TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ^^'? ^ 

Date: <;(iW n

Address: l^l( H^HtCA. bU ^ 

Remediation Contractor: Coastal Environmental Group_ Year: 2010ARRA 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

f 

Video ofproperty (DVD) 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

Settlement documents (i.e., for damage or to replace plants, etc.) 

Confirmation data 

Photographs if^ ^jyO^mo^A ^ t^C^^^r^y^ y ^ ^ 

y As-built sketch 

ifi Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

- ^ Description ofareas not meeting ROD cleanup criteria 

a/ Utility clearances 

Propprt5Mnfprmation from Douglas County Assessor's Office 

-r y 

^ s p '1 

Date 

30261032 

Superfund 
K 

^ 

Property Access Checklist 

Property D): ^ ^ ^ D WORK STARTED ON: __/__/_ 

Property Address: ^< ^ j pCtJiPMJL UTJ ^ n WORKCOMPELTED ON: / / 

Owner: ^yrr(M^'C^ Renter: 

Address 

Phone: m(^-^?M ^ 

Fax: 

Cell/Pager: 

n Notification Letter 

QCXccess Agreement 

^^Restoration Agreement 

rn Topsoil Sampling (if applicable) 

n Disposal Sampling (if applicable) 

Q Garden Sampling (if applicable) 

[ J UtiUty Clearance 

1^ Video/Photos (Before) 

n Video/Photos Puring) 

n Video/Photos (After) 

n Video/Photos (30-Day) 

• Property Completion Agreement 

• Final Report 

Air Monitoring (as applicable) 

• Community • Crew On: 

Results: 

l~l Community CD Crew On: 

Results: 

l~l Conununity CD Crew On: 

Results: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

Sent: / / 

Signed:}S^/fLf_f_Q 

Signed) ^//_^/L 0 

1 1 

1 1 

' 1 1 

CaUed: \K / Q; 1 \ ^ 

On: \o / VH / ..o 

On: / / 

On: / / 

On: / / 

Signed: / / 

Issued: / / 

/ / By: 

/ / By: 

/ / By: 

Omaha Lead Site 

By: 

By=

By:

By: 

By: 

By: 

vi>0_ 

 \>\< ^ 

By=\^AoKo liJwvAvyj 

By: vi.cyc ' 

By: 

By: 

By: 

By: 

By: 
Douglas County Accoimt In Page 1 of2 « » -

Douglas County, Nebraska Property Record - R1402640000 

Print Reoort 

View Interactive GIS Mao Information is valid as of 2010-8-30 Treasurer's Tax Report 

1 New Feature -•-»- • Subdivision Sales Search 

Owner 

CITY OF OMAHA 

C/O PLANNING DEPARTMENT 

1819 FARNAM ST#1 111 

OMAHA NE 68183-0000 

Property Informatio n 

Key Numtier: 0264 0000 14 

Account Type: Ex Government 

Parcel Numlier: 1402640000 

Parcel Address: 

Legal Description: 

1521 FLORENC

OMAHA NE 681

HORBACHS 2N

E BLVD 

10-0000 

D ADD LOT 9 BLOCK 3 N 1/2 30 X 140 

Value Informatio n 

2010 

2009 

2008 

2007 

2006 

2005 

Land 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Show All Transactions 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.09 4200.0 0.0 140.0 30.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R140... 9/2/2010 
3/31/2011 www.idhon.org/irthinternet/DHONNotic.. 

• ^ Create Another Ticket Back<^nr TTrirti h Intemet Send Email 

YOUR TICKET NUMBER IS 2699978. 

Original Call Date; 3/31/11 Time: 12:51 pm Op: ALFONSO18790 


Work to Begin Date; 4/04/11 Time: 1:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1521 Street: FLORENCE BLVD 


Twp: 15N Rng: 13E Sect-Qtr: 15-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of work: Lead Remediation 


Location of Work: LOCATE ENTIRE PROPERTY, ALL EASEMENTS AND TO THE PEDESTAL 


Remarks: FAX ALL CLEARS TO: (402)934-2811 


: PLEASE INCLUDE ALL EASEMENTS 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name: ALFONSO Phone: (402)934-2837 


Work Being Done For: Coastal 


Depth of Excavation: 4ft Corner Lot: N Front: Y Rear; 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVELS MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Utility Service Area Contact Phone Number Type 

Day: 4029S40469 

CXCATV COX COMMUNICATIONS, INC HEIDI Ai: 4029S40469 

Emerg: 4029S29757 

Day: 8773668S44 

LEVELS COMMUNICATIONS, LEVELS NA Alt: LLC 

Emerg: 877S668S44 


Day: 402504782S 


METROPOLITAN UTILITIES MUDOl SANDY MUD At: DISTRICT 

Emerg: 4025047970 


Day: 4024447197 


CITY OF OMAHA- OMAHACOF RICH/TRAFFIC Alt: 4024445161 TRAFFICSEWER 

Emerg: 4024445160 

dhon.org/irthintemet/.../MessageText.as... 1/2 
3/31/2011 ^ ^ www.dhon.org/irthinternet/DHONNotic 

Day: 406728934S 

^T.T.r^^T,T,c OMAHA PUBLIC POWER ELM _ .«....,.. . 

0PPDGPR5 j^j^^^ ^ LOCATING ^ ^ 4062071494 

Emerg: 8887289343 

EIM Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK TM\-T^T ^ AH: 4062071494 

LULAllNO 

Emerg: 8887289343 

dhon.org/irthinternet/.../MessageText.as... 2/2 
As-Built Drawing 

COASTA

IMVI aONHC NTAL L Omaha Lead Superfund Site G • O U P . IN C 

OLS#: 26239 

Date Excavated: 4/5/2011 

Date USEPA Sianed Off: 4/19/2011 2C>ZSf 

Area Sodden: 1687 sa ft 

Omah Exterior Paint North AfTow OwwerName a Lead Site : CIT V O F OHAH A 

Sit • Good e Sketch Address: I 5" 2 1 F\<irgjMi^ j:^^ , • PoOf 

Phone: H^ 

Q^Not paint 

Lead Sampte Samples Collected Sample Number LAB Concentration Collected Fimn: 

RVASCPXA- eGS33'" ' ppm 0' n Date C A - 7.Jr - o L. 

RVBSCPXA-ecgJ ^ F2 20 0 ppm D Time: \D : Z.?, at ^ 

RvcscpxA-ee^3^ BI 7 3S ppm D Samples Analyzed 

ppm 0' RyDSCPXA-eC23 3 B2 2/s- D RDZOCPXJ«I- - 0 2 ppm D D XRF Unit <5n5 Book: //g 

RGZSCPXA- -GZ ppm n D Date: ^-Ol-Qi t 

•RPZSCPXA- -PZ , ppm D D Time; / M 

Staff: M<;w Number of Samples = '•• A -

Legend: Fl = Front Left, F2 = Front Right. 81 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

M qufldrants are as viewed from the (traet, lacing property 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced wilJi 

Scxl Rock/Mulch Area left bare 

Contract #: EP-R7-07-05 Coastal Environmental Group Inc. 

^Hiii 2Ge^f 

Exterior Paint North Arrow Omaha Lead Site ter Name: CIT V O F OHAH A " 

Sit • Good e Slcetch Address: 15J2J_ F lorej-icje. BT^ • Poor 

H: W: 

Q^Jot paint Phone: 

rSample Number Lead Sample 

Samples Collected LAB Concentration Collected Firm: _Eji£L_L2.StlILfcl. 

RVASCPXA-^C(?35F1 3o \ ppm D Date: o4- - 24- -Q L 

RVBSCPXA-eGS35 ^2 2 0 O ppm D Time: ID : 2.^.0 rv. 

RVCSCPXA-^C^35B1 7 3S ppm n 

0^ Samples Analyzed RVDSCPXA-^C^J^ B2 2 / r ppm D 

RDZOCPXA- 92 ppm D a XRF Unit. 9o 2 Book: /yg 

RGZSCPXA -SZ ppm D D Date: <-0 / OU 

RPZSCPXA^ •Pi. ppm D D Time: k ^ 

Staff: \^S W Number of Samples = A- \ 

LegeJid: Fl = Front Left, F2 Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

y y (.A) 
2GZ^f 

OwmerName: CIT V O F OMAH A 

Address: LS-2J__El£LLfcQXA_8l> 

Phone: H:

Sample Number 

RVASCPXA- SG23 3 f"" 

RVBSCPXA-SQS33 F2 

RVCSCPXA-ec^S^BI 

RVDSCPXA-SC^aS B2 

RPZOCPXA­ D2 

ROZOCPXA­ -SZ 

RPZ3CPXA­ -PZ 

Legend: Fl = Front Left, F2 

 W: 

Lead 

Concentration 

3o\ 

2 0 o 

738 

2 / r 

Omaha Lead Site 

Site Sl<etch 

LAB 

D 

D 

D 

D 

D 

D 

D 

Exterio North Arrow r Paint 

• Good 

• Poor 

g^Not paint 

Samples Collected 

Firm: j£j;ia_X£.ilJlil . 

Date: DA- - 24- -O H 

Time: tn : 2.'=,^ ^ 

Samples Analyzed 

XRF Unit; qn l Book: //g 

Date: ^-Qj - OU 

Time: _Aj^ 

Staff: M^w ^ 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Sample 

Collected 

& ' 

IT 

D 

D 

D 

Number of Samples • 

Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property i 

ENTERED 

A f ^ 2 ^ 2006 

£ 1 .51. 13B i 2.} ^ 

.i.52.L.P.blr.eoce:.BX> 

/ t^.,-. f 

I 

2op 

Tt*^' 

Rev 4 3^ Uc4'>Ct. • fi.j^. • • '. •. '. '• '. 046141 ,0123 

AO (A 
2(^a3f 

Omah Exterior Paint North Arrow Owme a Lead Site r Name: CIT V O F OMAH A 

Site • Good Sketch Address: 1 !T H F\orej>ce- 0t > • Poor Phone: H: W: 

Q^Not paint 

:Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: ci^ft \ ft!;.\ O^to 

RVASCPXA- S(2e3 3 F1 3o\ ppm 0- a 

Date: o A - 1A- - c L. 

RVBSCPXA-e<S23S F2 2 0 O ppm 0- D Time: ^t? : 2.«nnr-> 

RVCSCPXA-e<S235Bl 7 38 ppm & ' 

D Samples Analyzed RVDSCPXA-2<;g35 82 2yr ppm (T D 

RPZOCPXA- -92 ppm D D XRF Unit: qn l Book: //g 

R02CGPXA. -GZ ppm D a Date: •^•Ql-OL> 

RPZSCPXA^ -P2 ppm D Time: _Atl 

Staff. y[^ W Number of Samples = ALegend: Fl = Front Left, F2 = Front Right, B1 = Back Left. B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

Alt quadrants are as vtewed from the street, ^cing property 1 

I 

ENTERED 

m I 4 200S 

£1 •©" 

bX. 738 i 2.\r 

I 

.».5ZL.e.W.eoGe:.BJi 

-t:­ -

I fz 

.30;. \ 2op 

IL il :-A-refiI 

Rev4. PkcepCt . ^h. 046141 .0123 
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t I O -J t ' »• c 

COIIJ-;KII\ WA A(:c;e.i;5--. 'i o r-io|je.i(y 

RIGHT OF EK'TRYTO PREMISES 

Grantot (the property' ownei) conssnlK to £.nd authorises the Uniteo Siste?. 

Environmenlal Protection Aoency (f:PA) oi its autiiorized representsiives, collectively 

the Grantee, to enter snd perform certain environmental lesponse activities upori the 

following described premises: —7 , -;, ^ 

... ^ f((Zy..l 

Ownei's Name: Da^'time Phone: 

MH^ i\1^ ^ 

.-^Lf^^.y ..pj^.jQ..yp.^^ 

Address of Property 

covered by this 

Agreement; }5t \ fioc.^i^L^ B D 

PURPOSE OF RESPONSE AcTivniES 

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

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

excavated to remove contaminated soil. The removed contaminated soil will 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 CBrantor in-person to discuss the work to be performed, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration v/ork 

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 v\'ith 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 Giantor is granting the EPA, its employees, 

contractors snd subcontractors the right to enter the properly, at all reasonable times 

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

remain in effect until the work has been satisfactorily cornpleled. The Grantor also 

agrees to: 

Page 1 of 2 
r. c A s "I k 1 

' Remove obstructions including boats, trailers, vehicles, pisyscfipe iiemr, wood 

piles, doo houses, etc; 

< F^emove fiov>'ei bulbs oi piants that the Grantoi or the Granloi's lenanl

to save; 

rnay wish 

Water and maintain leplacemenl vegetation, iricluding fertilizer application,

necessa0' subsequeni to an inilial v^'atering period by EPA; 

 as 

< Abide by health and safety guidance piovided by EPA; 

If the properly is rented, assist EPA in obtaining tenant appiovgj foi

the property to perform the work, 

 access lo 

I Allow videotaping and/or photographing of the properly. 

AGREEMENT HO I To INTERFERE 

The Grantor agrees not to interfere or tampei with any ofthe work activities, oi Vv'ith 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 lo endanger the health or 

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

such a manner. 

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

Environmental Group, at (402) 991-1199 

0 1 grant access to my properties D ' do not grznt access tc my properties 

.Dete SignEture Date 

C3 I would (ikt to btr. pteseni tiufiY:^, any Semplino thct tf required, 

Paae 2 ol 2 
C <J A. S T />. U 

Restoration Agreement 

The purpose ofthis agreement is.to provide a mutual agreement as to conditions ofthe property prior to 

remediation activities. This will also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction of the property owner and the United States Environmental 

Protection Agency (EPA). 2k2 ^ 

Property ID: l^QV^'j 6000 -^ 0 2^39 

Property Address: y^^ / fjCf^ffMUf.. if^O, 

Owner: 6;-fV Qt d mfit AD, 

Phone: m ^ WlM^o 

On the attached diagram(s) indicate area(s) to excavate, surface strucuires and landscaping features and 

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

Photographically and Videographically document the existing conditions ofthe property and the basement if 

necessary. 

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

The removal, storage, disposal, and/or return of these items is the Owner's respons ibility. 

Item: 

yj^ ^ 

Item: 

Item: • . 

Item: 

Items to be Removed ,by the Contractor Durinc 1 Remediation and Not Replaced 

Item: 

.yvC-^ 

Item: 

1 Item: 

Item: 

Page 1 of. 
C C A S T A, L CNVIMONM I taTAl . 

C N O U r . IMC . 

Items to Be Removed By Contractor Durinq Remediation and Replaced 

Item: 

^ 

Item: 

^ ^ 

Item: 

Item: 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, Quadrants that will be excavated, that Zf 

is covered with grass. 

Number of trees > 2 inch Each 

trunk diameter 

Number of trees <= 2 inch ^iy Each 

trunk diameter . 

Number of Sprinkler 

Zones, Control Valves, Each Timers, Heads, etc. 

.^iiach a skeich o'i the 

.sprii-il<,lei' layoui. 

Number of and size of 

each garden/ flower bed Each 

area. Square Feet 

Aiiin.:!) a .';keicli o'i relmi'.e 

^•\zt^ ;irid lociiiioiis. 

•^greed upon value of plant 

materials not to be 

replaced by contractor. 

Nni p this MiliiC' \\-\\\ l)c 

:i<e(l lo i,'>siie n plain 

voucher Id tlu- propeny 

Easement Area, to be 

excavated 

Page 2 of 
C O A S T /> L 

Additional Comments / Instructions: 

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

as driveways or vehicle parking areas. 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 parking 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 the contrary, you may 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. 

Ifyou have any question about legality bf a certain driveway or parking area, you may contact 

the city of Omaha's Planning Department at (402) 444-5150. 

[~1 Please check this box if you understand the information outlined above. 

Q Check the box if Owner does not want CEG to 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. 

[ZflI agre a e • I do not agree 

1 ^ - "i-' O /iQ^^yq^^^r- IONUL) ^V^^ ^ ,;;;?^wner's Signature Date Contractor's Signature Date 

Page 3 of. 
BVID# '^'^^5' ^ 

XRF PROPERTY SAMPLE SHEET 


Date 4 ' Ctf ' Vo^\ Address 

Project Omaha Lead ARRA Sample time 

XRF ID# b'lOL C sample length 

Shot# Reading Sample area Shot# 

1 ^ lo4 l IxV 1>x 

n i ^^l t a*r Depth 

y^ ^^!? t tj . ^ " 

Average a.i^1>i ^>^ Average 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# 

y Depth 

y y 

Average Average 

Signature_ 

PrintJ^Af^^fVo^l 

\ ^ 2,\ 'pt^e.'fc^c-e. 

am/pm 

30 sec 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 74 

Mode SOIL 

Time 2011-04-06 19:51 

Duration 90.63 

Sequence Final 

Flags 

AVERAGE Avg of 71-73 

ADDRESS 1521 Florence 

QUADRANT Bl 

DEPHT 4" 

XRF TECH M. MATEUS 

MISC Confirmation 

NOTE CLEAR 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 204.507 

Supervised By: 

Certificate of Verification 

71 

SOIL 

2011-04-06 19:49 

30.19 

Final 

26239 

1521 Florence 

Bl 

4" 

M. MATEUS 

Confirmation 

CLEAR 

± Error 

± 22.079 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 291.394 

Supervised By: 

Certificate of Verification 

72 

SOIL 

2011-04-06 19:50 

30.23 

Final 

26239 

1521 Florence 

Bl 

4" 

M. MATEUS 

Confirmation 

CLEAR 

Error 

± 25.472 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 293.229 

Supervised By: 

Certificate of Verification 

73 

SOIL 

2011-04-06 19:51 

30.21 

Final 

26239 

1521 Florence 

Bl 

4" 

M. MATEUS 

Confirmation 

CLEAR 

± Error 

± 26.500 
/ ,J3t,^ \ Omaha Lead Site—Fixed Price EP-R7-07-05 

S J^^2 ^ ° Coastal Environmental Group Inc. 

V^*^^ * www.coastalhazmat.com — ^"tPHo-it'' COASTA L ENVIIONHENTAL 

GROUP , IN C 

EXECUTIVE SUMMARY: 

BVID #26239-(1521 FLORENCE BLVD) 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 

-DAN GARVEY WALKED THE PROPERTY ON 04/19/2011 
Front: ENV I ROWORKS LLC. 402 934 2811 041 12011 14:42 
 #139 P.010/011 


Property Compietlon Agreement 

Ihis agreemenl {k^culTlenI^ the completion ol remedial aciivmes perloimed on my property My signature 

will dcMgiiaic Ihal I am salisried with the restoration of my property, and Ihal no items are m queslions. 

now, or al any lime m the future, except those ilems listed below, ifany 

Property '''• yu^^^n . Propcrfy Address: t CZ^{ P(.p-,M:£- /^W ^ 

Owner: CAM 0?./> /W^e<. Phone: J 0 ^L^L{-li2.H9> 

Restoration Ilems In Question: 

Ilem: 

Ilem: 

Item: 

item: 

Item: 

Item: 

Additional CommenIs: 

nd i nyrc r rutoralio n n complcttd, rxnp t M noltif 

[ I I fto nnt aurcc rctloratinn it roniplclcri 

little 
% 

^ 1 

EPA Property Close Out Form 

Property tf: ^1^3^^^ / Property Address:,—^ 

DBtc/Tirae: Owner's Name:. /^ L <i 

Quads Excavated: Confractor Croup (Itn . 

Excavation Yes No General 

1. If necessaiy, were the correct qtiadrant($) excavated and restored? / 

2. If necessary, were the correct areas ofdrip zone excavaied and restored? / 

Gradine Yes No Sod and VcKctation 

I. Does the grading around the perimeter ofthe house in excavaied areas generally slope away /

from tbe house? 

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

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

4. Are sodded areas generally furn and evenly graded? / 

5. Are thejoints between the sod strips generally tight? (Only evaluate if inspected at a 30 day / time period) 

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

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

Gates, Fences and Rctainloe Walls Ves Nu 

1. Do gates open and clo.se freely? (If applicable) / 

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

3, Was damage to gates or fences avoided? (Ifapplicable) y 

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

Foundation, SidioKand Guders Yes No 

I. Was damage to the siding or trim avoided? / 

2. Was damage to the foundation avoided? J 

3. Was damage to windows avoided? f 

^ Was damage to windows or door screens avoided? J 

5. Was damage to downspouts or downspout extensions avoided? y 

Sidewaliu and Driveways (Concrete) Vcv No 

1. Was damage to driveway surfaces avoided? I 

2. Wa.s damage to walkway surfaces avoided? 

1 
* m 

Orf'ners comments: 

JFnspection no<es: 

Removal and restoration aclivates complete including the 30-day sod warranry; 

HPA Representative Q-^ ^ Date : M\\*tV^