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Radon Level
*
Year Home was Built
*
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is there a Radon System Installed in the Home
*
Please Select
YES
NO
UNSURE
Is the Passive Radon System?
Please Select
IN FLOOR ACCESSIBE THROUGH ROOF
IN FLOOR ACCESSIBLE NOT THROUGH ROOF
NOT IN FLOOR IS ACCESSIBLE THROUGH ROOF
Foundation & Basement Information
Construction (Best describes)
*
Please Select
ALL SLAB ON GRADE
ALL CRAWL
RANCH BASEMENT
RANCH PARTIAL SLAB & BASEMENT
2-STORY BASEMENT
2-STORY PARTIAL SLAB & BASEMENT
SPLIT LEVEL PARTIAL SLAB & BSMT
SPLIT LEVEL PARTIAL CRAWLSPACE & BSMT
TOTAL BASEMENT SQ FT SLAB ON GRADE
Foundation Wall Type
Please Select
BLOCK
BRICK
CONCRETE
COMBO
Total Basement Square Feet
Slab on Grade Square Feet
If the Home has Part/or Concrete slab on Grade, are the Heating Ducts in the Concrete Floor?
Please Select
YES
NO
UNSURE
Basement Finished Space
Please Select
NOT FINISHED
ONE HALF FINISHED
COMPLETELY FINISHED
BASEMENT FLOOR UNCOVERED
ALL CONCRETE
ALL BRICK
CONCRETE AND BRICK
CONCRETE, BRICK, AND DIRT
Is there any Structures Installed to the Foundation that would Interfere with the Mitigation System to the Outside Wall of the Home?
Please Select
YES
NO
UNSURE
Anything else we should know about the Basement?
Garage & Crawl Space Information
Is there an Attached Garage?
Please Select
YES
NO
UNSURE
Number of Crawl Spaces?
Please Select
1
2
3
4
5
Length and Width of Each Crawl Space
Crawl Space is Accessible to Seal and is at least 36" from the Floor to the Rafters?
Please Select
YES
NO
UNSURE
Crawl Space Floor is
Please Select
DIRT FLOOR COVERED IN PLASTIC
DIRT FLOOR NOT COVERED IN PLASTIC
GRAVEL FLOOR COVERED IN PLASTIC
GRAVEL FLOOR NOT COVERED IN PLASTIC
CONCRETE FLOOR
Crawlspace Utilities
Please Select
NONE
FURNACE ON DIRT
FURNACE ON RAFTER
FURNACE ON CONCRETE BLOCK
WATER HEATER ON DIRT
WATER HEATER ON RAFTER
WATER HEATER ON CONCRETE BLOCK
FURNACE & WATER HEATER ON DIRT
FURNACE & WATER HEATER ON RAFTER
FURNACE & WATER HEATER ON CONCRETE
Crawl Space Moisture
Please Select
DRY, CLEAN & LEVEL WALL TO WALL
DAMP, CLEAN & LEVEL WALL TO WALL
DRY, CLEAN & NOT LEVEL WALL TO WALL DAMP, CLEAN & NOT LEVEL WALL TO WALL
PEIRS, DRY CLEAN LEVEL WALL TO WALL
PIERS, DAMP, NOT LEVEL, NEEDS CLEAN OUT
PIERS, DRY CLEAN, NOT LEVEL WALL TO WALL
PIERS, DAMP, CLEAN & NOT LEVEL WALL TO WALL
CONCRETE FLOOR
Anything else we should know about the Crawl Space?
Sump Pump
Please Select
UNSURE
NONE
SUBMERSIBLE PUMP SEALED BASEMENT
SUBMERSIBLE PUMP NOT SEALED BASEMENT
SUBMERSIBLE PUMP SEALED CRAWLSPACE
SUBMERSIBLE PUMP NOT SEALED CRAWLSPACE
PEDESTAL PUMP SEALED BASEMENT
PEDESTAL PUMP NOT SEALED BASEMENT
PEDESTAL PUMP SEALED CRAWLSPACE
PEDESTAL PUMP NOT SEALED CRAWLSPACE
Back Up Type
Battery, Water, Battery and Water,
Sump Pit Tile Information: how many 3" or 4" tiles come into the pit?
Please Select
NONE
ONE
TWO
THREE
Count only 3" and 4" tiles
Heating & Roof Information
Do you have Hot Water (baseboard) Heat in Basement?
Please Select
YES
NO
UNSURE
Do you have Radiant Heat in Basement?
Please Select
YES
NO
UNSURE
If Yes, How are the Baseboard Convectors Piped
What Type of Roof do you have?
BACK OF HOUSE
BACK OF GARAGE
SIDE OF GARAGE
OUTSIDE POTENTIAL "OUT" LOCATION
INSIDE "OUT" LOCATION
SECOND "OUT" LOCATION
PHOTOS OF ATTIC
PHOTOS OF BASEMENT/CRAWL/SLAB
MORE PHOTOS OF BASEMENT/CRAWL/SLAB
DEFECTS: CRACKS IN FLOORS, PERSONAL ITEMS, CHALLENGES TO WORK AROUND
MORE: DEFECTS: CRACKS IN FLOORS, PERSONAL ITEMS, CHALLENGES TO WORK AROUND
MORE: DEFECTS: CRACKS IN FLOORS, PERSONAL ITEMS, CHALLENGES TO WORK AROUND
SUMP PIT
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