TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION HLE FOLDER 

SAID #: l^at^- ^ Date: (Q/^^/0< ^ 

Address: HT-OC^ VJ\C \ 

Remediation Contractor: Coastal Environmenta l Group _ Year: _200i _ ic<7l 

SOIL REMEDIATIO N 

PROPERT Y FILE FOLDER DOCUMENTS 

z T Video ofproperty (DVD) 

\ y Executive Summary 

J ^ EPA-provided property sketch 

y f Signed Access Agreement for subject property 

m ^ Signed Access Agreement(s) for adjacent property 

J^T Restoration Agreement 

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

0 ^ Confirmation data 

j y Photographs ff^­ tr^^VWTkM , ^lC^I>r Vv^ Y ^ f \0ll^-7 

SZY As-built sketch 

12 ^ Satisfactory restoration signed by Property Owner 

-cT Property close-out check list signed by EPA 

«w Description ofareas not meeting ROD cleanup criteria 

P ^ Utility clearances 

0 ^ Property information from Douglas Coimty Assessor's Office 

D 

D • • • 

D 

signature 

30054540 

II 

Superfund 
Property Access Checklist 

Property ID: ^Q(\lo- ^ 

D WORK STARTED ON. _/ /_ 

D WORK COMPELTED ON: / /

Propcnv Address: ^^ ^ t^//- f T ^ 

Renter 0^^"*='^ E-P-<^,^ H r. r^auaf^^ 

Addrciss: ^ 

Phone: 

FiLv: 

Cell/Pager: 

Plione: Additional IntormMion-. 

Fsx: 

Ccll/Pager. 

CD Nutirication Letter Sent: Bv: 

^ Access AgrceincDt Signed: l^/JS/Q Q 

"^'BijptJiag ^ Tfii^tYx^ McD^tdi^ 

Restonitioo Agreement Signed:^? / KlCO^ By;.Ql^>^V^;y>.WufV<\^^ V4ryr>f^<f. 

EH Topsoil Sampling (if applicable) By: 

O DisposaJ Sampliog (if applicable) By: 

Q Gnrdcn Sampliag (if applicable) By: 

• Ulility Clearance Called: By: 

B^ideo/Photo s (Before) On: ^ / 2 ^ O^ 

By=^gri^M /gA^/wJ 

Q Video/Photos (During) On: Bv: 

D Video/Pholos (After) On: By: 

D ViOeo/Photoj (30-Day) On: By: 

D Property Completion Agreemeni Signed: / / By: 

D Final Report Issued: By: 

u 

Air MonitorinK (a& applicable 

n Community Q Crew Oo: / / By: 

Rc&ults: 

D Community' D Crew On: / / By: 

Results: 

Q Communiri Q Cri:»v On: / / By: 

ResulU: 

Omaha Lead Site 
Property ID #

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

1 <^^\^"1 

47.01^ W\fi^-\ 

 Date: Time: Action: 

 Date: Time: Action:_ 

 Date: Time: Action: 

 Transmit to EPA D Other Action: D 

•pc> Kt>T ^^- ^ ^ 
Douglas Coimty Account j||Drmation Page 1 of2 

Douglas County, Nebraska Property Record - R1711870000 

Print Report 

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

New Feature -•••- • Auto Sales Search 

Owner 

MC DOUGLE EFFIE L 

ETAL 

4206 WIRT ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 1187 0000 17 

Account Type: Residential 

Parcel Number: 1711870000 

Parcel Address: 

Legal Description: 

4206 WIRT ST 

OMAHA NE 68111-0000 

MAPLEWOOD LOT 3 BLOCK 1 W 53.1 FT LTS 2 & 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$5,600.00 

$5,600.00 

$5,600.00 

$5,600.00 

$5,600.00 

$5,600.00 

Improvement 

$40,800.00 

$47,700.00 

$47,700.00 

$47,700.00 

$23,700.00 

$21,500.00 

Total 

$46,400.00 

$53,300.00 

$53,300.00 

$53,300.00 

$29,300.00 

$27,100.00 

Land Informatio n 

Acras 

0.11 

SF 

4876.0 

Units 

1.0 

Depth 

92.0 

Width 

53.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R171... 6/7/2009 
Douglas Coimty Account ijArmation Page 2 of2 

•aWWRTST 

dftoer tq.B » f f 

First Floor 

M4.D sq fl 

» • M 

Jl> 10 t f 

E>dSMV>«< 

itir I 1/2 STORY FIN 

e>60«ii 

CLICK TO ENLARGE IMAGE CLICK TQ ENLARGE IMAGE 

Square Footage: 1276.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Average 

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

HVAC: Forced Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Blocl< 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1923 0% 1923 86 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Blocl< 8 ft 816.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch End Solid Wall 128.0 

User Attic Full Finish 332.0 

http://dougIasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 71... 6/7/2009 
Page 1 of 1 

[^ Create^ Another Ticket _ j ] [i J .Back to Irth Intemet ,| Send Email 

• YOUR TICKET NUMBER IS 2326029. 

Original Call Date: 7/24/09 Time: 5:49 pm Op: ELIZABETH18790 


Work to Begin Date: 7/28/09 Time: 6:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4206 Street: wiERT ST 


Twp: 15N Rng: 13E Sect-Qtr: 08-NE-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation 


Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 


Remarks: F7VX 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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuinber Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/24/2009 
r As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

29967 

Omah Exterior Paint North Arrow a Lea d Sit e 

• Good Sit e Sketc h 

[a^Poo r 

Sampling Address: 4206 WIRT ST .1 I Not paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm: 

RYASCPXA-29967 F1 ppm D Date: 7~-2.S-33 

RYBSCPXA-29967 F2 Z 5 1 ppm Time: IZ-. I'^ n p- '>^­ RYCSCPXA-29967 Bl ^ n q oom Samples Analyzed RYDSCPXA-29967 82 HH O ppm n 

RDZSCPXA-29967 DZ 6.20 ppm n XRF Unit: <^agH<S Book: Z I "^ 

RGZSCPXA-29967 GZ Zi(o ppm n Dale: ^ - tS'-0 & 

RPZSCPXA-29967 PZ 

A± ppm [Ef D Time: f\rr\ 

Lab RYCSCPLA-29967 Staff: miU- > Number of Samples Result 510 ppm [T /

i-eyeiiu. r i = rrom i_en, t-J: —Front Right, Bl = Back Left. 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

: -"I n S ^' 

OLSff:2996T 

Date Excavated: 11291^9 

Date USEPA Signed Off: 8/6/Q9 

Area Sodden: 1490 sq ft 

Rc^ ^m ) CroiKt l 0.t-May-<ni W«»\ sy (kMTDI 01 2.1 

Legen d 

Concrete Drip Zone Excavated ^<^ Quadrants Excavated 

Area replaced

Sod 

 with Area replaced with 

Rock/Mulch Area left bar e 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc , 
1 

29967 

Omaha Exterior Paitit North Arrow Lead Site 

Sit • Good e Sketch 

[3^Poor 

Sampling Address: 4206 WIRT ST yQ Notpaint 

Sampl Lead Sample Samples Collected e Numt)er LAB Concentration Collected Firm: ?E C-C- C-K-

RYASCPXA-29967 Fl 2 0 3 _ ppm Q"^ 

D Date: T-aS-'^S 

RYBSCPXA-29967 F2 2^-? _ ppm 0 D Time: \Z\\ ^ p.^ . 

RYCSCPXA-29967 Bl . ppm 0 

Samples Analyzed 

RYDSCPXA-29967 B2 HHO _ ppm 0 ' n 

RDZSCPXA-29967 DZ (alO . ppm H 

D XRF Unit: ^o5Hfi Book: 2 H 

RGZSCPXA-29967 GZ 11(6 _ppm o f D Date: ^-/5"-D 6 

RPZSCPXA-29967 PZ i^l _ ppm H ' D Time: (\fn 

Lab RYCSCPLA-29967 1 _—1 Staff: nit O 

: Result 510 ppm Number of Samples = / | / 

Lcytjiiu. r I = t-roni Len, i-2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

Rev 2008 Creaied: 0.1-May 044701.01.2.? 
m P 29967 

Exterior Paint North Arrow Omaha Lead Site 

Sit • Good e Sketch i 

[g^Poor 

SamDiina Address: 4206 WIRT ST £ ] Notpaint 

Sample Numt)er Lead 

Concentration 

Sample 

Collected LAB 

Firm: 

Samples Collected 

RYASCPXA-29967 Fl 2o 3 ppm D Date: 

RYBSCPXA-29967 F2 23 1 ppm D Time: 

RYCSCPXA-29967 

RYDSCPXA-29967 

81 

B2 

iL!l3__PP m Q' 

D Samples Analyzed 

RDZSCPXA-29967 DZ n XRF Unit: Yt^SHfs Book: 21 ? 

RGZSCPXA-29967 GZ D Date: A-lT'O B 

RPZSCPXA-29967 PZ D Time: A m 

Lab RYCSCPLA-29967 

Result 510 ppm _ Number of Samples = | 7 | | / | Staff: P1itL> 

mymiu : r i = rro m Len, 1-2 = Front Right, B1 = Back Lefl, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, fadng property 

• I I 'J n ? ? . • j 

(Sr 22.(» [ 

mo ^^^ 

n 

: in. 

( )C X )f 

p t 

203 231 

o n 

wissz 

\h)'k\. .SV. Rev 2008 Created: O.1-May-08 044701,01.2.1 
i^i ' _- COASTA * L bi, _tl ^ INYIIIONMEKT«L 

' t PBOH* C > 0 U r . 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: no^Y^f n 

Owner's Name: Daytime Phone: 

1^1 toto l ^ iKc'^'^icj,^ 

Address of Property 470- w\i'X s-r 

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 
# 

# 

' V 'T ^ COASTAL 

'<• PROT* C II O U P , INC . 

• 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 

0 1 grant access to my properties D I do not grant access to my properties 

Signature A Date Signawre Date 

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

Page 2 of 2 
•nto «r4 . 

COASTA l 

tNVIItOHHEttTAl 

C I O U r . I h C 

Kcce^s %• 

Corksenl fof Access To Pfopsfti' 

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: 

ler's Name: 

r\Tp S^\r,V 1-H - 'T-TS 

Address of Property 

covered k>y this 

Agreement: MZQl \K)\c^ R\ 

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 underthe 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 pertorming the work. This access shall 

remain in effect until the work has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
COASTA L irrVtRONHIKTAt 

C 11 O U P tN C 

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

piles, dog houses, etc; 

c 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; 

c 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 wori<. 

» Allow videotaping and/or photographing of the property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the wort< 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 

A 

Signature Date Signature Date 

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

Page 2 of 2 
C OA^S T-A~t­ • MvinoNM r MtA L 

c n o u p IN C 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions of the 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: 2j^<=^^y 

Property Address: ^^- p ^ f^J/Z ^ ^' ^ 

Owner: -^Q ^ h^) t Mr . 'Da>U^ e 

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. 

Photogr^hically 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: 

Item: 

ttem: 

ttem: 

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

fvAV ^M^ f ^Ci+fcrG <^li,v,A 

ttem: / 

Item: 

Item: 

Pagel of. 
COASTA L rMVIAONM f MTAl . C n O U r . IN C 

Items to Be Removed By Contractor During Remediation and Replaced 

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. 

Atiach a sl^etcli ul' the 

sprinlvlor lavout. 

Number of and sire of 

each garden/ flower bed 

area. 

Aiiacli a sketch of relative 

sizes and locations. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Note this \nlue ^vill he 

used to issue H plant 

voucher lo the property 

o^^ne^. 

Easement Area, to be 

excavated 

Quantity 

^\,>5'> 

^ 

^(t^ 

4 

/ 

i^ 

Landscape Inventory 

Unit 

Quadrants 

Each 

Each 

Each 

Each 

SquareFeet 

$ 

Condition/Type/Species 

Each 5e^A^) b/VA.H> 

Page 2 of. 
C OrA-S T An. • MVIMONnC N TA I 

Addttlonal Comments / Instructions: 

^ P^ ' of^ c^^^-r void b ^ ^ ^ ^ ^^''^ 

> (^p}\ ^' ^ '^^y ^b^Q>^ fe^T^M.ov^ 

D Check the box if Owner does not want CEG to docunnent 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. 

Q I do not agree ^ agree 

jynMti 

ner's Signature te Contnunor's Signarare Date 

Page 3 of. 
Date 

Proiect 

XRFID# 

Shot# 

2281 

^-^.Sl 

T7.R6_

71:8^ 

Average

Shot# 

Ji31 

.ZZ£ i 

_2i£5_ 229^ 

Average

Shot# 

Average 

Shot# 

Average 

lab sample # 

BViD#J2aStial. XRF PROPERTY SAMPLE SHEET 


l'Z^-^< ^ Address 

Omaha lead FP 2nd year option Sample time 17 '.^^ am/|fl& 

?)'K>^<\ sample length 30 sec 

Reading Sample area Shot# Reading Sample area 

UM.u^»ir>.<^l 2 1 &U L^.M± 11.rs^ 

wq.-SlJrjfZ B\ «sr5.<Wi^.95? B2 izn SH.-^*?±l2..Vf Depth 7-l.«S (/?.jw±//.;2 Depth 

i l I?.:t 12.11 a-zi.q 72.Mmi.l-i 1^ 

 7^.H 2 ± 11 l. ^ Average b'J.^' P J It) M 

Reading Sample area Shot# Reading Sample area 

ma.1 ± M.L.if .ZZ^k L JMna'^^/'^ ^ y^\ i^7,nini:M.}fi PZ .22^ 1 n^g-*./^ iPi^ ^ 

m.^itiHi Depth Depth ? 77q^ wo.-y4J-gsi o 

WM.ifiti-!)^! IZ 72qq[ \r^'k.l7.fi*.^ 

 ID^.l^ ^ t K V."? Average \^Pl.O[^ X |<^ _ 1^ 

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. ^ ^ A ^ ^ 

Print Pil y AoPJH^ CMSJS ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2285 

Mode SOIL 

Time 2009-07-29 17:59 

Duration 121.84 

Sequence Final 

Flags 

AVERAGE 

ADDRESS 

QUAD/ZONE Bl 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb /75.415 / ± 

Supervised By: /W^/LC£y|2g< 0 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2281 

Mode SOIL 

Time 2009-07-29 17:57 

Duration 30.48 

Sequence Final 

Flags 

BVID # 29967 

ADDRESS 4206 Wirt st 

QUAD/ZONE Bl 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 64.643 ± 10,917 

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 69.513 

Supervised By: 

Certificate of Verification 

2282 

SOIL 

2009-07-29 17:57 

30.48 

Final 

29967 

4206 Wirt st 

Bl 

Nicolas 

6 

CLEARANCE 

± Error 

± 11.197 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2283 

Mode SOIL 

Time 2009-07-29 17:58 

Duration 30.43 

Sequence Final 

Flags 

BVID # 29967 

ADDRESS 4206 Wirt st 

QUAD/ZONE B l 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 84.385 ± 12.337 

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 83.119 

Supervised By: 

Certificate of Verification 

2284 

SOIL 

2009-07-29 17:59 

30.45 

Final 

29967 

4206 Wirt st 

Bl 

Nicolas 

6 

CLEARANCE 

± Error 

± 12.105 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2290 

Mode SOIL 

Time 2009-07-29 18:02 

Duration 121.36 

Sequence Final 

Flags 

AVERAGE 

ADDRESS rewirtsT 

QUAD/ZONE B2 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb ^3 5 

Supervised Bv: ^Cajgg^ M 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2286 

Mode SOIL 

Time 2009-07-29 18:00 

Duration 30.39 

Sequence Final 

Flags 

BVID # 29967 

ADDRESS 4206 Wirt st 

QUAD/ZONE B2 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 65.043 ± 11.031 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerlca, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2287 

Mode SOIL 

Time 2009-07-29 18:01 

Duration 30.48 

Sequence Final 

Flags 

BVID # 29967 

ADDRESS 4206 Wirt st 

QUAD/ZONE B2 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 50.590 ± 9.978 

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 69.341 

Supervised By: 

Certificate of Verification 

2288 

SOIL 

2009-07-29 18:01 

30.10 

Final 

29967 

4206 Wirt st 

B2 

Nicolas 

6 

CLEARANCE 

± Error 

± 11.122 
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 72.430 

Supervised By: 

Certificate of Verification 

2289 

SOIL 

2009-07-29 18:02 

30.39 

Final 

29967 

4206 Wirt st 

B2 

Nicolas 

6 

CLEARANCE 

± Error 

± 11.754 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2295 

Mode SOIL 

Time 2009-07-29 18:05 

Duration 121.71 

Sequence Final 

Flags 

AVERAGE fA^*6?>2291^229# 

ADDRESS 4206 WIrt st 

QUAD/ZONE DZ 

INSPECTOR Nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 108.676' ± 1'3.6(6& 

Supervised >teAi 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2291 

Mode SOIL 

Time 2009-07-29 18:03 

Duration 30.37 

Sequence Final 

Flags 

BVID # 29967 

ADDRESS 4206 WIrt st 

QUAD/ZONE DZ 

INSPECTOR Nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb 70.310 ± 11.660 

Supervised By: 
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 132.063 

Supervised By: 

Certificate of Verification 

2292 

SOIL 

2009-07-29 18:04 

30.52 

Final 

29967 

4206 WIrt st 

DZ 

Nicolas 

12 

CLEARANCE 

± Error 

± 14.850 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2293 

Mode SOIL 

Time 2009-07-29 18:05 

Duration 30.40 

Sequence Final 

Flags 

BVID # 29967 

ADDRESS 4206 Wirt st 

QUAD/ZONE DZ 

INSPECTOR Nicolas 

DEPTH 12 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb 117.506 ± 14.219 

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 114.825 

Supervised By: 

Certificate of Verification 

2294 

SOIL 

2009-07-29 18:05 

30.42 

Final 

29967 

4206 WIrt st 

DZ 

Nicolas 

12 

CLEARANCE 

± Error 

± 13.944 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2300 

Mode SOIL 

Time 2009-07-29 18:09 

Duration 121.45 

Sequence Final 

Flags 

AVERAGE 3ygof229 & 

ADDRESS •'420S'WlrFst 

QUAD/ZONE easement 

INSPECTOR Nicolas 

DEPTH 1 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm ± Error 

Pb ^54" ± |i5^i3g 

Supervised By: (QOMk.\ Qjd ^ 
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 140.946 

Supervised By: 

Certificate of Verification 

2296 

SOIL 

2009-07-29 18:07 

30.56 

Final 

29967 

4206 WIrt st 

easement 

Nicolas 

1 

CLEARANCE 

i. Error 

± 15.451 
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 119.795 

Supervised By: 

Certificate of Verification 

2297 

SOIL 

2009-07-29 18:08 

30.54 

Final 

29967 

4206 Wirt st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

14.089 
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 140.344 

Supervised By: 

Certificate of Verification 

2298 

SOIL 

2009-07-29 18:08 

30.19 

Final 

29967 

4206 Wirt st 

easement 

Nicolas 

1 

CLEARANCE 

± Error 

± 15.032 
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 158.730 

Supervised By: 

Certificate of Verification 

2299 

SOIL 

2009-07-29 18:09 

30.16 

Final 

29967 

4206 Wirt st 

easement 

Nicolas 

1 

CLEARANCE 

Error 

15.965 
cr — ** 

i^^Af\ Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^ ^ I Coastal Environmental Group Inc. M ^ 7 V"^^! ^ www.coastaIhazmat.com 

^^tpnoT*! ^ COASTA L INVmONNINTAL 

CIOUP . IN C 

EXECUTIVE SUMMARY: 

BVID # 29967 - (4206 WIRT ST) 

~x| No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 

NO ISSUES PENDING 
^ % 

EPA Property Close Out Form 

Property #: 2^^JL>~1 . 

Date/Tine: 

~ 7Z Owner's Waiae;.,^,R fi£i,^ j .M&UT' "^ 

Quads Excavattd: 61j pX^jl X 

rnntmrto r Croup C„ftA<Ntr%| Ff \ iiAOrrrveri+q 1 

Excavatio Yes No n GcBeral 

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

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

GradlBE Yes No Sod and Vegetation 

I. 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? U-^ 

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

day time period) \y^ 

Sotrv^lOnf^ % ^ ^f^^S 

4. Are sodded areas generally firm and evenly graded? l y 

5. Arc the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 1 / ' 

time period) 

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

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

Gates, Fences and Retoining Walls 

Yes No 

I. £>o gates open and close freely? (Ifapplicable) [ y ' k l 

I. Were all gates or fences laken down during restoralion activitie Act! s reinstalled? (Ifapplicable) 

17' 3.

 Was damage to gates or fences avoided? (Ifapplicable) 

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

Foundation, Siding and Gaiters Yes No 

I. Was damage to the siding or trim avoided? 

2. Was damage to Ihe foundation avoided? 17' 

7. Was damage to windows avoided? 1 ^ ' 

<l. Was damage to windows or door screens avoided? y

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

Sidewalks nnd Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? y
Ovt'oers comments: 

Inspection notes: 

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

EPA Representative J^JT ^ DYJAI ^ Date: 9Jf()l6f 
i 

Property Completion Agreement 

This agreement documents the completion ol remedial activities perlbimed on my properly My signature 

will designate (hai I am satisfied with the restoralion ofmy properly, and Ihal no items are in questions, 

now, or at any time in the future, except ihose ilems listed below, ifany 

Property IP: 2 ^ ^ 6 7 

Property AddrcM: ^^.CA lO \ J" f- *^4 

Owner: C.^J^ ^ ^ 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

[ j S I nyrcc I c.ttoralion i% complded, rxccpt a j noted 

t. I I do not a(;rec resloration it, completed 

Contrarlor's Signature Dale