TRANSIMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ^0 ^ 

Date: MJLIL LL 

Address: . \N{ o 7<^ ^^ O ^T? 

Remediation Contractor: Coastal Environmental Group Year: ^ l{ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

D Video of property (DVD) 

30262109 Executive Summary 

EPA'provided property sketch I

Superfund 

L . ' Signed Access Agreement for subject property 

Signed Access Agreement(5) for adjacent property 

-er'^ Restoration Agreemen t 

x-? ^ Settlement documents (i.e., for damag e o r to replac e plants, etc.) 

• ^e ^ Confimiation dat a 

y ^ Photoglyphs ^r ^ S^Tjlrf^Jtw ^ ^kOh-r^J^ , "^ ^ 

^y ^ As-built sketch 

^—" Satisfacloiy restoration signed by Property Owner 

',j Property close-out check list signed by EPA 

"G^ Descriptioii of areas not meeting ROD cleanup criteria 

&— Utility clearances 

rcL^^ Property information from Douglas Coimty Assessor's Office 

[' 

D • _ 

n 'J i 

Dite 
^v 

Property Access Checklist 

PropertylD; 2^L|( ^ 

Property Address: ^q^ ^ VWAS V 

n

n

 WORK STARTED

 WORKCOMPELTED

 ON;

 ON;

 /

 /

 / 

/ 

Address: 

Phone;(qQp q<^y^ ^p^9 

Fax! 

Cell/Pager: 

Renter: 

Phone: 

Fax; 

Cell/Pager; 

Additional Information; 

D Notification Letter 

S Access Agreement 

Ijfl^ Restoration Agreement 

D TopsoU SampUng (if appUcable) 

D Disposal SampUng (if appUcable) 

D Garden Sampling (if appUcable) 

^ UtiUty Clearance 

^ Video/Photos (Before) 

D Video/Photos (During) 

D Video/Photos (After) 

D Video/Photos (30-Day) 

M Property Completion Agreement 

D FinalReport 

Sent; ' / / 

Siened; S ftM/ U 

Signed: S /^/ll _ 

/ / 

/ / 

/ / 

CaUed: / / 

On:(Q_//^/iL 

On; / / 

On: / / 

On: / / 

Signed; S_/25/lL 

Issued: / / 

By; 

By; 

By; 

By; 

By: 

By: 

By; 

By; 

By; 

By; 

By; 

By: 

By; 

Air Moiutoring (as appUcable 

r~l Community IZ] Crew 

Results: 

On; / / By: 1 

• Conununity

Results; 

D Crew On: / / By; 

r~l Commiuuty

Results; 

 \Z\ Crew On: / / By: 

Omaha Lead Site 
Douglas County Account In^'-mation Page 1 of2 

Douglas County, Nebraska Property Record - R1403450002 

Print Report 

View Interactive GIS Map I Information is valid as of 2010-8-30 Treasurer's Tax Report I Wcw rtsiute -^ -> -> Subdivision Sales Search I 

I Owner 

! R AND W CORPORATION 

I 5616 FORT ST 

I OMAHA NE 68104-0000 I 

Property Informatio n 

Key Number: \ 0345 0002 14 

Account Type: | Residential 

Parcel Number: j 1403450002 

1146 N 20 ST 

Parcel Address: OMAHA NE 68102-0000 

Legal Description: HORBACHS 2ND ADD LOT 6 BLOCK 7 -EX S 48 E 59 FT- LOT 5 & 1/2 VAC 

ALLEY ADJ & S 12 FT LOT 6 IRREG 

Value Informatio n 

Land Improvement Total 

2010 $400.00 $0.00 $400.00 

2009 $400.00 $6.00 $400.00 

2008 $400.00 _$0.00 $400.00 

2007 $400.00 $0^0 $400.00 

2006 $400.00 $0^0 $400.00 

2005 $400.00 $0.00 $400.00 

Land Informa tion 

Acres SF Units I Depth Width Vacant 

0.14 6384.0 0.0 133.0 48.0 I Yes J . 

Utt^.//A r ./r»«. ,l,.../^~'KT»/..«..« .r ; o. . 
dCtf ^ Ms-Built Drawing ^ 

OLS#: 25409 

DATE EXCAVATED:8/8/11 

coAST^ Omaha Lead DATE USEPA SIGNED OFF 8/26/11 

AREA SODDEN: 7538 

Environmental Group, Inc. Superfun d Sit e 

25409 liJiilll 

Omaha Lead Site Exterior Paint 

Site Sketch Q Good 

Q Poor 

Sampling Addrets: 1146N20ST p] Not paint 

Sampte Number Lead 

Concentration 

Sample 

Collected LAB Firm

Samples Collected 

 fPf i Dt!).fl3 

RyA3CPXA-g5409 H­ . ppm D D Date: S-ll-O ^ 

RYBSCPXA-25409 F2 -iSi . . ppm E T D Time: ll-b R f¥^ 

RYCSCPXA-25409

RYDSCPXA-25409

 B1 

 B2 

2-T&1

2392 ­

 ppm 

 ppm 

GT 

[3f 

n 

D Samples Analyzed 

RDZOePXA-25409 B2­ " ppm D n XRF Unit: tOA^Z . Book; 2^ 1 

nOilOCPXA 25400 

Ry2SePXA-2D409 

-G Z 

-P E 

" "

~

 ppm 

 ppm 

D 

D 

D 

D 

Date 

Time 

fg Cl • g ^ 

jdco . 

Number of Samples = | 3 | | Ci I Staff nsw 

Legend: F1 = Front Left. F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden. PZ = Pla> 

Al quadrants ara as vivwed from the itrect, facing property 

CONCRETE DRIP ZONE EXCAVATED QUADRANTS EXCAVATED 

AREA AREA REPUVCED WITH AREA LEFT BARE REPLACED WITH SOD ROCK/MULCH 

CONTRACT #: EP-R7-09-06 COASTAL ENVIRONMENTAL GROUP, INC. 
I 

!....,< i 25409 

Omaha Exterior Paint Lead Site 

Site • Good Sketch 

n Poor 

Sampling Address: 1146 N 20 ST % Pj Not paint 

Sample Number Lead Sample LAB Samples Collected 

Concentration Collected 

Firm fPfi Dfe.Qt^ 

RYA3ePXA-25409 Pt-

Date: S-Il-o^ ^ 

RYBSCPXA-25409 F2 .-2Lii. Time: ll-bR fvA 

RYCSCPXA-25409 81 

RYDSCPXA-25409 Samples Analyzed  82 

XRF Unit: IOf?,6iZ. Book: 2^ / 

Date: Oi Oi • C ^ 

Number of Samples = | 3 | 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = BSL All quadrants are as viewed from the street. 

Tf. 

• • • ^^^^u^ M • 

Nto^V 

Re\':i«)S Creaed: OS-Kov-OS CM47i)l 01.23 
( ^ 25409 

Omah a Lea d Site Exterior Paint North Arrow 

Site Sketc h • Good 

n Poor 

Sampling Address: 1146 N 20 ST P I Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Finn:

Samples Collected 

 fPf i pg>,Q:^ 

RYA3ePXA-25409

RYBSCPXA-25409

 F t 

 F2 

-

.^^ ^

 Pom 

 ppm D D 

D 

Date:

Time:

 S'll-O ^ 

 ll-bf i f¥A 

RYCSCPXA-25409

RYDSCPXA-25409

 81 

 82 

2-Tai ppm 

_23a2_ppm a' D 

D Samples Analyzed 

RDZ3CPXA-25409

nGZ6CPXA-2S400

 B2­

 6Z 

"•

"

 ppm 

 ppm D D 

a 

XRF Unit: \Oe>(aZ Book: ZH I 

Date: (o O l • C ^ 

RPZSCPXA-25409 P2 "" ppm n n Time At 

Number of Samples = | 3 | | Q | Staff: MSW 

Legend: F1 = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla; 

Alt quadrants are as viewed from the street, facing property 

ReN'MiS Creaiid: iM-NovJ* 1:144711101.23 
{ '^ 25409 J 

Omaha Lead Site Exterior Paint North Arrow 

Site Sketch • Good 

Q Poor 

Sampling Address: 1146 N 20 ST 13 Not paint 

Sample Number 

RYA3CPXA-25409 F t 

Lead 

Concentration 

~ ppm 

Sample 

Collected 

D 

LAB 

D 

Finn:

Date:

Samples Collected 

 fPf i pfe , flC^ 

 S -ll-oC \ 

RYBSCPXA-25409 F2 -^-3 3 ppm D Time: ll-O B Q ^ 

RYCSCPXA-25409

RYDSCPXA-25409

 81 

 82 

2-T& 1

2.^9 Z

 ppm 

 Dom [ / 

a 

n Samples Analyzed 

RDZ3CPXA-25409

nOZOOPXA-25400

 B2­

 G£ 

-

~

 ppm 

 ppm 

D 

D 

a 

n 

XRF Unit: IOfi6t2. Book: 2^ / 

Date g) g>| •C>=\ 

RPgSCPXA-25409 P2 ~ Pom D n Time Axn. 

Number of Samples = | 3 | | Q | Staff: h$W 

Legend: F1 = Front Left, F2 • Front Right, 81 = Back Left, 82 = Back Right DZ = Drip Zone. GZ = Garden, PZ = Pla; 

All quadrants are as viewed from ttw street, facing property 

ENTERED 

HA ns 2009 

- - - . •>-' . :... .^ 

V -^—V -: -r^ ^

270J :2.3^Z . tf 

^y. ] 1• b.z.. 

. Dsi^.u 2 0 . • 

i^ 

! 

< 

•. . . ./ v 

( 

333 

i e) Fl 

. Nto4t 

Rev2iM8 i^reaed: OS-NovJift 1.14471)1 01.23 
— -4 ' 

\ • ./f COASIA I 

1 I 0 u f I . ( 

Ccnseril foi Act^tij^is 'ic^ l-idpt-iily 

RIGHT OF ENTRY TO PREMISES 

Granloi (Ihe property' owner) consents lo and authorizes the United States 

Environmental Protection Agency (EPA) oi its authorized representatK'es, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

following described premises: 'N - , i /o,

^O^D3___ 

Owner's Name: Daytimee Phone Phone:: 

Address of Property 

covered by this 

Agreement: 

BULJL^CI^: . PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of lead and may pose a health hazard. The area(s) will be 

excavated to remove contaminated soil. The removed contaminated soil wili be 

replaced with clean materials and the area will be restored to its original condition. This 

work is being performed under the Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Group, contracted by USEPA, will contact 

the Grantor in-person to discuss the work to be perfomned, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration work 

before it begins. Once the work is finished, the Grantor will be asked to review the work 

and confirm that it is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive written documentation from EPA that the property 

has been remediated. 

ENVIRONMENTAL RESPONSE ACTIONS 

By signing this Access Agreement, the Grantor is granting the EPA, its employees, 

contractors and subcontractors the right to enter the property, at all reasonable times 

and with prior notice, for the sole purpose of performing the work. This access shall 

remain in effecl until the work has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
1^ v~­

\y^/y * 

\ • • J C 0fc5 1 A i 

Remove obstructions including boats., trailers, vehicles, playscape ilems, vt'ood 

piles, dc^ houses, etc; 

< Remove flower bt^lbs oi plants that the Grentoi oi Ihe Gianloi's tenant may Vi'ish 

to save; 

' Water and maintain leplacemenl vegetation, including fertilizer application, as 

necessary' subsequent to an initial Vv'atering period by EPA; 

« Abide by health and safety guidance provided by EPA; 

' If the property is rented, assist EPA in obtaining tenant approval for access to 

the property to perform the work. 

»• Allow videotaping and/or photographing ol the property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the work activities, or with any 

of the work done, or with the equipment used on his property, or to undertake any 

actions regarding the use of said property which would tend to endanger the health or 

welfare of the Grantees or the environment, or to allow others to use the property in 

such a manner. 

Should you have any questions about this program, please contact Coastal 

Environmental Group, at (402) 991-1199 

7 ^ I grant access to my properties O ' do nol grant access to my properties 

.iTjoM&Mmzl'jt^ii 

Signature Date Signature // Date 

Q I would like to be present during any sampling thai is required. 

Page 2 of 2 
C O A S 1 A L 

c » *e u • . IN I 

Re^kJCcUon Aorpnrn^.iii 

The purpose of this aj-'reemcnl is lo provide a mutual agreement as lo condiiions of ihe properly prior to 

remedialion aciiviiies. This will also serve as documeniation for ihe purpose of assuring ihai resioralion 

aciiviiies are compleied lo ihe satisfaction of ihe propeny owner and the United .Siaies Environmenlai 

Protection Agency (EPA). 

Property ID: "^f^ D>V 

Prope rty Address: \ M(p K\. ;;)n5^ 

Owner: \J\<:^yO(X\te r V^Wen^r.. ^ 

Phone^4.Qr ) H?^^^MhZ2 . ^ 

On the attached diagram(s) indicate area(s) lo excavate, surface structures and landscaping features and 

access location(s) to be used by the contractors. Indicate distances, depths, material types, eic. 

Photographically and Videographically document ihe existing conditions oflhe propeny and Ihe basemen! if 

necessary. 

Items fo be Removed by the Owner before Start of Remediation: 

The removal, storage, disposal, anitfyor return of these 'Aims is the Ovi'ner's responsibility. 

Item: 

U^^^e 

Items to be Removed by the Contractor During Remediation and Not Replaced 

I Item: 

Page 1 of 
COASTA L 

c< * o u r . I M r 

liertis to Be Removed By Conttgctor Durint.; Remedifetion and RejgLace_d 

Landscfepe Inventory 

Item Quantity Unit Condition/1 ype/Species 

Pre-existing property area, ^ V Quadrant.s' thai will be excavated, thai 

is covered with grass. 

Number of trees > 2 inch a Each 

trunk diameter 

Number of trees <- 2 inch Each 

trunk diameter 

^ 

Number of SprinkJer 

Zones, Control Valves, 

Each Timers, Heads, etc. ^D^ ^ 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed Each 

area. Square Feet 

^ 

Attach a sketch of relative 

sizes and locations. 

Agreed upon value of plant 

materials nol to be 

replaced bv contractor. 

Not ( ^ e Ihis value will be 

used io issue a plant 

voucher lo Ihe property' 

owner. 

Easement Area, to be na^c Each 

excavated 

Page 2 of. 
Additional Comments / Instructions: 

The city of Omaha ordinances may prohibit you from using dirt or gravel areas on your properiy 

es driveways or vehicle parking cress. The Environmental Protection Agency (EPA) may be 

removing and replacing soil underlying a gravel or dirt area on your property that you may be 

using as a driveway or vehicle parhing area. If this is the case, you should understand that this 

removing and replacing of soil does not mean that any illegal driveway or parking area on your 

property is made legal. To Ihe contrary, you msy be cited by the city if you use a gravel or dirt area 

as a driveway or parking area, not withstanding any removal or replacement of soil by the EPA. 

If you have any question about legality of a cerlain driveway or parking area, you may contact 

Ihe city of Omaha's Planning Department at (<02) 444-5150. 

0> lease check this box if you understand the information outlined above. 

4 Vlease discard c i cxnu^-ltosh 

A yj8 Check the box if Owner does not want CEG fo document interior foundation walls and possible 

^pre-existing damage. By checking this box CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

0 1 agree Q) ^ do nol agree 

Owner's Sisnalure Dale Conlraclor's Signaiure Dale 

Page 3 of 
BVID# ZSCfol 

XRF PROPERTY SAMPLE SHEET 

Date V~^- o Address .//V.» AJ g o 

Project Omaha Lead ARRA Sample time am/pm 

XRF iD# S^oSi-s^ sample length 30 sec 

Shol# Reading Sample area Shot# Readinij Sample area 

2H- IcoXtL JiL 3^ 7S'±/0 6:i 

.2SL Depth 3? /6I/ 6 Depth 

7(^ mk ic' ' ^ <Loo i /(^ A ^ 

Average is7, ^ I ^ Average /y:l/o 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading Sample area Shot# Readir^g Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Signature », 

Print %^fio,l4 
J 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 37 

Modpe Soil 

Time 2011-08 

Durationn 90.40 

Units ppm 

Sigma Valua e 2

Sequence Final 

Flags 

AVERAGE Avg of 34-36 

ADDRESS 1146 n 20 st 

QUADRANT Bl 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE confirmation 

ppm Error 

Pb 62.004 14.386 

Supervised By: \_ai^ fbr­
s . ^ 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 34 

Mode Soil 

Time 2011-08-09 09:42 

Duration 30.12 

Units ppm 

Sigma Value 2 

Sequence Final 

Flags 

BVID 25409 

ADDRESS 1146 n 20 st 

QUADRANT Bl 

DEPHT 6" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE confirmation 

ppm ± Error 

Pb 60.897 ± 14.308 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 63.672 

Supervised By: 

Certificate of Verification 

35 

Soil 

2011-08-09 09:43 

30.10 

ppm 

2 

Final 

25409 

1146 n 20 st 

Bl 

6" 

N. LOPEZ 

confirmation 

confirmation 

± Error 

± 14.653 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 61.443 

Supervised By: 

Certificate of Verification 

36 

Soil 

2011-08-09 09:44 

30.18 

ppm 

2 

Final 

25409 

1146 n 20 st 

Bl 

6" 

N. LOPEZ 

confirmation 

confirmation 

± Error 

± 14.198 
f" 

v u 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 17.379 

Certificate of Verification 

41 

Soil 

2011-08-09 09:47 

90.71 

ppm 

2 

Final 

Avg of 38-40 

1146 n 20 st 

B2 

6" 

N. LOPEZ 

confirmation 

confirmation 

± 

± 

Supervised By: .CU. 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 18.722 

Supervised By: 

38 

Soil 

2011-08­

30.23 

ppm 

2 

Final 

25409 

Certificate of Verification 

09 09:45 

1146 n 20 st 

82 

6" 

N. LOPEZ 

confirmation 

confirmation 

± Error 

± 10.805 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 18.949 

Supervised By: 

Certificate of Verification 

39 

Soil 

2011-08-09 09:46 

30.29 

ppm 

2 

Final 

25409 

1146 n 20 st 

82 

6" 

N. LOPEZ 

confirmation 

confirmation 

± Error 

± 10.912 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Pb 

Supervised By: 

Certificate of Verification 

40 

Soil 

2011-08-09 09:47 

30.19 

ppm 

2 

Final 

25409 

1146 n 20 st 

82 

6" 

N. LOPEZ 

confirmation 

confirmation 

ppm Error 

< LOD 16.390 
^^!Z''>» jOk \ Omaha Lead Site—Fixed Price EP-R7-09-06 

\^^ ^ S Coastal Environmental Group Inc. >9i 

'^ipROt*''^ V~*^( f www.coa8talhazmat.com  COASTA L EN«IIONHEIITA l 

S lOUP , IH C 

EXECUTIVE SUMMARY: 

BVID #25409-(l 146 N 20 ST) 

py] No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 
Property Completion Agreement 

I h u tijiiccmeni rkicumtnl^ ihe comp>Clion ol remedial acnviiies pcflbimcflnn my pioperly My .iigiiflluit 

ivili designate ihai I am satisfied with ilie resioralion of my piopeily. and ihai no iicm.": are ni t)uesiioii<. 

now. 01 al sny inne m ihe fiiiuie. except ihose iiems listed below, if any 

Property fO: ^^HL;' ^ 

Phone: i\OX - \\<^-^ ' ^Oly y 

Resloration Items in Question: 

/tern: 

llem: 

Ifem: 

Ifem: 

Additional Comments: 

b u ' "t'""'" I rv I or a I ion U cnmplrlf d, ricrp i «s nnitri 

I rio nni aiiiFC itupmun n it Mni|ilcicri 

7f ihhmL^-y±_L 

Dale fiinl i »iloi s Sil^ahiii ' Oair 
» 

iPt l ^ 1 

EPA Property Close Out Eorm 

'-"^-•-^.SHQ.I ^ Sr.;^t^dcBiSiSM^s^'^ 

Datc/TliDc: 9^-1^-fI 7^^ ^ 

Quadi Excavated; P|~H V _ ContrjBctor Croup iSu^llS 

ExcivatloB Cenenl 

\ Yes r^io 

1. Ifnecessary, were the correct qiiBdrant(s) excavated and reslored? 

2. If necessary, were the correci areas of drip zone excavaied aod restored? • / 

Cradlpg Sod and Vcuctolioii Y H Nu 

Does the grading around (he pcrimeier oflhe house in excavaied areas generally slope awny 

from the house? 

y.. 2.

 Has sod been laid in all areas ihal were excavaied? / 

.i. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 / day time period) — 4.

 A n sodded areas generally rirm and evenly graded? 

f>. Are the joints between the sod strips generally tight? (Only evaluate if inspected ai a 30 da; 

time period) 

6. Was the property graded such thai waier will not pool on the prnpeny*' sy.i 

I 7. Was damige to landscaping or plant maieriali avoided? .ly 

Gales. Fence* aad RcuiBlng Walli 

V« .N(i 

I I. Do gales open and close freely? (If applicable) 

2. Were all gates or fences laken down during restoration activities reinsulled? (If applicable) 

?.. Was damage lo gates or fences avoided? (If applicable) / _ 

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

Foundatiott, SidiaK and Callers 

Yes .No 

I. Was damage lo the siding or trim avoided? y 

2. Was damage to ihe foundaiion avoided? 

Was damage lo windows avoided? y 

4 Wa.s damage to windows or door screens avoided? /I 

f. Was damage to downspouts or downspoul extensions avoided? 

Sidewalks and Driveways (Concrete) 

Vcs No 

I. Was damage to driveway surfaces avoided? 

1. Was damage to walkway surfaces avoided? y 
J > 

OM-ners comments: 

! Inspection notes: 

Removal and restoration aclivales complete including ihe 30-day sod warranry: 

IrTA Representative ?!^^*1 Date: 8l?^l'l._