CONTRACT # EP-R7-06-04

 

ASW Associates Inc. 

Omaha Lead Site Remediation, Omaha, NE 

EPA 

ASW Associates Inc Certification for Property Closeout 

BVIO 48396 Property Address 5030 S 20th

 Street 

Field Work Started 23-Oct-06 Field Work Completed 2-Nov-06 

Summary: 

The excavation was performed in compliance with the work plans and specifications. 

The F2 quadrant was excavated to a depth of 12 inch. 

The 81 quadrant was excavated to a depth of 6 inch. 

The drip zone was excavated to a depth of 12 inch. 

Verification samples confirmed that the cleanup standards were met. 

Verification samples were taken from bottom of excavation.

 

The site was backfilled with materials which meets contract specifications. 

The backfill was compacted to acceptable standards. 

Sod placements and site restorations were conducted in compliance with work plans and 

specifications. 

Analytical data provided is post excavation at the bottom of the excavation for confirmation 

purposes. 

40258591 

Comments: 

None SDPEKFUNI) RECORDS . 

Jan Prawdzik ASW Project Manager 

Name Title Date Signarore 

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Jj. jfr f\ "7O 

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CONTRACT # EP-R7-06-04 

ASW Associates Inc. 

Omaha Lead Site Remediation, Omaha, NE 

EPA 

Analytical Result Summary 

OLS ID: 48396 

Property Address: 5030 S 20"th 1 Street 

XRF Results Lab 

Sample ID Avg. Results 

(ppm) (ppm) 

48396-DE-B1-06 67.4154.3 NA 

48396-DE-DZ-12 164.7165.3 NA 

48396-DE-F2-I2 559 ±93 NA 

Jan Prawdzik ASW Project Manager 

Name Title Date "Signature 

Sample Designation 

OLSID-DE-Location-dd 

OLSID is a particular residential property ID from which the sample is collected. 

DE = During and Post Excavation 

Location of the sample as follows, 

Fl = Front Yard (I" Quadrant) 

Bl = Back Yard (I* Quadrant) 

F2 = Front Yard (2nd Quadrant) 

B2 = Front Yard (2nd Quadrant) 

DZ = Drip Zone 

PZ = Play Zone 

GA = Garden 

EA = Easement 

dd describes the depth from which the sample was collected. 

NA = Not Applicable 
&EPA

 

Remediation/Excavation Contract (ASW) 

EPA Property Close Out Form 

Property #: Property Address: "> ?-O $ t 

Date/Time: Jl Owner's Name: peh>b>'€-

Quads Excavated: fT~T$ , 6 I -/ PZ Contractor Croup 

Excavation General Yes No 

1 . If necessary, were the correct quadrant(s) excavated and restored? / 

2. If necessary, were the correct areas of drip zone excavated and restored? 

^ 

Grading Sod and Vegetation Yes No 

1 . Does the grading around the perimeter of the house in excavated areas generally slope away 

from the house? i/ 

2. Has sod been laid in all areas that were excavated? \S 

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day time period) s 

4. Are sodded areas generally firm and evenly graded? y 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) >/ 

6. Was the property graded such thai water will not pool on the property? •/ 

7. Was damage to landscaping or plant materials avoided? / 

Gates, Fences and Retaining Walls Yes No 

1 . Do gates open and close freely? (If applicable) y 

2. Were all gates or fences taken down during restoration activities reinstalled? (Ifapplicable) s 

3. Was damage to gates or fences avoided? (Ifapplicable) / 

4. Was damage to retaining walls avoided? (Ifapplicable) s 

Foundation, Siding and Gutters Yes No 

1 . Was damage to the siding or trim avoided? S 

2. Was damage to the foundation avoided? S 

3. Was damage to windows avoided? s 

4. Was damage to windows or door screens avoided? s 

5. Was damage to downspouts or downspout extensions avoided? •s 

Sidewalks and Driveways (Concrete) Yes No 

1 . Was damage to driveway surfaces avoided? -/ 

2. Was damage to walkway surfaces avoided? t/ 
Owners comments: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranty: 

EPA Representative ,6L, j&., Date: ,, 
Contract No: EP - R7 - 06- 04 VST) Property Closeout Agreement @) Omaha Lead Superfund Site 

OLSID Property Address ^\ ^*sf 

be.bb1*' Property Owner / Is the Resident the Owner fQ, Yes D No 

Compliance Statement: 

U.S. Environmental Protection Agency (EPA) or its authorized representatives, (or its contractors), to enter 

and conduct environmental restoration services for the Omaha Lead Site. 

Your cooperation in giving EPA/ASW permission to access your property during the removal/restoration 

phase is sincerely appreciated. This document certifies that all work performed at this property was 

completed in accordance with the contact specifications and EPA requirements. 

If you have questions or need additional information please contact the EPA Public Information Centers at 

(402) 731-3045 or (402) 991-9583 or the EPA Office of External Programs at 1-800-223-0425. 

Additional Comments by EPA and/or ASW: 

CONTRACTOR CERTIFICATION 

Jan Prawdzik ASW Project Manager 

Name Title Date Signature 

Property Owner Section 

This agreement documents the completion of remedial/restoration efforts at the property to my satisfaction 

$3 I agree that restoration is completed at my property 

D I Do Not Agree: Comments: 

(jtV+t'ijft"' ' L\^4^LfJ--^ j /// OpfoC, Property Owner's Signature ' Date 

^MM vC^i/Uxwttf fer^ /!/ o?l ' r>(o 

EPA Representative Signature ' Date 
• \ 

l

c Page 1 of 

Omaha Lead Site 

Omaha, NE 

U.S. Environmental Protection Agency Region VII 

Residential Yard Soils 

Environmental Restoration 

Services 

esta forma esparto I pur lave -223-042: 

Grantor (the property owner), consents to and authorizes the United Sates Environmental Protection Agency (USEPA) 

or its authorized representatives (or its contractors), the Grantee, to enter and perform certain environmental response 

activities upon the following described premises. For further information please contact EPA at 1-800-223-0425. 

Property Access Granted By IV ) 

(Property Owner Signature) / \ (Date) I 

NOTE: Granting permission DOES NOT necessarily imply your property will be remediated at this time. 

PROPERTY INFORMATION 

(10 be completed bv resident ami/or properlv own 

Resident Name: KL Owner D Renter 

Residence Address: 5b3 O S . 

(CITY) (STATE) (ZIP) 

Property owned by: 

Owners mailing address:_ S. 

Owner's telephone number— Home: *JO'2.-2(2.- tf-j *f ( Work: 

Age of Home? _ pQ_ years How long have you lived here? / Q years 

Has the exterior been painted or covered with siding since 1978 ErYES D NO 

Has the interior been painted or covered since 1 978? BYE S D NO 

Total number of occupants: ^*—_ List Ages: r« fl\*~ V"T~_S 

List ages of occupants under 6 years old who play in the yard for 5 or more hours per week: \c) f 

Comments: 

AUTHORITY FOR ENVIORNMENTAL RESPONSE ACTIONS 

The activities to be implemented by EPA under this agreement are pursuant to Section 104 of CERCLA, 42 U.S.C. 9604. EPA's right of access to the 

property for in Section 104(e) of CERCLA, 42 U.S.C. 9604 (e), which provides entry for, "determining the need for response, or choosing or taking 

any response action under this title, or otherwise enforcing the provisions of this title." 

Access Attempts: 

First: Second: Third:

 
List of existing Conditions pg. of 

Property Address: 

Owner: PEJJo^ O/^/vcAgZ. Date: O8//JO,/0

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Description: 

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Owner Signature: ASW Associates Inc 

Print & Sign <? Priift & Sign 
Omaha Exterior Paint North Arrow Lead Site Owner Name: Sit fj] Good e Sketch Address: *5 O 1 »>o S. .ao­ n Po^r 

Phone: H: W: 0^4ot paint 

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Lead Sample Samples Collected Sample Number LAB Concentration Collected Firm: /^I^S R/4 Jrf^ 

RYASCPXA- \\ <§ 2$ V*F1 CSA.0 L»om nfl, n Date: / 2. / it 1 &<4 

RYBSCPXA-l\%3^l, ,F2 ^r )Q Pom MX n Time: \\\ 1 '^ 

RYCSCPXA-\_^3$)^ „ B1 \ S I —> oom r7| n Samples Analyzed RVDSGPXA — B2 — pom | I/ D 

RDZSCPXA-^%3G\l. ^PDZ I I ^L "7 PPrn R n XRFUnit: ^ \\ Book: \0& 

RGZSCPXA — GZ — ppm [~l n Date: I^ -in- r^4 

RPZ3CPXA­ — P2­ — ppm |~I n Time: " VM ' 

Number of Samples = | ^ I [A] Staff: Por~\ 

V 

ENTJBEED 

2004 

Omaha Lead Site 46130