Form Lrec - Disclosure Of Information On Residential Sewerage Treatment Systems
ADVERTISEMENT
1ADDENDUM to PROPERTY DISCLOSURE DOCUMENT FOR RESIDENTIAL REAL ESTATE
DISCLOSURE OF INFORMATION ON RESIDENTIAL SEWERAGE TREATMENT SYSTEMS
Property Description (Address)
____________________
City, State, Zip
____________________
S
: Complete this disclosure document if city, town, or municipality waste
ELLER OF RESIDENTIAL REAL ESTATE
treatment does not serve the property described herein.
Improperly treated or partially treated residential sewage poses significant risks to human health and to the
environment. Untreated or poorly treated water contains parasites, bacteria, and viruses that cause serious
disease. D.H.H Title 51, Subsection 707 states: “Individual sewerage systems shall be kept in service and in
serviceable condition sufficient to insure compliance with this code and in order to avoid creating or contributing
to a nuisance or public health hazard.”
HEALTH HAZARDS AND DISEASES
Gastroenteritis – severe inflammation of the intestines that may cause severe vomiting and diarrhea leading
to dehydration.
Severe infection – result of contact with untreated water where there are cuts or abrasions on the skin.
Hepatitis – serious infection of the liver that can lead to long term illness.
A residential sewerage treatment system that is not properly operated or maintained may also result in the
pooling of improperly treated water at the surface. Health risks also exist from mosquito infestations
that may cause West Nile Virus, Encephalitis, and other diseases. Improperly operating systems
may be subject to fines and penalties under Louisiana law.
□
□
□
□
1. Sewerage treatment is supplied by:
Private Utility
Onsite System
None
Not Known
□
□
□
2. If there is an onsite system, it is:
Septic Tank
Advanced Treatment System
Oxidation Pond
□
□
Other
Not Known
a. Is there more than one system on the property, e.g. guest house, outbuildings, barns, etc.?
□
□
□
Yes
No
Not Known
b. If yes, answer all questions for each system on a separate sheet of paper and attach to this addendum.
□
3. What is the approximate age of the system? _______________
Not Known
□
a. The original permit was issued by _____________ on ________ (date).
Not Known
(A non-permitted system of any type is illegal, regardless of age or type.)
□
b. The system was last inspected by _____________ on ________ (date).
Not Known
□
□
c. An inspection report is attached.
Yes
No
□
□
□
d. Has the health department inspected the system?
Yes
No
Not Known
e. If yes, on what date was the inspection? ________ (date)
4. The system was last pumped out when? ________ (date)
□
□
□
5. Is the system an Advanced Treatment System?
Yes
No
Not Known
□
a. If yes, name the manufacturer. _________________________________
Not Known
(The name of the manufacturer may be located on the data plate on the tank, compressor, or control box.)
b. If yes, do you have an ongoing maintenance agreement with a licensed maintenance provider?
□
□
□
Yes
No
Not Known
(D.H.H. Title 51, Appendix A, Section A:6, 12 requires that perpetual
maintenance be provided on Individual Mechanical Sewerage Treatment Plants.)
□
□
□
6. What type of discharge is used?
Surface Drainage
Drain-Field
Spray Irrigation
□
□
□
□
Artificial Drain-Field
Drip Disposal
Over Land Surface Flow
Below Ground Pipe to Ditch or
□
Stream
Not Known
(D.H.H. Title 51, Subsection 717 prohibits the discharge of the effluent from septic
tanks into street gutters, surface ditches or streams.)
□
7. If the discharge is from over land flow or from a pipe, where does it drain? ____________
Not Known
□
□
□
□
□
8. What type of tank is used?
Metal
Concrete
Fiberglass
Other
Not Known
□
□
□
9. Does the system have a compressor/aerator?
Yes
No
Not Known
a. If yes, where is it located? _______________________
□
□
□
b. If yes, is it in working order?
Yes
No
Not Known
LREC 01/01/05
Seller’s Initials: _____ _____
Purchaser’s Initials: _____ _____
1 of 1
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal