFR, Part 35, issued pursuant to the Lead Based Paint Poisoning Prevention Act, 42 U.S.C. 4801, and the dwelling unit has been treated in accordance with such HUD regulations. If the property was constructed prior to 1950, I hereby certify that this Family upon occupancy will receive the notice required by HUD Lead-Based Paint regulations and procedures regarding the hazards of lead-based paint poisoning, the symptoms and treatment of lead poisoning and the precautions to be taken against lead poisoning and that records showing receipt of such notice by the Family will be maintained for at least three I hereby certify that the foregoing report correctly represents the condition of the above-identified dwelling unit. If this report discloses any deficiencies, I further certify that they will be remedied by the date set forth in the Request for Lease Approval for inspection by the issuing agency. |