CONTRACT # EP-R7-06-04

 

ASW Associates Inc. 

Omaha Lead Siite Remediation, Omaha, NE 

EPA 

ASW Associates Inc Certification for Property Closeout 

BVID 21228 Property Address 4244 Mason Street 

Field Work Started 20-Oct-06 Field Work Completed 28-Oct-06 

Summary: 

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

The F1 quadrant was excavated to a depth of 6 inch. 

The F2 quadrant was excavated to a depth of 6 inch. 

The B2 quadrant was excavated to a depth of 6 inch. 

The drip zone was excavated to a depth of 6 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. 

40261727 

Comments: 

None. SUPERFUND RECORDS

Jan Prawdzik ASW Project Manager 

Name Title bale Signatifre 
CONTRACT # EP-R7-06-04 

ASW Associates Inc. 

Omaha Lead Site Remediation, Omaha, NE 

EPA 

Analytical Result Summary 

OLS ID: 21228 

Property Address: 4244 Mason Street 

XRF Results Lab

 

Sample ID Avg. Results 

(ppm) (ppm)

 

21228-DE-F1-06 90.2 ±41 NA 

21228-DE-F2-06 113.6 ±42 NA 

21228-DE-B2-06 129.3 ±39 NA 

21228-DE-DZ-06 90.6 ± 42.3 NA 

Jan Prawdzik ASW Project Manager 

Name Title Date Signature 

Sample Designation 

OLSID-DE-Location-dd 

OLSFD is a particular residential property ID fiom which the sample is collected. 

DE = During and Post Excavation 

Location of the sample as follows; 

Fl = Front Yard (1st Quadrant) 

Bl = Back Yard (1° 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 *ras collected. 

NA = Not Applicable 
<vEPA 

Remediation/Excavation Contract (ASW) 

EPA Property Close Out Form 

Property#: Property Address: 

Date/Time: Owner's Name: a € I 

Quads Excavated: ff{ F<?f f)2 -4- Contractor Group 

Excavation General 

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

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

from the house? 

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

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

day time period) 

4. Are sodded areas generally firm and evenly graded? 

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

lime period) 

6. Was the property graded such that water will not pool on the property? 

1 . Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls

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

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

3. Was damage to gates or fences avoided? (If applicable) 

4. Was damage to retaining walls avoided? (If applicable) 

Foundation, Siding and Gutters

1 . Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

1 . Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes No 

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 Yes No 

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 Yes No 

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 Yes No 

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Yes No 

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Owners comments: 

Inspection notes: 

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

EPA Representative {)„.„ Jl Date: 

if 
f Contract: No: EP - R7 - 06 - 04 

Propert

Omah

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 Closeou

 Lead Superfun

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OLSID Property Address 42 r/ WAteif 

Property Owner

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Is the Resident the Owner [0£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 

& 1 agree that restoration is completed at my property 

D I Do Not Agree: Comments: 

,-x y 

I//04/0 6 

Property Owner's Signature ' Date 

i ^ i 

lt/of/06 

EPX Heptfsentative Signature 1 Date 
Page 1 of 

Omaha Lead Site 

xSf""^v Omaha, NE 

is ^\ A U.S. Environmental Protection Agency Region VII 

(i ^^7 fl Residential Yard Soils 

XSb^^y Environmental Restoration 

Xj^n.o^' ^— Services 

I '' PROPERTY ACCESS (to be completed by Property Owner)

 

Para recibir esta forma espaiiol por lavor ilame al 1-800-223-0425 i 

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

or its authorized representatives (or its contractors}, the Grantee, to enter and perform certaii i environmental response 

activities upon the following described premises. For further information please contact EP/ i at 1-800-223-0425. . ——i |Vj . / •, c~~-> — Property Access Granted By \ \ 'Cf]C(P | --} •

 

^ —, « _ __----^7 (Please Print Name) ^ti,j) d)<

^rjtij~~ ii>c-ou 

(P'roperty Owner Signature) (Date) 

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

1 PROPERTY INFORMATION 

(to be completed by resident and/or property owner— Please Print) 

Resident Name: [H (cllQF \ ' ["ATUKA ESI Owner D Renter 

*A /I • 1 L / 

Residence Address: M^-HM IMA^M -S\ C )Wt^C\ M<5. (o^lO*5~ 

(CITY) (STATE) (ZIP) 

Property owned by: ^ | lo/V/\B-( | f\'^L)^ 

Owners mailing address: M^MM 1 l&Jv)/1-^ 

Owner's telephone number—Home:_5^?U"5(A o/ i']

1 Work: Mcr-Q^'" M"! 

Age of Home? <^Z> years How Ion? have vou lived here?c>--3 years 

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

Has the interior been painted or covered since 1978? tS YES D NO 

Total number of occupants: O List Ages: —>n <"Co <^-^~~ lSList ages of occupants under 6 years old who play in the yard for 5 or more hours per week: *i/h 

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: : 42-44 (V\AS0rJ 

Owner: Date: [O 4? ~ O ^QLS# 

Description: 

( o S 

O\vner Signature: ASW Associates Inc 

Print & Sign ; Print 
21228

 

Omaha Exterior Paint Lead Site Owner Name: MICHAEL S TATUM Sit Good e Sketch Address: 4244 MASON ST PJ Poor 

Phone: H: 402-556-5189 W: 402-426-4121 Not paint 

Lead Sample Samples Collected Sample Number 

Concentration Collected Firm: tf^tJ O 5 

RYASCPXA-21228 Date:

 

RYBSCPXA-21228 Time: .^ -If)

 

RYCSCPXA-21228 

Samples Analyzed RYDSCPXA-21228

 

RDZSCPXA-21228 

RGZSCPXA-21228 

RPZSCPXA-21228 

Number of Samples = ; 

ENTEBED 

Omaha Lead Site 46130