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Appendix D <br /> <br />https://www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • Use your preferred relay service • Available in alternative formats <br />c-rem3-01a • 1/13/21 Page 2 of 8 <br /> If there are multiple residential units, indicate how many units: When was building constructed: 1979 <br /> Type of insulation used in building: Foam board Elevators or lifts: Yes No <br /> Basement/Lowest level depth below grade: 10 (feet) <br />Observed basement characteristics (Check all that apply) <br />Frequency of <br />basement/lowest level <br />occupancy Full time Occasionally Almost never <br />Bedrooms in the <br />basement/lowest <br />level? Yes No If yes, are the bedrooms occupied regularly? Yes No <br />Basement type Full Partial Slab Other: <br />Floor materials Concrete Dirt Stone Other: <br />Floor covering Uncovered Covered Covered with: Most basement spaces have a carpeted <br />floor, with one room in the northwest corner <br />having a partially tiled floor. Mechanical <br />rooms have uncovered floors. <br />Concrete floor Unsealed Sealed Sealed with: <br />Foundation walls Poured Block Stone Other: <br />Basement finished Unfinished Finished Partially finished <br />Basement wetness Wet Damp Seldom Moldy <br />Sump pump present Yes No If yes, was water present: Yes No <br />Are there any crawl <br />spaces present? <br /> Yes No If yes, describe the crawl space floor conditions (earth, concrete, etc.) and <br />construction (walls, use, connectivity to building, etc.) and illustrate location on the <br />attached grid plans: <br /> <br /> <br /> <br /> <br />Have there been any <br />building additions? <br /> Yes No Describe addition construction including how it ties to the existing floor plan (footings, <br />slab connectivity, etc.) illustrate locations of additions on the attached grid plans: <br /> <br /> <br /> <br /> <br />Thickness of the concrete floor slab in the lowest level(s): Approx. 6 inches <br />Soil type present beneath the building: Silty sand <br />Is there evidence of saturated or high moisture conditions beneath the floor slab? Yes No <br />If yes, explain: <br /> <br /> <br /> <br /> <br />Indicate sources of water supply sources (i.e., drinking, irrigation, etc.) and type of sewage disposal <br />(Check all that apply) <br />Water supply: Public water Drilled well Driven well Dug well <br />Sewage disposal: Public sewer Septic tank Leach field Dry well <br />81