TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: V^^0<, Date . \i,l')^A 

Add,»s.: %^^ WWA(:, ^ t 

Remediation Contractor: _Coastal Environmental Group_ Year; 2001 

% 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

Video ofproperty (DVD) \ H ^ t^C^f^o' ^ 

Y Executive Summary 

Y EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

</ Restoration Agreement 

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

Confinnation data 

Photographs ^ > ^ ^^P , k^^l^TlCM ^ fe tVOVAfK^ 

As-built sketch 

y

Y 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

-Br Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

Property infonnation from Douglas County Assessor's Office 

Date 

30054529 

Superfund 
0

Property Access Checklist 

D

D

 WORK STARTED

 WORK COMPELTED

 ON: 

 ON: 

/ / 

Owner: ^^^^^^ ^

Address: 

 p^^^^y-;^^^^^ ^ 

UU2d 

Renter 

Phone: 

P.L\: 

Cell/Pager: 

Ptione: 

Fax: 

Ccll/Pager. 

fc 

D Notification Letter 

Acceu Agrcemeni 

Restoration Agreement 

O Topsoil Sampling (if applicuble) 

d Disposal Sampling (rf applicable) 

Q Gurdcn Sampliog (if applicable) 

D ^ Utility Clearance 

 Video/Photos (Before) 

CD Video/Photos (During) 

D VIdeo/Pholos (After) 

D Video/Photos (30-D<y) ' 

""©—Property Complelion Agreement 

• Final Report 

Air Monilorint; {us applicable) 

O Community CD Crew On; 

Results: 

D Communitj' D Crew On:

Remits: 

CD Communiri CD Crc>v On: 

Results: 

Additional InlormMtion-. 

Sent: 

Signed: LP / L^/GC\ 

Signed!^/5L/D9 

Called: 

On M./.2J' X 

On 

On 

On 

Signed: $^J2&M ^ 

Issued: 

/ / By: 

/ / By: 

Bv: 

Omaha Lead Site 

Bv: 

^yAS:i±j^n^^ ^ VdirAi) 

By:,gjijj^j^faeiJr\vOy^u_dotA4t:>{A<^*- By: 

By: 

By: 

By: 

Bv; 

By: 

By: 

By: 

By: 
Property ID M

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 Z'TlOD ^ 

HO?.! La fav| f-rif" g ^ 

 Date: Time: Action: 

 Date: Time: Action: 

 Date; Time; Action; 

 Transmit to EPA D Other Action: D 
Douglas County Accovmt ]^~^—»atiori Page 1 of3 

^ 

Douglas County, Nebraska Property Record - R2406710000 

Information is valid as of 2009-5-12 

Owner 

POINDEXTER ZEDEKA N 

4027 LAFAYETTE AVE 

OMAHA NE 68131-0000 

Property Informatio n 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vle W O n Ma p 

Treasurer's Tax Report 

New Feature -•->- • Auto Sales Search 

Key Number: 

Account Type: 

Parcel Number: 

Parcel Address: 

Legal Description: 

Value Informatio n 

Land 

2009 

2008 

2007 

2006 

2005 

2004 

Sales Informatio n 

Sales Data: 

Deed Type: 

Price: 

Grantor: 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Sales Data: 

Deed Type: 

Price: 

Grantor: 

0671 0000 24 

Residential 

2406710000 


4027 LAFAYETTE AV 

OMAHA NE 68131-0000 

WALNUT HILL LOT 7 BLOCK 14 40 X 150 

Improvement Total 

$2,500.00 $67,500.00 $70,000.00 

$2,500.00 $67,500.00 $70,000.00 

$2,500.00 $67,500.00 $70,000.00 

$2,500.00 $67,500.00 $70,000.00 

$2,500.00 $51,000.00 $53,500.00 

$2,500.00 $51,000.00 $53,500.00 

2006-05-16 

QC Book: 2006 Page: 054357 

$1.00 

Velma P Poindexter 

Zedeka N Poindexter 

Invalid 

Family Sale 

2005-10-26 

QC Book: 2005 Page: 135047 

$0.00 

Velma P Poindexter 

http://douglasne.mapping-online.com/DouglasCoNe/static/accovmtinfo.jsp?accountno=R240... 6/7/2009 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=R240... 6/7/2009 
Douglas County Account L^M|^tio n Page 2 of 3 

Grantee: Velma P Poindexter 

Valid/Invalid: 

Invalid 

Exclusion Reason: Family Sale 

Sales Date: 1997-09-29 

Deed Page: Type: D Book: 2072 486 

Price: $51,350.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Unita Depth Width Vacant 

0.13 6000.0 1.0 150.0 40.0 No 

Improvemen t Informatio n 

Building 1 

X t 7 

A 

Mt 1 1 6 %x 

B ri "\/ ^ 

CLICK CLICK TO ENLARGE IMAGE TO ENLARGE IMAGE 

Square Footage: 1602.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: ! 2 1/2 Story Unfin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 8.0 

Exterior: \ Frame Siding Units: 1.0 

Interior: j Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Hip Stories: 2.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R240... 6/7/2009 
Douglas Cotmty Account Ijj^a^tio , n Page 3 of3 

yearSu//f 

1908 

Detail Type 

Add On 

Appliance 

Appliance 

Basement 

Basement 

Fixture 

Fixture 

Garage 

Porch 

Year 

Remodeled 

0 

Percent 

Remodeled 

0% 

Detail Description 

Fence Chain Link 

Allowance 

Security System 

Bsmnt Block 8 ft 

Outside Entrance 

Base Fixtures 

Bath Full 

Detached 

Slab Roof Ceil 

Adjusted Year Physical Age Built 

1908 100 

Units 

1.0 

1.0 

1.0 

780.0 

1.0 

1.0 

1.0 

360.0 

166.0 

http://douglasne.mapping-onIine.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R240... 6/7/2009 
Page 1 of 1 

» • 

"> 

Create Another Ticket Back to Irth Intemet Send Email 

• YOUR TICKET NUMBER IS 2313918. 

Original Call Date: 7/09/09 Time: 2:21 pm Op: ELIZABETH18790 


Work to Begin Date: 7/13/09 Time: 3:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4027 Street: LAFAYETTE AVE 


Twp: 15N Rng: 13E Sect-Qtr: 17-NE 


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 Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Niunber Utility Type 

CXCATV co x COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK NA Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/9/2009 
As-Built Drawing 

COASTA

• NVIRONHINTA

L 

L Omaha Lead Superfund Site O R O U r , IN C 

25005 

Omah a Lead Site Owner Name: VELMA P POINDEXTER 

Site Sketc h Address:_4027 LAFAYETTE AV 

l»lione: H: W: 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

RYASCPXA-25005 F1 (fi O'Z­ ppm Ef D 

RYBSCPXA-25005 F2 2.05 * ppm D B" 

RYCSCPXA-25005 B1 Ef D 

RYDSCPXA-25005

RD2SCPXA-25005

 B2 

 DZ 

l" 2Yb

"2. ^ /

 ppm 

 ppm 

D

• 

«easewcA-36©©6—az­ " • ppm D n 

RPZSCPXA-25005 PZ 'Z- 3 ^ ppm Ef n 

Lab RYBSCPLA-25005 Number of Samples = | 3 ~ / I— Result 214 ppm 

Exterior Paint North Arrow 

H^Good 

1~1 Poor 

I I Not paint 

Samples Collected 

Firm: .4j'-v-- ^u-/iA A< 

Date: 

Time: 

Samples Analyzed 

XRF Unit: 8/(g Book: 5 - 5 

Date: &Az-<pAoy 

Time: Af-^ 

Staff: /•AY . 

OLS#: 25005 

Date Excavated:7/16/p9 

Date USEPA Sianed Off:!/11/09 

Area ggddgn; 792 gg 

K.ji. 

• AijG • r f JCfCe 

Omaha Lead Site 46130 

Are a

Concret e 

 replace d

Sod 

 wit:h 

Legend 

Dri p Zone Excavate d 

Area replace d witJi 

Rock/Mulch 

Quadrants Excavate d 

Area lef t bar e 

Contrac t #: EP-R7-07-05 Coastal Environmental Group Inc . 
25005 

Omaha North Arrow Lead Site Exterior Paint Owner Name: VELMA P POINDEXTER I^Goo d Site Sketch Address: 4027 LAFAYETTE AV • Poor 

Phone: H: W: Q] Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Finm 

Samples Collected 

•45'^­ U-!if-AA. RYASCPXA-25005

RYBSCPXA-25005

 F1 

 F2 

ppm 

ppm 

ET 

D 

D Date 

Time 

j££. 9:H Y 

cAl_ 

RYCSCPXA-25005

RYDSCPXA-25005

 B1 

 82 

ppm 

ppm 

Ef 

Ef 

D 

D Samples Analyzed 

l _

RDZSCPXA-25005 DZ 

fiegSGf?XA 26005 GZRPZSCPXA-25005 PZ 

Lab RYBSCPLA-25005 

 Result 214 ppm 

•2-3^ 

ppm 

ppm 

ppm 

Ef 

D 

Ef 

Number of Samples = j 3 ~ 

n 

D 

D 

\ 

XRF Unit: 

Date: _ 

Time: _ 

Staff: 

2>/0 Book: S 3 

0AZ(^Ae^y 

yfAY 

i./y. 

^AiAlJAikA'A-^A'}. A' ^•1A/£LA1. 

mAAYAAA 

^.'^{wA-k. .-AA . Omaha Lead Site 46130 
Owner Name: VELMA P POINDEXTER 

Address: 4027 LAFAYETTE AV 

Phone: H: W: 

Sample Number Lead 

Concentration 

RYASCPXA-25005 F1 LtOT, 

RYBSCPXA-25005 F2 2.05 

RYCSCPXA-25005 81 

RYDSCPXA-25005 B2 

RDZSCPXA-25005 DZ -2.^7 

nozocPXA a6oofr • az 

RPZSCPXA-25005 PZ -2-^'? 

Lab RYBSCPLA-25005 

Result 214 ppm 

25005 

Exterior Paint North Arrow 

Q^Good 

• Poor 

Q Notpaint 

Samples Collected 

Fimi: .^ ^ US/ A A 

Date: ^ < A ' 

Time: 9.' VoT 

Samples Analyzed 

XRF Unit: 8/<y Book: ^ 3 

Date:_ 9/z,(pyoy 

Time:. A/? j 

Staff: 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Omaha Lead Site 

Site Sketch 

Sample 

Collected 

Ef 

D 

ET 

^ . Ef 

D 

Ef 

LAB 

D 

^ 

D 

D 

n 

n 

n 

Omaha Lead Site 46130 
3> >« -

COASTA L ENVIRONMENTAL 

CIOUP , INC . 

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: _^ ^ ^ 

Owner's Name: Daytime Phone: 

Address of Property 402-7 Lv^hKe^-r-r^ UJ 

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 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 confimi 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 
f 

^TH ­

V*"iTe"' / COASTAL *K -,A tNYI«0«HINTAL 

'IPnOT* ^ CIOUP . 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 wish 

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 

Environmental Group, at (402) 991-1199 

I grant access to my properties D I do not grant access to my properties 

loA-b<\ 

Signature Date Signature / Date 

D I would like to be present during any sampling that is require 

Page 2 of 2 
C.J3 A. S r-ii. L w a^t ^ § m n ttM mm 0 u rjh l 

Restoration Agreement 

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

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

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

Protection Agency (EPA). 

Property ID: -ggy T^C^CtZ) S 

Property Address: ^^^.^y L^t^JrfiA<^jr6. Au A 

Owner: Yf^i^u - fY?lMpey-T<5<2-

Phonc; ^y ^ • C^ 3 ^ 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. 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. 

Item: 

S.^11 YLi^A 

Item: "" 

Item: 

Item: 

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

Item: 

^^ v 9^---^/' PA/Y/Or Lo^Y ^r^ J 

Item: 

Item: 

Item: 

Page 1of ^ 
C O A S T ^ L 

C • O U » . IM C 

Items to Be Removed By ' Contractor Durinc 1 Remediation and Reolaced 

Item: 

Kem: 

r^oo- ^ i 

Item: 

Item: • 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, Quadrants that will be excavated, that •PI 

is covoned with grass. 

Number of trees > 2 inch Each 

trunk diameter 1 

Number of trees <= 2 inch Each 

trunk diameter 1

Number of Sprinkler 

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

Attach a sketch A the A 

sprinkler layout. 

Number of and size of 

each garden/ flower bed Each 

area. 'A SquareFeet 

Attach a sketch of relative 

sizes and locations. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. $ Note this \HIIIC will he 

used to Issue H pl^nt 

voucher lo the propcrt\ 

owner. 

\k^4^y^^ lls2^^l'r'=> . Easement Area, to be Each excavated ies 

Page 2 of ^ 
C^O /k S T ^ L 

Additional Comments / Instructions: 

^ \ (*P<Vy^l f^/^AJ T 9<^ J\eXKJ.\Ad 

Q Check the box rf Owner does not want CEG to document interior foundation walls and possible 

pre-existing damage. By checking this t>ox CEG is not responsible for any damage done to the 

Interior of house, including foundation cracks or fissures. 

I do not agree 

Date ' Siei 

PageSof £_ 

Owner's Signature Contractor'ss Signajnre Date 
BVID# X^OC)S 

XRF PROPERTY SAMPLE SHEET 

Date 

Project 

XRFID # 

Shot# 

15-4 L, 

)6H-7 

\'=>Ht 

15^4 

Average

Shot # 

Average 

Shot# 

Average 

Shot# 

Average 

lab sample # 

n/n\(yi 

Dmah imahaa lea leadd FFP 2nd year opilon

^^n^^g ) 

Reading Sample area 

41c,^M ± q.i^q 

L^.HUtll.D O Fl 

^^.u,i^±^.^q Depth 

yi-iV-n,!?. 10 

^ l o -?q ± iD.^ g 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Address 

Sample time 

sample length 

Shol# 

)5H I 

Iiiil. 

JSiii /S^ ^ 

Average

Shol# 

Average 

Shot# 

Average 

Reading 

RETEST AREAS 

Sample area Shot# 

Depth 

Lab result Sample area XRF Avg. 

Average 

Mean igfrMjTfft^ 

am/pm 

30 sec 

Reading 

i2M.o«±n.^ 

137. 0MJ-)5.7q 

ID^ M^±l?.13 

/Z/ 5?qi:y^D=^ 

Sample area 

<jase^M* ^ 

Depth 

1 

I 21 . ?^U t

Reading 

\^.%[n 

Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Signature (^^M^JP/) 

Print PlionhPU^ Oyfeye^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1550 

Mode SOIL 

Time 2009-07-17 14:39 

Duration 121.62 

Sequence Final 

Flags 

AVERAGE ^VQo f 1546rl549 j 

ADDRESS 4027 Lafayette ave 

QUAD/ZONE Fl 

INSPECTOR Bryan 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb ~56!796 ^ ± 

Supervised By: C^{hyf'S>JYyoYS 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1546 

Mode SOIL 

Time 2009-07-17 14:37 

Duration 30.34 

Sequence Final 

Flags 

BVID # 25005 

ADDRESS 4027 Lafayette ave 

QUAD/ZONE F l 

INSPECTOR Bryan 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 46.339 ± 9.690 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1547 

Mode SOIL 

Time 2009-07-17 14:38 

Duration 31.15 

Sequence Final 

Flags 

BVID # 25005 

ADDRESS 4027 Lafayette ave 

QUAD/ZONE Fl 

INSPECTOR Bryan 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 63.463 ± 11.003 

Supervised By: 
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 49.658 

Supervised By: 

Certificate of Verification 

1548 

SOIL 

2009-07-17 14:39 

30.05 

Final 

25005 

4027 Lafayette ave 

Fl 

Bryan 

10 

CLEARANCE 

± Error 

± 9.996 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1549 

Mode SOIL 

Time 2009-07-17 14:39 

Duration 30.08 

Sequence Final 

Flags 

BVID # 25005 

ADDRESS 4027 Lafayette ave 

QUAD/ZONE Fl 

INSPECTOR Bryan 

DEPTH 10 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 67.724 ± 11.222 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 1545 

Mode SOIL 

Time 2009-07-17 14:35 

Duration 121.91 

Sequence Final 

Flags 

AVERAGE (^\vg]ofJL541^1544 | 

ADDRESS ^D'27 Lafayette ave 

QUAD/ZONE easement 

INSPECTOR Bryan 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± 

Pb 121.861 ) ± 

Supervised By: j^r/iemA^ 
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 124.082 

Supervised By: 

Certificate of Verification 

1541 

SOIL 

2009-07-17 14:33 

30.60 

Final 

25005 

4027 Lafayette ave 

easement 

Bryan 

1 

CLEARANCE 

± Error 

± 14.400 
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 137.042 

Supervised By: 

Certificate of Verification 

1542 

SOIL 

2009-07-17 14:34 

30.47 

Final 

25005 

4027 Lafayette ave 

easement 

Bryan 

1 

CLEARANCE 

± Error 

db 15.288 
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 104.431 

Supervised By: 

Certificate of Verification 

1543 

SOIL 

2009-07-17 14:35 

30.19 

Final 

25005 

4027 Lafayette ave 

easement 

Bryan 

1 

CLEARANCE 

± Error 

± 13.725 
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 121.888 

Supervised By: 

Certificate of Verification 

1544 

SOIL 

2009-07-17 14:35 

30.65 

Final 

25005 

4027 Lafayette ave 

easement 

Bryan 

1 

CLEARANCE 

Error 

14.027 
/ ^^/ % Omaha Lead Site—Fixed Price EP-R7-07-05 

I Coastal Environmental Group Inc. ^ 7 

j f www.coastalhazmat.com 

"'tPnoT*'^ COASTA L • NVOONHENTAl a • 0 U r. IN C 

EXECUTIVE SUMMARY: 

BVID #25005- (4027 LAFAYETTE AVE) 

No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 
SMIL EPA 

EPA Property Close Out Form 

Property Add«..mLi^%^ ^ Property #:_250Q5L ^ 

Datc/Tlne: Owner's Name;. ^f^lYYf ic?i.rVlf:?^-<:: -

Quads Excavated: _ £ CoRtractor Group f>-x/i^-4-A\ XZr^/1/tiA)/\i^ A^ fiY\ VExciv«ttoB Genertl 

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

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

-A^ 

Gmdlog Sod and VcteUtioB 

Yes No 

I. Does the grading around the perimeter ofthe house in excavaled areas generally slope away TA 

6x>m tbe house? 

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 

day time period) 

4. Are sodded areas generally finn and evenly graded? T/^ 

S. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day YA time period) 

6. Was the property graded such that waler will not pool on the property? 

7. Was danuge to landscaping or plant materials avoided? 

Gates. Fcncea and Retelnlni Walls 

Yes No 

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

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

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

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

Foundation, Siding and GnHcrs 

Ves No 

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

2. Was damage to die foundation avoided? A 

3. Was damage to windows avoided? T^^ 

4. Was damage to windows or door screens avoided? (/

^ 

5. Was damage lo downspouts or downspoul extensions avoided? iA^ 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage lo driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 
CM'oer^ comments: 

Inspection notes: 

Removal and resloration aclivales complete including the 30-day sod warranty: 

EPA Representaiive [ Jrrw/C^JL/ - Dale:^//6 9 
Property Completion Agreement 

This agreemeni documents the completion of remedial acliviiies perloimed on my properly My signature 

will designate lhat I am satisfied with the restoration ofmy propeily, and thai no items are in questions, 

now, or at any lime in Ihe fulure, excepl those ilems listed below, ifany 

Property ID: 25<S^ 5 

Property Addrew: ijj^j ? LAfA^E^y e 

Owner: &j^>,;,d,^ r 

Phone: ^t< ^ -^y^"^ ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

0 i 1 <i(;rcr restoralion it complded, except as noted 

[_J I do not licccc resl«rAtiai) is completed 

MiHA'rkAuL. Y2ilf] 9frma,^ MMlnOi 

Owner's Signaturr Date Cbnti actor's Signalure ' 'Dale