TRANSMITTAL of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID #: 2^'6l ^ Date: z/ 'njo^ 

Address: llpi 2- V\Of\C ^ t 

Remediation Contractor: _Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

5 / Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Confirmation data 

Photographs prg-i>y/'^jQ4tt^y J.)CrjMnDA^ ^(u d So A 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Office 

D 

^^ Signature Date" 
m 

Property Access Checklist 

Property ID: 2 ^ J?Ti^ 

Property Address: ^^^ 9 Mft^lf>S \ 

n

n

 WORK STARTED

 WORK COMPELTED

 ON:

 ON:

 /

 /

 /

 / 

1 

I Owner: C^^;^ ^ Cif\\\Q . 

Address: 

Phone: ^q^2'^L\q^.'^2.? 0 

Fa\: 

Cell/Pai-er: 

Renter: 

Phone: 

Fa.\: 

Cell/Pa"er: 

Additional Information: 

O Notification Letter 

l/t Access Agreement 

0 " Restoration .Agreement 

O Top.soil Sampling (if applicable) 

I CH Disposal Sampling (if a|)()licable) 

1 1 Garden Sampling (if applicable) 

1 0 " Utility Clearance 

1 D Video/Photos (Before) 

1 n Video/Photos (During) 

n Video/Photos (After) ­-

D Video/Photos (30-Day) 

d l Property Completion Agreement 

n Final Report 

Sent: / / 

Signed: ^/iX/£]i ^ 

Signed: X/il/OS : 

/ / 

/ / 

/ / 

Called: ^ / ^ / OR 

On: / / 

On: / / 

On: / / 

On: / / 

Signed: / / 

Issued: / / 

By: 

By: P C 

By: <pc. 

By: 

By: 

By: 

^y^wcfk 

By: 

By: 

By: 

By: 

By: 

By: 

Air Monitoring (as applicable) 

1 n Community n Cre«' 

Results:

On: / / By: 1 

1 

LJ Community 

Results: 

n Cre«' On: / / Bv: 

LJ Community 

Results:

D Cre^i' On: / / By: 

1 

Omaha Lead Site 
m 

CONTACT FORM 

Property ID # •^0^^- ^ 

Property 

Address: JAA Mft^\f> f\^ 

Initial Contact: Date: Time: ActionL 

Second Contact: Date: Time: Action:_ 

Final Contact: Date: Time: Action: 

Final Action: Transmit to EPA D Other Action: D 

^rr^\Ws QprpUg i^iL) ^al -1,1 ^ 

Comment: 

Owner 

Comment (s): 

Site q-2M 

Coordinator ^.30 

Comment (s): 

1K ^ Y 
Douglas County Account IrAamatio rmmsric n Page 1 of 1

# 

Dougla s County , Nebrask a Propert y Recor d - R174477000 0 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St • Vie w On Ma p Information is valid as of 2008-6-19 Treasurer's Tax Report 

New Feature ->-•- • Auto Sales Search 

Owne r 

SMITH CECELIA P 

ETAL 

4552 JENKINS DR 

PLANO TX 75024-0000 

Propert y Informatio n 

Key Number: 4477 0000 17 

Account Type: Multiple Res 

Parcel Number: 1744770000 

Parcel Address: 1612 MAPLE ST 

OMAHA NE 68110-0000 

Legal Description: MILLARD & CALDWELL'S ADD LOT 22 1 /2 BLOCK 0 N 71.625 FT 71.625 X 180 

Valu e Informatio n 

Land 

2008 $800.00 

2007 $800.00 

2006 $800.00 

2005 $800.00 

2004 $800.00 

2003 $800.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$800.00 

$800.00 

$800.00 

$800.00 

$800.00 

$800.00 

Lan d Informatio n 

Acres 

0.29 

SF 

12780.0 

Units 

0.0 

H/iiU 

180.0 

Oe^A Vacant 

71.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 7/17/2008 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2127339. 

Original Call Date: 9/09/08 Time: 3:36 pm Op: ELIZABETH18790 

Work to Begin Date: 9/11/08 Time: 4:00 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 1612 Street: MAPLE ST 

Twp: 15N Rng: 13E Sect-Qtr: 10-NE-NW-SE-SW 

Twp: Rng: Sect-Qtr: 

Legal Given: C 

Type of Work: lead remidiation 


Location of Work: LOCATE ENTIRE PROPERTY ALL THE WAY TO THE STREET AND THE 


: HOUSE. 


Remarks: FAX ALL CLEARS TO: (877)662-4211 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name: ELIZABETH Phone: (877)662-4210 


Work Being Done For: coastal 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MAGELLAN MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 9185747098 

MAGELLAN MAGELLAN MIDSTREAM PARTNERS LP TONYA Alt: 

Emerg: 9185747098 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047946 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/9/2008 
Page 2 of2 

Day: 4067289343 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 8887289343 

Emerg: 4067289343 

Day: 4067289343 

QLNNE1C QWEST LOCAL NETWORK NA Alt: 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/9/2008 
(

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As-Built Drawing 

C OASTA L ENVIRONMENTAL Omaha Lead Superfund Site CROUP , IN C 

^^^"1 ^ 

] Name: C-cc^iic, S^-V-I^VA Omaha Lead Site Date; ^-/</ - " V North Arrow \ 

Address; l(r,IZ A^ip u 5/ - Site Sketch Time: •? •"•/:> 

Phone; f 1 

Team 3i/lr, /U;,rv ^ CMS ^ BVID# '???!' $ XRF Code gC>'\ 

Sample Number Lead Concentration Confirmation Sample 

IC3 ^ 

ppm -P'Yes a No E3 

-M^n. f^Yes n No ET 

11^/'^' ^ ppm 

ppm No 13' 6'Yes C3 ^ ^ ppm '?<:Yes a No 13 ^ 

ppm Yes n No CD 

ppm Yes CD No CD 

ppm Y e s • No CD 

Omaha Lead Site 46130 

Legend 

Concrete Dri p Zone Excavate d Quadrants Excavate d 

Area replaced with 

Sod ' ' 

Are a replace d wit h 

Rock/Mulch Are a lef t bar e 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
D Remote ID: R page of k 

Name: drili'r . <>^,Jin 

Address; i(r,tZ A^jpk 5/ 

j Phone: 

Team BtlUt/lU,.^ory (MeC ^

Sample Number 

 BVID #

Omaha Lead Site 

Site Sketch 

 ^fg7 ^ 

Lead Concentration 

L^a. ppm 

i^^T^ 

^ ­ ^ ppm 

ppm 

ppm 

ppm 

Date: S/^-c^ / 

Time: l:¥'y 

^^^^^^ % 

North Arrow

XRF Code SC"^ 

Confirmation SampI* 

-P'Yes n 

•r^Yes ° 

•j'Yes n 

e^Yes D 

Yes n 

Yes t=3 

Yes • 

No E3 

No ^ 

No ta' 

No S ^ 

No D 

No n 

No • 

^ 

—) 

V 

V ^ 

t^ 

<i> 

-Lyl4Afl?-J. 

Omaha Lead Site 46130 
'^^'%'^ % 

Name: C^rj h ^^/-ll n Omaha Lead Site Date: S--/y- ^V North Arrow —i 

Address: /fe/Z A^f k s i Site Si(etch Time: ?•'•/:> 

Phone: f 

Team Me,/lL>fi,^or^ CMe ^ BVID # 'Zfdr B XRF Code ^^ ^ 

Sample Number Lead Concentration Confirmation Sample 

f2rA^pyA-g"7g7 l^a. -P'Yes n No ^ d-7 PP'" f^Yes n No 3 ^ 

u'Yes n No ^^r jyi T ppm 

'3<:Yes [^ No C3^ —^-I ppm Yes D No n ppm Yes n No O ppm Yes • No • ppm 

„^^44i.^*jJ 

Omaha Lead Site 46130 
D Remote ID: R page of 


• 

COASTA L IMViaONHTNTA) 

< • O U r . IH C 

Consent For Access To Propeily 

RIGHT OF ENTRY TO PREMISES 

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

Environnnental Protection Agency (EPA) or its authorized representatives, collectively 

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

following described premises: nna -irs 

Owner's Name: Daytime Phone: 

tSmilt, OMMA 

Address of Property 

covfired by this 

Agreement: 

Ikl l Mftf if S4 

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 dean 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 

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 vwll 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 
D

 Remote ID: R page of 

# 

—<~,' 

\

\ IM I

 o* COASTftL •*3i , .X ^ [NVIftONHrMTftl 

'lr«crt«- t > 0 u p. IN C 

• Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

• Remove flower bulbs or plants that the Grantor or the Grantor's tenant may vwsh 

to save; 

• 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 for access to 

the property to perform the work. 

• 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 

Envirc^nmental Group, at (712) 352-0188 

Q] I grant access to my properties

 G I do not grant access to my properties 

/ 

'L,.Xii ^itm 

ignature ' Data/ / Signature Date 

G

 1 would like to be present during any sampling that is required. 
D Remote ID: R page of 


C O A ST A U 

C B O O ' 

Restoration Agreement 

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

remediation activities. This will also ser\'e as d«Kumcntarion for the purpose of assuring that restoration 

activities are completed Co the satisfaction of the property owner and the United Stales Environmental 

Protection Agency (EPA). 

PropLrtvID: 2(\^^ ^ J 

I P'^oP'^'^y Address: ^^^ ^ ^g,pt g St 

' Phone lau ) HHi 

On the attached diagram(s) indicate area(s) to excavated and deptli oi' excavation, location of all known 

utilhies, subsurface feattii^es, surface structures and landscaping feature-s, access location(s) to be used by 

contractor, and tlie direction of North, Indicate distances, depths, material types, etc. indicate digital photos 

by referencing the photo-log number with an arrow indicating direction of view. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

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

Item: 

Kem 

Item: 

item: 

Kem: 

Item: 

Item: 

Item: 

Page 1 of ^ 
D Remote ID: R page of 

COASTA L 

C n o u r I »« « 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

! Item: / 

i Ite/h: 7 

7i^^-/r /j- Tl//) eKP/rv^^ ;^ ;^/; 

Item: 

7^/fery Ud/UtiL 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

I 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of _ ^ 
D Remote ID: R page of 


C O A S T A I. 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

^t l \f\ P>\ ft ^ g>g. 

Item: 

Srvl in Ri ariA P.2 

Item: 

Item: 

Item: 

Kem: 

Item: 

Hem: 

Item: 

Item: 

Item: 

Kem: 

Item: 

Item: 

Item: 

Page 3of ^ 
D Remote ID: R page of 

COASTA L 

1 Item 

1 

Prt-existing propeny area, 

ihai will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

HTink diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones. Control Valves, 

Timers. Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity i Unit Condition/Type/Species 

e>z Square feet 

•w 

H-ft 

Each 

W'^ 

Kach 

Ufl 

Each 

M i n 

Each 

Square Feet 

Page 4 of. 
D Remote ID: R page of 

* ^ 

C O A S T A L 

b K O U f • M C 

Item 

Agreed upon value of 

Dlant materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

by the contractor. 

Agreed upon area of 

property to be replaced 

with gra.ss sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

Area of City or County 

propertv' to be landscaped 

per their requirements. 

Include a sketch of the 

aiea (s) 

Easement Area, to be 

excavated ^ 

# 

Quantity 

Q 

Uriit 

$ Hm 

Condition/Type/Species 

B Each H\ft 

SF 

SF 

U|fl 

To V)e d€A«*^*«*<^ 

SF 

Pcndir^ V^'OaKkS \ 

Page 5 of ^ 
D Remote ID; R page of 

# 

• 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 rwt responsible for any damage done to the 

interior of house, including foundation cradcs or fissures. 

NTTJ I^re e Q I do not agree 

/ 

OW'ner' i s Signs' SignatiM^ T I^te / CoDtMctor's Sigoatnre Date 

Page 6 of. 
Date 

Project 

XRFID# 

Shot# 

\h 

\p 

m 

tyc 

Average

Shot# 

iij ^ 

.a 

i

Mi i 

Average

Shct# 

Average 

Shot# 

Average 

lab sample # 

XRF PROPERTY SAMPLE SHEET 

(^ h 0% 

Omaha lead FP 2nd year option 

'^0% ^ 

Reading 

ni.-v:>* ]\.i\ 

V-i^ - U ^ 

9\-'6*?, t 10.K 

^•^2 . i ^.^M 

 ^1-'^^ ; j

Reading

iLmt\i(K 

iSOi-^liZ. i'M-q ';a%t ^. kh 

^ .^ Q j

Reading 

Reading 

Lab result 

Sample area 

H 

Depth 

t," 

 ^.^ ^ 

 Sample area 

l { 

Depth 

M 

 \(?\ \ 

Sample area 

Depth 

Address 

Sample time 

sample length 

Shot# 

s 

E 

ill 

Average

Shot# 

Average 

Shot# 

Average 

RETEST AREAS 

Sample area Shot# 

Depth 

Average 

Sample area XRF Avg. 

Signature, 

BVID «_MM]L 

UT_ M^6/ »r ~ 

l"^: n am(pmg. 

30 sec 

Reading Sample area 

m-l<,'L\<.-% 

y^h(M\ ni-n.3i: U-n 

IH3.q]^t \\y ^ Depth 

nu^'jt ivxc -Ui. 

 |H( . V t \^-< ^ 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

^ 

./-'Depth 

' / ^ ^ 

X X 

Print |AiM^6i \Kfcvhn 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 186 

Mode SOIL 

Time 2008-09-19 15:10 

Duration 129.78 

Sequence Final 

Flags 

AVERAGE • Avg of 182-185 

ADDRESS 1612 maple st 

QUAD/ZONE 

INSPECTOR ^northcutt 

DEPTH 

SAMPLE TYPE r 1 

NOTE J_Clea ranee ' 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 71.332 

Supervised By: 

Certificate of Verification 

182 

SOIL 

2008-09-19 15:07 

30.88 

Final 

29878 

1612 maple st 

82 

northcutt 

6 

Clearance 

± Error 

± 11.215 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 36.166 

Supervised By: 

Certificate of Verification 

183 

SOIL 

2008-09-19 15:08 

37.88 

Final 

29878 

1612 maple st 

B2 

northcutt 

6 

Clearance 

± Error 

± 8.553 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 51.885 

Supervised By: 

Certificate of Verification 

184 

SOIL 

2008-09-19 15:09 

30.52 

Final 

29878 

1612 maple st 

B2 

northcutt 

6 

Clearance 

± Error 

10.058 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 52.428 

Supervised By: 

Certificate of Verification 

185 

SOIL 

2008-09-19 15:10 

30.50 

Final 

29878 

1612 maple st 

B2 

northcutt 

6 

Clearance 

± Error 

± 9.949 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

Pb 

Supervised By 

Certificate of Verification 

191 

SOIL 

2008-09-19 15:41 

123.32 

Final 

i;Avg of 187-190 IF 

1612 maple st 

I easement 

^northcutt 

J ' 

H^^Clea ranee 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 187 

Mode SOIL 

Time 2008-09-19 15:39 

Duration 30.90 

Sequence Final 

Flags 

BVID # 29878 

ADDRESS 1612 maple st 

QUAD/ZONE easement 

INSPECTOR northcutt 

DEPTH 1 

SAMPLE Pr'PE Clearance 

NOTE 

ppm ± Error 

Pb 174.756 ± 15.967 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE Pr'PE 

NOTE 

ppm 

Pb 131.039 

Supervised By: 

Certificate of Verification 

188 

SOIL 

2008-09-19 15:40 

31.15 

Final 

29878 

1612 maple st 

easement 

northcutt 

1 

Clearance 

± Error 

± 13.970 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE Pi'PE 

NOTE 

ppm 

Pb 143.482 

Supervised By: 

Certificate of Verification 

189 

SOIL 

2008-09-19 15:40 

30.68 

Final 

29878 

1612 maple st 

easement 

northcutt 

1 

Clearance 

± Error 

± 14.395 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 190 

Mode SOIL 

Time 2008-09-19 15:41 

Duration 30.59 

Sequence Final 

Flags 

BVID # 29878 

ADDRESS 1612 maple st 

QUAD/ZONE easement 

INSPECTOR northcutt 

DEPTH 1 

SAMPLE TYPE Clearance 

NOTE 

ppm Error 

Pb 132.342 ± 13.850 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 200 

Mode SOIL 

Time 2008-09-23 11:16 

Duration 128.33 

Sequence Final 

Flags 

AVERAGE I Avg of 196-199 

ADDRESS 

QUAD/ZONE 

1612 maple st 

Ibl 

INSPECTOR , northcutt 

DEPTH ; 6 

SAMPLE r/PE • CLEARANCEjjf 

NOTE 

Supervised By 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 196 

Mode SOIL 

Time 2008-09-23 11:13 

Duration 30.75 

Sequence Final 

Flags 

BVID # 29878 

ADDRESS 1612 maple st 

QUAD/ZONE b l 

INSPECTOR northcutt 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 70.483 ± 11.057 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 197 

Mode SOIL 

Time 2008-09-23 11:14 

Duration 31.31 

Sequence Final 

Flags 

BVID # 29878 

ADDRESS 1612 maple st 

QUAD/ZONE b l 

INSPECTOR northcutt 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 50.978 ± 9.809 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 198 

Mode SOIL 

Time 2008-09-23 11:15 

Duration 30.85 

Sequence Final 

Flags 

BVID # 29878 

ADDRESS 1612 maple st 

QUAD/ZONE b l 

INSPECTOR northcutt 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 50.812 ± 9.684 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 52.926 

Supervised By: 

Certificate of Verification 

199 

SOIL 

2008-09-23 11:16 

35.42 

Final 

29878 

1612 maple st 

b l 

northcutt 

6 

CLEARANCE 

± Error 

± 9.901 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

\ ^"tPBOT*^ 

.<P* www.coastalhazmat.com COASTA L 

ENVIRONMENTAL 

GROUP . IN C 

EXECUTIVE SUMMARY: 

BVID # 29878 - (1612 MAPLE ST) 

I I No Issues or Concerns X Issues/Concerns 

Detail Explanation: 

SOME DEAD SOD IN EAST PORTION OF LOT. IT APPEARS TO HAVE BEEN DRIVEN 

ON AND POSSIBLY HAD SOMETHING PARKED ON IT. 
«EPA 

EPA Property Close Out Form 

Property ft: C:>)^o D 

Property Address^ — 

Date/Time: 

Owner's Name: ^ f, rf' ^'^^_^_~trji , - ' .'— . Q 

Quads Excavated: ^ \ ^ P ^ 

Contractor GronoCxncxJ^lSl ^ ^fxu \ ^o^^^^^^-^^^^^ 

Excavation Yes No General \/^gAi ^ Lo1" 

1. If ncccssBiy, were the correct quadrant(s) excavated and reslored? L 

2. if necessary, were the correct areas of drip zone excavated and restored? Oi 

Grading Sod and Vegetation Yes Nc 

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

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

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

^ day time period)

 __^___ ^ ^1

^ 

4. Are sodded areas generally firm and evenly graded? ^ 

5 Arc the joints t>etween the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) ^ 

6. Was the property graded such that water will nol pool on the property? 

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

Gates. Fences and Rclaining Walls Yes No 

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

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

> 3.

 Was damage to gates or fences avoided? (Ifapplicable) 

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

FouodatioD, SidioKand Gutters 

Yes No 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? f/V f Is^Mt" 

3. Was damage to windows avoided? \ ^^ u>X t)k 

4 Was damage to windows or door screens avoided? 

5. Was damage to dovkTispouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) Yes No 

1 Was damage to driveway surfaces avoided? 

1 ^ 2.

 Was damage to walkway surfaces avoided? 
Ort'oers comments: 

Inspection notes: 

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

EPA Represe Date: ^2/^/^ ^ 
Property Completion Agreement 

This agreement documenis the completion of remedial activities perlbrmetl on my pioijerly. My signature 

will designate that I am satislied wilh the restoration of my property, and thai no items are in qucstion.s, 

now, or at any time in the future, except those ilenvs listed below, if any. 

Propc^tyjD: cOS'SHg ) 

Pr«pe7trATd^£ i k\Q JSC^JU- -SL .._ 

Phone: (^^QX^^X^H^rLQ -

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

l/Q I agret restoration is* complcled, except »s noted 

^fjdo not agree resloration is completed / 

^ Q\^ 

Owner's Sienatiirr DaK / Omtractor's .Signature Date