Crumbling Foundations Testing

Before you begin the application, please have the following documents ready for upload:

Testing/Visual Inspection Results
Proof of Homeownership (e.g. mortgage statement, tax bill, for condos or PUDs proof of foundation ownership such as the declaration)
Documentation of Payment (receipt, canceled check, etc)

Beginning February 1, 2018 Visual inspections will be required to follow Testing Guidelines outlined by Department of Housing

Contact Information

First Name

Last Name

Primary Phone Number

Status updates will be sent to this email address.

Email Address

Confirm Email Address

Tested Address

Please enter the address of the home where testing was conducted.

Address
Start typing the street number and street to select your address. This will autofill your address information below.

Street Address

Apt/Suite Number

City/Town

State

Zip Code

What year was this home built?

Does this home share a foundation with any other home, condo or units? (check for yes)

List any other address which share the foundation

Mailing Address

Use my tested address as my mailing address.

Street Address

Unit or PO Box

City/Town

State

Zip Code

Testing Information

Please select the type of test conducted

Name of Lab/Company

Name of Contact/Engineer

Lab/Engineer Contact Email Address (if available)

Lab/Engineer Contact Phone

Invoice Total

Date Test or Inspection was Performed

Is the Engineer licensed?

Have you applied for or received reimbursement for a similar test on this foundation? (check for yes)

Please enter a brief description of the test and the amount received

Test Results

Please indicate the number of cores tested

Did the core test find pyrrhotite?

If available, what was the percentage of pyrrhotite found?

Did the test or visual inspection determine damage to the foundation?

Level of Damage

Location of Damage

Optional: Do you have any of the following in your house? (check off all those that you know)

Waterproofing on the exterior of the basement
Waterproofing in the interior walls
Gutters
Gutters with downspouts extensions 10 feet from the house
Capillary break between the footing and the foundation
Finished basement or partially finished basement
Footing Drains
Curtain or French Drain

Supporting Documents

(Please black out any sensitive information including account numbers, social security numbers, etc)
How to Upload

Testing/Visual Inspection Results

Proof of Homeownership (for condos proof of ownership of the foundation)

Additional Photos or Documents

Documentation of Testing Costs (e.g. invoice, canceled check etc.)

By checking this box, I do hereby affirm and certify that the above information is true and accurate to the best of my knowledge. I understand that any misrepresentation of information or failure to disclose information requested may disqualify my application. The provision of false information may subject me to the penalties provided by law.

As a condition of applying for and receiving reimbursement for testing costs through the Crumbling Foundations Testing Program funded by the State of Connecticut, any inspection or test results, including, but not limited to written reports, must be made available when the tested property is offered for sale, transfer, exchange or lease.

Please type your name as your electronic signature:

Reimbursement Application