## TRANSIMITTALof OMAH ALEA D SIT E SOI LREMEDIATIO NFIL EFOLDE R
SAID# : ^0 ^ Date : 

# MJLI L L L Address : . \N{ o 7< ^ ^^ O ^T ? Remediatio nContractor : Coasta l Environmenta l Grou p Year : ^ l { SOI LREMEDIATIO N PROPERT Y FIL EFOLDE RDOCUMENT S D 

### Vide o o f propert y (DVD ) 3026210 9 

### Executiv e Summar y 

# I EPA'provide dproperty sketc h Superfun d

L . ' 

### SignedAcces s Agreement fo r subject property SignedAcces s Agreement(5 ) fo r adjacen t propert y -er' ^ Restoratio nAgreemen t x-? ^ Settlemen t document s (i.e. , fo r damag e o r t o replac e plants , etc. )

• ^e ^Confimiatio ndat a



### y ^ Photoglyph s ^r ^ S^Tjlrf^Jtw ^ ^kOh-r^J^ , "^ ^ ^y ^ As-built sketc h ^— " Satisfacloi y restoratio nsigne db y Property Owne r ',j Propert y close-out check lis t signedb y EP A "G ^ Descriptioii o f area s no t meetin g RO D cleanup criteri a &—Utilit y clearance s rcL^ ^ Propert y informatio nfro mDougla s Coimt y Assessor' s Office [ ' D • _ 

### n 

# ' J 

# i

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# ^ v Propert yAcces s Checklis t PropertylD ; 2^L|( ^ Propert y Address : ^q^ ^ VWASV 

### n n WOR K STARTED WORKCOMPELTE D ON ; ON ; / / / /

Address : 

## Phone;(qQ p q<^y ^ ^p^ 9 Fax ! Cell/Pager : Renter : Phone : Fax ; Cell/Pager ; Additional Information ;

D Notificatio nLette r S Acces s Agreemen t Ijfl

^ Restoratio nAgreemen t D Topso U SampUn g (if appUcable ) D Disposa l SampUn g (if appUcable ) D Garde nSamplin g (i f appUcable ) ^ UtiUt y Clearanc e ^ Video/Photo s (Before ) D Video/Photo s (During ) D Video/Photo s (After) D Video/Photo s (30-Day ) M Propert y Completio nAgreemen t D FinalRepor t Sent ; ' / / Siened ; S ftM/U Signed : S /^/ll
_ / / / / / / CaUed : / / 

## On:(Q_//^/i L On ; / / On : / / On : / / 

## Signed ; S_/25/l L Issued : / / By ; By ; By ; By ; By : By : By ; By ; By ; By ; By ; By : By ; Ai r Moiutorin g (a s appUcabl e r~l Communit y IZ ] Cre w Results : On ; / / 

### By : 1

• Conununity Results ; D Cre w On : / / By ;

r~l Commiuut y Results ; \Z \Cre w On : / / By :

Omah a Lea d Sit e_ 

### Dougla s County Accoun t In^'-matio n Pag e 1 of2
Dougla s County , Nebrask a Propert yRecor d - R140345000 2 Prin t Repor t ViewInteractiv e GI S Ma p I Informatio n i s vali d a s of 2010-8-3 0 Treasurer' s Ta xRepor t 

## I Wc wrtsiut e - ^ - > - > Subdivisio n Sale s Searc h I I Owne r ! R AN D W CORPORATIO N I 561 6 FORTS T I OMAH AN E 68104-000 0 I Propert yInformatio n Ke yNumber : \ 034 5 000 2 1 4 Accoun t Type : | Residentia l Parce l Number : j 140345000 2 114 6 N 2 0 S T Parce l Address : OMAH AN E 68102-000 0 Lega l Description : HORBACH S 2N D AD D LO T6 BLOC K7 -E X S 4 8 E 5 9 FT - LOT5 & 1/ 2 VA C ALLE YAD J & S 1 2 F TLO T6 IRRE G Valu e Informatio n Lan d Improvemen t Tota l 201 0 $400.0 0 

### $0.0 0 $400.0 0 200 9 $400.0 0 

### $6.00 $400.0 0 200 8 $400.0 0 

### _$0.0 0 $400.0 0 200 7 $400.0 0 

### $0^ 0 $400.0 0 200 6 $400.0 0 

### $0^ 0 $400.0 0 200 5 $400.0 0 

### $0.0 0 $400.0 0 Lan d Inform a tio n Acre s S F Unit s I Dept h Widt h Vacan t 0.1 4 6384. 0 0. 0 

### 133. 0 48. 0 I Ye s J
.

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# dCtf ^ Ms-Buil t Drawin g ^ OLS# : 2540 9 DAT E EXCAVATED:8/8/1 1 DAT E USEP ASIGNE D OF F 8/26/1 1 

# coAST ^ Omah a Lea d ARE ASODDEN : 753 8 

# Environmenta l Group , Inc
. Superfun d Sit e 2540 9 

# liJiill l Omah a Lea d Sit e Exterio rPaint Sit e Sketc h Q Goo d Q Poor Samplin g Addrets : 1146N20S T p ] No t paint Sampt e Numbe r Lea d Concentratio n Sampl e Collecte d LA B Fir m Sample s Collecte d fPf i Dt!).fl 3 RyA3CPXA-g540 9 H ­ . pp m D D Date : S-ll-O ^ RYBSCPXA-2540 9 F2 

### -iSi
. . pp m ET D Time : ll-b R f¥ ^ RYCSCPXA-2540 9 RYDSCPXA-2540 9 B 1 B 2 2-T& 1 2392 ­ pp m pp m G T [3 f 

## n D Sample s Analyze d RDZOePXA-2540 9 B2 ­ " pp m D 

## n XR F Unit : tOA^Z
. Book ; 2^ 1 nOilOCPX A2540 0 Ry2SePXA-2D40 9 -G Z -P E " "

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. Numbe ro fSample s = | 3 | | C i I Staf f 

## ns w Legend : F 1 = Fron t Left
. F 2 = Fron t Right , B l = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden
. P Z = Pla > A l quadrant s ar

a a

s vivwed fro m th e itrect , facin g propert y

CONCRET E DRI P ZON E EXCAVATE D QUADRANT S EXCAVATE D
ARE AREPUVCE D WIT H ARE ALEF TBAR E ARE AREPLACE D WIT H SO D ROCK/MULC H 

### CONTRAC T# : EP-R7-09-0 6 COASTA L ENVIRONMENTA L GROUP , INC
.

# I !...., < i 

## 2540 9 Exterio rPain t Omah a Lea d Sit e • Goo d Sit e Sketc h n Poor % Samplin g Address : 1146 N2 0 ST P j No t pain t Sampl e Numbe r Lead Sampl e LA B Sample s Collecte d Concentratio n Collecte d Fir mfPf i Dfe.Qt ^ RYA3ePXA-2540 9 Pt - Date : S-Il-o^ ^ RYBSCPXA-2540 9 F2 

## .-2Lii
. Time : ll-b Rfv A RYCSCPXA-2540 9 8 1 Samples Analyze d RYDSCPXA-2540 9 8 2 XR F Unit : IOf?,6iZ
. Book : 2^ / Date : O i O i • C ^ Numbe ro f Sample s = | 3 | Legend : F 1 = Fron t Left , F 2 = Fron t Right , B l = Back Left , B 2 = BS L Al

l quadrant s ar e a s viewe dfromth e street . Tf

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## Nto^V Re\':i«) S Creaed : OS-Kov-O S CM47i) l 01.2 3( ^ 

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pp m 

## D D D Date : Time : S'll-O ^ ll-bf i f¥ A RYCSCPXA-2540 9 RYDSCPXA-2540 9 8 1 8 2 

### 2-Ta i pp m 

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# a ' D D Sample s Analyze d RDZ3CPXA-2540 9 nGZ6CPXA-2S40 0 B2 ­ 6 Z " • " pp m pp m 

## D D 

# a XR F Unit : \Oe>(a Z Book : ZH I Date : ( o O l • C ^ RPZSCPXA-2540 9 P 2 " " pp m 

# n n Tim e 

## A t Numbe ro fSample s = | 3 | | Q | Staff : 

## MS W Legend : F 1 = Fron t Left , F 2 = Fron t Right , 8 1 = Bac k Left , B 2 = Bac k Righ t D Z = Dri p Zone , G Z = Garden , P Z = Pla ; Al t quadrant s ar e a s viewe d fro m th e street , facin g propert y

ReN'Mi S Creaiid : iM-NovJ * 1:144711101.2 3{ '^ 

## 2540 9 J Omah a Lea d Sit e Exterio rPain t Nort h Arro w 

### Sit e Sketc h • Goo d Q Poo r Samplin g Address : 114 6 N 2 0 S T 1 3 No t pain t Sampl e Numbe r RYA3CPXA-2540 9 Ft Lead Concentratio n

~ pp m Sampl e Collecte d 

## D LA B 

## D Finn : Date : Sample s Collecte d fPf i pf e , flC^ S -ll-oC \ RYBSCPXA-2540 9 F 2 -^-3 3 pp m 

## D Time : ll-O B Q ^ RYCSCPXA-2540 9 RYDSCPXA-2540 9 8 1 8 2 2-T& 1 2.^9 Z pp m Do m 

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# a n Sample s Analyze d RDZ3CPXA-2540 9 nOZOOPXA-2540 0 B2 ­ G £ -

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. G Z = Garden , PZ = Pla ; Al l quadrant s ar e a s viewe d fro m tt wstreet , facin g propert y 

# ENTERE D H A 

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## Nto4 t Rev2iM 8 i^reaed : OS-NovJif t 1.14471) 1 01.2 3—-4 '

\ • ./ fCOASIA I 1 I 0 u f I
. ( 

## Ccnseri l foi Act^tij^is 'ic ^ l-idpt-iil y RIGH T OF ENTR Y TO PREMISE S 

### Granlo i (Ih e property ' owner ) consent s lo an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA ) oi it s authorize d representatK'es , collectivel y th e Grantee , to ente ran d perfor m certai n environmenta l respons e activities upo n th e followin g describe d premises : 'N - , i /o , 

# ^O^D3__
_ Owner' s Name : Daytim e e Phone

Phone : :

Addres s ofPropert y covere d bythi s Agreement : 

# BULJL^CI^:
. PURPOS E OF RESPONS E ACTIVITIE S 

### Th e EP A is requestin g acces s to collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s oflea d an d ma ypos e a healt h hazard
. Th e area(s ) wil l be excavate d to remov e contaminate d soil
. Th e remove d contaminate d soi l wil i be replace d wit h clea n material s an d th e are a wil l be restore d to its origina l condition
. Thi s wor k is bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e ofCoasta l Environmenta l Group , contracte d byUSEPA , wil l contac t th e Granto rin-perso n to discus s th e wor kto be perfomned , th e Granto rwil l hav e an opportunit y to revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e it begins
. Onc e th e wor k is finished , th e Granto rwil l be aske d to revie wth e wor k an d confir m tha t itis complet e an d meet s wit h th e Grantor' s approval
. Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Atha t th e propert y ha s bee n remediated
.
ENVIRONMENTA L RESPONS E ACTION S 

### Bysignin g thi s Acces s Agreement , th e Granto r is grantin g th e EPA , it s employees , contractor s an d subcontractor s th e righ t to ente rth e property , at al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e ofperformin g th e work
. Thi s acces s shal l remai n in effec l unti l th e wor k ha s bee n satisfactoril ycompleted
. Th e Granto rals o agree s to :

Pag e 1 of2

# 1 ^ v~ ­ 

# \y^/ y * \ • • J C 0 fc 5 1 Ai 

### Remov e obstruction s includin g boats. , trailers , vehicles , playscap e ilems , vt'oo d piles , dc ^ houses , etc ; < Remov e flowe rbt^lb s o i plant s tha t th e Grento i o i Ih e Gianloi' s tenan t ma yVi'is h t o save ;

' Wate ran d maintai n leplacemen l vegetation , includin g fertilize rapplication , a s necessary ' subsequen t t o a n initia l Vv'aterin g perio d b yEPA ; « Abid e b yhealt h an d safet yguidanc e provide d b yEPA ;

' I fth e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l fo racces s t o th e propert yt o perfor m th e work
. » • Allo wvideotapin g and/o rphotographin g o l th e property
. AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo fth e wor k activities , o rwit h an y o fth e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o fsai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (402 ) 991-119 9 

# 7 ^ I gran t acces s t o m ypropertie s O ' d o no l gran t access t o m ypropertie s 

# .iTjoM&Mmzl'jt^i i Signatur e Dat e Signatur e / / Dat e
Q I woul d lik e t o b e presen t durin g an ysamplin g tha i i s required
.

Pag e 2 o f2C O AS 1 AL c» * e u • . IN I 

## Re^kJCcUo n Aorpnrn^.ii i Th e purpos e o f thi s aj-'reemcn l i s l o provid e amutual agreemen t a s l o condiiion s o f ih e properl y prior t

o remedialio naciiviiies
. Thi s will als o serv e a s documeniatio nfo r ihe purpos e o f assurin g iha i resioralio n aciiviiie s are compleie dlo ihe satisfactio no f ih e propen y owner an dthe Unite d.Siaie s Environmenlai Protectio nAgenc y (EPA)
.

Property ID : 

# "^f ^ 

# D> V Prop e rty Address : \ 

# M( p K\
. ;;)n5 ^ Owner : \J\<:^yO(X\te r V^Wen^r.. ^ Phone^4.Qr ) H?^^^MhZ2
. ^ 

### Onthe attache ddiagram(s ) indicate area(s ) l o excavate , surfac e structure s an dlandscapin g feature s an d acces s location(s ) to be usedby th e contractors . Indicate distances , depths , materia l types , eic
. Photographicall y andVideographicall y document ih e existin g condition s oflh e propen y an dIhe basemen ! i f necessary . Item s f o b e Remove d b yth e Owne rbefor e Star t o fRemediation : Th e removal , storage , disposal , anitfyo rretur n o fthes e 'Aim s i s th e Ovi'ner' s responsibility
. Item : 

# U^^^ e

Item s t o b e Remove d b yth e Contracto rDurin g Remediatio n an d No t Replace d 

### IItem :

Pag e 1 o fCOASTA L c < * o u r. I M r 

## lierti s t o B e Remove dB y Conttgcto r Durint. ; Remedifetio nan dRejgLace_ d

Landscfep e Inventor y Ite m Quantit y Uni t Condition/ 1 ype/Specie s Pre-existin g property area , 

# ^ V Quadrant.s ' tha i wil l b e excavated , tha i i s covere dwit hgrass . Numbe r o f tree s > 2 inch Eac h 

# a trunk diameter Numbe r o f tree s <- 2 inch Eac h trunk diameter ^ Numbe r o f SprinkJe r Zones , Contro l Valves , Eac h Timers , Heads , etc . 

# ^D^ ^ Attac hasketc ho f th e sprinkle r layout
. Numbe r of andsiz e o f eac hgarden/ flowe r bed Eac h area . Squar e Feet ^ Attac hasketc hof relativ e size s an d locations
. Agree dupo nvalu e of plant material s no l t o b e replace db v contractor . ( ^ Not e Ihi s valu e will b e use di o issu e aplan t vouche r l o Ih e property ' owner . Easemen t Area , to be Eac h 

# na^ c excavate d
Pag e 2 of
.Additiona l Comment s / Instructions : Th e cit yo fOmah a ordinance s ma yprohibi t yo u fro m usin g dir t o rgrave l area s o n you rproperi y e s driveway s o rvehicl e parkin g cress . Th e Environmenta l Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi l underlyin g a grave l o rdir t are a o n you rpropert ytha t yo u ma yb e usin g a s a drivewa yo rvehicl e parhin g area . I fthi s i s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o fsoi l doe s no t mea n tha t an yillega l drivewa yo rparkin g are a o n you r propert yi s mad e legal
. T o Ih e contrary , yo u ms yb e cite d b yth e cit yi fyo u us e a grave l o rdir t are a a

s a drivewa yo rparkin g area , no t withstandin g an yremova l o rreplacemen t o fsoi l b yth e EPA
.

I fyo u hav e an yquestio n abou t legalit yo fa cerlai n drivewa yo rparkin g area , yo u ma ycontac t Ih e cit yo fOmaha' s Plannin g Departmen t at (<02 ) 444-5150
. 

# 0> leas e chec k thi s bo xi fyo u understan d th e informatio n outline d above
. 

# 4 Vleas e discar dc i cxnu^-ltos h

Ayj 8 Chec k th e bo xi fOwne rdoe s no t wan t CE G f o documen t interio rfoundatio n wall s an d possibl e ^pre-existin g damage
. B ycheckin g thi s bo xCE G 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 Q ) ^ d o no l agre e

Owner' s Sisnalur e Dal e Conlraclor' s Signaiur e Dale Pag e 3 o f

### BVID# ZSCfo l XR F PROPERTYSAMPL E SHEE T Dat e 

# V~^ - o Addres s 

### .//V. » A J g o Projec t Omah a Lea d ARR A Sampl e tim e am/p m XR F iD # 

### S^oSi-s ^ sampl e lengt h 3 0 se c

Shol # Readin g Sampl e are a Shot # Readini j Sampl e are a 

# 2H

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Averag e is7 , ^ I ^ Averag e 

# /y:l/ o Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e Shot # Readin g Sampl e are a Shot # Readir^ g Sampl e are a Dept h Dept h Averag e Averag e
RETES TAREA S Shot # Readin g Sampl e are a Shot # Readin g Sampl e are a Dept h Dept h Averag e Averag e Signatur e » , 

# Prin t %^fio,l 4

# J Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1 

## Certificat e of Verificatio n XL3t-3902 2 Readin g No 37 Mod p e Soi l Tim e 2011-0 8 Duratio n n 90.4 0 Unit s pp m a 2 Sigm a Valu e Sequenc e Fina l Flag s AVERAG E Av g of 34-3 6 ADDRES S 114 6 n 20 st QUADRAN T Bl DEPH T 6" XR F TEC H N. LOPE Z MIS C confirmatio n NOT E confirmatio n

pp m Erro r Pb 62.00 4 14.38 6 Supervise d By : 

# \_ai ^ 

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# Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1 

## Certificat e o fVerificatio n XL3t-3902 2 Readin g N o 3 4 Mod e Soi l Tim e 2011-08-0 9 09:4 2 Duratio n 30.1 2 Unit s pp m Sigm a Valu e 2 Sequenc e Fina l Flag s BVI D 2540 9 ADDRES S 114 6 n 2 0 s t QUADRAN T B l DEPH T 6 " XR F TEC H N
. LOPE Z MIS C confirmatio n NOT E confirmatio n
pp m ±Erro r P b 60.89 7 ±14.30 8 Supervise d By :

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e 

### Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 63.67 2 Supervise d By : 

## Certificat e o f Verificatio n

3 5 Soi l 2011-08-0 9 09:4 3 30.1 0 pp m 2 Fina l 2540 9 114 6 n 2 0 s t B l 6 " N
. LOPE Z confirmatio n confirmatio n

± Erro r ± 14.65 3

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 61.44 3 Supervise d By : 

## Certificat e o fVerificatio n

3 6 Soi l 2011-08-0 9 09:4 4 30.1 8 pp m 2 Fina l 2540 9 114 6 n2 0 s t B l 6 " N
. LOPE Z confirmatio n confirmatio n

± Erro r ± 14.19 8

# f " v 

# u Therm o

SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s AVERAG E ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 17.37 9 

## Certificat e o fVerificatio n

4 1 Soi l 2011-08-0 9 09:4 7 90.7 1 pp m 2 Fina l Av g o f38-4 0 114 6 n2 0 s t B 2 6 " N
. LOPE Z confirmatio n confirmatio n

± ± Supervise d By : 

# .CU
.

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , MA0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 18.72 2 Supervise d By : 3 8 Soi l 2011-08

­ 30.2 3 pp m 2 Fina l 2540 9 

## Certificat e o fVerificatio n

0 9 09:4 5

114 6 n2 0 s t 8 2 6 " N
. LOPE Z confirmatio n confirmatio n

±Erro r ±10.80 5

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

pp m P b 18.94 9 Supervise d By : 

## Certificat e o fVerificatio n

3 9 Soi l 2011-08-0 9 09:4 6 30.2 9 pp m 2 Fina l 2540 9 114 6 n2 0 s t 8 2 6 " N
. LOPE Z confirmatio n confirmatio n

± Erro r ± 10.91 2

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E

P

b Supervise d By : 

## Certificat e o f Verificatio n

4 0 Soi l 2011-08-0 9 09:4 7 30.1 9 pp m 2 Fina l 2540 9 114 6 n2 0 s t 8 2 6 " N
. LOPE Z confirmatio n confirmatio n

pp m Erro r
< LO D 16.39 0

## ^^!Z''> » jO k \ Omah a Lea d Site—Fixe d Pric e EP-R7-09-0 6 \^^ ^

S Coasta l Environmenta l Grou p Inc
. >9 i '^ipROt*'' ^ V~*^(fwww.coa8talhazmat.co m COASTA L EN«IIONHEIITA l S lOUP , IH C 

# EXECUTIV ESUMMARY : BVID #25409-( l 14 6 N20 ST )
py ] N o Issue s o r Concern s | ^ Issues/Concern s
Detail Explanation :

### Propert yCompletio n Agreemen t
I h u tijiiccmeni rkicumtnl ^ ih e comp>Clio n o l remedia l acnviiie s pcflbimcfln n m ypioperl yM y.iigiifllui t ivil i designat e iha i I a m satisfie d wit h ili e resioralio n o fm ypiopeily
. an d iha i n o iicm." : ar e n i t)uesiioii<
. now . 0 1 a l sn yinn e m ih e fiiiuie
. excep t ihos e iiem s liste d below , i fan y Propert yfO : ^^HL;' ^


### Phone : i\OX

- \\<^-^ ' ^Oly y Resloratio n Item s i n Question : /tern : llem :

Ifem : Ifem :
Additiona l Comments :

b u ' "t'""' " I r vI o ra I io n U cnmplrl fd , ricrp i «s nnitr i I rio nn i aiiiF C itupmun n i t Mni|ilcicr i 

# 7 f 

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Dal e fiinl i »ilo i s Sil^ahiii ' Oai r

### » 

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# ^ 1 EP APropert y Clos e Ou t Eorm 

# '-"^-•-^.SHQ. I ^Sr.;^t^dcBiSiSM^s^' ^ Datc/TliDc : 9^-1^-f I 7^^ ^ Quad i Excavated ; P|~H V
_ ContrjBcto r Crou p 

# iSu^ll S
Excivatlo B Cenen l \ Ye s r^i o 1
.

Ifnecessary , wer e th e correc t qiiBdrant(s ) excavate dan dreslored ? 2
.I f necessary , wer e th e correc i area s o f dri p zon e excavaie dao drestored ? • / Cradlp g So dan dVcuctolioi i Y H N u Doe s th e gradin g aroun d(he pcrimeie r oflh e hous e inexcavaie darea s generall y slop e awny fromth e house ? 

# y. . 2
.Ha s so dbeenlai di nal l area s iha l wer e excavaied ? / .i
.

Doe s th e so dappea r to b e generall y health y andgrowing ? (Onl y evaluat e if inspecte da t a3 0 / da y tim e period ) — 4
.Ansodde darea s generall y rir man devenl y graded ? f>

. Ar e th e joint s betwee nth e so dstrip s generall y tight ? (Onl y evaluat e i f inspecte da i a3 0 da ; tim e period ) 6
.Wa s th e property grade dsuc hthai waie r wil l not poo l onth e prnpeny* ' 

# sy. i I 7
. Wa s damig e t o landscapin g o r plant maierial i avoided ? 

# .l y Gales
. Fence * aa dRcuiBln g Wall i V « .N( i I I
. D o gale s openan dclos e freely? (I f applicable ) 2
.Wer e al l gate s o r fence s lake ndow ndurin g restoratio nactivitie s reinsulled ? (I f applicable ) ?.
.Wa s damag e l o gate s o r fence s avoided ? (I f applicable ) / _ 4
.Wa s damag e t o retainin g wall s avoided ? (Ifapplicable ) Foundatiott , SidiaK an dCaller s Ye s .No I
.Wa s damag e l o th e sidin g o r tri mavoided ? 

# y 2
.Wa s damag e t o ih e foundaiio navoided ? Wa s damag e l o window s avoided ? 

# y 4Wa. s damag e t o window s o r doo r screen s avoided ? 

# / I f
.Wa s damag e t o downspout s or downspou l extension s avoided ? Sidewalk s an dDriveway s (Concrete ) Vc s N o I
.Wa s damag e t o drivewa y surface s avoided ? 1
.Wa s damag e t o walkway surface s avoided ? 

# yJ > 

### OM-ner s comments :



## ! Inspectio nnotes :

Removal andrestoratio naclivale s complete includin g ihe 30-da y sodwarranry : IrT ARepresentativ e ?!^^* 1 Date : 8l?^l'l.
_