## SOI LREMEDIATIO NFIL EFOLDE R SAID# : 3704 4 Date : Address : 532 5 N1 8 S t Remediatio nContractor : Environmenta l Restoration , LL C Year : _201 1 SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S Vide o o f propert y (DVD ) JSaeiox Q D After D Basemen t D Executiv e Summary (Fina l Report ) ^y f EPA-provide dproperty sketc h y f Signe dAcces s Agreemen t for subjec t propert y nSigne dAcces s Agreement(s ) for adjacen t propert y y y Restoratio nAgreemen t nSettlemen t document s (i.e. , for damag e o r t o replac e plants , etc. ) yy ^ Confirmatio ndat a Photograph s ^ f Before DCre w Photo s jz f Durin g Excavatio nD So d j/sO-da y So dD As-buil t sketc h Completio nAgreemen t signe db y Property Owne r 

# y Property close-ou t chec k lis t signe db y EP A nDescriptio no f area s no t meetin g RO D cleanu p criteria . Contaminatio nlef t behin d yy Utility clearance s Property informatio nfromDougla s County Assessor' s Offic e Property acces s checklis t 3026233 3 

### y ( Contac t Lo g
• Superfun d Envirormienta l RestOTationSignatur e Dat e

P ACO Rsignatvir e y Dat e

# EPA EP APropert y Clos e Ou t For m Omah aLea dSit e Propert y # : 3704 4 Propert y Address : 532 5 N1 8 S t Date/Time : Owner' s Name : PB M Asse t Quad s Excavated : B 2 Contracto r Group : Environmenta l Restoratio n(ER ) Excavatio nGenera l Ye s N o LI f necessary , wer e th e correc t quadrant(s ) excavate dan drestored ? 

## y 2 . I f necessary , wer e th e correc t area s o f dri p zon e excavate dan drestored ? 

### A/I T Gradin g So dan dVegetatio n Ye s N o 1 / house ? 2 . Ha s sodbee nlai dinal l area s tha t wer e excavated ? L ^ 3 . Doe s th e so dappear t o b e generall y health y an dgrowing ? (Onl y evaluat e i f inspecte dat 30-day tim e period) . 4 . Are sodde darea s generall y firman devenl y graded ? •- ^ 5 . Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte dat 30-day tim e period) . 6 . Wa s th e property grade dsuc hthat wate r wil l no t poo l o nth e property ? u ^ 7 . Wa s damag e t o landscapin g o r plan t material s avoided ? cy Gates , Fence s an dRetainin g Wall s Ye s N o 1 . D o gate s ope nan dclos e freely? (i f applicable ) 2 . Were al l gate s o r fence s take ndow ndurin g restoratio nactivitie s re-installed ? (i f applicable ) 3 . Wa s damag e t o gate s o r fence s avoided ? (i f applicable ) l y 4 . Wa s damag e t o retainin g wall s avoided ? (i f applicable ) tJH Foundation , Sidin g an dGutter s Ye s N o 1 . Wa s damag e t o sidin g o r tri mavoided ? 2 . Wa s damag e t o th e foundatio navoided ? 

## Jn^jiA. ^ /b4
­ 3 . Wa s damag e t o window s avoided ? 

# h i 4 . Wa s damag e t o windo w screen s o r doo r screen s avoided ? 5 . Wa s damag e t o downspout s o r downspou t extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e t o drivewa y surface s avoided ? 

## f^ ^ 2 . Wa s damag e t o walkway surface s avoided ? ^ Inspectio nnotes : 

# Ckej ^ s. d "> Spnn j t^i ^
Remedia l an drestoratio nactivitie s complet e includin g 30-da y so dwarranty : EP ARepresentative : 

## .^[t^Zy^y^/s'.H^.^J^j ^ Date : 

# /y^// /

### OMAH ALEA D SITE — EP-R7-09-0 5 ENVIRONMENTA L RESTORATION , LL C WWW.ERLLC.CO M



# EXECUTIV E SUMMARY : 3704 4 532 5 N 1 8 St



# N O ISSUE S O R CONCERN S ISSUES/CONCERN S
DETAI L EXPLANATION :

### Ogde nS t



## N 

# 532 5 N1 8 S t 

# ii i Printed : Nov 22 , 201 1 www.dcgis.org/dogi s 

# AL\ . X J . 1.—K J AXV—KJK*l. l Diggers Hotlin e O

f Nebrask a 

### Hom e Ticke t Ticke t Creatio n Creat e Anothe rTicke t 

### G o t o Hom e Pag e Sen d Emai l 

### Logou t

• YOU R TICKE T NUMBE R I S 2904915 . Origina l Cal l Date : 11/18/1 1 Time : 8:3 2 a m Op : TIM2418 6 Wor k t o Begi nDate : 11/22/1 1 Time : 8:4 5 a m State : NE County : DOUGLA S Place : OMAH A Address : 532 5 Street : N18T H S T Twp : 15 NRng : 13 E Sect-Qtr : 03-N W Twp : 16 NRng : 13 E Sect-Qtr : 34-S W Lega l Given : C Typ e o f Work : LEA D REMOVA L Locatio n o f Work : LOCAT E ENTIR E VACAN T LO T Remarks : FA X AL L CLEAR S TO : (402)451-106 9 : 3704 4 Compan y: ENVIRONMENTA L RESTORATIO N Contac t Name : TI M SUTTO N Alt . Contact : CEL L Phone : Phone : (402)451-131 4 x226 7 (402)306-234 7 

# i
Wor k Bein g Don e For : EP A Dept h o f Excavation : 2 4 INCHE S Corne r Lot : N Front : NRear : N Involve s Tunnelin g o r Horizonta l Borin g : N Explosives : N MUDO l OMAHACO F 0PPDGPR 5 QLNNEI C

Servic e Are a Utilit y Servic e Are a Nam e Contac t Phon e Number s Cod e Typ e MUDO l METROPOLITA N UTILITIE S SAND YMUDO l Day : (402 ) 50 4 - 782 3 DISTRIC T Emerg : (402 ) 50 4 - 797 0 OMAHACO F CIT YO F OMAHA - RICH/TRAFFI C Day : (402 ) 44 4 - 719 7 XDACITTI " CCVA/C D / ^ M A U A



### http://www.dhon.org/IRTHOneCall/Ticket/TicketCreation.aspx?ViewTicketID=89820 6 11/18/201 1ENVIRONMENTA L
RESTORATIO N 

# Question s t o answe ra t th e hous e 1 Doe s th e ma p matc h th e property ? MgjS > 2 I s ther e a doR ? r\c: a 3 I s ther e anythin g tha t nee d t o b e moved ? lik e a ca ro rboat?__{jO _ 4 Doe s th e propert yhav e eas yaccess ? \ i ^L5= > 5 I s th e propert yEasy , Norma l o rHard ? ^OSaS i 6 I fno . i s ther e a propert yw e ca n ge t acces s from? _ 7 I s soi l goin g t o hav e t o b e shuttle d out ? CN Q 8 I s th e propert yal l han d work ? CX Q 9 I s ther e a retainin g wail ? r\ o l b I s i t i n ha d shape ? 1 1 I s ther e unde rgroun d lin e t o th e garage ? > \ 0 1 2 I s ther e a sewe rclea n out ? \\o > 1 3 Istherean yhazard s i n th e yard ? P\f > 1 4 I s th e sidin g ol d o n th e house ? H n V^pyjl^T y 1 5 Tr yt o leav e th e tim e fram e ope n whe n w e wil l b e there ? (A Q 1 6 I fthe ynee d a notic e Mar k i t bi g o n th e map . Tryt o leav e i t a t a 2 4 hournotic e only ? 1 7 Wha t kin d material s ar e nee d fo rreplacement? . 1 8 I s ther e zoysi a gras s a t th e propert y( Re d fla g thi s property) ? (iC N 1 9 I s thi s propert yboarde rlin e o n routine ? (\c > 2 0 ( s ther e sentimenta l ite m b e awar e of ? Iv O 2 1 Ca n w e us e th e driveway ? 2 2 I s th e propert ylin e marke d i n th e excavatio n areas? . 

## 5'g"—U^;^rOi^$:i^uddb ^

## Contac t Informatio n Lo g SAfD # ^104 U Gorrtouiik - TOfY ^ Owner' s Name : ^ P^ ^ ^ ^^ . _ 

## Ce( / S^Q ^ H'^ l QS^ s 

# i j Propert y Address : 5*^2 8 V A• ^5 ^ '^Z 

### Attemp t t o contac t DateAim e Nam e 

# s-n-To w^tj\ o T S

## P I ^pert yAcces s Checklis t SAID : -anO^l V D WOR K STARTE D ON : Propert y Address : S^Tf j * ^ V^ ^ «^\i D WOR K COLMPELTE D ON : 0>vner:pfi ^ ^ ^ f^^r,,^CjC.r ^ Renter : Addres s Phone : Fax : Cell/Pager : 

## Phone : (^J Jf? f . O 5 g T "~ ~ Additiona l Information : Fax : L Cell/Pager :

KTAcces s Agreemen t Signed : S Il* f I \ f B y 

# M
^ Restoratio nAgreemen t Signed : 5 / /'f / i f B y 

## 1 . ^ ^ O ^

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Digital Photo s Befor e 

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• Vide o Propert y .\fte r O n B y nDigita l Photo s After O n B y 1 ^ Propert y Completio nAgreemen t 

### Signed : jJr/Jc/Ji B y 

# S ^ nFina l Repor t 

### Signed : / ! B y Additiona l Vide o o r Digita l Photo' s Taken : nVide o nDigita l Phot o O n: / ! B Y : Reason : nVide o nDigita l Phot o O n / / By : Reason : nVide o nDigita l Phot o O n: / / . By : Reason : nVide o nDigita l Phot o O n / / By : Reason :Froni:40 2 43 5 008 8 

### 0 5 1 1 10:0 3 #70 1 P.001/00 4 05/1J/201 1 TH U >!5 2 PA X B003/00 6 I- •.( 

## Consen t fo rAcces s t o PropertySAID^ ryiO|i ^ RfGH T O f E^^^^< Y T O PREMISE S 

### Grantor (the propert y owner) , consent s to an dauthorize s the Ujwte dState s Environmenta l ProtectionAgency (USEPA ) o r it s authorize drepresentatives , collectivel y th e Grante e t o ente r an dperfor mcertai nenvironmenta l respons e activitie s upo nth e followin g describe dpremises ; Owner' aName ; p g /V \/ H- ^ - ^ MiLy\^%^i^*y*^ * ^''*>'" " ^ ^ y^< ^ ~0 O K \ Ad«r«i : 552 5 *^
- V^'^Si V Address : Addreiseao f Propertk u Addreu : covere db y thi s Agre«mept : Address : Address' . PURPOS EOFlNVESnOATlO N 

### Th e purpos e o f th e remedial activitie s i s to remov e al l soil s a t th e propert y whic hare contaminate dwit hhazardou s substances , inparticula r leadat concentration s greate r tha no r equal to 40 0 part s pe r millio n(ppm) . REMEDXALAC170N S Th e environmental respons e action s t o b e perfomie do nsai dproperty may mclud e th e followin g activities : a .Takin g photogtaph s and/o r vide o o f th e property before , during , an dafter remedia l activities ; b .Locatin g equipment an dmachiner y on-sit e i npreparatio nfo r an di nth e cours e o f th e enviroiunental response ; c . Plannin g an dimplementin g th e remova l actio no no r near Grantor' s property , d

- Obtainin g sample s fromGramor' s property ; ^0{t£EM^Nl ' NO TT O l^rERf BR E Th e Granto r agree s not to interfere o r tampe r wit hany o f th e activitie s o r work done , or th e equipment use dt o perfor mih e activities , o r to undertak e an y action s regardin g th e us e o f sai d propert y whic hwoul dten dt o endange r (he healt ho r welfare ofth e Grantee s o r th e environment , ot

t

o allo w other s to us e th e property i nsuc h C D I d o no t gran t acces s to m y propertie s to m y propertie s
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### JX l Chec k thi s boxi fowne rdoe s no t wan t E.R . t o ente rth e resident s t o documen t interio r foundatio n wall s an d possibl e preexistin g damage . Bycheckin g thi s boxE.R . i s no t responsibl e fo ran ydamag e don e t o th e interio ro fhouse , includin g foundatio n crack s o rfissures .



# .0 1 agre e nI d o no t agre e 

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### Froni:40 2 435 0088 0 5 J[^1 1 10:0 3 #70 1 p.002/00 4 05A9/201. 1 TH U J:5 2 PA X SlOOd/OO S ( • 

## Restoratio n Agreemen t Th e purpos e o f thi s agreement i s to provide amutua l agreemen t a s to condition s o f propert y prio r t o contracto r activities . Thi s wil l als o serv e a s documentatio nfor th e purpos e o f assurin g that restoratio n activitie s ar e completedt o th e satisfactio no f di e propert y owne r andth e Unite dState s Environmenta l Protectio nAgency (EPA) . SAID : 

### 2>lO»4« 4 Propert y Address ; 5S)2 S 

## Kx
- 

# ty^^ . Owner : Phone ; Onth e attacheddiagram(» ) indicate area(s ) t o b e excavate danddept ho f excavation , locatio no f al l knov m utilities , subsurface features , sur&c e stmcture s andlandscapin g features , acces s locatioa(9 ) t o b e use db y contractor , andthe directiono f North , fadicate distances , depths , material types , etc . Indicat e digfta l photo s by referencing th e photo-lo g number wW i a

narro w indioatmg directio no f view . Item s l o b e remove db y Contreeto r an dno t f«ptac«d : I Item : "^ " --———^—— — Item : Item : litem :

Item : Item : Item :

Pag e 1 o f2Froiii:40 2 43 5 008 8 

### 05f[^1 1 10;0 3 #70 1 P.003/00 4 OS/lJ/ZOl l TH U 9'.5 2 ?A X E1005/00 S f f. ^ 

### Additiona l Comments / Inetruetiona :



# •^eyXoLC ^ txa' Aoy> d "^c A

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# zr i agre e 

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### Pag e 2 of Z

### Frora:40 2 43 5 008 8 12/0'''^01 1 10:1 4 #240 P.001/00 2 12/05/201 1 MO N17iI S PA X 0002/00 3 

# h ' IZ^i l PropertyCdmpletTonT^greemen t Thi s agreemen t documents the completio no f remedia l activitie s performedo nm y property . M y signature wi ddesignat e tha t I a msatisfie dv«t hth e restoratio nof m y property , an dtha t n o Hems ar e in question , now , o r a

t any tim e inth e future , excep t thos e item s liste dbelow , if any . SAID : 

# ^yo W Propert y Address : ^2J $ hi
- f^tkf f Oyi'ner : Pbode ; 

### Restoratio nItem s I nQueetton : Item : Item : Item : Item : Item : Kem : Additional Comments ;

KJ^iigr w rettorktioB^ b coiRplteed , except u iiot« t nI d o no t agre e restoratii ^ i s completed /0 I sgrc e restorativ e I s complet«d , excep t M a«t« d i 1 1 d » no t agre e rMtoretio nto corapletc H 

# ^^^- w CoatractoP s Signatur e Dat eL C4.t^ ^ 1 Vi . ~ J 

### Uougia s uount y Accoun t iniormaiio n Dougla s County , Nebrask a Propert yRecor d ­ R120380000 0 Informatio n i s vali d a s o f2011-3-3 1 Ne wFeatur e -•-•- • Prin t Repor t Vie wInteractiv e GI S Ma n

Treasurer' s Ta xRepor t Subdivisio n Sale s Searc h Owne r PB M ASSE TMANAGEMEN TIN C 120 1 N S T#10 2 LINCOL N N E 68508-000 0 Propert yInformatio n Ke yNumber : 038 0 000 0 1 2 Accoun t Type : Residentia l Parce l Number : 120380000 0 Parce l Address : Lega l Description : 532 5 N 1 8 S T OMAH AN E 68110-000 0 GOODLAN D LO T3 2 BLOC K0 4 0 X 12 0 Valu e Informatio n 201 0 200 9 200 8 200 7 200 6 200 5 Lan d $2,300,0 0 $2,300.0 0 $2,300.0 0 $2,300.0 0 $2,300.0 0 $2,300.0 0 Improvemen t $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 $0.0 0 Tota l $2,300.0 0 $2,300.0 0 $2,300.0 0 $2,300.0 0 $2,300.0 0 $2,300.0 0 Sale s Informatio n Sale s Date : 2005-07-1 9 Dee d Type : Price : Grantor : W D $2,225.0 0 IN AGROU P LL C Book : 200 5 Page : 08704 9

Grantee : PB M ASSE TMANAGEMEN T Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1994-07-2 6 Dee d Type : Price : Grantor : D $15,000.0 0 Book : 198 3 Page : 57 0


### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12. . . 4/13/201 1

### uougia s L^ouni y Accou miniormauu u Grantee : Valid/Invalid : Vali d Exclusio n Reason : 

### Sho wAl l Transaction s

Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 1 4800. 0 0. 0 120. 0 40. 0 Ye s



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12. . . 4/13/201 1

### Dougla s Count y Accoun t Informatio n TageToT T

Th e abov e ma p i s powere d b yGoogle , an d i s intende d t o provid e a genera l ide a o fa property' s location . I f yo u requir e a more exac t propertylocation , yo u ma yus e th e Interactiv e GI S Map s tha t ar e maintaine d byou r office .



### http://dougIasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12. . . 4/13/201 1ENVIRONMENTA L AS-BUIL TDRAWIN G OMAH ALEA D 3 SUPERFUN D SIT E .{ f '« < «o^' ' RESTORATIO N Contract # EP-R7-09-0 5 

### 3704 4 Exterio rPam t Nort h Arrow Omah a Lea d Sit e r~ | Goo d Sit e Sketc h r~ l Poo r r Samolin q Address : 532 5 N 1 8 S T F^ f No t pain t Sampl e Numbe r Lea d Concentratio n XR F LA B Sample s Collecte d RYASCPXA-3704 4 F 1 

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# • Fir m P F T^C . P R Ki A pp m RYBSCPXA-3704 4 F 2 Date : 

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# • • Date ; /2 . • Qg . - /£ > Time : 

### AC 2 Numbe ro f Sample s = | '- j | | ( ^ | Staff : 

### M<;u / Legend : F l = Fron t Left , F 2 = Fron t Rigftt , B l = Bac k Left , B 2 = Bac k Rigti t D Z = Dri p Zone , G Z = Garden , P Z = Pl a Al l quadrant s ar e a s viewe d fro m th e street , facin g propert y

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# J2 1 pp m pp m 

# n n D Fimi : ?f Xxl C Date ; Time : 

### nlllli n 1.-?>'>P K P 5 K A
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# a n Date : Time : I Z ­ 02 . • 1 

### A/- 1 Numt)e ro f Sample s = | ^ | | Q | Staff : 

# ns w Legend ; F l = Fron t Left , F 2 = Fron t Right , B 1 = Bac k Lett , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pl a A

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