TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: ?&(^0 \ Date: IO/2^/o Q 

Address: ?>-\0.\ ^jfiLfgdrtayy 'Sy^ 

Remediation Contractor: Coastal Environmental Group_ Year: 2008 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

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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 

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

Confirmation data 

Photographs y^^6«^|<\11cv\ ^ bc(Pfl/P(*U<M 

As-built sketch 

 Satisfactory restoration signed by Property Owner 

 Property close-out check list signed by EPA 

Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

 Property information from Douglas County Assessor's Office 

D 

D 

^ 

tr22A. Ignature Date 

30054531 

Superfund 
Property Access Checklist 

Propert, ID: p,f y U ( ^ \ D WOR K STARTED ON; / / 

Property Addrew: -:»,-) 2-1 SA^.K1(DCJ]4 ^ 

D WORK COMPELTED ON; / / 

[Oxvnci: |?p)^^,r-\ - V<^.A^V ^ 

AddiTHS: —>* 

••••o"^ U^U? ^^l(? ^ 

Fav 

Ccll/Tijger. 

D Notification Lelicr 

• Acceu Agrcemeni 

H^ Restonilioo Agrcemeni 

J S^ Topsoil Sampling (if applicuble) 

Q Disposal Sampling (K applicable) 

D Gnrdcn Snmpliag (if applicable) 

D Uiililv Clearance 

' ^ Video/Phoios (Before) 

D Video/Pholos (During) 

D Video/Pholos (After) 

D Video/Phoios (30-Day) 

D Projicrty Complelion Ajjreement 

D Fin*' Report 

/^ir MonilorinK {»s applicable) 

n Communrty D Crew On: /

RcsuJis: 

D Community' D Crew On: /

Remits: 

D Community • Crvw On; /

ResulU: 

Rcnier 

Phone: 

PJLV: 

Cell/Pager; 

Additional Inlnrmxtion; 

Sent: / / 

siEncd: [D il y /rP 

Signed: [pilh/C ^ 

1 1 

1 1 

1 1 

Called: / / 

On:J^/ZS / £| 

On: / / 

On: / / 

Oo: / / 

Signed: / / 

Issued: / / 

By: 

8j=t^HM­ K^v^-iom 

»>=«Ghci4 Re#//V^u- By: 

By: 

By: 

By: 

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By: 

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1 

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Omaha Lead Site 
CONTACT FORM 

Property 

Address: 

Property IDM

Initial Contact:

Second Contact:

Final Contact:

Final Action:

 'bt>^0\ 

 Date:^V<'<34 Time: (^ ' ) ^

 Date: Time: 

 Date: Time: 

 Transmit to EPA D 

 Action: ? ^ ^/A

Action: 

Action; 

Other Action: D 

 ^C ^ ^^t^ P 

Commenl: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): ^l^^^c f +t?u1J^WV Sl/6f 6 ­ (jJ-clR-c4 £3i4,Oc«^ 

rt 

^••^F' ^ (W( cv ^ «^»// AiT^ -r*^ ^ ^ 

37i) ^^^^'5^ 

7:0 0 f>­
Douglas Cotmty Account Ir^Kmatio r^Krna n Page 1 of3 

Douglas County, Nebraska Property Record - R0804950000 

Print Report 

NEW Feature - Parrel Dimensions available (3 scale 0-50 fi west of 52nd St - Vie w Oi l IMap Information is valid as of 2009-5-12 Treasurer's Tax Report 

New Feature ->->-> Auto Sales Search 

Owner 

KEITHLEY ROBERT A 

ETAL 

3721 SARATOGA ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 0495 OOOO 08 

Account Type: Residential 

Parcel Number: 0804950000 

Parcel Address: 3721 SARATOGA ST 

OMAHA NE 68111-OOOO 

Legal Description: CENTRAL PARK LOT 5 BLOCK 19 60 X 125 

Value Informatio n 

Land Improvement Total 

2009 $5,300.00 $17,£ 100.00 $23,200.00 

2008 $5,300.00 $12,7 '00.00 $18,000.00 

2007 $5,300.00 $12,700.00 $18,000.00 

2006 $5,300.00 $12,700.00 $18,000.00 

2005 $5,300.00 $4,600.00 $9,900.00 

2004 $5,300.00 $4,200.00 $9,500.00 

Sales Informatio n 

Sales Date: 2007-06-29 

Deed Type: QCM Booilr; 2007 Page: 073972 

Price: $0.00 

Grantor: KEITHLEY ROBERT 

Grantee: KEITHLEY ROBERT A ETAL 

Valid/Invalid: Invalid 

Exclusion Reason: Multiple Parcel Sale 

Sales Date: 2007-05-21 

Deed Type: QCM Book: 2007 Page: 059941 

Price: $11,000.00 

Grantor: REESE E R^ /IAE _ . _ ­ _ ^ ­^ - - -

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R080... 6/7/2009 
Douglas County Account Infiamiatio T^mmz n Page 2 of3 

Grantee: KEITHLEY ROBERT A 

Valid/Invalid: Invalid 

Exclusion Reason: Multiple Parcel Sale 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.17 7500.0 1.0 125.0 60.0 No 

Improvemen t Informatio n 

Building 1 

im iMvmdAst 

Second Flix)r 440.0 m a 

« ir Httr 

FvitNoof 

fiPOiq fl^ 

H V >•• t934*« 1 

» G 

i3lr 13J 1 v : STORV ki t «tfl 10<r 

Bsim Hom t It 

CLICK CLICK TO ENLARGE IMAGE TO ENLARGE IMAGE 

Square Footage: 1052.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Fair 

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

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Aluminum Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1908 0 0% 1908 101 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 

612.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Attached 322.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R080... 6/7/2009 
Douglas County Accoimt ItiiKmatio It|Kn; n ^jk Page 3 of 3 

Porch Encl Screen 102.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accoimtinfo.jsp?accoimtno=R080... 6/7/2009 
Page 1 of2 

"> 

Create Another Ticket ] Back to Irth Internet ] [ Send Email ] 

• YOUR TICKET NUMBER IS 2328308. 

Original Call Date: 7/28/09 Time: 4:28 pm Op: ELIZABETH18790 


Work to Begin Date: 7/30/09 Time: 5:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3721 Street: SARATOGA ST 


Twp: 15N Rng: 13E Sect-Qtr: 05-NE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation 


Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 


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


: UNSURE OF CORNER LOT 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: Coastal 


Depth of Excavation: 4 ft. Comer Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV METRO MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber UtiUty Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4024572307 

METRO METRO COMM. COLLEGE CHRIS Alt: 4026727033 

Emerg: 4024572313 

Day: 4025047823 

MUDO METROPOLITAN UTILITIES DISTRICT SANDY AU: l 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/28/2009 
Page 2 of2 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA

Day:

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/28/2009 
As-Built Drawing ^ 

COASTA

INVIRONMINTA

L 

L Omaha Lead Superfund Sne a R O U P , IH C 

Name: PidMA. 

Omaha Lead Site 46130 

Legend 


Concrete Drip Zone Excavated 
 Quadrants Excavated 


Area replaced with D Area replaced with ^^^ 


Sod Rock/Mulch ^ ^« * ^^^ ^ ^"""^ 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
Name: PldUA. %^f " Omaha Lead SKe Date: to North Arrow —i 

Address:

Phone:

 7>"72.l

 Lif^^ '

 SAgA ' 

 '^U« q 

a2it»A Sfte Sketch Time: ^ 

4^ 

Team' OrpoirViitl Ig^te BviD# 36^01 

-S^i2iVlZ)6iA 

Omaha Lead Site 46130 
Name: Hg^4 ^ Omaha Lead Site Date: North Arrow 

Address: '^'^Z l 32i6A Site Sketch Time: 5fe"

Phone: Uff^'S-l i 

Team fVp4JrV ^ kr\l6llS BV1D# 36^0 1 XRF Code ^^ O f 

Sample Number Lead Concentration Confimiation Sample Q ^ Q. I 

1 

2 

3 

4 

5 

6 

7 . Lab RYCSCPLA-35601 

MJL 

/7;T .a± 

^CP 3 

IiL2. 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

:( Yes ° No g 

No iX> 

No 2 

No g 

No Qi} 

No ta 

No D 

Result 167 ppm 

^Ai2AT2)6 A 
COASTA L ENVmONMENTAL 

CIOUP . INC . 

Consent for Access To Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States 

Environmental Protection Agency (EPA) or its authorized representatives, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

following described premises: 

'^'^<^p| 

Owner's NName ; Daytime Phone: : 

i ^ 

Address of Property 3^21 Sf^^To6^ 

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 
>^^'% 

COASTAL 

Xp„0lt«5 ENVIRONMENTAL ^ CROUP , 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 perfonn 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< ^ <^ , ^-/^-"=v 

ignature Date Signature Date 

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

Page 2 of 2 
COASTA 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 tbe purpose of assuring that restoration 

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

Protection Agency (EPA). 

Property ID: 3^^^ / 

On the attached diagram(s) indicate area(s) to excavate, surface structures and landscaping features and 

access location(s) to be used by the contractors. Indicate distances, depths, material types, etc. 

Photographically and Videographically document the existing conditions ofthe property and the basement if 

necessary. 

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

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

»«•"= A^u i ^•>^y^^e^ 9 ( ^tf«/u^< , 

Item: 

Item: 

ttem: 

Items to be Removed by the Contractor During Remediation and Mot Replaced 

4VA^ ^/Wll i "^XOAJ. <. ,t£i- te-W"* \y^ 

Item: 

Item: 

Item: 

Pagel of. 
COASTA L tNVinONM f NTAt . C H O Lt P . t M C 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, Quadrants that will be excavated, that ^ - ^ 

is covered with grass. 

Nirmber of trees > 2 inch Each 

trunk diameter 

Number of trees <= 2 inch Each 

trunk diameter 1

Number of Sprinkler 

Zones, Control Valves, M/^ Fach Timers, Heads, etc. 

Atiach a sketch ol" the 

.sprinkler layout. 

Number of and size of 

each garden/ flower bed Each 

area. Square Feet 

Atiacli a skelch of relative 

sizes and locations. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. — - Note this \aliic wili he' 

used to issue H plant 

voucher lo the property 

owner. 

Easement Area, to t>e Each excavated isO — - ^ 

Page 2 of. 
I

COASTA L MVIttOMMLNTA t 

O n O U * , IN C 

Additional Comments / Instructions: 

0 ^ OVVl^C vju'vu^. 

Check the box if Owner does not vi^ant 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. 

[ g ^ agree O I do not agree 

yO^^ ^ t'Kr-/ 

Owner's Signature' Date Contractor's Signature Date 

PageSof. 
BVID # ?:fb(cib\ 

XRF PROPERTY SAMPLE SHEET 


Oate 

Project 

\^/?>W 

Omaha lead FP 2nc) year option 

Address 

Sample time 

•6'i7,\ bOrcx-^T^ 

am/pm 

XRF(D # sample length 30 sec 

Shol# 

XMT ^ 

^Ml ^ 

ij=iai­ 7M^> 

Reading 

iD^.K^^I^^f^M 

i?Amt^.31 

IC^/toQi^a^) ^»^1^I2..33 

Sample area 

r^ 

Depth 

C^ 

Shol# Reading Sample area 

Depth 

Average | OR> f,?; 1 B , M 4 Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading Sample area Shot* Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

Signature. ?c£M.mi^ 

Print ?}a^W ^ Cnr^^ft/) 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Blllerica, MA 01821 

Certificate of Verification 

XL3t-32089 

Reading No 2482 

Mode SOIL 

Time 2009-08-03 09:18 

Duration 121.64 

Sequence Final 

Flags 

AVERAGE ^ygDTM7?P2?f81.J 

ADDRESS 392ttii^t6g3-sr 

QUAD/ZONE F2 

INSPECTOR Nicolas 

DEPTH 6 

SAMPLE TYPE CLEARANCE 

NOTE 

ppm Error 

Pb ijQMZf ± /C2S3Z 

Supervised By: Y^^i^liJ^ A 
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 109.156 

Supervised By: 

Certificate of Verification 

2478 

SOIL 

2009-08-03 09:16 

30.22 

Final 

35601 

3721 Saratoga st 

F2 

Nicolas 

6 

CLEARANCE 

± Error 

13.543 
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 129.782 

Supervised By: 

Certificate of Verification 

2479 

SOIL 

2009-08-03 09:16 

30.61 

Final 

35601 

3721 Saratoga st 

F2 

Nicolas 

6 

CLEARANCE 

± Error 

± 14.369 
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 109.600 

Supervised By: 

Certificate of Verification 

2480 

SOIL 

2009-08-03 09:17 

30.24 

Final 

35601 

3721 Saratoga st 

F2 

Nicolas 

6 

CLEARANCE 

± Error 

13.508 
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 85.770 

Supervised By: 

Certificate of Verification 

2481 

SOIL 

2009-08-03 09:18 

30.57 

Final 

35601 

3721 Saratoga st 

F2 

Nicolas 

6 

CLEARANCE 

± Error 

± 12.329 
flQ A

{^^^jL I

\~^^j ^

Xp„oi*<^

 Omaha Lead Site—Fixed Price EP-R7-07-05 

 Coastal Environmental Group Inc.

 www.coastalhazmat.com 

 vl] 

 COASTA L 

^ y 

INVmOHHENTAl 

G • O U P. IN C 

EXECUTIVE SUMMARY: 

BVID # 35601 - (3721 SARATOGA ST) 

X No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 

NO ISSUES PENDING. 
li 

•- . • tt 

EMIJT ^ 

EPA Property Close Out Form 

Property #; ^fYiKaV^K. Property Add««:- ^J-i^^^^SS^^ i 

Datc/rimc: 

Quads Excavated: FT. ~ Contractor Crour P fy^.TFal rKv/in f men^ / 

Yes NV Excavatioii General 

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

2. If necessary, were the correct areas ofdrip zone excavated and restored? 1?^ 

Gradlii£ Sod and Vegetation 

I. Does the grading around the perimeter ofthe house in excavated areas generally slope away i^ fix)m the house? __^__^ _ 

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

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 7 ^ ^ day time period) ^ • 

4. Are sodded areas generally firm and evenly graded? 

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

6. Was die property graded such that water will not pool on thcf propert>'? 17^ 

7. Was danuge to landscaping or plant materials avoided? ly-^ 

Gates, Fences awl Retaining Walh Yes No 

1. Do gates open and close freely? (Ifapplicable) YYT 

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

3. Was damage to gates or fences avoided? (Ifapplicable) 17' 

4. Was damage to retaining walls avoided? (Ifapplicable) 17' 

Foupdation, Siding and Gutters Yes No 

I. Was damage to the siding or trim avoided? 

1. Was damage to the foundation avoided? Y 

3. Was damage to windows avoided? Yy^ 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspoul extensions avoided? 

Sidewalks and Driveways (Concrete) No 

1. Was damage to driveway surfaces avoided? iTt 

2. Was damage to walkway surfaces avoided? V­
\ 

OMoers comments: 

Inspection notes: 

Removal and resloration activates complete including the 30-day sod warranty: ion acuvaies compieie inciuaing me ju-aay soa warranty: 

EPA Representative 
Property Completion Agreement 

Ihl i agreemeni documenls the completion o( remedial acliviiies perConned on my properly My signature 

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

now, or al any lime in the future, except those items listed below, ifany 

Property fP: 364 Q 

Property Addrew: ST^I I ^^^Q^^_£ ± 

Q^""' RaUr ^ 

Phone: •

 CK>^ qS6 3 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Itsm: 

Item: 

ttem: 

Additional Comments: 

^P ^ I Rgrce r»for«(io n i« complcttd, cxccpl as noted 

do not «(»r«c rcstorftfion js completed 

Owner's Sicnahftf D(W Conti itonr's SignAliirc