TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID* 3 1 b% ] DATE: ^ / f?//t. 

ADRESS: H I \ 0 ' Pm>UV/j | Sl ^ 

REMEDIATION CONTRACTOR: COASTAL ENVIRONMENTAL GROUP Contract: EP-R7-09-06 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Executive Summary 

V0 EPA-provided property sketch 

iv/ Signed Access Agreement for subject property 

fW^ Signed Access Agreement (s) for adjacent property 

\ n Restoration Agreement 

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

^ Confirmation data 

\jj i Photographs SOD 

Pre-Excavation 

Excavation 

<G As-Built sketch 

*^i] Satisfactory restoration signed by Property Owner 

VD Property close-out check list signed by EPA 

KM T Description of areas of areas not meeting ROD cleanup criteria 

J n Utility clearances 

V ] Property Information from Douglas County Assessor's Office 

• 

Signature Sigijaturg Signature-- fCOAST COAS OASTATL Signature- EPA ^Jj

^ 

Date 30262923 ^^^^ 

Superfund 
^ 

Property Access Checklist 

Property ID: ^ f '^^ / D WORK STARTED. ON: /

 /

Property Address:^;^^ Pf/^j ^ ^ D WORKCOMPBLTED ON: / / 

Renter: 

Address: Phone: 

Fax: 

Cell/Pager: 

Phone: Additional Information: 

Owner: ^^^ ^ TT^UJAZJ C 

Ll9yi»r^ 

Fax: 

Cell/Pager: 

D Notification Letter Sent: / / By: 

^ Access Agreement Signed: Vo / TD / ,.0 By:

 v»>^t 

S Restoration Agreement Signed: v o / 3s>/to 

By=^»^o^ 

D Topsoil Sampling (if applicable) / / By: 

IZI Disposal Sampling (if applicable) / / By: 

D Garden Sampling (if appiicable) / / By: 

1^ UtiUty Clearance Called: VV / SL? / vw 

By= v.^,«/. o \..,<t.nA.^A 1 

Q Video/Photos (Before) On:_\^ 1J^ / \.c> By: '^it...'^ 

D Video/Photos (During) On: / / By: 

n Video/Photos (After) On: / / By: 

D Video/Photos (30-Day) On: / / By: 

Q Property Completion Agreement Siened: / / By: 

n Final Report Issued: / / By: 

Air Monitorine (as applicable) 

• Conmiunity • Crew On: / / By: 1 

Results: 

• Community • Crew On: / / By: 

Results: 

Q Community DCrew On: / / By: 

Results: 

Omaha Lead Site 
Douglas County Account In &|a|tion Page 1 of2 

Douglas County, Nebraska Property Record - R1438950000 

Print Reoort 

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

New Feature r r f4> r f Subdivision Sales Search 

Owner 

MOORE SR KENNETH 

4066 SPENCER ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Numtier: 3895 0000 14 

Account Type: Residential 

Parcel Number: 1438950000 

Parcel Address: 4110 PINKNEY ST 

OMAHA NE 68111-0000 

Legal Description: KENWOOD ADD LOT 433 BLOCK 0 W 45 FT LTS 435 434 & 45 X 120 

Value Informatio n 

Land Improvement Total 

2010 $900.00 $0.00 $900.00 

2009 $900.00 $0.00 $900.00 

2008 $900.00 $0.00 $900.00 

2007 $900.00 $0.00 $900.00 

2006 $900.00 $0.00 $900.00 

2005 $900.00 $0.00 $900.00 

Show All Transactions 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.12 5400.0 0.0 120.0 45.0 Yes 

http://douglasne,mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R14... 9/15/2010 
3/31/2011 www.dhon.org/irthinternet/DHONNotic... 

Create Another Ticket Back tWRSB h Intemet [Send Email 

• YOUR TICKET NUMBER IS 2700333. 

Original Call Date: 3/31/11 Time: 3 41 pm Op: ALFONSO18790 


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


State: NE County: DOUGLAS Place: OMAHA 


Address: 4110 Street: PINKNEY ST 


Twp: 15N Rng: 13E Sect-Qtr: 08-NE-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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Utility Service Area Contact Phone Number Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 


Emerg: 4029329757 


Day: 4025047823 

METROPOLIT/y^J UTILITIES MUDOl SANDY MUD Alt: DISTRICT 

Emerg: 4025047970 

Day: 4024447197 

CITY OF OMAHA- OMAHACOF RICHAFRAFFIC Alt: 4024445161 TRAFFICSEWER 

Emerg: 4024445160 

Day: 4067289343 


OMAHA PUBLIC POWER ELM 0PPDGPR5 /Ut: 4062071494 DISTRICT LOCATING 

Emerg: 8887289343 


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

W ^Day : 4067289343 

QLNNEIC QWEST LOCAL NETWORK r^r^A-nxTr^ Alt: 4062071494 

LUCAllNU 

Emerg: 8887289343 

dhon.org/irthintemet/.../MessageText.as... 2/2 
IP As-Built Drawing ^ 

C

CNVmONHCNTA

 OASTAL L Omaha Lead Superfund Site C M O U P . IN C 

OLS#: 31381 

Date Excavated: 4/14/2011 

Date USEPA Signed Off: 6/28/2011 

r Area Sodden: 3712soft 

3/36/ 

Omaha Exterior Paint 

NoithArrow Lead Site Own er Name t.£>HNBU CAVITUOH 

Site Sketch • Good 

.Address: quo pi>iKfjEV^ • Poor Phons: « [g^Not paint 

Sampl Lead Sample 

Samptes Collected e Number LAB Concentration Collected Firm: FPA Fig g i 

RVASCPXA-3f3fl/ Fl / 2 0 _pp m D Date: 4 1 W j Of, RVBSCPXA-3i3a/ F2 6>6>5 _pp m D Time: IV^ ^ 

RycscpxA-3/3a/ BI ;22- _pp m D 

Samples Analyzed RVDSCPXA-a/a^/ B2 .ppm D 

ROaSCPXA- DZ- ppm D D XRF Unit <^r71 Book: m 

RSZscexA^ -G2 - ppm D D Date: ^-^ii-o u 

BPZSCEXA- J2Z- ppm D D 

Time: Ph 

Staff: ^ ^ U Number of Samples = 

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

AD quadrants are as vtew«d From tha street, facing propert/ 

Legend 

Concre'te Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced wilUi Area left bare 
 Sod ' ' Rock/Mulch 


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

LLy/ ^ 

3i3a i 

Exterior Paint 

North Arrow 

Ow Omaha Lead Site n er Name: LCNNBU CAWTUOM 

Sit • Good e Sketch Address: t^ilOJitiJiiM^ • Poor 

Phone: H W: 

\ [g^o t paint 

Sample Number Lead Sample 

Samples Collected LAB Concentration Collected Firm: FD/^ F & ( J 

RVASCPXA-3f3fl/ Fl / 2 0 ppm D Date: 

A

22 w iiSsRyBSCPXA-3/3a/ F2 6.(<5 ppm 

D Time: 

RyCSCPXA-3/3a/ Bl / ^2, ppnfi 

D 

Samples Analyzed RVDSCPXA-3/35/ B2 .8* 7 ppm 

D 

ReZSCPXA- D2- *• ppm D D XRF Unit: Q<02 Book: //g 

RGZSCEXA. -G2-

D D Date : ^ - :?•? -0<<. 

gpZSnPXAr ~ ppm 

D D 

Time: ,^^^2 

Staff: m\f / Number of Samples = 

Legend- 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, fadng property 
3i3a t 

Omah Exterior Painl North Arrow 

Ow a Lead Site n er Name: LCNN^U CAWTUOA J 

Sit • Good e Sketch 

• Poor 

Phone: ^• W: f [g^o t paint 

Sample Number Lead Sample 

Samples Collected LAB Concentration Collected Firm: Fp/> F^ y^ 

RyASCPXA-3/3fl / F1 /2Q ppm D Date: 

Ujil ah. RyBSCPXA-3/3a/ F2 Li>5 ppm 

D Time: 

RyCSCPXA-3/3a/ Bl I I Z ppm D Samples Analyzed RyDSCPXA-3/3,g/ B2 _S1 ppm D 

ROZGCPXA DZ­ ppm D D XRF Unit: CtOI Book: }i i 

RGZSCPXA. . -GZr~ ppm D D Date: M - :i.i -OL> 

gPZSCPXA. JJZ­ ppm D D 

Time: PA1 

Staff: //<?(,/ Number of Samples = 

Legend: 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 
Omah Exterior Paint North Arrow 

Ow a Lead Site n er Name: LCNNBU CAvJTUoM 

Site • Good Sketch Address:, qll C P>'MKfOEV ^ • Poor Phone: H; W: \ (g^Not paint 

Sample Number Lead Sample Samples Collected LAB Concentratksn Collected Firm: FP/^ E&jA. 

RyASCPXA-3/3fl/ F1 /20 ppm D 

Date; A | ><? j ofc iUii RyBSCPXA-3/3a/ F2 6? IB 5 ppm D Time: 

RycscpxA-3/3a/ B I 

/ 22, ppm n Samples Analyzed RyDSCPXA-3/3^/ B2 8 1 ppm 

RBZOCPXA- DZ­ D — ppm D XRF Unit: CJOI Book: J/d_

RGZSCPXA. G2­ D - ppm D Date: H-::>i-OL> 

gPZSCPXAn D -ez- ppm D Time: /V7 D 

Staff: ^^i ^ Number of Samples 

Legend: Fl = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

ENTERED 

M l ] mm 

8 1 

I : ^ ^ I 2 0 

T\ 

• ^ ^ 

n 

• • . ^ . . . . . 

mM% : 

ppef 5:^ 

Rev 4. I 046141.0123 
>^''*'l^*'u 

COASl A 1 

[NVItOMKIXUI 

c I 0 u r I h c 

Consent \o\ AocciSi^- To Piopc-irly 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property' owner) consents to and authorizes the United States 

Environmental Protection Agency (EPA) oi its authorized representatives, collectively 

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

following described premises: ^ i ^ C / 

Owner's Name: Daytime Phone: 

/(o^r e T r f^e/int^fj ^ y/oi-¥S6^^H9 

Address of Property 

covered by this 

Agreement: "(" ^ ?in7i ric^ sy 

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

opporlunity 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 effect until the work has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
XA/y : 

C0A.S 1 A l IhVIROhKtKTA l 

C R O U f I K c 

I Remove obstructions including boats, trailers, vehicles, playscape ilems, wood 

piles, dog houses, elc; 

f Remove flower bulbs or piants that the Grantoi or the Granlor's tenant may wish 

to save; 

I Water and maintain replacement vegetation, including fertilizer application, as 

necessary' subsequent to an initial watering period by EPA; 

« Abide by health and safety guidance provided by EPA; 

« If the property is rented, assist EPA in obtaining tenant approval foi access lo 

the property' to perform the work. 

t Allow videotaping and/or photographing of 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 

D1 grant access to my properties 

O I do not grant access to my properties 

Signatur i 

e Date Signature Date 

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

Page 2 of 2 
COA S T A L • NVmONMINTA L GROUP , INC . 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions of the property prior to 

remediation activities. This will also serve as docimientation for the purpose of assiiring that restoration 

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

Protection Agency (EPA). 

Property ID: jyT'jf/ 

Property Address; ^/y/c; F7^/f^e.^f~ h 

Owner: /Uoor e 5'^{ /^g^^ M e T V 

Phone: 702. -Hfy^riH J 

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

access location(s) to be used by the contractors, hidicate 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 responsibility. 

Hem: 

/L/a>i ^ 

item: 

Hem: 

Item: 

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

Hem: 

y^Cf7U>. 

Kem: 

Kem: 

Kem: 

Page l o f 7 
COA S T A L • MVmONMKNTAL O II O U P . INC . 

Items to Be Removed By Contractor During Remediation and Replaced 

Kem: 

^ y 

Kem: Sj 

Kem: 

Kem: 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, 

that will be excavated, that Fz Quadrants 

is covered with grass. 

Number of trees > 2 inch Each 

trunk diameter ^ 

Number of trees <= 2 inch Each 

trunk diameter ^ 

Number of Sprinkler 

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

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 not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Easement Area, to be Each excavated 

^2^ ^ 

Page 2 .J_ 
COA S T A L • MViaONMB N T * L O • O U P . INC . 

AddKional Comments / Instructions: 

The city of Omaha ordinances may prohibK 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 cKed by the cKy If you use a gravel or dirt area 

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

If you have any question about legalKy of a certain driveway or parking area, you may contact 

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

n Please check this box if you understand the Information outlined above. 

yth ^n F L ^^ ^ h^y7d\ 

D 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. 

Emi I i Q I do not agree agree 

Owner's Signature Date Contractor's Sienature Date 

Pages ^Z 
BVID# 3138 

XRF PROPERTY SAMPLE SHEET 

Date a^\%[pl^/y)\\ Address M-lln p\nk^y1^ ^^t 

Project Omaha Lead ARRA Sample time am/pm 

XRF ID# 7,^017­ sample length 30 sec 

Shot# Reading Sample area Shot# Reading Sample area 

nyi^ \^^ t ll f^ 

nSh \^ \ t \U? Depth Depth 

7.4 1301 n 4 I, 

Average \^ ^ j : y\ Average 

Shot# 

lAf) 

2.n 

XSb 

Average

Reading 

\0 ^ t \u> 

\\9>^^\u> 

Yi(\ ^^i-n 

Sample area 

^P c 

Depth 

\ " 

 \ V ^ t H 

Shot# 

Average 

Reading Sample area 

Depth 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading 

RETEST AREAS 

Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Signature_ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 129.042 

Supervised By: 

Certificate of Verification 

25 

SOIL 

2011-04-26 11:03 

95.06 

Final 

Avg of 22-24 

4110 pinkney st" ^ 

F2 

4" 

N. LOPEZ 

confirmation 

none 

Error 

17.427 * 
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 135.295" 

Supervised By: 

Certificate of Verification 

22 

SOIL 

2011-04-26 11:01 

31.26 

Final 

31381 

4110 pinkney st 

F2 

4" 

N. LOPEZ 

confirmation 

none 

Error 

17.878 
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 121.129 

Supervised By: 

Certificate of Verification 

23 

SOIL 

2011-04-26 11:02 

31.82 

Final 

31381 

4110 pinkney st 

F2 

4" 

N. LOPEZ 

confirmation 

none 

± Error 

± 16.923 
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 130.701 

Supervised By: 

Certificate of Verification 

24 

SOIL 

2011-04-26 11:03 

31.98 

Final 

31381 

4110 pinkney st 

F2 

4" 

N. LOPEZ 

confirmation 

none 

± Error 

± 17.480 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 29 

Mode SOIL 

Time 2011-04-26 11:06 

Duration 94.74 

Sequence Final 

Flags 

AVERAGE Avg of 26-28 

ADDRESS 4110 pinkney st 

QUADRANT ,_, . EA 

DEPHT 1" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm ± Error 

Pb 119.253 ± 17.129 

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 109.663 

Supervised By: 

Certificate of Verification 

26 

SOIL 

2011-04-26 11:04 

31.73 

Final 

31381 

4110 pinkney st 

EA 

1" 

N. LOPEZ 

confirmation 

none 

db Error 

± 16.607 
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 118.723 

Supervised By: 

Certificate of Verification 

27 

SOIL 

2011-04-26 11:05 

31.73 

Final 

31381 

4110 pinkney st 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 16.951 
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 129.372 

Supervised By: 

Certificate of Verification 

28 

SOIL 

2011-04-26 11:06 

31.28 

Final 

31381 

4110 pinkney st 

EA 

1" 

N. LOPEZ 

confirmation 

none 

Error 

17.82' 
iy;A^\ Omaha Lead Site—Fixed Price EP-R7-09-06 

S ^^^^ I Coastal Environmental Group Inc. .•• 

\^^^J ^ www.coastalhazmat.com TM 

'"•'"^ COASTAL 

EXECUTIVE SUMMARY: 

BVID #31381- (4110 PINKNEY ST ) 

pxl No Issues or Concerns | ^ Issues/Concerns 

•

Detail Explanation: 

 COASTAL IS UNABLE TO PROVIDE PRE-EXCAVATION, EXCAVATION, AND SOD 

PHOTOS AS PART OF THIS FINAL PROPERTY FOLDER. THESE PHOTOS WERE IN 

THE POSSESSION OF A SUBCONTRACTOR THAT WAS CONTRACTED TO PERFORM 

ALL OF THE SITE COORDINATIOIN REQUIRED BY THE SCOPE OF WORK AND THE 

SUBCONTRACTOR HAS SINCE LEFT THE PROJECT. THEREFORE, THE PHOTOS 

ARE NO LONGER AVAILABLE. 

• DAN GARVEY WALKED AND SIGNED OFF ON THE PROPERTY AS COMPLETE ON 

6/28/2011. 
I

Property Completion Agreement 

This agreement documenis the complclion of remedial acliviiies perroimed on my properly My signature 

will designate Ihal I am satisfied with (he restoralion of my properly, and thai no items are in queslions. 

now, or al any inne in the future, except ihose ilems listed below, if any 

Property ID: ^{ ^ $^\ 

Property Address: ^//^"//^i^^i ^ " ^ 

Owner: ^^.^ ^ ,uJ>V 

Phone ^^r i^fH 

Restoration Items in Question: 

Item 

H r . Hoo^" ^ ^Vc^ ^ ]X ^ kfe eg^o^es -ro 5-iciLj 

Item 

Item: 

'QCaA^f ^ MKS^ . g-KYv/^li/^Tt ^ <avj^^<^ T-G rt^ATTll-fc K l r 

Item. 

Item y^^/^^^. j^/. , 

item: 

Additional Comments: 

 I I agree restoralion i« completed, except as noted 

[_J I do nol ai;rec restoration is completed 

Owner' s Signature Date Conti arior's Signalure Dale 
4

tF% 

EPA Property Close Out Form 

Property #: HML Property Address:- -pDatcATime: Owncr's Name:. /i^ ^ 

Quads Excavated: Contractor Group 

Excavation Geaeral 

1. IF necessaiy, were the correct quadrant(s) excavated and restored? 

2. If necessary, were the coirect areas of drip zone excavaled and restored? 

Grading Sod and Vengtelton 

I. Does the grading around the perimeter orthe house in excavated areas generally s)ope away 

from the house? ^ 

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

3. Docs the sod appear to be genenlly healthy and growing? (Only evaluale if inspected ai a 30 

day time period) 

4. Are sodded areas generally firm and evenly graded? 

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

time period) 

6. Was the propetty graded such that water will not pool on the prapem'? 

7. Was damage to landscaping or plant materials avoided? 

Gates. Fences and Retatolng Waib 

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

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

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

4. Was dainage lo retaining walls avoided? (Ifapplicable) 

Foundation, SidiBRflBd Gmters 

t. Was damage to the siduig or trim avoided? 

2. Was damage to the foundation avoided? 

Was damage lo windows avoided? 

 Was dainage to windows or door screens avoided? 

5. Was damage lo downspouts or downspoui extensions avoided? 

Sidewalks and Driveways (Concrete) 

I. Was damage lo driveway surfaces avoided? 

2. Was damage to wallcway surfaces avoided? 

.,^f^ 

Yes No 

/ 

y 

Yes No 

y 

y 

y 

y 

/ 

y 

y 

Ves No 

y 

y 

- y 

yYes No 

r

/ 

/ 

r 

Yes No n 

y 
Owners comments: 

I ^^ _ 

jln.spection noles: 

^i" y 

^ > ^ iCi>^' 

y 

Rempval and restoration activates complete including the 30-day sod warranry: 

EPA Representative Qg^A^Oy Date:___^_£\i,t\\^