• 

TRANSMITTAL of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID #: ^b'^^M Date: -

Address: 4\ ^ \jOo&l t^t)C44v (W 

Remediation Contractor: Envrionmental Restoration, LLC_ Year: _2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) jSBefore DAfter D Basement Oy Jid j^/H^/my 

^ Executive Summary (Final Report) /f6^X^ e, 

ns«. EPA-provided property sketch 

* ^ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

"*^ Restoration Agreement 

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

" ^ Confirmation data 

\£ Photographs ^SsBefore DCrew Photo>C] During Excavation D Sod 

S^'sO-day Sod D 

^bv. As-built sketch 

*^^ Completion Agreement signed by Property Owner 

" ^ Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

" ^ Utility clearances 

^B- Property information from Douglas County Assessor's Office 

" ^ Property access checklist 

30260054 

^ Contact Log 

• Superfund 

n/Lo/io Environmental Restoration Signat gnatur u e 

EPA COR signature Date" 
^*^"»"^v 

/ @ -»j Omaha Lead Site—EP-R7-09-05 

8 ,\^^;^ f Environmental Restoration, LLC 

VT ^ ^ * viftvw.cr1Ic.com 

EXECUTIVE SUMMARY: 

40844 - 415 WOOLWORTH ST 

• ^ t; N J NO Issues or Concerns Q Issues/Concerns 

Detail Explanation: 
Ak 

.r.;?--

EPA 

EPA Property Close Out Form 

Omaha Lead Site 0U#2 

Property #: ap^^^ PropertyAddress: Hv? U>i>p)uJD(-t^^ ArcDate/Time: Owner'sName: '<V\^C>J V^^^'^KJ' 

Quads Excavated: S>t ,i^< , f 9^ Contractor n^lR Group : Environmental Restoration (ER) 

Excavation General Yes No 

1. Ifnecessary, were the correct quadrant(s) excavated and restored? y 2. Ifnecessary, were the correct areas ofdrip zone excavated and restored? ^ 

Grading Sod and Vegetation Yes No 

I. Does the grading around the perimeter ofthe house in excavated areas generally slope away from 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 30-day time 

period). 

4. Are sodded areas generally firm and evenly graded? t ^ 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at 30-day time period). 

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

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

Gates, Fences and Retaining Walls Yes No 

1. Do gates open and close freely? (ifapplicable) 

2. Were all gates or fences taken down during restoration activities re-installed? (ifapplicable) 

3. Was damage to gates or fences avoided? (ifapplicable) l i ^ 

4. Was damage to retaining walls avoided? (ifapplicable) 

Foundation, Siding and Gutters Yes No 

1. Was damage to siding or trim avoided? ^ 

2. Was damage to the foundation avoided? K ^ 

3. Was damage to windows avoided? l - ^ 

4. Was damage to window screens or door screens avoided? 4.. ^ 

5. Was damage to downspouts or dovmspout extensions avoided? ^y ' 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? %^ 

2. Was damage to wallcway surfaces avoided? \ ^ 

Inspection notes: 

Remedial and restoration activities complete including 30-day sod warranty: 

EPA Representativ ^Jy^yL^.r.>X.^>^ Date: S/j-lj/0 
Pase 1 of 2 

"> 

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

o YOUR TICKET NUMBER IS 2470321. 

Original Call Date: 4/20/10 Time: 4:54 pi 


Work to Begin Date: 4/22/10 Time: 5:30 pii • 


State: NE County: DOUGLAS 


Address: 415 Street: WOOLWORTH AVE 


Twp: 15N Rng: 13E Sect-Qtr: 26-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C •fwo LJ^^^ 

bOorfZ-


Type of Work: Excavating the entire property ^BiK^ ^ 

Location of Work: LOCATE ENTIRE PROPERTY V, 

'8 

Remarks: FAX ALL CLEARS TO: (402)451-1069 


: SAID #20044 


Company ENVIRONMENTAL RESTORATION 


Contact Name TRACY BRISTOW Phone: {402)451-1314 


Alt. Contact Phone: (314)504-4874 


Work Being Done For: EPA 


Depth of Excavation; 12 Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVELS MUD02 OMAHACOF 0PPDGPR6 QLNNEIF QWESTNE 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVELS COMMUNICATIONS, LLC NA 

Day: 8773668344 

Ah: 

Emerg: 8773668344 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

http://wvAv.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asD?ret=<R FSI u T S /t/on/^ni/-! 
Page 2 of2 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day:

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QWESTNE QWEST LONG DISTANCE 

Day: 8002834237 

Alt: 

Emerg: 8002834237 

http://www.dhon.orgyirthintemet/DHONNoticeCreationMessageText.asp?ret=<RESULTS... 4/20/2010 
f^m^^^m m 

SAiD# ^Q<>^y 

Owner's Name: D^cyH lUc^i y Daytime Phone: y>{-^S7 7 \ 

l l l l I I • • - ^ . ^ - - . - - - - _ _ . _ . - _ — _ 

I Property Address: ^/ ^ k)oo j l/QQfJJt^ 
f''"'f^'-ff^~Z'!^ 

Property Access Checklist 

^o W n WORK STARTED ON: / / 

Property Address: V/ g- [^^^ fc^gr^J ^ n WORK COMPELTED ON: / 1 

Owner: /^ ; J. ; \L^:^i, i Renter: 

Address 'y^i ^ \y>oo\{/)or^ PhoEie: 

Fax: 

Celt/Pager: 

Phone:^;(/. C^Sl I Additional Information: 

Fax: 

CeSl/Pager: 

ICtHC* ccess Agreement 

s ^ Restoration Agreement 

Signed:

Signed;

 ^ 7 2­

 3/ 2

 / K> 

 I \0 

By: 

By:

^4 ^ 

 tV l 'M;g^ 

0 Video Property Before o»i y I ^ f ic> By: 5^^ 

0 Digital Photos Before Oa :A_iAih. By: (C-zJ 

Q Video Property After Oa / / By: 

n Digital Photos After On By: 

0 Property Completion Agreeinent SigRed:_SfJlfJJL By: '^ J 

n Final Report Signed: / / _ By: 

Additional Video or Bigltat Photo's Taken: 

j D Video D Digital Photo On : / / By: • II 

Reason: ­ • 1 

n Video n Digital Photo On : / / By: 1 

Reason: | 

n Video n Digital Photo On : . / / By: • 

Reason: ' 1 

n Video n Digital Photo On : / / By : • • 1 

Reason: • 1 

Omaha Lead Project Work Plan Page 1 of 19 
Consent for Access to Property SA5D# 

RIGHT OF ENTRY TO PREMISES 

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

Protection Agency (USEPA) or its authorized representatives, collectively the Grantee to enter 

and perfonn certain envlroivmental response activities upon the following described premises.: 

Owner's Name;/>];<J:^' ^/.j^./ - | Daytime Phone: (/Q2,-^/</ ^ 75'9- 7 

Address; 

Addresses of Properties 

covered by this 

Agreement: 

PURPOSE OF INVESTIGATION 

The purpose of the remedial activities is to remove all soils at the property which are 

containinated with hazardous substances, in particular lead at concentrations greater than, or equal 

to 400 parts per million (ppm). 

REMEDIAL ACTIONS 

The environmental response actions to be performed on said property may include thefollovving 

activities: 

a. Taking photographs and/or video of the property before, during, and after remedial 

activities; 

b. Locating equipment and machinery on-site in preparation for and in the course of the 

environmental response; 

c. Planning and implementing the removal action on or near Grantor's propeity. 

d. Obtaining samples from Grantor's property; 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the activities or work done, or the 

equipment used to perform the activities, or to undertake any actions regarding the use of said 

property vv^hich would tend to endanger the health or welfare ofthe Grantees cr the envirorunent, 

or to allow others to use the property in such 

^m I graat access to my properties 

n I do not grant access to my p-raperCies 

/HuiL^' J/Co<^^^yiy ^'Z-' o 

Signature ^ Date 

Signature Date 
Addtteonai Comments / Instructions: 

S3 Check this box if owner does not want E.R. to enter the residents to document interior 

?oundation Vs/alls and possible preexisting damage. By checking this box E.R. is not responsible 

for any damage done to the interior of house, including foundation cracks or fissures. 

"Plag r~l Idonotagree • "•£!! lagree n i dp tkiit agree agree 

:^,4^ j^2'/ o 

Ovyner's Signature Bats Contractor's Stgnattire Bate 
Restoration Agreerrierit 

The purpose of this agreement is to provide a mutual agreement as to conditions of property prior to 

contractor 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 die United States Environmental 

Protection Agency (EPA). 

PropertyAddress; q^g- (/)oQ|(^oyvfh 

Owner: p^^^v^; t^iok ^ 

Phone: g^j^^ (ffN-^ST f\ ] 

On the attached diagram(s) indicate area(s) to be excavated and depth of excavation, location of all known 

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

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

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

Stems to be removed by Contractor arid not repSsced: 

Page 1 of 2 
I agree CD I do not agree Q I agree [U I do :LCt agree 

ynocXy 

Owner's Signature Date Contractor's Signature Date 

Attachnnents 

Pzge 2 of 2 
I

Property Cornpletion Agreement 

This agreement documents the completion of remedial activities performed on my property. My 

^"^r.ature v/ill designate that I am satisfied with the restoration of my property, and that no items are in 

question, now, or at any time in the future, except those items Usted below, if any. 

SAID: ^ 0 ^ 

PropertyAddress: qj ^ UJoolu^Ofi h 

Owner: /7)/^ ; tn!^K ^ 

Phone: L/c^.^ l^/(^ ^^^S'^q -

Restoration Items in Question 

Item 

item 

AddEtional CoETijr.snts: 

j I agree restoration is compieted, except as noted 13^1 agree restoration is completed, except s.s aoted 

I I do not agree restoration is corapleted I I I do not agree restoration is completed 

Gv/ner's Signature' Contractor's Signature Date 
^vyvic,^"-^ >-.\jiim.^ /-\ccoum luiormation Page 1 of 2 

Douglas County, Nebraska Property Record - R0902400000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - VJeW OH Ma p Information is valid as of 2009-9-29 Treasurer's Tax Report 

New Feature ->-•- • Auto Sales Search 

Owner 

SMITH SHARON K 

415 WOOLWORTH AVE 

OMAHA NE 68108-0000 

Property Informatio n 

Key Number: 0240 0000 09 

Account Type: Residential 

Parcel Number: 0902400000 

Parcel Address: 415 WOOLWORTH AV 

OMAHA NE 68108-0000 

Legal Description: CREDIT FONCIER LOT 3 BLOCK 21 15 FT STRIP ADJ ON N & E 55 FT 55X147 

Value Informatio n 

Land Improvement Total 

2009 $5,400.00 $30,900.00 $36,300.00 

2008 $5,400.00 $30,900.00­ $36,300.00 

2007 $5,400.00 $27,200.00 $32,600.00 

2006 $5,400.00 $27,200.00 $32,600.00 

2005 $5,400.00 $27,200.00 $32,600.00 

2004 $5,400.00 $19,400.00 $24,800.00 

Land Informatio n 

••.cres S F Unit s Dept h Widt h Vacan t 

0.18 8085.0 1.0 147.0 55.0 No 

Impro vemen t Informatio n 

Building 1 

http://douglasne.mapping-onIine.com/DouglasCoNe/static/accountinfo.jsp?accountao=R09... 10/6/20nQ 
LvuLiymi \„uuiu}' /Account inrormation Page 2 of 2 

PI 1 1/2 Story Fin 415 Woolworth Av 

i 

y 

M

• 

-•ja w ^ f ^ 4 f:m'\ 

^lj|y^^^^^M-_ _ 

SMHHHIHH 

; CLICK TO ENLARGE IMAGE

Square Footage: 936.0

Perimeter 0.0 

Unit Type: 

Built As: 1 1/2 Story Fin 

HVAC: I Forced Air 

Exterior: Frame Siding 

Interior: Drywall

Roof Cover: i Composition Shingle

Roof Type: Gable

Floorcover: Allowance 

^^?n-ri.iv^; .n

] 1

Year Built Year

Remodeled

 Percent 

 Remodeled 

1890 0 0% 

Detail Type Detail Description 

Appliance Allowance 

Basement Bsmnt Block 8 ft 

Fixture Base Fixtures 

Fixture Bath Full 

Porch Slab Roof Ceil 

Porch j Slab Roof Ceil 

User \ Half of 2nd floor fin per owner 

•?)?.l) Sit Fl 

 "^-v''-*-:! >-; 

 CLICK TO ENLARGE IMAGE

 Percent Complete: 

Quality: 

Condition: 

Condo Square Footage: 

Rooms: 

Units: 

 Battis: 

 Bedrooms: 

 Stories: 

Foundation: 

Sprinkler Square Footage: 

\ 

100.0% 

Average 

Fair 

0.0 

6.0 

1.0 

1.0 

2.0 

1.5 

Block 

0.0 

"*"£/"' • P-ys/ca/Xge 

1890 119 

Units 

1.0 

792.0 

1.0 

1.0 

120.0 

120.0 

1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo .jsp?accountno=R09... 10/6/2009 
ENVIRONMENTAL AS-BUILT DRAWING 

i^ivlAHA LEAD SUPERFUND SITE 

RESTORATION 

20044 

Omati a North Arrow Owne Lead Site r Name: SHARON K SMITH 

Site Sketc h Address: 415 WOOLWORTH AV 

Phone; H: 402-346-5480 W; 

i 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: ' F D Pi Z\ S 'Z)\ s 

RYASCPXA-20044 Fl ^i 7 ppm V. n Date; 0-= ; - ::? o - o- t 

RYBSCPXA-20044 F2 C^'S^ ppm Cl, g ] D Time: \ 3- . .PlS <p r^^ 

RYCSCPXA-20044 Bl ___4j^^ _ ppm Q>, El n Samples Analyzed RYDSCPXA-20044 82 3 0 ppm Q-L Q n 

RD2SCPXA-20044 DZ ^6^ 3 ppm D2.BI n XRF Unit: 9yy \ Book: 

—RGZSGPXA-20044 G2­ ppm ' n a Date: C."'ZM{ZZ'^\ 

RPZSCPXA-20044 PZ ':7LJ I ppm ^- Time: 

Lab RyASCPLA-20044 Staff: 

n 

Number of Samples = Result 556 ppm 

SAID #20044 

DATE EXCAVATED 5-5-10 

DATE EPA SIGNED OFF 5-21-10 

AREA SODDED 5289 SQ FT 

Omaha Lead Site 

QuaAaitt excavated Drip Zoito Excavated CofitaminatiQfi Left Behind 

r^nti-ar t fl­ PP.R7-0<i^5 ; Environmental Restoration LLC 
^ ^ 

K Mlilllilllli 200^ 

Owner Name: SHARON. K SMITH 

Address: 415 WOOLWORTH AV 

Phone: H: 402-346-543G W: 

Onnaha Lead Site 

Site Sketch 

North Arrow 

i 

Sample Lead Sample Samples Collected Number LAB Concentration Collected Firm: Y^.D<^ glS'"^C s 

RYASCPXA-20044 Fl S Date: o-=; - ^ c. - o-i 

RYBSCPXA-20044 ^ l 7 ppm ^ . • F2 6 ^ ppm Time: \ P. •. fis 9 ^

RYCSCPXA-20044 Bl ^&' ^ n

ppm 

Samples Analyzed RYDSCPXA-20044 B2 .^ ^ ppm 6. Sl D 

RDZSCPXA-20044 DZ n

^^^' 3 ppm XRF Unit: ^3^ . Book: 

RGZSCP.YA 2004^ SZ- ppm a Date: r.^->h(r\r. U 

RPZSCPXA-20044 PZ ^3 7 ppm ^. a Time: •

Lab RyASCPLA-20044 Staff; Number of Samples = \ Result 556 ppm _ 

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.-? = f^ =^y,^ 

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r Omaha Lead Site 46130 

.'••K •-.•s^ . 
20044 r/lj'ci' ^y ^ 

Omaha Lead Site 46130 
Thermo Fisher Scientific Therm 900 Middlesex Turnpike o Billerica, MA 01821 

SCIENTIFI C 

LW'KkAor. ..\i)i)ui:ss s.vMi'Lr. AUKA OIT.RArou NOIT'S .SAID IM. 1 2010-05-07 12:45 Avg of 6415-641-415 woolwonhmEZ JIMMY surface final clearance 292.07 ± 27,60 

2 2010-05-07 l:):45 4l5woolwonha\EZ JIMMY surface final clearance 20044 310.73 ± 28,48 

3 2010-05-07 i;!:45 415 woolworth n\ EZ JIMMY surface final clearance 20044 278.88 ± 27.05 

4 2010-05-07 i;'.:44 415 woolwoith a\ EZ JIMMY surface final clearonce 20044 286.60 ± 27,26 

5 2010-05-07 i;::42 Avg of6411-641; 415 woolworth inPZ JIMMY 10 final clearance 193.83 ± 22,76 

6 2010-05-07 i;:42 415 woolworth Q^PZ JIMMY 10 final clearance 20044 198.36 ± 23.04 

7 2010-05-07 12-.42 4 IS woolworth a\PZ JIMMY 10 final clearance 20044 212,69 ± 23.60 

g 2010-05-07 12.41 415 woolworth a\PZ JIMMY 10 final clearance 20044 170.43 ± 21,63 

9 2010-05-07 12:39 Avg of 6407-640! 415 woolwonli a\ DZ JIMMY 13 final clearance 773.20 ± 44,95 

10 2010-05-07 12:39 415 woolwortliaiDZ JIMMY 13 final clearance 20044 763.70 ± 45.06 

11 2010-05-07 12 38 415 woolworth a\DZ JIMMY 13 final clearance 20044 808.87 ± 45,93 

12 2010-05-07 12:38 415 woolworth a\ DZ JIMMY 13 final clearance 20044 747,03 ± 43,86 

13 2010-05-07 12:3fi Avg or6403-640:415 woolworth n\ 131 JIMMY 8 final clearance 172,35 ± 21,63 

14 2010-05-07 12:36 415 woolworth m B1 JIMMY 8 final clearance 20044 179.51 ± 22,11 

15 2010-05-07 12:35 415 woolworth a\BI JIMMY 8 final clearance 20044 161.32 ± 20,93 

16 2010-05-07 12:35 415 woolivortJi a\ B1 JIMMY 8 final clearance 20044 177.71 ± 21,83 

17 2010-05-07 12:;il Avg of 6399-640:415 woolworth a\ F2 JIMMY 8 final clearance 197.08 ± 23.59 

18 2010-05-07 12::il 415 woolworth a\F2 JIMMY 8 final clearance 20044 200.47 ± 23,70 

19 2010-05-07 ll-.-il 415 woolworth o\F2 JIMMY 8 final clearance 20044 186.42 ± 23,17 

20 2010-05-07 I2:;0 415 woolworth a\ F2 JIMMY 8 final clearance 20044 204.34 ± 23.91 

21 2010-05-07 12:28 Avg of 6395-639- 415 woolworth a^ F1 JIMMY 8 final clearance 151.35 ± 20.82 

22 2010-05-07 12.28 415 woolworth avF I JIMMY 8 final clearance 20044 149,79 ± 20,90 

23 2010-05-07 12:27 415 woolworth a\FI JIMMY 8 final clearance 20044 152,81 ± 20,80 

24 2010-05-07 12:27 415 woolworth a\ F1 JIMMY 8 final clearance 20044 151.46 ± 20.77 

Page 1 of 1 05/07/10 14:38:15 
I 

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