TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: 

im 

Date: W^//^ 

Address: ^<a q n ^ ^r 

Remediation Contractor: Coastal Environmental Group Year: 200 

* ! 

SOIL REMEDIATION 

PROPERTY nL E 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 

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

Confinnation data 

Photographs ^<^ m "^ I^'^I^W M ^ ^ H bpU^P^X^^ 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property informatkjipfrom Douglas County Assessor's OfTice 

[J 

D 

D 

Signature 

30054475 

Superfund 
^ > 

Property Access Checklist 

Property ro: 2.)^^ ! 

1 Property Address: ;^J ^ 5 Zf i .^T T 

D

D

 WOBK STARTED 

 WORK COIVIPELTED 

ON:

ON:

 /

 /

 / 

/ 

^''^^' JAYfif^ RoW^ O 

Address: 

, Phone: 1^2 . VO?^C^.alU q 

Fax: 

Cell/Pager: 

Renter 

Phone: 

Fax: 

Cell/Pager. 

Additional Infonnation: 

D Notification I^ettcr 

. -0 ' Access Agreement 

J S Restoration Agreement 

j D Topsoil Sampling (If applicable) 

D Disposal Samplhig (if applicable) 

D Garden Sampling (if applicable) 

D Utility Clearance 

Q^VIdeo/Photos (Before) 

D Video/Photos (Dnring) 

D Video/Photos (After) 

D Video/Photos (30-Day) 

^Q^ropcrty Completion Agreement 

D Final Report 

Sent: / / 

Slgned:^-/!! ^ 

Signed.^/4i./l9 

/ / 

/ / 

Called: / 

OniJL/'h^'A. 

On / / 

On; / / 

On 

'/ '/ ^ 

Signed: 

Issued: 

Bv: 

By: 

By: 

By: 

By: 

By: 

By: 

»y•hC-ti^l{ ^ 

By: 

By: 

By: 

By: 

By: 

Air Monitorins (as applicable) 

D Community Q Crew 

Results: 

On: / / By: 

O Community

ResnHs: 

Q Crew On: / / By: 

D Community

Results: 

 D Crew | On: / / By: 

Omaha Lead Site 
• • 

Douglas County Account I [tj|tfn|||ion Page 1 of3 

Douglas County, Nebraska Property Record - R2110960001 

Print Report 

NEW Faature - Parcel Dimensions available (§) scale 0-50 ft west of 52nd St - VIe W O n Ma p Information is valid as of 2009-9-15 Treasurer's Tax Reoort 

New Feature ->->- • Auto Sales Search 

Owner 

ROBISON JAMES E 

857 S 28 ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 1096 000121 

Account Type: Residential 

Parcel Number: 2110960001 

Parcel Address: 857 S 28 ST 

OMAHA NE 68105-0000 

Legal Description: REEDS 2ND ADD LOT 11 BLOCK 0 W 80 FT S 1/2 

Value Informatio n 

Land /mproi^emenf Total 

2009 $3,000.00 $63,400.00 $66,400.00 

2008 $3,000.00 $63,400.00 $66,400.00 

2007 $3,000.00 $63,400.00 $66,400.00 

2006 $3,000.00 $49,600.00 $52,600.00 

2005 $3,000.00 $49,600.00 $52,600.00 

2004 $3,000.00 $49,600.00 $52,600.00 

Sales Informatio n 

Sales Date: 

Deed Type: 

Price: 

Grantor: 

2001-09-15 

WD 

$15,000.00 

BooHr; 2191 Page: 702 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Invalid 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.05 2240.0 1.0 80.0 28.0 No 

Land Attributes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R21... 9/17/2009 
• • 

Douglas County Account I j||ui|a|ion Page 2 of3 

Attribute Attribute Description 

Negative Influence Traffic 0 

Improvemen t Information 

Building 1 

Ss; 

\: j.^fST-." 

SeoondFlxjr Rrst Floor 260.0 sail 712.0 S<»fl 

1 1/2 STORY FINISHED 

na laMt t« Mr;rt T« u. • I n l 

CLICK TO ENLARGE IMAGE 

Square Footage: ; 972.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

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

HVAC: Central Air to Air Rooms: 7.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: I 3.0 

Roof Type: [ Gable Stories: 1.5 

Floorcover: i Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1916 0% 1916 93 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 704.0 

Basement Finished 500.0 

Fixture Additional Fixtures 1.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Basement Single 1.0 

Porch Encl Solid Wall 96.0 

Porch Open Slab 400.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R21... 9/17/2009 
• • 

Douglas County Account I jjjIlijH^on Page 3 of3 

Porch Slab Roof Ceil 112.0 

User Attic Full Finish 260.0 

User 1-480 noise 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R21... 9/17/2009 
• • 

Page 1 of2 

# • 

"> 

Create Another Ticket 1;^ Back tojrth Internet | i [ Send Email J 

• YOUR TICKET NUMBER IS 2380057. 

Original Call Date: 10/05/09 Time: 4:28 pm Op: ELIZABETH18790 


Work to Begin Date: 10/07/09 Time: 5:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 857 Street: S 28TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 21-SE 


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 Corner Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 PAETEC QLNNEIC 


UtiUty Service Area Contact Phone Number Type 

Day: 4029340469 

/-vz-A-r^/ COX COMMUNICATIONS, TTCTT^T 

CXCATV TVT/-. HEIDI Alt: 4029340469 INC 

Emerg: 4029329757 

Day: 8773668344 


LEVELS LEVELS COMMUNICATIONS, ^^^ Alt: 


Emerg: 8773668344 

Day: 4025047823 

METROPOLITAN UTILITIES MUDOl SANDY Alt: DISTRICT 

Emerg: 4025047970 

Day: 4024447197 

CITY OF OMAHA- OMAHACOF RON Alt: 4024445161 TRAFFIC.SEWER 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/5/2009 
• • 

• • 

Page 2 of2 

Day: 4067289343 


0PPDGPR5 g;^^^^^"^^°^^ ^ NA Alt: 4062071494 


Emerg: 8887289343 


Day: 8002891901 


NO NEED TO CALL OUT 
 PAETEC PAETEC COMMUNICATIONS Alt: 
 EMERGENCY 


Emerg: : 8002891901 


Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK NA Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/5/2009 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Name: .7*<"^<f-s O^^JTVP O Omaha Lead Site Date: lU3/o 3 North Arrow jAddress: t^r v T, =2i'l ^ Site Sketch Time: ' 

Phone:/V<E'i-A?v4- - 7.^35 ^ ^- 1 

^ 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 

Area lef t bare Sod ' ' Rock/Mulch 

Contrac t #: EP-R7-07-05 Coastal Environmental Group Inc . 
• • • • 

Name: ,7^"^<f"r ^oSrn^ n Omaha Lead Site Date: lU^lo J North Arrow 

Address: ^T l .V, ^71 ^ Site Sketch Time: ' ' 

Phone:/*ioxJ^^C ­ 7S'3 r 

Team / ^6 y f rci^ l 
k i 1/.)^>^L. ioh0 g57 5 ^^-n^5^ 

Name: Te^'-^^^ ^oht^^i"'-) 

Address: "^T l Si ^71 ^ 

Phone:^V<?x;.^'/Cr ­ 7^ 3 r 

Omaha Lead Site 

Site Sketch 

Date: 1U3/1D? 

Time: ' 

North Arrow 

?eam t (-''JM[Pci^ l 

Sample Number 

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BVID# ^/?^ / 

Lead Concenfration 

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XRF Code S~ S O / 

Confirmation Sample 

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Name: Tff^^ t ^ohiff n Omaha Lead Stte Date: : 7/23/^J NorttiAncMr - • 

Address: y5 7 i : ^gj ^ Site Sketch Time: 

^^i^rr>LyfPciJ BVID# ^ll'^ll XRF Code S" SO \ 

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Sample Number Lead Concentratic Ml Confinnation Sample 

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COASTA l INVIROHH t KlA t 

C t O tl P IN C 

Oonsenlfoi Accciss To Propferty 

RIGHT OF ENTRY TO PREMISES 

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

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

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

following described premises: 

Owner's Name: Daytime Phone: ^3^ ' Y' Z ^ ^ 

Address of Property 8^ 7 ^ -Z^^-rcovered 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 perfomned, 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 vwitten 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 
c

g 

C 0 A S *! A i tftVINOhHrKTA l 

CROU * I H C 

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

piles, dog houses, etc; 

r 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; 

f 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. 

t 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 

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

t-i\-o^ 

2>*o 

Signature Date Signature Oate 

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

Page 2 of 2 
/ 

COASTA L 

C N O U . 

Restorataor^ Agreemetrt 

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: Zj9f / 

Property Address: J^^ y ^ ^J'S T 

Owner: 

Phone: ,<^y-^^^^ 

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, matenal 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 itoms is the Owner s responsibility. 

ttem: 

'C7^C< 

Item: 

Ay^ottem: 

ttem: 

items to be Removed by the Contractor During Remediation and Wot Replaced 

ttem: 

ttem: 

ttem: 

Pagel of 17 
4 

rrr'^ 

COASTA L 

IMViMCIMH t MTA I 

Items to Be Removed By ContractorDuring Remediation and Replaced 

ttem: 5<^ 

ttem: -^^/2 

Item: 

s Item: 

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. 

Aiiath ;i sketcli ul llie 

••rrii'kloi lin'.Kii 

Number of and size of 

each garden/ flower bed 

area. 

Aiii\ch il skclcli 1)1 rfliiiivo 

M/i-s nnd loc;lIilMl^ 

Agreed upon 'ralue of plant 

materials not to be 

replaced bv contractor. 

Vol*' l!-ii' \HIUC *MII hi 

usi't' 10 is;ui .1 plan: 

VOIIIIK T Id llif |;ri!))cil\ 

u\y ner. 

Landscape Inventory 

Quantity Unit 

6Z Quadrants 

Each 

Each 

/ ^ 

K7 f a Each 

V. Pjidi 

Square Feet 

4' s 

Conditionrrype/Species 

Jt//4£^ ^ pT^U^f ^ 

Easement Area, to be Each 

excavated / 

Page 2 of ^ 
^^r~m 

C O A S 1 A L 

D >• O U ' , IN C 

I. Additional Comments / Instructions: 

|— 3uf^ e i^ l ykuu€<f T^a**^ -foyi^JcMcnA^, 

5 bA^€> -o e 42jeP f^^^UCH. 

Q 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. 

STagrec r~11 do not agree 

f- f-;^-c? 

^wtJer' ""G^s s Signature Date Contractor's Signaturr Date 

Page 3 of -7 
m. 

BVID#_^_2i7 

XRF PROPERTY SAMPLE SHEET 


Date Address //?/?/h ^S9- ^ ^ ^ ^ 

Project Omaha lead FP 2nd year option Sample time am/pm 

XRFID# sample length 30 sec 

__Shot#_ Reading Sample area __Shot # Reading Sample area 

Ifi^^ll 

^2*«* ^ 12i. 0 ^ 2f &± Depth Depth 

D ^ 

Jet l/f ± l-h - i ^ .^22^ 2- :2S S ^ 22z 

Average y ^ t ^ / 3 Average ^h'^Z^ ^ 

Shot# Reading Sample area Shot# Reading Sample area 

I3epth 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 ?(fhHj(bA 

Print r Vi^ir ^ Co^iJOn^ 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmentai Group Inc. 

www.coastalhazmat.com COASTAL 

iNVIIOmiillTAl 

c lour , IN C 

EXECUTIVE SUMMARY: 

BVID #21991-(857 S 28 ST) 

No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 
4

fciy^ 

EPA Property Close Out Form 

Properly #: 2 - t ^< ^ [.. Property Addr^ . , ^i ^ ^ ^ ' '^>fc ­

Datc/Tlroe: Owner's Name:. .JtJj^yyyJSi . TK'-^-'^'^^ ^ 

Quads Excavated; p *£ Contractor Group U^»^9^430>./ 4/fc«K.-U3 

Excavation Yes No General 

1. If necessary, were the conect quadrant(s) excavated and restored? rx 

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

Grading Sod and Vegetation 

Yes No 

I. I)oes the grading around the perimeter ofthe house in excavated areas generally slope away rx from the house? 

2. Has sod been laid in all areas that were excavated? 1?-^ 

3. Does the sod appear to be generelly healthy and grovring? (Only evaluate if inspected at a 30 L X ^ day time period) 

4. Are sodded areas generally fum 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 the property graded such that water will not pool on the property? y 

7. Was danuge to landscaping or plant malerials avoided? y 

Gates, Fencci and Retatotng Walls 

Ves No 

I. Do gates open and close freely? (Ifapplicable) 

^ ^ ' 

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

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

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

Foundation, SidiBg and Gutlers 

Yes No 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 7 

3. Was damage lo windows avoided? y

-y^ Was damage to windows or door screens avoided? 

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

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? y 

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

Inspection notes: 

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

EPA Representative UnY ] PriJhjL ^ Date: JO 30 M 
f 

Property Completion Agreement 

Ihis agreement documenls the complclion of remedial acliviiies perloimed on my properly My signalure 

will designate that I am satisfied with Ihe restoralion of my properly, and Ihal no iieins are in questions, 

now, or al any lime in ihe fulure, except those ilems listed below, ifany 

Properry ID: ^ ]qq \ 

Property Address: ft^^-| <^ ^_( ^ 5>^_ 

Owner: , ) ^m ^ KDWAq-^/ ^ 

Phone: l^Qp. ]^ ^ _ UHQ Q 

Restoration Items in Question: 

Item; 

Item: 

Item: 

Item: 

Item: 

Item: 

\/Q I nyrcc restoration it completed, cxccpl a» nnteil 

[_| I rto nnt aurcc restoratinn it completed 

Date Conti onti arlor' j s Signature Dale