TRANSMITTA L of OMAH A LEA D SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: A^0?70) Date: <^ZfdB 

Address: y/^^S' /^QnTl^ Sf ^ 

Remediation Contractor: _Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

Y 

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

Confirmation data 

Photographs 

As-built sketch 

i / 

y 

u 

Satisfactory restoration signed by Property Ovvner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas County Assessor's Office 

D 

D , 

D 

40317894 

niiiiii 

Superfund 
- f^'^SS HtxcZ'S ?># 

Final Report Property Check List (Please place with each file) 

Hard Copy Information 

iQ Property Check List 

iffl Site Working Drawing Map 

|2i EPA originals Map 

141 Douglas County Assessor's Map 

p j Property Contact Sheet 

Agreement 

Tf Access Agreement 

"^Restoration Agreernent 

Miscellaneous Documents 

| ] Final Map from the Field 

2. Change Orders 

121 XRF Data 

4, Any emails or PO correspondences 

Property Completion 

A. Executive Summary 

V 2 , AS BUILT 

jl^Property Completion Agreement 

4. Any buyout info or reimbursement info 

5. Check or money order copies 

g i EPA Property Close Out Fonn 

V/ 7 , Attached Begin Video 

Electroni c Documentatio n 

Drawings 

rn EPA original 

/(Z7 Working Drawing 

"^AA S Built.vso 

\/4 . AS Built.jpg 

Photos 

Begin Photos 

During/Excavation Photos 

Sod Photos 

30-Day Sod Photos 

Scanned Documents 

Final Documents 

Executive Summary 

Videos 

Begin Video 

My Movie 
Property Access Checklist 

Property ID: WizAO n WORK STARTED ON: / / 

Property Addrc.s.s: ^qC^C j /jg/yZ S Sf- n WORKCOMPELTED ON: / / 

Owner: Ccar/'m Renter: p f/OzM 

A(l<lre,s,s: Plionc: -^ J 

Fax: 

Ccll/Pager: 

Phone: Additional Information:

(y/9-^e>nH 

Fax: 

Ccll/Pascr: 

D Notification Letter Sent: / / By: 

PZn Access A}>rccment Siuned: Zfl I.PPif P ^y- (IhziZ) 

Q^ Restoration Agreement Siuned: P l93lZ:p ».>•= O.Dr h 

CD Topsoil Sampling (ifapplicable) 1 1 By: 

n Disposal Sampling (ifapplicable) 1 1 By: 

CH Garden Sampling (if applicable) 1 1 By: 

E3 Utility Clearance Called: ^/^/£ ^ 

^r- AidrCCS/' p .•'^SIIHU. 

^ Video/Photos (Before) On:_^/2^_a 7 By= ^vc k 

S^ Video/Photos (During) On:X/a^ / ^7 

^y a\r)zx ^ Vidco/Photos (After) QIV.ZLISPS-CLI By= ^(r K 

0 Vidco/Photos (30-Dav) On: C| / -4- / OT By= R^'^cK 

1^ Property Completion Agreement Siuned: T IplLlCPf By: CACi S 

D Final Report Issued: / / By: 

Air IVIonitoring (as applicable) 

CH Community CD Crew On: / / B y : II 

Results: 

n Com mu n ity CH Crcw On: / / By: 

Results: 

CH Community CH Crew On: / / By: 

Results: 

Omaha Lead Site 
Total Qj^Hn t Square Footage to be Excavated =1915 

Property Classification: 800 TotallPK Zone Linear Footage to be Excavated = 83 

f ^ 

Legend 

^ ^

Y A

^ 1

YP^

•—•— •

— — —

<Q>

 Concrete 

 Excavated Area 

 Existing Structure 

 Permanent Landscaping 

 Fence 

 Quadrant Boundary 

Street Boundary 

 Tree/Shrub 

^7- . 

^ ^ S 

North Arrow Omaha Lead Site j^r. Omatia, Nebraska 

Property Number N OLS-20670 

Scale Property Address 1 Inch = 20 feet or 1 grid = 5 x 5 ft 2955 HARRIS ST 

Post Excavation Concentrations (ppm) 

F1 82 Play Area 

F2 DZ Easement 

81 Garden Ottier 

Description of post excavation areas Fl. front yard left-tiand quadrant; F2, front yard rigtit-tiand quadrant; Bl, bacityard left-tiand quadrant; B2, backyard hgtit-tiand quadrant; 

DZ, drip zone {1-3 foot area of soil around the foundation of ttie tiouse) 
late: ~lM ^ North Arrow 

Address: ,'^'^•5'5" Z/cjrr , j 5 P Site Sketch ime: J\o O f f in 

Name: O YPn'^ i <^ ^^CH jei n ^ Omaha Lead Site Date -3 

Time 

Phone: {H^2)^/D ^ - £>HH Z 

\ 

~^A^ Al 

BVID# o C^^-~\Z> XRFCode 5'^^ ( Team P--^^^^/''>y\Jjtuz 

Sample Number Lead Concentration Confirmation Sample 

gy^AScrrPVA- ^Q^7C P/Yes a No ^ 

jg^igSc r p)c A - ^gg.T g p i Yes n No 12 

-<?^Yes n No S 

{gypSc : PXA. - g^^Z O g^7±2 0 PP"" a^^Yes ° No 13 

litre s El No 13 

ppm PftYes a No ^ 

ppm Yes • No • Lab RD2SCPLA-2067(rResult 1220 ppm 

^-zi ^ i |-r0p"---jr 

p^^z|6± 2^ 

t--t4'-i­ f ' A \ 

/ 

tr r I..-J. t-. -••J......L£.\t 

1^1 

5

i • ^ 

i )^,? r^cJH/ 

ai-:s: 

<d w 

^"^^ize \ ^^•t\ ^ 

'•^""^h fyF^JM^W^^^^^j^i^t^^^WlzK 

Wz^AArilA^X.. • ^ 

Omaha Lead Site 46130 
Print Preview Page 1 of 1 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

0917710000 

FLOYD 

COURTNEY 

2955 HARRIS 

ST 

OMAHA 

68105 

2955 HARRIS 

ST 

OMAHA 

NE 

68105 

Sec-Twn-Rng 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Assessor 

Website Link 

28-15-13 

DEAN PLACE 

0 

11 

E40 FT 

40X100 

http://douglasne,mappingonline.com/DouglasCoNe/static/accountinfo,jsp? 

accountno=R091771 OOOO 

Disclaimer: Map and parcel data are believed to be accurate, but accuracy is not Map Scale guaranteed. This is not a legal document and should not be substituted for a title search, 1 inch = 98 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis alias/dogis/piintPreview.aspx?PrintOptData=Douglas County-... 6/16/2007 
Property ID # 

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

90Z1D 

^155 Zarris S-. 

 Date: izHz> XimA^^zA^ Action: WY> ' 

 Date:// ^ Time: /03<- Action: PZZ^-ZI^^^ 

 Date: Titne: Action: 

 Transmit to EPA D Other Action: D 

1 

I^Ppi-paZ. Y»^-ol £ io:oo 

pZJ'/i v Z^?0 JCC-tS^Z^ZlMTfh 

1 
COASTA L ENViRONMENTA L 

GROUP . INC . 

\ cZ 

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'sName: (jlufheU flo^J^^^m/Af Daytime Phone: h^^^T/ ^ 

Address of Property 

Agreement

covered by

: 

 this ZZ'^65 Mir/s M

ipM^if. ZVZ z m 

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 rneeis 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 

9o^no 
COASTA L ENVIRONMENTA L 

CROUP , INC . 

\ p 

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 penod by EPA; 

Abide by health and safety guidance provided by EPA; 

Ifthe property is rented, assist EPA in obtaining tenant approval for access to the 

property to perform the work. 

Allow videotaping and/or photographing ofthe 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 (877) 234-6270. 

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

Signature Date 

^ 1 would like to be present during any sampling that is required. 

Page 2 of 2 
COASTA L [ NVIRONMENTA L 

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 ofthe property owner and the United States Environmental 

Protection Agency (EPA). 

PropertylD: 2^<^; ^ 

Property Address: ^S5'A^4l^j^/ 3 ^ 7 

Owner: 

Phone: W-zAS7A 

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

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

contractor, and the direction of North. Indicate distances, depths, material types, etc. Indicate digitai photos 

by referencing the photo-log number with an arrow indicating direction of view. 

Items To Be Remove d By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

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

6«-^n'5 

l/»(trUy Utr- L) r 

Item 

^C,^4 S ~^ ^T H -

Item: 

^£^c. t cz^j^^iiPiz(/je/ 

Item: 

Item: 

Item: 

Item: 

Page 1 of. 
^m^ 

COASTA L ENVIRONMENTA L 

CROUP . IN C 

Items To Be Removed Bv Contractor Durinq Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

^mc t ^tzt^oxik Z>^z^~n^e54a^<>^^ 

Item: 

PryzPl/^q tz^m& Fy<3:?fJM^ zry(^ V/^^t^i^ ^ 

Item: (

TcA^r/^ ^^/A f 

Item: 

rLi^r y -^-f^i^&j^KS 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of_k. 
COASTA L ENVIRONMENTA L 

CROU P IN C 

Items To Be Remove d By Contractor During Remediation An d Replaced 

(Use additional sheets as necessary) 

Item: 

P^b 

Item SW ^ 

Item: 

f^^YlC^ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of _U_ 
I

COASTA L P4VIRONMENTA L C H O U P . IN C 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with orass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves. 

Timers, Heads, etc, 

.\nach a sketch of the 

sprinkler la\ out. 

Number of and size of 

each garden/ tlower bed 

area. 

,\nach a sketch of relative 

sizes and locations. 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Species 

(W Square feet 

Each 

Each 

Each 

1 - . 

Each ^ ^ # 

Square Feet 

Page 4 of is 
COASTA L 

Item Quantity Unit Condition/Type/Species 

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. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

b\ the contractor. 

Each 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

iirass sod. 

^ SF 

Area of City or County 

property to be landscaped 

per their requirements. SF 

Include

area (s) 

a skeich of the 

Easement Area, to be 

excavated SF 

Page 5 of k. 
COASTA L 

CROU P IN C 

Additional Comments / Instructions: 

tfm- zjcmc£ 

/Z-r S/<i Gt^Zt/ ov /^ ^ S' 

^I^^ea-- S-ch6 4g<fOMi yi4e ' 

_ r^P^i ^ /:Uz^ Tmen^^ ^^zzoT//^J STC^/^'^ 

^p2fJ^ 3 Bc^-TBZ^ ^ZH^A.^ -

O Check the box if Owner does not want CEG to document interior foundation walls and possible 

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

interior of house, including foundation cracks or fissures. 

I agree HH I do not agree 

bbpoi 

Owner's Signature ^ Date Contractor's Signature 

Page 6 of ^ 
PROPERTY CLEARANCE WORKSHEET 

Date 

O' Property ID l iq m 

sryPT') Property Project 

Omaha Lead — Fixed Price Address cS7BP; \¥^e\%'='^ 

Measurement XRF ID 

0107-51 Count/Time 

Field Shots 

Shot * Reading Sample Area Shot # Reading Sample Area 

m § 

2 ^ i'T^O 

b ^ '"cv^ 12^. I/'L U 

qgg Z ^ ^ P^r-iC 

Sample Area ^ . (nP:- I n Situ 

Composite Composite Analytical Aliquot Composite Readings 

Lab Analytical 

Readinq 

Average (Dried & Spilt Sent (Bag) 

Number Results 1 ( M A (Baq) Sieved) ? 

2 ~ y ^ P>1^ 

3 /•pl "77 -ZS 4 c~Z] XRF Corrected Value --> 

5 (£>^ (use catibration chart or add 

2 0 % to value) 

4^ 

S(i, 

Sample Area -^ rtti/")- Pass/Fai l ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings 

Lab Analytical 

Reading Average (Dried & Spilt Sent (Bag) 

Number Results 1 \(Pi ' (Baq) Sieved) 7 

2 

3 

'icv 71 

4 

i p ^ ^ 76 ^to 71 XRF Corrected Value - > '&\ 

qo 5 

(use calibration chart or add 

2 0 % to value) 

Sample Area >•/ |/-I,U " Pass/Fai l ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings 

Lab Analytical 

Readinq Average (Dried & Spilt Sent (Bag) 

Number Results 1 (Baq) Sieved) 

2 

3 

( c ^ ^ ^ 

4 

S ir (<£) XRF Corrected Value —> 

5 (use calibration chart or add 

2 0 % to value) 7 ^ 

Sample Area 

Aliquot 

1 

I n Situ 

Readinq 

ZrA 

f Z^-UZ' I I'-l ! 

Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Pass/Fai l ? 

Analytical 

Spilt Sent 

? 

Lab 

Number 

Analytical 

Results 

2 ^ irf^ 

3 

4 

5 

^ 6 

/ o l 

CoO 

tfia 

(O ^ XRF Corrected Value - > 

(use calibration chart or add 

2 0 % to value) 

Up 

n 

Sample Area Pass/Fai l ? 

Aliquot 

1 

I n Situ 

Readinq Composite Readings 

(Bag) 

Composite 

Average 

(Baq) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent 

7 

Lab 

Number 

Analytical 

Results 

2 

3 

4 

XRF Corrected Value --> 

5 (use calibration chart or add 

• • 

2 0 % to value) 

USE ADDIIIOHAI SHEETS IF 

XRF HEEDED Technician's Signiture 
Total a^ ^ nt Square Footage to be Excavated =1915 

Property Classification: 800 Total ^..^ Zone Linear Footage to be Excavated = 83 

(f f ^ 

-u ¥-pAAryi^^'^ U.P^ 

'^rr^Vf^tAj4^ 

:i) 

pec o-. tne "B^t:^ 

^/£^«Hr Pfexxiei^ ^t^ s 

Legend North Arrow Omaha Lead Site t ^ r 

Omaha, Nebraska i l Concrete 

Y Z Excavated Area Property Number N OLS-20670 

[gfecl Existing Structure Scale Property Address ^ ^ Permanent Landscaping 1 Inch = 20 feet or 1 grid = 5 x 5 ft 2955 HARRIS ST •—•— • Fence 

— — — Quadrant Boundary Post Excavation Concentrations (ppm) 

F1 . B2 Play Area Street Boundary F2 DZ Easement 

Z P Tree/Shrub Bl Garden Other 

Description of posl excavation areas Fl, tront yard left-hand quadrant. f2. front yard ngtit-hand quadrant, Bl, backyard left-hand quadrant: B2, backyard nght-hand quadrant. 

DZ. dnp zone (1-3 foot area ot soil around the foundatton ofthe house) 
X 

vA^' o Omaha Lead Site—Fixed Price EP-R7-07-05 {(^f^ 

^^^V^ S Coastal Environmental Group Inc. ^^^^^ ^ 

\y^^ ^ www.coastalhazmat.com 

%pnoit ^ COASTA L ENVIKONMENTA L 

CROUP , INC . 

EXECUTIVE SUMMARY: 

20670—2955 HARRIS ST 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 
As-Built Drawing 

COASTA L % maha Lead Superfund Site 

Total Quadrani Square Footage to be Excavated = 1915 

Propeny Classification 800 Total Drip Zone Linear Footage to be Excavated = 83 

DescrfHionorpost excavation areas Ft, from yard lon-riand ouadrant. F2. from yara risfithand quadrant. Bl . tiackyard le)1,nand quadrant. B2. backyard riQm,lian3 Quadrant, 

DZ, anp zone (1-3 foot area of soil around trie foundation oflfie nouse) 

Legen d 

Area not Excavated Dripzone Excavatetd Quadrants Excavated 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
SEPA 

^ * A Property Close Out Form 

Property #: ^ 6 70

 Propert Propertyy Address . .. : A'^^'^A^^^' ^ V

Datc/TiBc: Owner'rfs Name: ZP/ZZ/^r/^SY zZ/ZZ/^r/^eYZ \ PZA^ A'r 

Quadt Eicavated: Contractor Group ^ 

Excavatton General Yes No 

1. If necessary, were the correct quadram(s) excavated and restored? t ^ 

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

Grad>n£ Sod and Vetctation 

Yes No 

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

from the house? 

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

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

day time period) 

4. Are sodded areas generally fum and evenly graded? y 

5. Are the joints between the sod strips generally tight? (Only e%alaate if inspected at z 30 day 

time period) 

6. Was the property graded such that water will not pool on the prope-ry ? ! y 

Was dairage to landscaping or pla-it rriaterials avoided? \ y 

Gums Peaces and Rcuinint '^alb \es No 

1 Do gates open and close freely'' (Ifapplicable) ^^ 

Were all gates or fences laken down during restoration act;\ ities rein :*.a!lec? ..ifapplicable) y 

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

4. Was damage tc retaining walls avoided? ^If applicable) 

A//^ ' 

Foundation, Sidiat >Dd Gutters >es No 

1, Was damage to the siding or trim avoided? %^ 

2. W4s damage tc the foundation avoided? L ^ 

3, Was damage to windows avoided? ^-^ 

4 Was damage to windows or door screens avoided? / -­ 1 

5. Was damage to dowTispouts or dov»7ispo'jt extensions avoided? y { 

Sidewaitu and Driveways (Concrete) Ves No 

I, Was damage to drivev^ay surfaces avoided? i ^ 

2, Was damage to wallow ay surfaces avoided? 

l y 
Owners comments: 

Inspection DCte<: 

(PO/u/zzu^e. jO c^^ZuJ^y A YytSriK^ify^ SO A. 

Remc%al and restoration acti\ates corr:c'e1e including "he T-O-day ?od '>A,arrantA': 

EP.A Representat ntative.^y^I^^^^A^W.jyL^3te i : '^/^'^/^ .^ 
Property Completion Agreement 

This agrccnicnl documents the completion of remedial activilies performed on my properly. My 

signature vvill designate lhal I am satisfied with llic resloralion of my properly, and thai no ilcms are in 

qucslions. now, or at any time in the future, cxccpl those items lisled below, ifany. 

PropertylD; ^/^yZ Z 

Property A.l.lrc,s,s: Z^Z^^/^/Z^j^ j ^ ^ 

OwnerTT^^^^ ^ ^ /^za//b 

Phone: ^^- ^ ^''/ ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

I I I :ip;ice restoration is oomplrtcd, except iis noted 

I I I do not agree restoration is completed 

Owner's Signatur^ / Contractor's Signature ' Dat<<