TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID .: ^^<^ ^ Date: ^ H 1/ 

Remediation Contractor: Coastal Environmental Group_ Year; _200© 

SOIL REMEDIATION 

PROPERTY HLE FOLDER DOCUMENTS 

t / Video of property (DVD) 

t2 Executive Summary 

0 EPA-provided property sketch 

|{2 Signed Access Agreement for subject property 

- D Signed Access Agreement(s) for adjacent property 

(Z Restoration Agreement 

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

-B- Confirmation data 

E / Photographs ^T^^A-IT^ ^ Y l U ^CAV*^ n^> ^ 

i As-built sketch 

Satisfactory restoration signed by Property Owner 

U Property close-out check list signed by EPA 

"E~ Description of areas not meeting ROD cleanup criteria 

^ Utility clearances 

Property infonnation from Douglas County Assessor's Office 

Superfund 
Property Access Checklist 

Prope,t,ID: Z U 5 S ) 

D WORK STARTED ON _/ /_ 

D WORK COMPELTED ON: / / Property Addr^^.:'2^2'S Dri'A-fU ' SfV 

Renter 0""^' Mf>r;one HQSe,V: 

Address; VA 

Phone: ^ Ot^&Vur ^V 

Fa.\: 

Cell/Pager: 

Phone: Additionul Intftrmittion: 

SHfe - JMbH 

F«v 

Ccll/Pager 

G Nofirication Letter Sent: / / By: 

Q Access Agreemenl Signed: :!./23/0 4 

8>0t."\ra.v»D 

IB" ReslonttiOD Agreement Signed: JI/2/|/6 5 ^y Vev^-Wv/ 

O Topioil Sampling (if applicuble) / / By; 

O DisposiU Sanapliog (rf ;ipplicable) / / By: 

• Garden Snmpliag (if applicable) / / By: 

D Uiilitv Clearance Called: / / By: 

^KVideo/Phofos (Before) On: / / J 

»y= Dc^av^O • Video/Photos (During) On: / / By: 

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

D ViOeo/Phofos (30-Day) OD ; / / • By: 

-tl!r Property Completion Atsreemenl Signed: ^//£9/J2 ^ By: 

D Final Repon Is!(ued: / / By: 

Air MonitorinE (*& jpplicable) 

D Communrty O Crew O D : / / By: _ 

Results: 

Q Community d l Crew On: / / By: 

Results: 

nu Communiri D Cn^w On: / / By: _.. _ Resultj: 

Omaha Lead Srte 
Property ID # 

Property 

Address: 

Initial Contact: 

Second Contact: 

Final Contact: 

Final Action: 

Comment: 

Owner 

Comrhent (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

21^5-5) 

90(25 n^DA+nr S^ 

Date: 7/ ^ Time: i^aS Action: 

Date: ' Time: Action: 

Date: Time: Action: 

Transmit lo EPA D Other Action: D 

I'D ^y i i^vv ^ , 
Douglas County Account Infoi inn^m n Page 1 of 1 

Douglas County, Nebraska Property Record - R2212400000 

Print Report 

NEW Feature - Parcel Dimensions available ISf scale 0-50 ft west of 52nd St - Vle W O n Ma p Information is valid as of 2009-7-20 Treasurer's Tax Report 

New Feature -^ *4> -^ Auto Sales Search 

Owner 

MASEK MARJORIE 

2935 DECATUR ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number 1240 0000 22 

Account Type: Residential 

Parcel Number: 2212400000 

Parcel Address: 2925 DECATUR ST 

OMAHA NE 68111-OOOO 

Legal Description: SHINNS 2ND ADD LOT 5 BLOCK R 60 X 127.5 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

Land Informatio n 

Acres 

0.17 

SF 

7620.0 

Units 

0.0 

Depth 

127.0 

Width 

60.0 

Vacant 

Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accotmtinfo.jsp?accountno=R22... 7/23/2009 
Page 1 of2 

"> 

[(^^_._7^CreateAnotherTjcket, .~\ Back-to Irth:Intemet |[.: Sendjmail^ i] 

• YOUR TICKET NUMBER IS 2324307. 

Original Call Date: 7/23/09 Time: 9:13 am Op: EL1ZABETH18790 


Work to Begin Date: 7/27/09 Time: 9:45 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2925 Street: DECATUR ST 


Twp: 15N Rng: 13E Sect-Qtr: 16-NE-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation 


Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 


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


: UNSURE OF CORNER LOT 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: coastal 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number UtiUty Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVELS LEVEL3 COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 


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


Emerg: 4024445160 


http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/23/2009 
Page 2 of2 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEl C QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/23/2009 
OLS#: 26531 i^ As-Built Drawing Date Excavated:7/31/09 

Date USEPA Signed Off: 8/11/09 

C CAST A L Omaha Lead Superfund Site , Area Sodden: 3878 sa ft 

26531 

Exterior Paint North Arrow Omah a Lea d Sit e • Good Sit e Sketc h 

Sampling Address: 2925 DECATUR ST 02"^ Not paint 

Sample Number 

RYASCPXA-26531 Fl 

Lead 

Concentration 

52-3 ppm 

Sample 

Collected LAB 

D 

Samples Collected 

Firm: ? E TkiC. 

Date: lo i 9,1n ^ 

RYBSCPXA-26531 F2 2 Oft ppm n Time: q-ir> A K 

RYCSCPXA-26531

nVDOCPXA-26531

 SI 

 B2 

ppm 

ppm • 

n 

n Samples Analyzed 

RDgOCrXA-26531 

nQZ00rXA-26S3> 

r^rgocrxA-g6S3i 

-BE 

-6Z 

- P S 

ppm 

ppm 

ppm 

D 

D 

D 

n 

D 

XRF Unit: 

Date: 

Time 

lQg./i>2. Book: ZH I 

(fi -icxo^i 

Number of Samples = 3 n Staff M$vV 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ Drip Zone, GZ = Garden. PZ = Pla; All quadcaQt& are as viewed from the street, facing property 

^ -^i 

pEotrut Ssr 

Legend 

Concre'te Drip Zone Excavated Quadrantis Excavated 

Area replaced with Area replaced with 


Area left bare 
 Sod ' ' Rock/Mulch ' ' 


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

26531 

Exterior Paint North Arrow Omaha Lead Site • Good Site Sketch .O Poor 

Sampling Address: 2925 DECATUR ST gJ^Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB Samples Collected 

Firm: ?C IMC. RYASCPXA-26531 Fl 5Z 3 ppm n Date: Lol^lcfi 

RYBSCPXA-26531 F2 2 Ofl ppm D Time: °l-m AK 

RYCSCPXA-26531

RYDCGPXA-26531

 Bl 

 B2 

f^e o ppm 

ppm D 

n 

n Samples Analyzed 

RDZOCPXA-26531 BZ ~ ppm D n XRF Unit: l0fe/i,2. Book: 2.^1 

ROZ0CrXA-2GD31 SZ ppm D D Date: (a-lOto ^ 

RPZ0CrXA-26S31 P? ~ ppm n D Time: Prv. 

Number of Samples = I 3 O Staff: M$vV 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = P\a\ 

All quadrants are as viewed from the street, facing oroperty 

ENTEBEB 

JUH 1 7 2009 

Rev:0(lS Created: 'I5-Nm'-0S! i:a47f)i 01,:3 
26531 

Omah Exterior Paint Nuilh|AiiiJW a Lead Site • ^Good Site Sketch 

Sampffng Addresi: 2925 OECATUR ST ' Ed '^°* P*"* JL 

Sample Numtwr Lead Sample Samples Collected LAB Concentration Collected 

RrmltJIfcK. RYASCPXA-28531 Fl • Date: (o/ft/f/* 

RYBSCPXA-26531 F2 

2 Of t PPf" a Time: 'i^lO AK 

RYCSCPXA-26531 Bl _SfiO_pp m 

a Samples Analyzed RVP6CPXA-a6S31 B2 D D 

RDZoopxAraesoi—BZ ~ Pom D a XRF Unit: lQfe/<2. Book: 2.HI 

nCfflOOPXA'20501 6Z com D a Date: &>-/qo< ^ 

RPZSOPXA-aOSOl PS "• ppm n a Time: Pr ^ 

Staff: M^tA / Numtwr of Samples = I 5 I | Q | 

Legend; Fl = Front Left, F2 > Front Right, Bl " Back Left. B2 « Back Right DZ = Drip Zone, GZ = GanJen, PZ « Pla; 

are 88 vtomnd from the sirael, tacli 

T ''Vl'^f*/. 

ENTEBEB (z): 

Hes^. JUfI 17 2009 { Tie^ 

i&ttX^* £i J.. 

- F ­

® 

f5 

^.icir)..!... ,&IUS> 

Rev 2008 Creoed? 05-K<>v48 Wftil 2s: M470101U t 
lit " "^irj. 

COASTA L ENVIKONHENTAl 

" t PHO^*^ CROUP , IH C 

Consent for Access To Property 

RIGHT OF ENTRY TO PREMISES 

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

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

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

following described premises: ^ ^ ^ 

•7^^ 31 

Owner's Name: Daytime Phone: ^ ^ J S yj/iyy w

Address of Property 

covered by this l^t6 Vt^C^Mu^ 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 performed, 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 
.vito«r, . 

f 

COASTA L 

ENVI80HHENTA L 

GROUP , IN C 

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

piles, dog houses, etc; 

e Remove flower bulbs or plants that the Grantor or the Grantor's tenant may wish 

to save; 

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

necessary subsequent to an initial watering period by EPA; 

e 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 

Environmental Group, at (402) 991-1199 

I grant access to my pix>perties 

D i do not grant access to my properties 

I^LX ^^4 2^£ ^ 

Signature 

Date 

O I woufd like to be present during any sampling that is required. 

Page 2 of 2 
COASTA L I M VIMO N M l N TAL 

G H O tJ r . IN C 

Restoration Agreement 

The purpose of this 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). 

Property ID: ^(^ ^ ^ j* 

Property Address: 7,^x 5 \yeCj^u(L ^ 

Owner: jyui.\i.(ixt^.y\iyii^y<<^ 

Phone; l-^ii^ - \\\ \,j^ 

On the attached diagrani(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 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. 

Kem: • n 

y ^ "^^M puU 

Kem: 

Kem: 

Kem: 

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

Jrw^ b>—^ll yil/h^ y^Vf y ^ m 

ttem: 

Item: 

Item: 

Page 1of y 
C O ASTA L 

C R O U r . < N C 

Items to Be Removed By Contractor During Remediation and Replaced 

Item: 

^ l i - ^'ir t 

ttem: 

ttem: 

1-andscape Inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, Quadrants that will be excavated, that % ' ^ is covered with grass. 

Number of trees > 2 inch Each 

trunk diameter f 

Number of trees <= 2 inch Each 

\

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Each Timers, Heads, etc. 

Atiach a skeicli ot llie 

sprinkler la\oui. 

Number of and size of 

each garden/ flower bed n Each 

. area. Square Feet 

Aiiacli a skcich of relative 

sizes and locatidiis. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Note this \aliic will he 

used lo issue H plant 

\oiieher to the propcrt> 

owner. 

Easement Area, to be tJO Each excavated 

Page 2 .:k 
COASTA L • NVIIIOMnl.f4TA L 

a N O U P . IN C 

AddKional Comments / Instructfons: 

^C^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. 

I agree Q I do not agree 

^ 

Fof^C/JiA- liTll m 

Contractor's Signature Date 
BViD# Z(g6^^ 

XRF PROPERTY SAMPLE SHEET 


Date 

Project 

XRF1D # 

Shot# 

^M6Z,.. JJi^a. 2r..^m 

_2il^ 

Average

Shot# 

J d ^ 

_zy^ 

2>4sa. QMia Ml O 

Average

Shot# 

• ^Hi.T. 

Aii<^ 

-HbU 

-LUt^g

Average

Shot# 

Average 

lab sample # 

"lM\|o^ 

Omaha lead FP 2nd year option 

Reading I Sample area 

 .^(/)g).-Hb 1 Zii.b,{ ^ 

Reading Sample area 

52aaiU32L5i> 'h\ aictLS£l2lia 

Mc^^.^l^2q>^> .Depth 

^^<k.ti^±^.IJi.\ \% 

 M^l > 30 ^ 30.&Q | 

Reading Sample area 

\m.M<\vv<^.H 

\^.iz:^\u.2- ^ E ^ 

\^1^.fc$-^\M.y Depth 

 h/oH.iqil(..^ H t 

 \Sa.Cig. J \^.^< i 

RETEST AREAS 

Reading Sample area 

Depth 

Address 2M-^ .fT \ XT gjuz: 

Sample time am/pm 

sample length 30 sec 

Shot# Reading Sample area 

Depth 

Average 

Shot# Reading Sample area 

Depth 

Average 

Shot# Reading Sample area 

Depth 

Average 

Shot# Reading Sample area 

Depth 

Average 

Lab result Sample area XRF Avg. 

Signature. ^£ M Woh 

Print ?X\A/lClh>^ CCCQSf^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2456 

Mode SOIL 

Time 2009-07-31 17:09 

Duration 131.83 

Sequence Final 

Flags 

AVERAGE i^Avgjtgg^^SS"^ 

ADDRESS "1^15 Decatur sf 

QUAD/ZONE F l 

INSPECTOR Nicolas 

DEPTH 24 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb ("369.3^ ± OSSSrj 

Supervised By: ^^Cj^.j^H D 
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 389.628 

Supervised By: 

Certificate of Verification 

2452 

SOIL 

2009-07-31 17:06 

30.22 

Final 

26531 

2925 Decatur st 

Fl 

Nicolas 

24 

CLEARANCE 

± Error 

26.369 
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 351.692 

Supervised By: 

Certificate of Verification 

2453 

SOIL 

2009-07-31 17:07 

30.28 

Final 

26531 

2925 Decatur st 

Fl 

Nicolas 

24 

CLEARANCE 

± Error 

24.432 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 365.161 

Supervised By: 

Certificate of Verification 

2454 

SOIL 

2009-07-31 17:08 

40.73 

Final 

26531 

2925 Decatur st 

F l 

Nicolas 

24 

CLEARANCE 

± Error 

± 26.095 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 370.965 

Supervised By: 

Certificate of Verification 

2455 

SOIL 

2009-07-31 17:09 

30.60 

Final 

26531 

2925 Decatur st 

F l 

Nicolas 

24 

CLEARANCE 

± Error 

± 25.732 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2461 

Mode SOIL 

Time 2009-07-31 17:13 

Duration 121.19 

Sequence Final 

Flags 

AVERAGE LAygo.f,2457-2460 j 

ADDRESS ^2S*Decatijr st 

QUAD/ZONE Bl 

INSPECTOR Nicolas 

DEPTH 18 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb ± 

Supervised By: L^CM^mb 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 589.735 

Supervised By: 

Certificate of Verification 

2457 

SOIL 

2009-07-31 17:11 

30.29 

Final 

26531 

2925 Decatur st 

Bl 

Nicolas 

18 

CLEARANCE 

± Error 

± 33.495 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 464.954 

Supervised By: 

Certificate of Verification 

2458 

SOIL 

2009-07-31 17:12 

30.26 

Final 

26531 

2925 Decatur st 

Bl 

Nicolas 

18 

CLEARANCE 

± Error 

± 28.504 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 457.307 

Supervised By: 

Certificate of Verification 

2459 

SOIL 

2009-07-31 17:13 

30.32 

Final 

26531 

2925 Decatur st 

Bl 

Nicolas 

18 

CLEARANCE 

± Error 

29.731 
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 437.996 

Supervised By: 

Certificate of Verification 

2460 

SOIL 

2009-07-31 17:13 

30.32 

Final 

26531 

2925 Decatur st 

Bl 

Nicolas 

18 

CLEARANCE 

± Error 

± 30.639 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2466 

Mode SOIL 

Time 2009-07-31 17:23 

Duration 121.51 

Sequence Final 

Flags 

AVERAGE C5vg3Qgi2H24653 

ADDRESS 2925 Decatur st 

QUAD/ZONE easement 

INSPECTOR Nicolas 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 

Supervised By: C^i/i h $l/ ) 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 142.485 

Supervised By: 

Certificate of Verification 

2462 

SOIL 

2009-07-31 17:21 

30.65 

Final 

26531 

2925 Decatur st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 15.110 
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 174.278 

Supervised By: 

Certificate of Verification 

2463 

SOIL 

2009-07-31 17:21 

30.31 

Final 

26531 

2925 Decatur st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 16.286 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

XL3t-32089 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID # 

ADDRESS 

QUAD/ZONE 

INSPECTOR 

DEPTH 

SAMPLE TYPE 

NOTE 

ppm 

Pb 138.647 

Supervised By: 

Certificate of Verification 

2464 

SOIL 

2009-07-31 17:22 

30.31 

Final 

26531 

2925 Decatur st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 14.707 
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 164.289 

Supervised By: 

Certificate of Verification 

2465 

SOIL 

2009-07-31 17:23 

30.24 

Final 

26531 

2925 Decatur st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 16.206 
flA. \ Omaha Lead Site—Fixed Price EP-R7-07-05 

§ ^^^^ ^ I

S!y^^ ^

 Coastal Environmental Group Inc.

 www.coastalhazmatcom 

M ^ 

'•-'tPBOT*^ COASTA L IHVItONNiHTA L 

G • 0 U P, IH C 

EXECUTIVE SUMMARY; 

BVID #26531-(2925 DECATUR ST) 

No Issues or Concerns Issues/Concerns 

Detail Explanation: 
St0L PA 

EPA Property Close Out Form 

Property #: ^^?.^ J 

Datcn'inic: 

Quads Excavated: f p > ~ h \ 

Contractor Group C'r^if^ A P AWi roninOenK J 

Excavation General 

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

2. If necessary, were the correct areas ofdrip zone excavated and restored? y 

Grading Yes ISO Sod and Vegetatton 

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

from the house? _ ^ y 

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 y

day time period) 

4. Are sodded areas generally nrm and evenly graded? 

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

tinte period) 

/ ­

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

7. Was danuge to landscaping or plant materials avoided? 

Gates, Fepccs and RcUinlng Walls 

Yes JSo 

1. Do gates open and close freely? (Ifapplicable) y 

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? (Ifapplicable) V 

Foupdatton, Siding and Gullers Yes N« 

\. Was dainage to the siding or trim avoided? y ^ 

2. Was damage to the foundation avoided? 

y ^ 

Was damage to windows avoided? 

~y 

4. Was damage to windows or door screens avoided? 

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

Sidewalks and Driveways (Concrete) 

Vcs No 

1. Was damage to driveway surfaces avoided? IA 

y 2. Was damage to walkway surfaces avoided? 

y 
Owners comments: 

Inspection notes: 

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

EPA Representative DO>.J1ML. o..y////of 
Property Completion Agreement 

riiis agreemenl documenis Ihe complclion of remedial activities perloimed on my properly My signature 

willdesignale Ihal J am satisfied wilh the restoralion of my propeity. and ihal no ilcms are in questions, 

now, or al any lime in the fulure, except ihose ilems Iisled below, ifany 

Property W: Ih^' ^ \ 

Property Address: 2^" ^ ^^6^ f t/lL~"V( ^ 

Owner: M^j^ggg-t ^ MV\5>ft^ 

ft>o»e: q^^ yJbMM^M 

Restoration Items in Question: 

Item: 

Item: 

Item: 

uliii . WMPssana'* w * MWW m^tm^n^"^ 

Item: 

Item: 

Mem: 

1^ I I ngrcc r c.^tar«(Jon is complcttd, except AS noferi 

I, I I rto not aurec rcstorntinn is completed 

ONfiif/'.'! Sinnatme Dufc Conti »i:\m'% Signaliirc Date