TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

sMDn3yDM[Q DATE: 3lb\ll2 

ADRESS: 3^5 ^ )^rA\7e.nu}nf4-lz\ ^ 

REMEDIATION CONTRACTOR: COASTAL ENVIRONMENTAL GROUP YEAR: ^Q^ 2 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

IZ Executive Summary 

1/ EPA-provided property sketch 

W Signed Access Agreement for subject property 

N n Signed Access Agreement (s) for adjacent property 

V Restoration Agreement 

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

"3 Confirmation data # 

D Photographs V SOD 

V Pre-Excavation 

Excavation 

As-Built sketch 

Iv Satisfactory restoration signed by Property Owner 

[y Property close-out check list signed by EPA 

Description of areas of areas not meeting ROD cleanup criteria 

Utility clearances / 

VI Property Information from Douglas County Assessor's Office 

D 

Superfund 
Property Access Checklist 

Property ID: D WORK STARTED ON: __/__/ '5&^->^W 

Property Address: 

D WORK COMPELTED ON: / /" 

"^^S* ^ \ yci>v^Pr>i,^rvr-V\\^T 

Owner: , . v, » » 

Renter: 

V A > V_ i (J(>f>n e- y^yj^o 

Address: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

Phone: ^KO':i..-^\-\-UM P.f^ 

Fax: 

Cell/Pager: 

n Notification Letter 

Sent: / / By: 

bll Access Agreement Signed:-^

 /^/^ ^ By: 

SI Restoration Agreement Signed: -T- / ^a / ^ \ By: 

n Topsoil Sampling (if applicable) /

 / By: 

Q Disposal Sampling (if applicable) /

 / By: 

O Garden Sampling (if applicable) /

 / By: 

n utility Clearance Called:"!

 I^Z.1 CU By: 

[JJ Video/Photos (Before) On: / / By: 

D Video/Photos (During) 

On: / / By: 

n Video/Photos (After) 

On: / / By: 

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

Ffl Property Completion Agreement Signed: o-s

 f^tt i N\ By=^^ . V^^Vr. ^ 

n Final Report Issued: / / By: 1 

Air Monitoring (as applicable) 

• Community [H Crew On: / / By: 

Results: 1 

n Community • Crew On: / / By: 1 

Results: 

d Community • Crew On: / / By: 1 

Results: 

Omaha Lead Site 
Uouglas County Account iniormation http://douglasne.majming-onltne.com/DouglasCoNe/static/accountinfc 

Douglas County, Nebraska Propert y Record

Information Is valid as of 2011-7-15 

Owne r 

ANZALONE JONO A 

! 1101 WALNUT ST #509 

: KANSAS CITY MO 64106-0000 

Propert y Informatio n 

- R1038140000 

Print Report 

View Interactive GIS Map ; 

Treasurer's Tax Report 

New Feature -4 -• -> Subdivision Sales Search 

Key Number: 

Account Type: 

Parcel Number: 

Parcel Address: 

Legal Description: 

Value Informatio n 

Land 

2011 

[2010 

2009 

2008 

2007 

2006 

Sales Informatio n 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

3814 0000 10 

Residential 

1038140000 


3555 LEAVENWORTH ST 

OMAHA NE 68105-0000 

FEARON PLACE LOT 7 BLOCK 0 LTS 5 & 6 & E 1/2 55 X 121 

Improvement Total 

$11,300.00 $79,500.00 $90,800.00 

$11,300.00 $79,500.00 $90,800.00 

$11,300.00 $79,500.00 $90,800.00 

$11,300.00 $79,500.00 $90,800.00 

$11,300.00 $79,500.00 $90,800.00 

$11,300.00 $60,700.00 $72,000.00 y 

2002-09-04 

WD 8oo^; 2224 ] Page: I 57 

$79,000.00 

Valid 

1995-05-16 

D Book: I 2008 Page: 1 022 

$54,000.00 

Valid/Invalid: I Valid 

1 of4 7/19/2011 1:12 PN 
uougias v_uunty ACCOUIU miormaiioi) nttp://aougiasne.rnanping-oniine.com/UouglasCoNe/static/accounlinf .rnaiTp ( 

Exclusion Reason: 

Lan d Informatio n 

^cres ' SF 

0.15 ; 6655.0 

Units 

1.0 

' Depth 

0.0 

Width 

0.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

Z\lzi^'^3 y l f :.5 5Tc*i Ltj-:jishE:. ••.••ll­ ' ll.;"M H • 

CLICK TO ENUVRGE IMAGE 

Square Footage: 1642.0 ._.J__._. , 

Percent Complete: 

Perimeter 0.0 Quality: 

Unrt Type: Condrtion: 

Built As: 2 1/2 Story Unfin Condo Square Footage 

L. HVAC: Central Air to Air Rooms: 

Exterior: Frame Siding Unrts: 

Interior: Drywall Baths: 

Roof Cover: Composition Shingle Bedrooms: 

Roof Type: Gable Stories: 

Floorcover: Allowance Foundation: 

Sprinkler Square Footage 

Year Built 

Year 

Remodeled 

" T 

Percent 

Remodeled 

Adjusted Year 

Built 

1923 1 0% L 

1923 

I Detail Type Detail Description 

! Add On Fence Wood 

! Appliance Allowance 

i Basement Bsmnt Block 8 ft 

; Basement Finished 

I Fixture Additional Fixtures 

I Fixture Bath Full 

2 of 4 7/19/2011 1:12 PK 
uouglas county Account iniormaiion nttp://dougiasne.manDing-oniine.com'UouglasCoNe/static/accountinfc 9' 

Porch Slab Roof Ceiling _225J0 

Porch Wood Deck 120.0 

'-. 3 of 4 7/19/2011 1:12P\ 
As-Built Drawing 

OLS:50646 COASTAL DATE EXCAVATED:8/15/11 

DATE USEPA SIGNED OFF: 9/27/11 Omaha Lead Superfund Site AREA SODDED: 2475 

Environmental (iniup. Inc. 

S<D<Z^<2 

Omah a Exterio i Patn t North Arro w i_ea d Sit e Owno r Name . Af/'^ G y^n^sAjDn S • Good Sit e Sketc h Address: ^s'^TH ' As^\yer?£u.ja/''fA} cSy. I I Poor Phone : » ^/jSL'A3t3<3^y ^ (Z/a^OTs^jS . [g-No< paint 4-

Sampl Samples Collected e Number Lesd Sample Concentratio LAB n Collected Firm: T^t^<\\ Ci^ \ r> a 

RVASCPX A <S7 0 

ppm a Date: rT^ C - ^- \ - ^ £. RVBSCPXA - 2-2.-1 • Time: - p r-^. RVCSCPXA - /8 ^ ppm 

ppm •

RVDSCPX A 5 5 ^ • Samples Analyzed ppm 

-RE>ZSGPXA 

ppm • XRF Unit: ' ^ C) 7 Book: JoC ^ 

-RDZSCPXA ppm • Date; C=. - /(T, - OC> 

-R-F»^- ppm Time. yZT 

Staff A^I^W -

Legend : F l = Front Left. F2 = Front Right. B l ~ Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden. F'Z. = Play Al l quBfilrants are as vleM^ed fro m tr>e street, facing propert y 

Number of Samples 

B2=275 PPM @ 6" 

F1= 55 PPM @ 6" 

_L,.„-: 

; / <» CX-vy :«.r v C/vJ O ' ^ H- x f X ^ 046I 4 1 OIZ.'I 

CONCRETE m DRIP ZONE EXCAVATED QUADRANTS EXCAVATED 

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

CONTRACT #: EP-R7-09-06 COASTAL ENVIRONMENTAL GROUP, INC. 
a/ A ZAt fcZo ir 

y 

Omah North Arrow a Lead Site Exterior Paint Owner Name: 

Site Sketch • Good Address: <S7. • Poor Phone: »^/5--I3AA W; i

Q^o t paint 

Sample Number Lead Sample LAB Samples Collected 

Concentration Collected Firm; F^A_Lfi£iJ:ifi 

RyASCPXk-50G*fG P1 ^P^ O ppm 0 D Date:AiL -ot-og . 

RYBSCPXA-5-0Ci/<3 F2 21 1 ppm 

D Time: ^ '.nhf^r^ 

RYCSCPXA.S'0Qtp2 B1 _ifiil_PPm Q- D 

Samples Analyzed RYDSCPXA-50C V<S B2 5 5 3 ppm Q^ D •RDZSCPXA Jp(S<i»tC DZ 

ppm D D XRF Unit: ^Q ? Book: lO L 

RGZSCPXA-^^g^-GZ- ppm D D Date: fi - /Co ' 0 6 

.np26CPXA-50giy^ PZ ppm D D Time: 9 M 

Staff: /^-S W 

Numt>er of Samples = i 4 -

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 
50Q^G 

Exterior Paint North Arrow Owner Name: Mi7<Q AnrriZdn e O^ah a Lead Site • Good Address: 3S^^Ll.£a)zeaLuQrfh cf/. ^'*^ ^''^^^^ Q Poor 

Phone: Hg/>f./.^rt<^ w Cja-Q73^ . i g^Nlot paint 

Sample Number Lead Sample Sampies Coiiected LAB Concentration Collected Firm: HMlBnXia_ _ RYASCP'XA-50G ^ P1 (P70 ppm D Date:A;l -^T-^C > 

RrBSCPXA-.50C2y<S ^^ Z Z1 ppm D Time: ;!_ \ r• ^ p r^ 

RYCSCPXA-SOGH^ Bl ppm D 

Samples Analyzed RYDSCPXA-5t>G¥<S B2 ^5 3 ppm D 

ppm D • XRF Unit: ^0 ? Book: /OL , •RDZSCPXA-^raCy^GZ - ppm D D Date 

ppm D D Time I'1^ 

Staff Numbe /^^V^ r of Samples = ; 4 -

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 

Rev 4 046141 .0123 
Exterior Paint North Arrow 

Owner Name; Mikp Anra/one °"l^.^^ ^l^ f l'^^ • Good 

Address: ^ff^fT Leaveou torth <S^. Site Sketch • Poor 

Phone: " g/^-/.?d d '^ Glt'Q7a2 . g^o t paint 

\ 

Sample Number Lead Sample Samples Coiiected LAB Concentration Collected 

RYASCPXA-dOG>^ F1 61 0 ppm D Date:AiU-<:>T-oC. 

RYBSCPXA-^DCy^ F2 21 1 ppm D Time: n_ '.n^prvN 

RYCSCPXA-50CW Bl / 8 ^ ppm 

a Samples Analyzed 

RYDSCPXA-^OCVG 5 5 3 ppm B2 

ppm D D XRF Unit: ^0 ? Book: Jj2U. npz6Gr>XA sc^*i(A oz ppm D D Date: ' la • CXQ 

ppm D D Time: •2 5 

nPZSGPXA JOc ^ ^ ^ D Staff: Number of Samples =14 - n^y/ 

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

All quadrants are as viewedfrom the street, facing property 

AUf^ 

JUN a 8 

&.V. 

Gsfvc. 

.X>7.-' 55.3. 

\..^s^.^. 

Lea,vtnioPrHjft( 

^v-^bL^i ^ 

G7P 

ijiii< : it t 

•J_^a.c.'ej\w«T^ ^ y Rev4 044141.0123 . 
 I 

Go^Mi^ 

••z y 

y (. O A $ 1 /

C^OiuS'tilil ^n: /Xc.cui^;^: 'i c> I'lDpHit y 

R1GH1 OF EKHRY'IO PREMISES 

Gfanloi (the piopert^' owner) consents to and authorizes the United Slates 

Environmental Protection Agency (EPA) 01 its authorized representatives, collectively 

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

following described premises. 

Owner's Name: Dzylinne Phone: <~7/(/ . 7^7^77^ f^/ZyJ4d»^ 

Address of Property 59?$^ ^A^^<^^Q^.A ' 

covered by this 

Agreement: 

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

agrees to: 

Page 1 of 2 
C 0 A 5 1 *. i 

' Remove obstructions including bosis. tiaileis, vehicles, plcvscape items, v»'ood 

piles, dog houses, etc: 

Remove flower bulbs oi plants thai the Grantoi or the Grantor's tenant may wish 

to save; 

Water and maintain leplacement vegetation, including feiiilizer application, as 

necessary' subsequent to an initial watering period by EPA, 

' Abide by health and safety guidance piovided by EPA; 

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

the property/ to perform the work. 

I Allow videotaping and/or photographing of the property. 

AGREEMENT NOT To INTERFERE 

The Grantor agrees not to interfere or tampei with any of the worl^ activities, oi 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 

Q I grant access to my properties G ' do not grant access to my properties 

Signature Date 

Q I woul d like to be present duiin g any sampling that is requited. 

Page 2 of 2 
Restorallioin Agireemeinit 

The purpose of this agreement is to provide a mutual agreement as to condilions of Ihe property prior lo 

reinedialion 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 

Proleclion Agency (EPA). 

Property LP: ^50^^ ^ 

Propert. Address: ^^t ^ LgAvje&VLV^QlgXV l -^ A 

Owner: fiA^fj/O l^^-7J^,LJZ>\AJ^ 

Phone: c(6-Z- 1 H CTH.'Z? 

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. Indicate distances, depths, material types, etc. 

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

necessary. 

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

TOe removsS, gtorage;'diisposal, an<fi/or reSum oftfoase ISksms.fc fiilte.Ota^ciiiBir's reaipoiiwtibillilty. 

Item: ^*.A^C ( IX-AU-.3 

Item: 

[a^ ^ 

Item: Hd[cK (j)^U 2>'^^\ 

Item: 'b^%-H 

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

Item: 

^q^^^ y ( PI^^KJ^T-^ i 

Hem: 

Item: 

Item: 

Page 1 of. 
COASTA l 

c » o u r . I ^ f 

Items to Be Removed By Contractor During Remediation and Replaced 

Landscape inventory 

Item Quantity Unit Con dition/Type/Species 

Prc-exisiing propeny area, Quadrants 

thai «'ill he excavated, ihat 

is covered with grass. 

Number of trees > 2 inch Each I trunk diameter 

Number of trees <= 2 inch 0 Each 

UTjnk diameter 

Number of SprinkJer 

Zones, Control Valves, 

Each Timers, Heads, etc. 

Attach a sketch of the 

sprinlder layout. 

Number of and size of 

each garden/ flower bed Each 

area. A Square Feet 

Attach a sketch of relative 

sizes and Jocations. 

Agreed upon value of plant 

materials not to be 

replaced by contractor. 

Note this value will be 

used to issue s plcnt 

voucher to the property 

owner. 

Easemeni Area, to be 

excavated o Each 0o>yPage 2 of 
I

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. 

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

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

 I Please check this box If you understand the information outlined above. 

Do 77 yZxs^iZ^. 

^.y. • Chei^ the box if Owner does not want CEG to document interior foundation walls and possible 

pre-e»feting damage. By checking this box CEG is not responsible for any damage done to the 

inte^r of house, including foundation cracks or fissures. 

I agree 

/Owner's Signaiure 

 I 
% 

BVID# 5^^^ ^ 

XRF PROPERTY SAMPLE SHEET 

Date ^g-li.-U Address 

Project Omaha Lead ARRA Sample time 

XRF ID# 3^02Z sample length 

 . 

Shot# Reading Sample area Shot# 

^ OUj^ I'i Fl f.3 

\0 sn 'H Depth IH 

u ^H i '3 ^ ' ' IS 

Average g&i:'H Average

Shot# Reading Sample area Shot# 

Depth 

Average Average 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

Signature, i\ I .'OZy 

Print EPiA/ARv^ tCt/Jt, 

3 5 S 5 L ^/l i/*-<Vu/o?rt< s r 

am/pm 

30 sec 

Reading Sample area 

27^ rt25 B 2 

27^i: 2 5 Depth 

26«ri: 25 U' 

 >^^ 3 J l ^ S 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 
# 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 r^iddlesex 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 55.920 

Supervised By : Z/

Certificate of Verification 

12 

Soil 

2011-08-16 16:39 

90.43 

ppm 

2 

Final 

Avg of 9-11 

3555 leavenworth st 

Fl 

6" 

KING 

confirmation 

confirmation 

± Error 

± 14.018 

I y l -y 
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 64.428 

Supervised By: 

Certificate of Verification 

9 

Soil 

2011-08-16 16:37 

30.17 

ppm 

2 

Final 

50646 

3555 leavenworth st 

Fl 

6" 

KING 

confirmation 

confirmation 

± Error 

± 14.689 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Tumpike 

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 58.859 

Supervised By: 

Certificate of Verification 

10 

Soil 

2011-08-16 16:38 

30.12 

ppm 

2 

Final 

50646 

3555 leavenworth st 

Fl 

6" 

KING 

confirmation 

confirmation 

Error 

± 14.149 
"^'.-y^ 

Thermo 

S C I E N T I F I C 

Thermo Fisher Scientific 

900 Middlesex Tumpike 

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 44.472 

Supervised By: 

Certificate of Verification 

II 

Soil 

2011-08-16 16:39 

30.14 

ppm 

2 

Final 

50646 

3555 leavenworth st 

Fl 

6" 

KING 

confirmation 

confirmation 

± Error 

13.215 
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 

Pb 

Supervised By: 

Certificate of Verification 

16 

Soil 

2011-08-16 16:42 

90.52 

ppm 

2 

Final 

Avg of 13-15 

3555 leavenworth st 

B2 

6" 

KING 

confirmation 

confirmation 
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 279.071 

Supervised By: 

Certificate of Verification 

13 

Soil 

2011-08-16 16:40 

30.27 

ppm 

2 

Final 

50646 ' 

3555 leavenworth st 

62 

6" 

KING 

confirmation 

confirmation 

± Error 

± 25.439 
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 279.796 

Supervised By: 

Certificate of Verification 

14 

Soil 

2011-08-16 16:41 

30.22 

ppm 

2 

Final 

50646 

3555 leavenworth st 

B2 

6" 

KING 

Confirmation 

confirmation 

± Error 

± 25.462 
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 268.728 

Supervised By: 

Certificate of Verification 

15 

Soil 

2011-08-16 16:42 

30.03 

ppm 

2 

Final 

50646 

3555 leavenworth st 

B2 

6" 

KING 

confirmation 

confirmation 

± Error 

± 25.338 
X 

o 

Omaha Lead Site—Fixed Price EP-R7-07-05 

o ^^^^_ ^ Coastal Environmental Group Inc. ... 

Sy^^^ www.c0astaiha2mat.com '^ ^"^""^ COASTAL 

EXECUTIVE SUMMARY: 

BVID #50646(3555 LEAVENWORTH ST) 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 

COASTAL IS UNABLE TO PROVIDE PRE-EXCAVATION AND EXCAVATION 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 

COORDINATION REQUIRED BY THE SCOPE OF WORK AND THE SUBCONTRACTOR HAS 

SINCE LEFT THE PROJECT. THEREFORE, THE PHOTOS ARE NO LONGER AVAILABLE. 

9/26/11- PO NOTED IN COMPLETION AGREEMENT; KEEP SOD ALIVE, IF DEAD REPLACE. 

ADD MORE DIRT TO THE HILL AND PACK DOWN. 

9/27/11- DAN GARVEY SIGNED OFF ON THE PROPERTY AS COMPLETE. 
O ^ ^»-«be. Op-V^oAl 

COASTAL 

Property Completion Agreement 

This agreement documents the completion of remedial activities performed on my property. My signature will 

designate that 1 am satisfied with the restoration of my property, and that no items are in question, now or at any 

time in the future, except those items listed below, if any 

Property ID: so(y7(^ 

Property Address: 3^"^ ^ Z-CyiC^.^e^z-^y 

Owner: ZHyf-^ AZ/)2.i^/y^.^ 

Phone: cZtI 7/ ^ (i^VS'S 

Restoration Items in Question: 

/^^p ^ 3 cf/^'Z^ , IT cJ7es r^W^tdt 

Item: . . , 1 

/ W AUfif^ 3y7 - To hfll 4' 

ItemItem: 

Item: • 

Item: 

Additional Comments: 

I agree restoration in completed, except as noted 

I I I do not agree restoration is coniDleted 

yz f'^'// y 

Owner's Signature Date Contractor's Signature Oate 
E 

EPA Property Close Out Form 

Property Addrew.-'^'^^' ^ lfrow^r.^J='rV\ ^ iSV Property ff: ^Q>ia':r\^ . 

Date/Tine: 

Owner's Name:./,-.VA^ Af. . ..f^JQ^P ?P-r^f • -

Quads Excavated: Contractor Group 

Excavation Yes No General 

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

2. If necessary, were the correcl areas of drip zone excavated and restored? y 

Grading Sod and Vmelation Yes No 

I Docs the grading around the perimeter ofttie house in excavaied areas generally slope away 

from the house? 

y 

2. Has sod been laid in all areas that were excavated? y 3.

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

day time period) 

y 

4. Are sodded areas generally firm and evenly graded? y 5 Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) /

 

A 

' 

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

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

Gales. Fences and Retaialng Walls 

Ves .No 

!. Do gates open and close freely? (Ifapplicable) r 

yrr 

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

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

4. Was damage to retaining walis avoided? (If applicable) yFoundation, Sidiatand Cotters Yes /N o 

Was danuige to the siding or trim avoided? 

2. Was damage to Ihe foundation avoided? y 

3. Was damage to windows avoided? 

4 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspoui extensions avoided? / 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? y 

2. Was damage to walkway surfaces avoided? y 
1 

Owners comments: 

T.n.<;pection notes: 

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

HPA Representaiive ,6U^6^ Date: 9/27///