TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ^im^ ^ Date: \2/7n/lt>t 

Address: Mfj^l ^e.\JOarrl '. 

Remediation Contractor: Coastal Environmental Group_ Year: lOlOARRA 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

S^ Video of property (DVD) 

^ Executive Stmimary 

" y EPA-provided property sketch 

V0' Signed Access Agreement for subject property 

Q- Signed Access Agreement(s) for adjacent property 

"Q^ Restoration Agreement 

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

O^ Confirmation data 

i ^ Photographs 

G^ As-built sketch 

"^ Satisfactory restoration signed by Property Owner 

^ Property close-out check list signed by EPA 

-& Description ofareas not meeting ROD cleanup criteria 

VT Utility clearances 

'H' Property information fi'om Douglas Coimty Assessor's Office 

D 

D ; ^ ^ 

D ' \ . 

signatur maturee / . Date

30218043

nil 

Superfund 
^\ 

Property Access Checklist 

PropertylD: (j^jg q

Property Address: 

g D

•

 WORK STARTED

 WORKCOMPELTED

 ON:

 ON:

 /

 /

 / 

/ 

Owner 

Address: 

moo Dar+mMK s^. 

Plione: 

Fax: 

Cell/Pager: 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

n

"^

n

{ D

Q

Q

1^

^

n

n

n

n

D

 Notification Letter 

 Access Agreement 

 Restoration Agreement 

 TopsoU Sampling (if applicable) 

 Disposal Sampling (if applicable) 

 Garden Sampling (if applicable) 

 UtiUty Clearance 

 Video/Photos (Before) 

 Video/Photos (During) 

 Video/Photos (After) 

 Video/Photos (30-Day) 

 Property Completion Agreement 

 Final Report 

Sent: / / 

Signed: 2_/^/i Q 

Sisned: / / 

/ / 

7 / 

/ / 

CaUed: Ofe/ t^-Kl 10 

On: riZj l fO 

On: / / 

On: / / 

On: / / 

Signed: / / 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

®y= Oh/o>/\ 0

By: y U 1 c ^

By: 

By: 

By: 

By: 

By: 

 VJX^AKJ 

' 

Air Monitoring (as appUcable) 

• Community Q Crew 

Results: 

On: / / By: 1 

O Community

Results: 

 O Crew On: / / By: 

• Community

Results: 

 O Crew On: / / By: 

Omaha Lead Site 
Dpuglas County Account InfoHaation Page 1 of2 )jja^t 

Douglas County, Nebraska Property Record - R2152280000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - VJOW Ofl Ma p Information is valid as of 2009-12-15 Treasurer's Tax Report 

New Feature - • -> - • Auto Sales Search 

Owner 

HOLSTEN ELLEN A 

C/0 MARY JO BABCOCK 

1400 DARTMOUTH ST 

DENTON TX 76201-1718 

Property Informatio n 

Key Number: 5228 0000 21 

Account .Type: Residential 

Parcel Number: 2152280000 

Parcel Address: 4541 SEWARD ST 

OMAHA NE 68104-0000 

Legal Description: SAUNDERS & HIMEBAUGH TO WALNUT HILL LOT 11 BLOCK 4 50 X 140 

Value Informatio n 

Land Improvement Total 

2009 $6,600.00 $66,400.00 $73,000.00 

2008 $6,600.00 $66,400.00 $73,000.00 

2007 $6,600.00 $66,400.00 $73,000.00 

2006 $6,600.00 $66,400.00 $73,000.00 

2005 $6,600.00 $49,900.00 $56,500.00 

2004 $6,600.00 $49,900.00 $56,500.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.16 7000.0 1.0 140.0 50.0 No 

Impro vemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accountno=R2... 12/30/2009 / 
Dpuglas County Account Infojmation Page 2 of2 :)aual 

.M ;,/ ­

"T' 

^ & ^ ^ ^ ^^ -:.^. %

iisitii iissn uta 

W •• • -'^ H ' ^ 

% ­

1 \ CLICK TO ENLARGE IMAGE 

Square Footage: 1020.0 

Perimeter 0.0 

Unit Type: 

Built As: Ranch 

HVAC: Central Air to Air 

Exterior: Masonry Common Brick 

Interior: Drywall 

Roof Cover: Composition Shingle 

Roof Type: Hip 

Floorcover: Allowance 

YoarR.iiit ^®^'' Percent

Tearauii i Remodeled Remodeled ,

1949 0 0% 

Detail Type Detail Description 

Add On Fence Chain Link 

Appliance Allowance 

Appliance Security System 

Basement Bsmnt Block 8 ft 

Fixture Base Fixtures 

Fixture Bath Full 

Garage Attached 

Porch Slab w/Steps 

•or 

M » •BT MP 

«c 

"^"" ' 

CLICK TO ENLARGE IMAGE | 

Percent Complete: 100.0% 

Quality: Fair 

Condition: Average 

Condo Square Footage: 0.0 

Rooms: 5.0 

Units: 1.0 

Baths: 1.0 

Bedrooms: 2.0 

Stories: 1.0 

Foundation: ' Block 

Sprinkler Square Footage: 0.0 

Adjusted Year Physical Age Bu/7t 

1949 61 

Units 

1.0 

1.0 

1.0 

1020.0 

1.0 

1.0 

330.0 

24.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 12/30/2009 
"> 

Page 1 of 1 

Create Another Ticket. Back to Irth Intemet } [v^Send Bnail i] ][ 

• YOUR TICKET NUMBER IS 2510405. 

Original Call Date: 6/03/10 Time: 1:52 pm Op: ELIZABETH18790 


Work to Begin Date: 6/07/10 Time: 2:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4541 Street: SEWARD ST 


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


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: LOCATE ENTIRE PROPERTY, ALL EASEMENTS AND TO THE PEDESTAL 


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


: UNSURE IF CORNER LOT. 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: COASTAL 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPD6PR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 


Day: 4024447197 


OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 


Emerg: 8887289343 


Day: 4067289343 


QLNNE 1C QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://wAvw.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 6/3/2010 
Lemote ID: R page of 

: • : ^jii^L^".^^^.^ 

>T^F. I'VXC; ] 

^^as'ls.eLn'fe m«k^£(«M . 

arg'ar^-uaTa.d. f ai.cidm.'bd. i 

te- b : 2SdL040 S 

-4'S 4 iT SBI'WJ 

>3.aLe»< 

UkCO V <S«»vr@ag >

3d.-fe3r o £ Oznei.l:^aft.

 : 

 J3«!;«#^ag— >T ^ CT^x^ f Xd.O'ts . >«kag d.rk f o ^r k -t^h, ^ ^z^ ^ OALX X -bd-ctlc^i s 

rd.«> 

iacxnd.n^c3 . ota . 

i&X X <3«ant& 

ag fn.ad.Xd . 

te- b :

r«»s s :

 2SX040 9 

 230 6 S 3Sa? M SV* 

>Xek.c»^ r 

<S«»WAag > 

k«#«»ag— >T ^ c;^r&£Xd.«=»- b jackas- d.«» f ^ ^z ^ bl%«k c»«fcXX •fa.d.al&e- b 

UkCro v iO'agak.ffd.«» > : 

Ttx ^ Od.-bv ' o f ^>nkai.1>ai. ^ag«k. f f d.« i Slrk9d.s»^««agd.n 9 Dd.-v-d.^d.^z »

ft«>-b d. n «*<»n£Xd.ccf c wd.-b1:» -bh^ k «SLd.9 sd.b« » x»ago-vd.d@<a . la^ r

 tu i 

"(^l^ ' 

id.z»«s«9. ^-taa g

a«k.X X c«oi«>b^a g

 f

 . 

 0L43i.Xd . 

r^t A >%ai.^r«ii at-Ki^r aLd«9.d.-bd.^rkaL X qrui^'*^^^ ! ^X^ais ^ es^z«baL«t b OiTiai.>kak Xd.< a -PTo^lc i 
Lemote ID: R page of 

c:otJ^sa*Jwx< s>wxx%o>v»aBM'VJkx< asBX^'v^zcrB Jk.-b-bn: BX.XBA:8BV H 

s e : B776«2-42X O Vct.ac : 87'7ee242X X 

K d.c t stTx d.xngperag'bei.zs.-b zn^^^oLg^ a f ag^wn CT^ac CT^wcnnxazad.csak.-b.d.^zv.^ agcqpXyJi-**^ ' b ^ 3fa»Ta.a 

.^ciai.b ^ ^-«xag laz^dlcaggag^iarxrii , f ak<a d.Xd.b d.^ ^ d.*» eLZ« •k.agesa. di^^c(agd.3»ei4d L o^ n blk ^ ^ne t «*flk.XX 

y^ x bd.«»]c^ b . TT ^ ^L o z%e»b l%a.-v ^ «LZ%3r 'uiK^d^^agg'agotaixkd . f M.c(d.Xd.bd.^ ^ d.zii ar^'*^^ ^ cS.d.g' etag^M . 

t e b : 2SX0'40 S 

ab^ r : ^Ol7C»XiJihJ3 ^ 

kar v : 

n^dL ^ i ^ ei. n dLzntp^agbsLzii b Tn^^^mk.^f ^ f agon n CS^ac Ca»nunmazki«»abbia>z% ^ ag^jpXyd-r^ y b o 3^^^^^ ^ xi^ ­

s. ^ X^aak.b ^ ^Kxaag tax>.<A.^agg-ag^taa:a.cJi fct.od.Xd.bd.^ ^ d.x> ei.x» cLag^a t d.«»^<3agd.33^»d . ^ n bl» ^ ^n. ^ aai. X 

s^za.b^a g bd.oilc«» b . 'W ^ d. ^ z&o b ha^-v ^ OLZx^r 'utxa,d.^agg'ag^tax««9. f «LC(d.Xd.bd.^ ^ d. n ar^'^^as' d.d.g ' SLag^ . 

: £ " ar^' u >%e:k.-w^ ak.z»ar «0^^>^'^^^*^s > / 3^X^et.^« » ^ai.X X ^laa r ^ffd.a ^ «. b 40 2 — 934—046 9 

t e b : 26X040 0 

ress : 37X 9 X« 3 S V H JW W 

k W V s 

?hd. ^ d. ^ flLrk dLzcqp^agbai.zk b xn^^^sL^ ^ farcas n C^a c C^kxncn.tAz^d.oaiLbd.^rk ^ ag^ y Xy^r^ g b ^ y<»'utag ag^ ' 

s. ^ Xo«iai,b« k a»xa.ag tand.«»ag9'age»'«avkdL £«i.«»d.Xd.bd.eki 3 d.r& ai.r» okag^oi . d.«k^e»agd.]»^«S. ^ n bli ^ ^n ^ 4Siflk.X 

se»z»b^a g bd>e»l&^ b . W e d, ^ zs.^ b IrkaL'v ^ «i.na r ia»>riteapgag^ij.r»<a . £«[kcsd.Xd.bd.^c » d.ra. y^'*^^i= ' cfl.d.g' &ag^ . 

: £ ar^o a hok-v ^ A^na r ar*a«»^bd.«>x% ^ , ]B»X^a.^ ^ oak.X X otaa g a»££d.o ^ ak.b 40 2 — 934—0 4 6 9 

Leb : 2SX040 9 

kba r : DOire»X>A ^ S>Xaio e : 0»«Ik>U k 

ress : 230< 5 S 3SV M S V 

L W : 

nx:Li s d. ^ «t. n d.nqo^agb«iL(^ b xn«k^^4Bi,9« » £ag«>«n c;«»ac c;^»mnnAV»d.«»aibd.a»*» ^ ageyXar^»*'E f b o "s^ct-vias ae^ ­

fr^ X^«3«hb ^ ^^VLae -«Azid^ag9ag^iaz»«d l £«ic(iXibd.^i s d.x% aLZ» eK,ageis, d«is«»agd.3»^cfl . ^r k b]% ^ ^xa. ^ cta^JL 

s^rxb«ka g bd.«»3c^ b . W ^ dL ^ ««.^ b hflk-v ^ ai.ra.ar •mradl^aggag^'mgad . £«kod.Xd.bd.«» ^ d. n ar^^^ss ' d.d. 9 4Bi,ag^. 

: £ aro- u >aa.-v e eina r ^ruesbd.on s , IpXeais e oak.X X o-ua r o££d.o e a. b 40 2 — 934-046 9 

r^ya. In.wk.'xr^ s.r3iar ^n^etdBbi^za ^ jpXeis.^ ^ <s^xabaiei b ^^aa r X^«ss, X Ce»ac c:^»nncnAcad.etaibd.^n s <»£fd.o < 

-046 9 . 
As-Built Drawing 

COASTA

ENVIKONMENTAL L t maha Lead Superfund Sit l ^ t e C II O U P , INC . 

OLS#: 81848 

Date Excavated: 6/4/2010 

Date USEPA Sianed Off: 7/28/2010 

Area Sodden: 1790 sa ft 

81848 

Omah Exterior Pamt a Lead Site • Good Site Sketch 

Sampling Address: 4541 SEWARD ST Q Not paint 

Lead Sample 

Samples Collected Sample Number U B Concentration Collected Firm: ?E IN C P & T ^ 

RYASCPXA-81848 F1 

ppm \J D Date; alzilcf ? 

RYBSCPXA-81848 F2 ppm \J D Time: J&:aOAl- \ 

RYCSCPXA-81848 Bl S2^ ppm D 

Samples Analyzed 

RYDSCPXA-81848 B2 9W3 ppm D 

RDZSCPXA-81848 DZ _ai. ppm D XRF Unit: lOhUZ Book; 2. ^ 

ROgOOrXA-81848 -6 Z ppm D D Date ft l l -o^ 

Rri;ccrxA-ai8<6 -PZ- ppm D 

D Time .&ry. Staff; Number of Samples = [ 5 | | Q | n^v/ 

Legend: F1 = Front Left, F2 = Front Right. B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla; 

All quadrants are as viewed from the street, fating property ^ LUE Y 

ENTERED 

HAY 2 8 2009 

SEVV/AKD "sr. 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced

Sod 

 with Area replaced with 

Rock/Mulch Area left bare 

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

. ^ tail a 

KP ­

C 81848 l t<\y L.V- 6(> / o ^ 

Exterior Paint North A/TOW Omaha Lead Site • Good Site Sketch H'POO I 

Sampling Address: 4541 SEWARD ST Q Not painl 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm; ffTuL . DfS TA 

RYASCPXA-81846 Fl . ppm D 

Date ^IzM 

RYBSCPXA-81848 F2 . ppm D 

Time ICISOA K 

SfrfCSCPXA-81B« Bl (jpm EJ D 

Samples Analyzed RYDSCPXA-81848 82 2H3 ppm 0' D 

RDZSCPXA-81848 DZ .91. ppm Q ' D XRF Unil: lOMt Z Book; i.H\ 

r>Gg6CPXA-81846 ppm D D Date (t l l -oq nrzccPXA-ei64e -P2- ppm 

E 

D D Time 

Staff Number of Samples = 5 n^v/ 

Legend; Fl = Front Left, F2 = Front Right, Bl = Back Lefl. B2 = & WDZ = Drip Zone. GZ = Garden. PZ = Pla; 
Omaha Lead Site 

Site Sketch 

Sampling Address: 4541 SEWARD ST 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

RYASCPXA-81848 F1 ^1 5 ppm iJ D 

RYBSCPXA-81848 F2 ^?8 ppm D 

RYCSCPXA-81848 B1 SZH ppm D 

RYDSCPXA-81848 B2 2H3 ppm D 

RDZSCPXA-81848 DZ 93 ppm af n _ 

_ ppm 

ppm 

D 

D 

D 

D 

Number of Samples = [ 5 | | Q | 

81848 

Exterior Paint 

• Good 

g'Poo i 

Q Not paint 

Samples Collected 

Fimt;?FTKlt- DP>TA 

Date; sJz\\ m 

Time; ICf-iO^n 

Samples Analyzed 

XRF Unit; lOhU Z Book: Z*JI 

Date /^« ZZ -o ^ 

Time 

Staff; 

n^v/ 

Legend; Fl = Front Left, F2 = Front Right, Bl = Back Left, B2 = B i!t_DZ = Drip Zone, GZ = Garden, PZ = Pla; 
81848 

Omah Exterior Paint North Arrow a Lead Site • Good Site Sketch 

Sampling Address: 4541 SEWARD ST Q Notpaint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Fimi: ?g TMC- DP> T>> RYASCPXA-81848 F1 D Date: alailca RYBSCPXA-81848 F2 2,se ppm D Time: /&=2»C>An RYCSCPXA-81848 Bl _£2iL_PP-T« D Samples Analyzed RYDSCPXA-81848 B2 9 H 3 Dom D 

RDZSCPXA-81848 DZ aL_Ppm Of D XRF UnH: lOhUZ Book: 2M\ 

nogocrKA-84e48- -G i ~ POf D a Date: 6 - g 'O ^ 

nPiroor)(A.aio4e—PZ- ~ ppm D Time: flvi 

Staff: nM ^ Number of Samples = fs l | Q | 

Legend: Fl = Front Left, F2 : Front Right, Bl ' Back Lefl, 82 ' Back Right DZ <> Drip Zone. GZ ^ Garden. PZ « Pla; 

Ai r y vl«»>ed^ Bit yit , helm prepartvALuEY 

Kev2<XJII CmteA nft-Kn-JW W&UtSEWAW> ST . 
,*-'":*'•* , 

COASTA l 

(NVItONHIRU l 

C It 0 U r 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: Ifl^tj^ 

Owner's Name: / Daytime Phone: ^^^^^^^ ^ 

Address of Property / f f/ ^ez^/iy) 57 

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 K is complete and meets with the Grantor's approval. Upon 

completion, the Grantor virill 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 wori( has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
X COASTA L tllVIIIONHIKTt t ^.P^O**- ^ C t O U r I If C 

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; 

f 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 

^ ; ; - ?-/g 

Signature Date Signature Date 

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

Page 2 of 2 
COA S T A 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). 

PropertylD; "^/^^^ 

Property Address; ^^l/ / 5^/^/ ) <^ ^ 

Owner; (^^/< / ^ . y^^<r77:?>V ^ 

Phone; ^fifaZ.)-^6(/.^7l'C 

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 Videographicedly document the existing conditions of the property and the basement if 

necessary. 

Items to be Removed by the Owner before Start of Remediation: 

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

Item: 

Awv.^ ^o^ S f o \)^ ^-oPoc^f 

Item: 

Item: 

Kem: 

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

Kem: ^ 

Item: 

Kem: 

Pagel of. 
COA S T A L 

Items to Be Removed By Contractor During Remediation and Replaced 

1 Kem: 

Kem: 

Kem: 

Kem: 

r 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

^-7— 

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

Number of trees > 2 inch Each 

trunk diameter 0- Number of trees <= 2 inch a Each 

trunk diameter 

Nimiber of Sprinkler 

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

Attach a sketch of the 

sprinkler layout. 

" a ^ 

Nmnber of and size of 

each garden/ flower bed Each 

area; Square Feet 

Attach a sketch of relative 

sizes and locations. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Easement Area, to be 

excavated Each (?evJ('w^ fe>uf/$"

Page 2 of. 
COA S T A L 

AddKional Comments / Instructions: 

The city of Omaha ordinances may prohibK you from using dirt or gravel areas on your property 

as driveways or vehicle parking areas. The Environmental Protection Agency (EPA) may be 

removing and replacing soil underlying a grayel or dirt area on your property that you may be 

using as a driveway or vehicle parking area. If this is the case, you should understand that this 

removing and replacing of soil does not mean that any illegal driveway or parking area on your 

property is made legal. To the contrary, you may be cited by the city if you use a gravel or dirt area 

as a driveway or parking area, not wKhstanding any removal or replacement of soil by the EPA. 

If you have any question about legality of a certain driveway or parking area, you may contact 

the cKy of Omaha's Planning Department at (402) 444-5150. 

• ^lease check this box if you understand the information outlined above. 

L 

G 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. 

O I do not agree 

C ^ (%r£AA^ ^ 

Owner's Signature Date Cdntractor's Signature Date 

Page 3 of. 
p 

BV\D#_Sl£^l3 

XRF PROPERTY SAMPLE SHEET 

Date 9-/-/^ Address H<^ [ ^jji ^ ^ r

Project Omaha Lead ARRA Sample time am/pm 

XRF ID# ^l!73^ ^ sample length 30 sec 

Shot# Reading Sample area Shot# 

. 3 ^ 1 ^ ^ / ^ U. MH. .J ^ /fff^Hr ^ Depth 9^<r 

J^2^ ^ / i ( ^ (a± ^ ( f 

Average l^hzo Average

Shot# Reading Sample area Shot# 

Depth 

Average Average 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

Signature. M 

Print ,nU ^ CMlf^Qfi 

Reading Sample area 

^/^i-c:^ ^^^^ ^ 

\-d:/^ Depth 

\\^:^< ^ UL 

 ^"h h ^ O 

Reading Sample area 

Depth 

Reading Sample area • 

Depth 

Reading Sample area 

Depth 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 297 

Mode SOIL 

Time 2010-07-0108:12 

Duration 91.74 

Sequence Final 

Flags 

AVERAGE -jA553f ?Q40Qfi... —r; 

ADDRESS ^''^^'^SsilSeward st 

QUADRANT EA 

DEPHT 1" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm Error 

Pb ^^::::—2l^^t72A•^>'.py^;.•*'^s^?=^-7a-l9..84l 

Supervised By: mn^d^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 294 

Mode SOIL 

Time 2010-07-01 08:10 

Duration 30.59 

Sequence Final 

Flags 

BVID 81848 

ADDRESS 4541 Seward st 

QUADRANT EA 

DEPHT 1" 

XRF TECH N. LOPEZ 

MISC confirmation 

NOTE none 

ppm Error 

Pb 217.124 ± 20.024 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 204.643 

Supervised By: 

Certificate of Verification 

295 

SOIL 

2010-07-0108:11 

30.57 

Final 

81848 

4541 Seward st 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

± 19.479 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 218.649 

Supervised By: 

Certificate of Verification 

296 

SOIL 

2010-07-01 08:12 

30.58 

Final 

81848 

4541 Seward st 

EA 

1" 

N. LOPEZ 

confirmation 

none 

± Error 

20.020 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Supervised By: 

Certificate of Verification 

293 

SOIL 

2010-07-01 08:08 

91.77 

Final 

4541 Seward st 

Bl 

6" 

N. LOPEZ 

confirmation 

none 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Bilierica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 169.903 

Supervised By: 

Certificate of Verification 

290 

SOIL 

2010-07-01 08:07 

30.57 

Final 

81848 

4541 Seward st 

Bl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 19.248 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 182.715 

Supervised By: 

Certificate of Verification 

291 

SOIL 

2010-07-01 08:07 

30.59 

Final 

81848 

4541 Seward st 

Bl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 19.849 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Biilerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 201.228 

Supervised By: 

Certificate of Verification 

292 

SOIL 

2010-07-01 08:08 

30.61 

Final 

81848 

4541 Seward st 

Bl 

6" 

N. LOPEZ 

confirmation 

none 

± Error 

± 20.665 
/\0. \ Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^7 I Coastal Environmental Group Inc. V ^ • >«? www.coastalhazmat.com 

^^i-noy COASTAL CNVIIOIINENTAL 

S 1 0 U P, IN C 

EXECUTIVE SUMMARY: 

BVID #81848-(4541 SEWARD ST) 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 

-DAN GARVEY WALKED THE PROPERTY ON 7/27/10 
m 

0% 

EPA Property Close Out Form 

L/SV( Seu»^^^ . Property f»: fTi^ve. Property Address: 

Datc/Tlmc: Owner's Name:. i^, -.la^ 

Quads Excavated: 

Contractor Group 

Excavation Yes No Genenl 

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

2. if necesswy, were the correct areas ofdrip zone excavaled aod restored? y

Grading Sod and VcgetotioB Yes No 

I Does the trading around the perimeter ofthe house in cxcavaied areas generally slope away y from tbe house? 

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

y 

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

day time period) 

4. Arc sodded areas generally firm and evenly graded? 

y 

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

time period) ^ _ 

y 

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

y 

r 

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

Gates. Fences and Retatelog Walb Vcs Nu 

I 1. Oo gates open and c\o$t freely? (If applicable) y 

2. Were all gates or fences taken down during restoration aclivilies reinstalled? (If applicable) 

y 

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

4. Was danuge to reuining walls avoided? (Ifappiicable) y 

Foundation, SIdiiiK and Gntlcrs Yes No 

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

2. Was damage to the foundation avoided? y 1 

?. Was damage to windows avoided? y 

4 Was damage to windows or door screens avoided? y 

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

Sidewalks and Driveways (Concrete) Yes No 

I. Was damage lo driveway surfaces avoided? ~7 

2. Was damage to walkway surfaces avoided? ~7 
I 

Ort'Dcrs comments: 

[inspection notes: 

0 

iV» 1V 

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

EPA Represenlalive ^" j ^ ^ Dale: 7/11)10 
'^^'^ Property Owner Assessment of Performance Form 

^UH ^ ^ ^'^ American Recovery and Reinvestment Act (ARRA) 

—f^TTk nWlSlON Omaha Lead Superfund Site 

SOTEBFONDD^^ 2009/2010 

Remediation Contractor: Coastal Environmental Group - EP-R7-09-06 

Property Identifier Number: ^S^^f j 

Property Address: <^5'^/ ~^^CL>U^<gf ^7 " ^ 

Property Owner's Name: '^^y^'*^ ^r^ f^o^<^^^^^— 

***i^**i^**ili*****:i^:^^J^:^itii^ii ^lil^^,^l^,^^i^^f^,^^^^^:llliitim^^^i^L^itt** *^ 

Instructions to the Propertv Owner: 

This form serves to record the Property Owner's assessment of performance (Incentive 1 

- Quality Assurance Surveillance Plan) involving the listed remediation contractor, as applicable 

to the Omaha Lead Site. This form documents the timeliness of pxmch list resolution, business 

relations, complaint resolution and the overall quality of work. If need be, the Property Owner 

may utilize this form to record problems and/or issues not specifically tied to an assigned 

address, for example, business relations that generally don't follow the guidelines set forth in the 

Performance Work Statement. 

The Property Owner will indicate his/her assessment of performance with the contractor's 

work by checking a numerical rating on the table below using the numerical definitions fi-om 

the rating scale below, then sign & date the form. 

9-10 "excellent" 

7-8 'Very good" 

^ "acceptable" 

-4 "poor" 

1-2 'Very poor" 

Propertv Owner's Assessment of Performance Regarding the Contractor's Work 

10 5 ____ _ 

9 4 

8 3 

7 2 

6 V. 1 

Propertv Owner Additional Conmients from (optional; continue on back page if needed) 

Property Owner Signature: iiicl/ny li ^&&khy Date: h ^ 1^ ' lO. 
Property Completion Agreement 

ihis agieemeni documenls ihe complclion ol remedial acliviiies peribnned on my pioperty My signature 

will designale ihal I am salisfied with Ihe restoralion of my properly, and thai no items are in questions, 

now, or al any lime in the future, except Ihose ilems listed below, if any 

Propetty ID: ^/^Y 6 

Property Address: q^-q i S^^^JQU^ "BT^ 

Ownc '•• ^H^JS^^O^O l^JL^Ci^H^^L.*. Ul^ ^ /I . f-hL^TtKl 

Phone: ^L/^^^'^^ Q 

Restoration Items in Question: 

Item: 

Item: 

Item; 

Kem: 

Item: 

Item: 

Additional Comments: 

fX l I agree lestoralion w completed, excepl a$ noted 

[_J I do nnt a|;rec restoration \\ completed 

i&SajP^ G-^-^o 

Owner' s SignatiHf Date Contrarlor' s Signature Date