TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: Ocfki^T, Date: l/^bjO ^ 

Address: _23(n ^ ^'\CXC C. 'r k 

Remediation Contractor: Coastal Environmental Group_ Year; _200f|_ 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

/ Video ofproperty (DVD) 

Executive Summary 

N / EPA-provided property sketch 

2: Signed Access Agreement for subject property 

>)G^ Signed Access Agreement(s) for adjacent property 

/T Restoration Agreement 

^9r Settlement documents (i.e., for damage or to replace plants, etc.) 

0^ Confirmation data 

C Photographs 

2"^ As-built sketch 

0 Satisfactory restoration signed by Property Owner 

A Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

y Utility clearances 

<P Property information from Douglas County Assessor's OfTice 

[ I 

n 

n 

ilm.. ^'^^Signatur ^ e __ - —j Date 

30054494 

Superfund 
Property Access Checklist 

Property ID: ^^^V^ ^ 

Property Address: 'Z.'bij O ^ V'^ICY^ C f 

D

D

 WORK STARTED

 WORK COMPELTED

 ON: 

 ON: 

_/

/

 /_ 

/ 

o^*"'^'= F.AKj.-nrcS

1 Addre»s: 3^ ^ ^ 

 'S^o-H- Renter 

Phone: 

PH.\: 

Phone: '3MM-/«,M^ 

[Fax: 

Ccll/Pager 

^ 

Cell/Pager: 

Additionul Informittion: 

1 D Notification L.cttcr 

SZ) Access Agrcemeni 

Q ' Rettonitioo Agreement 

D Topsoil Sampling (if applicable) 

D Disposal Sampling (K applicable) 

Q Gnrdcn Sampling (if applicable) 

i 0 ^ Utility Clearance 

1 ^ Video/Photos (Before) 

\ ^ Video/Pholos (During) 

n Video/Pholos (After) 

D Video/Photos (30-Day) 

D Property Complelion Agreement 

D Final Report 

Scnl: / / 

Signed: (jj / fo / D 9 

Signed: i^/iZ,/(2 1 

/ / 

/ / 

/ / 

CMti\:C£_/\t/ ^ 

Oti:Si_/}i_/^ 

Ou'.^l21lQJ J 

On: / / 

On: / / 

Signed: / / , 

Issued: / / 

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By: 

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By=/\/(0.Jc//>4aw\o

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1 

Air Monitorine (»s jtDpJicable) 

D Community D Crew |

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D Communit}' Q

Results: 

 Crew | On: / / 1 By: 

L 

D Communitj

Results:

 Q Crew On: r / Bv: 

1 

Omaha Lead Site 
CONTACT FORM 

Property ID U

Property 

Address:

 IT)

 2- S

 % U ^ 

 W 4 P\-^rO. ^ S'V^ 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

 Date: Time:

 Date; Time:

 Date: Time:

 Transmit to EPA D

 Action: 

 Action: 

 Action: 

 Other Action: D 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 
Douglas County Account ition Page 1 of2 

Douglas County, Nebraska Property Record - R2218210000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - VleWf O n Ma p Information is valid as of 2009-5-12 Treasurer's Tax Report 

New Feature - • ^ - • Auto Saies Search 

Owner 

SCOTT EDWARD 

2569 PIERCE ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 1821 OOOO 22 

Account Type: Residential 

Parcel Number: 2218210000 

Parcel Address: 2569 PIERCE ST 

OMAHA NE 68105-0000 

Legal Description: SHULLS 2ND ADD LOT 4 BLOCK 8 E 50 FT 

Value Informatio n 

Land Improvement Total 

2009 $5,400.00 $64,700.00 $70,100.00 

2008 $5,400.00 $65,500.00 $70,900.00 

2007 $5,400.00 $65,500.00 $70,900.00 

2006 $5,400.00 $62,200.00 $67,600.00 

2005 $5,400.00 $62,200.00 $67,600.00 

2004 $5,400.00 $62,200.00 $67,600.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.19 8400.0 1.0 168.0 50.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R221... 6/6/2009 
Douglas County Account tion Page 2 of2 

,>. First Boa 1034 0»q fl '1%^/qT}'' 

»»"1 I 

1 1/2 STORY FINISHED 

ItVlai K 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1604.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

Built As: 1 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 7.0 

Exterior: Frame Shingle Units: 1.0 

Interior: Plaster Baths: 2.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Blocl< 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1910 0% 1910 99 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 1034.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Garage Detached 440.0 

Porch Slab Roof Ceil 165.0 

User Attic Full Finish 570.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=R221... 6/6/2009 
http://www.dhoaoi^jgfaintemet/DHONNoticeOeation/MessageTexL Oj^igfai] . 

Create Another Ticket | Back to Irth Intemet | Send Email 

YOUR TICKET NUMBER IS  2300189. 

Original Call Date: 6/22/09 Time: 12:53 pm Op: ELIZABETH18790 


Work to Begin Date: 6/24/09 Time: 1:30 pm 


State: NE County: DOUGLAS Place: OI^HA 


Address: 2569 Street: PIERCE ST 


Twp: 15N Rng: 13E Sect-Qtr: 28-NE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: Leam Remediation 


Location of Work: INCLUDE ALL EASEMENT. 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: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Utility Service Area Contact Phone Nuniber Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 


Emerg: 4029329757 


Day: 8773668344 


LEVELS LEVEL3 COMMUNICATIONS, LLC NA Alt: 


Emerg: 8773668344 

Day: 4025047823 

METROPOLITAN UTILITIES MUD02 SANDY Alt: DISTRICT 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 


OPPDGPR6 OMAHA PUBLIC POWER DISTRICT NA Alt: 4062071494 


lof 2 6/22/2009 12:53 PM 
ht^://www.dhon.or^ighintemet/DHONNotice&eation/MessageTexL.. QjWjiihi . 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIF QWEST LOCAL NETWORK NA Alt: 4062071494 

Emerg: 8887289343 

2 of 2 6/22/2009 12:53 PM 
As-Built Drawing |||^ 

C OAST A L Omaha Lead Superfund Site 

Name:

Address:

Phone;

 Sff M . .. . 

 -^C<^h "i>,v^<S-/. 

 'P.'-/(-i-Z'y'y't 

Omaha Lead Site 

SKe Sketch 

Date:

Time:

 "^/^V/^ ^ 

 '^'''-f< ^ 

North Arrow 

Team .^^"Z^S (JAOCCJLJI. BV1D# c^^^­ ^ XRF Code 55D4 

Sample Number Lead Concentration Confirmation Sample 

ppm 

ppm 

ppm 

< , Yes CD 

-1-:.Yes ° 

^•.Yes n 

15^-Yes ° 

t)-^e s CD 

? Yes • 

Yes • 

No ^ 

No 2S 

No ^ 

No 2 ^ 

No O"^ 

No E^ 

No • 

l!liaiii!Haii!ii!iiaiiii8!idteiiiiiSiiiiiniiM^^ 

Omaha Lead Site 46130 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 

Area left bare 
 Sod Rock/Mulch 

Contract #: EP-R7-07-05 Coastal Environmental Group Inc. 
1 Omaha Lead Site Date: North Arrow Name: 3cok\, ^ 

Address: • ^ ^ Site Sketch Time: ^ 

Phone: 

'rx\ y W^-rs- ^ 

Team y^i S Gx«i^k BVID # c^^^ 3 XRF Code as'pM' 

Sample Numt)er Lead Concentration Confirmation Sample 

<^Yes n No g ^ 

-f-Yes a No ^ 

'^lYes n No Q / 

I^Yes a No 2 / 

ty^e s a No OO 

l?>^ l l )$• ppm ? Yes • No a 

ppm Yes • No •

= 7 ^ 5 ^ _fi 

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Omaha Lead Site 46130 
Name:

Address:

Phone:

 .Srr M 

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'^^^/Q- 3SS ^ 

Omaha Lead Site

Site Sketch

 Date: 33-^^ fd ^ 

 Time: "? ^ ^/ y 

North Arrow

A J 

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Team ^T\^S___C^lji5,__ BV1D# 3^ ^ ^ 3 XRF Code 5^PMSample Numtier Lead Concentratk>n Confinnation Sample 

(W'^l^ l ppm 

32^^-Mgg: 

-^ ^ Yes

T^Yes

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9 Yes

Yes

 1 ^

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No g ^ 

No Q; ^ 

No gy 

No Cd / 

eo^-^et^^*^^ 

Omaha Lead Site 46130 
Name: -Sr&Vt ( . _ _ Omaha Lead Site Date: ^/^9/ ^ North Arrow 

Address: -;L<r<^9 Prcrj:^ Sf . SIteSkotch Time: "? - ^/ ^ 

Phone: '^^Q - S'^S^ 4J 

KK ^ (4.- Team r<yiS & ^ A BVID# 9^^^ 3 XRF Code 559^ 

Sample Numt)er Lead Concentratton Confinnation Sample 

<>Yes C Nwoo ^ "^ ^ 

KH^sSfyA ^io^i^ 

^?+l ^ PPf" 

32£^ ^ JJm 

I M 1^ |g^ ppm 

fei£^^' ,c­ =?f 

T^Yes CD 

'?.,Ye8 CD 

^Ye s CD Wes ° 

9 Yes a 

Yes • 

^^»=« ^ 

No 2/ 

No g; . 

No 2/ 

No QU 

No a 

No •M 

saL^Lai, 

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Omaha Lead Site 46130 
V 

# 

COASTA L fNfUOMMIHTAt 

e i o u f . 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: _ ^ 

Owner's Name: Daytime Phone: 

^D W 9d^(xM 

Address of Property 

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 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 
(A) COASTA L CNViaOMfirNTAl 

s • 0 u r. I ll 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 lo allow others to use the property in 

such a manner. 

Should you have any questions about this program, please contact Coastal 

Environmental Group, at (712) 352-0188 

[giggran r t access to my properties 

O I do not grant access to my properties 

Signature Date Signature 

Date 

Q I would like to be present during any sampling that is required. 
4 

C O A 5 T A t 

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: 2D^bi ^ 

Property Address: ^C^i^Q^ y\p^(r^ ^ C ^ 

Owner: g^^^,^,; ^ 9Cj!yitPhone aMU-2,MS^ 

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

utilities, subsurface features, surface structures and landscaping features, access Iocation(s) to be used by 

contractor, and the 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 retum ofthese items is the Owner's responsibiiity. 

Page 1 of. 
C O A S T A L 

o n o u r , I f* c 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Page 2 of. 
4 

C p A S T A L flMVlttOMnlHtAi 

e H o u r I N c 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

item: 

f\ J^P^ 

Item: 

1 ScHl Pi -* r?.. Item: 

Item: 

Item: 

item: 

Item: 

Item: 

Item: 

item: 

Item: 

Item: 

Item: 

Item: 

item: 

Page 3 of. 
COASTA L r*<t viHONM t wrAi . o It o u r . I M c 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk 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. 

Quantity 

Y\\^ 

# 

^ ^ ^ 

vilPf 

Unit Condition/Type/Species 

Square feet 

•, 

Each 

Each 

Each 

Each 

Square Feet 

Page 4 of. 
COASTA L 

<> A O U P ( N C 

Item Quantity Uriit Condition/Type/Species 

Agreed upon value of 

plant materials not to be 

renlaced 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 connector. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

by the contractor. 

^\ ^ 

. ^ Each 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

arca(s) to be replaced with 

grass sod. 

^ 

SF 

Area of City or County 

proper^ to be landscaped 

per dieir requirements. 

Include a sketch of the 

area(s) 

H ^ SF 

Easement Area, to be 

excavated SF 

Ve^dim e£su\t 

Page 5 of. 
e OASTA L •MVAkOMMCMTAt « * • V r . IN C 

Additional Comments / Instnictions: 

L^Chec k the box if Owner does not want CEG to document interior foundation walls and possible 

preHScisting damage. By cheddr^ this box CEG is not responsible for any damage done to the 

interior of house, induding fbutKiation cracks or fissures. 

\N M {.[L(^ 

Owner's S^nature ictor's Signatare Date 

Page 6 of. 
Date 

Project 

XRFID# 

Shot# 

^ 1 \ 

5-2.1 

5 1 ^ 

•bm 

Average

Shot# 

I 5^-^. 

5 q q 

-UCtL 

Average

Shot# 

Average 

Shot# 

Average 

lab sample # 

BVID#_2D2lk3 

XRF PROPERTY SAMPLE SHEET 

tp-7.^-Oq Address IO«U'?^ 

Omaha lead FP 2nd year option Sample time n. n €sapm 

1>10%' sample length 30 sec \ 

Reading Sample area Shot# Reading Sample area 

S?r.f. 1 VOM ^Z b \ai.UL,l H.-b? 

*>D.%^l•«\.^ti7 f 2 ^Z l ITT ni t M.sa o^- ^ 

5l.li«r'\.' ^ IDepth 52 ? laq.iffctM.i j Depth 

^«.l\ol: Mf l ^ ^ 52. «^ iHD.<?<?im.u,t 1 

 ^ q QK 1 ^.7 4 Average t^?>.qH 1 14.5*^ 

Reading Sample area Shot# Reading Sample area 

50.-HA q.SH 

^iiM'i^ q.^ fl 

tfZ..?)Lrt(n-5l Depth Depth 

•^T83t ^.^ JJL 

 M5^.35 ^ ^.^ 1 Average 

Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average 

RETEST AREAS 

Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average 

Lab result Sample area XRF Avg. 

Signature ^Cmm 

PrininiFliJlhlMnC/}me5 t s 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 525 

Mode SOIL 

Time 2009-06-29 11:19 

Duration 121.06 

Sequence Final 

Flags 

AVERAGE iAvg of 521-5247 

ADDRESS ^569~p1erce'st 

QUAD/ZONE F2 

INSPECTOR nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb 

Supervised By: Cp(^tiHY?Oy f 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 521 

Mode SOIL 

Time 2009-06-29 11:17 

Duration 30.02 

Sequence Final 

Flags 

BVID# 20863 

ADDRESS 2569 pierce st 

QUAD/ZONE F2 

INSPECTOR nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 58.503 ± 10.404 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 522 

Mode SOIL 

Time 2009-06-29 11:18 

Duration 30.33 

Sequence Final 

Flags 

BVID# 20863 

ADDRESS 2569 pierce st 

QUAD/ZONE F2 

INSPECTOR nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 50.838 ± 9.760 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 523 

Mode SOIL 

Time 2009-06-29 11:19 

Duration 30.40 

Sequence Final 

Flags 

BVID# 20863 

ADDRESS 2569 pierce st 

QUAD/ZONE F2 

INSPECTOR nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 52.258 ± 9.895 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 524 

Mode SOIL 

Time 2009-06-29 11:19 

Duration 30.31 

Sequence Final 

Flags 

BVID # 20863 

ADDRESS 2569 pierce st 

QUAD/ZONE F2 

INSPECTOR nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 38.164 ± 8.888 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 530 

Mode SOIL 

Time 2009-06-29 11:26 

Duration 121.28 

Sequence Final 

Flags 

AVERAGE S E of^526-529 

ADDRESS 2'569~plerce^ 

QUAD/ZONE easement 

INSPECTOR nicolas 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb [133^377 ± ^14^539^ 

Supervised By: ^Ma2Q ^ 
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 127.660 

Supervised By: 

Certificate of Verification 

526 

SOIL 

2009-06-29 11:24 

30.56 

Final 

20863 

2569 pierce st 

easement 

nicolas 

1 

CLEARANCE 

db Error 

± 14.351 
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 127.714 

Supervised By: 

Certificate of Verification 

527 

SOIL 

2009-06-29 11:25 

30.36 

Final 

20863 

2569 pierce st 

easement 

nicolas 

1 

CLEARANCE 

Error 

14.584 
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 139.377 

Supervised By: 

Certificate of Verification 

528 

SOIL 

2009-06-29 11:25 

30.14 

Final 

20863 

2569 pierce st 

easement 

nicolas 

1 

CLEARANCE 

± Error 

± 14.610 
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 140.999 

Supervised By: 

Certificate of Verification 

529 

SOIL 

2009-06-29 11:26 

30.22 

Final 

20863 

2569 pierce st 

easement 

nicolas 

1 

CLEARANCE 

± Error 

14.613 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 601 

Mode SOIL 

Time 2009-06-29 15:40 

Duration 120.92 

Sequence Final 

Flags 

AVERAGE lkyjof597^0 g 

ADDRESS ""2569 pierce st 

QUAD/ZONE Fl 

INSPECTOR nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 48.347 ± 9^61] 

Supervised By: CeCMMSiA 
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 50.713 

Supervised By: 

Certificate of Verification 

597 

SOIL 

2009-06-29 15:38 

30.29 

Final 

20863 

2569 pierce st 

Fl 

nicolas 

6 

CLEARANCE 

± Error 

± 9.839 
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 42.488

Supervised By: 

Certificate of Verification 

598 

SOIL 

2009-06-29 15:38 

30.16 

Final 

20863 

2569 pierce st 

Fl 

nicolas 

6 

CLEARANCE 

± Error 

± 9.300 
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 62.355

Supervised By: 

Certificate of Verification 

599 

SOIL 

2009-06-29 15:39 

30.07 

Final 

20863 

2569 pierce st 

Fl 

nicolas 

6 

CLEARANCE 

± Error 

± 10.507 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 600 

Mode SOIL 

Time 2009-06-29 15:40 

Duration 30.40 

Sequence Final 

Flags 

BVID# 20863 

ADDRESS 2569 pierce st 

QUAD/ZONE Fl 

INSPECTOR nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 37.830 ± 8.798 

Supervised By: 
/^|A^ \ Omaha Lead Site—Fixed Price EP-R7-07-05 

3 ^^^ ^ I Coastal Environmental Group Inc. Ml ^ ^ \'^^yjf www.c0astaiha2mat.com 

^tPBOi**^ COASTA L INVIIONHINTAl 

0 a o U P, IN C 

EXECUTIVE SUMMARY: 

BVID # 20863 - (2569 PIERCE ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 

NO ISSUES PENDING 
^EPA 

EPA Property Close Out Form 

Property #: 2X^ln? i ., Property Addrc«r.>7fiV?S. U^'^^' ^ '^• ' 

Datc/Tlmc: Owner'sName: g.&AltX^'^U, 

Quads Excavated: "Fv.Pz. ContractorGnu'oCfYy^LS Fx^JiCr^Antsnt^ 

Excavation Yes No General 

1. If necessary, were the correct quadrant(s) excavated and restored? uFl 

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

u-^ 

Grading Sod and VcgeUtJoa 

Yes No 

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

from the house? \y^ 

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

3. Doe

day tim

s th

e

e

 period

 sod appea

) 

r to be generally healthy and growing? (Only evaluate if inspected at a 30 w4.

 Are sodded areas genetally firm and evenly graded? \ y ^ 

5. Are the joinu iKtween the sod strips generally tight?/Only evaluate if inspected at a 30 day r?^ time period)

 jfiit^ Tlhtfaf^-C*^ 

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

7. Was danuge to landscaping or plant materials avoided? 33'^ 

Gates, Fences and Retaining Walls 

Yes No 

1. Do gates open and close freely? (If applicable) ho Ja-tQS 

UPI 

Were all gates or fences taken down during restoration activities reinstalled? (Ifapplicable) L y 

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

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

Foundation, Sidiag and Gntlcre 

Yes No 

I. Was damage to the siding or trim avoided? 

2. Was damage lo the foundation avoided? I^-* 

3. Was damage to windows avoided? yy^ 

^. Was damage to windows or door screens avoided? 

5. Was damage to dov^spouts or downspoul extensions avoided? 

Sidewalks and Driveways (Conyrele) 

Yes No 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkSway surfaces avoided? 
Owners comments: 

Inspection notes: 

Remova Kemoval an n s e e so warranty: i andd resloratio resloration activate activates complet complete includin includingg ththe 30-da 30-dayy sodd warrar 

EPA Represenlalive UrO n jjTjJLi L Dd\e:l 2^1-3'.0C 1 
p # 

Property Completion Agreement 

This agreemem documents the completion of remedial activities peribrmed on my pioperty. My signature 

will designate that I am satisfied with the restoration of my propeity, and that no items are in questions, 

now, or al any time in the future, except those ilems listed below, ifany. 

Property ID: ^ ^ ^ ^ 

Property Address: Z S' ^ 9 f(€.*-C<:- J / " 

<^"""=' S.«4-\- CA^c^r-X 

Phone: J i/ ^ JV T ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Additional Comments:, 

\/\\ agree restoration is completed, except as noted 

L I I do nol a(;rec resloration is completed 

3y)k^/r<y33i'^7yy7ff ?cCfiH\ioi\ ?//o/o4 

Owner' s Signature Date Contractor's Signature Dale