TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID # , 1'2-lH'l Date: l y \ 0 IP 

Address: ^V A le^(V^^^Q ^ ^ T 

Remediation Contractor: _Coastal Environmental Group_ Year; 20i 05j_ 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

d 

d 

-0-

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 rqilace plants, etc.) 

Confinnation data 

Photographs 

As-built sketch 

-s 

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 information from Douglas County Assessor's Office 

irv/// 

signature )ate 

30054843 

Superfund 
M # • 

Property Access Checklist -707' ^^ ^ 

Property ID: 22m Q 

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 WORKSTARTED

 WORKCOMPELTKD

 ON:

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0""«'"= Ja n ft icrK-,iEP Ewirt^i^iiE: 

Address: 

TO aSDC 6M0ti32 

OM^«A,NE l(?8V5M 

Phone: Mo2'-758.2e)^U? 

F«= ^02.3^o.v'5qtJQ 

CcJMPagen 

Renten 

Phone: 

Fax: 

Cell/Pagen 

Additional Information: 

D Notification Letter 

Q Acceaa Agreement 

^ Topsoil Sampling (if applicable) 

D Disposal Samplhig (if applicable) 

D Garden Sampling (if applicable) 

j3^Utillty Clearance 

0 ' Video/Photos (Before) 

D Video/Pbotos (Daring) 

D Video/Photos (After) 

D Video/Photos (30-Day) 

D Property Completion Agreement 

D Final Report 

Sent: / / 

Signed:'^ /2//rl 9 

Signed: 9_/^/Q 3 

/ / 

/ / 

/ / 

CMti:Q_f2Alt£ i 

On:^/iy/I ^ 

On: / / 

On: / / 

On: / / 

Signed: / / 

Issued: / / 

By: 

By-octav/o 

ByjrtckivJo 

By: 

By: 

By: 

^y-Q^lz?^ 

By: 

By: 

By: 

By: 

By: 

By: 

Air Monitorine (as apDlicable] 

D Community QCrcw 

Results: 

On: /_/ _ By: j 

O Community

ResuHs: 

 QCre w On: /_/ _ By: 1 

D Commnnity

Results: 

 QCrow | On: / / iBy: 1 

Omaha Lead Site 
• • 

Douglas County Account ^^na^o n Page 1 of3 

Douglas County, Nebraska Property Record - R1616620000 

Print Report 

NEW Featura - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vie w OH Ma p Information is valid as of 2009-9-15 Treasurer's Tax Report 

New Feature ->->-> Auto Sales Search 

Owner 

PUSCH JAN E 

K^- ^ KMUJU vu^^^ 

P O BOX 540432 

OMAHA NE 68154-0000 

Property Informatio n 

Key Number: 1662 0000 16 

Account Type: Residential 

Parcel Number: 1616620000 

Parcel Address: 4335 LEAVENWORTH ST 

OMAHA NE 68105-0000 

Legal Description: LEAVENWORTH HEIGHTS LOT 18 BLOCK 0 45 X 111.7 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land Improvement 

$5,700.00 $60,700.00 

$5,700.00 $60,700.00 

$5,700.00 $60,700.00 

$5,700.00 $60,700.00 

$5,700.00 $45,000.00 

$5,700.00 $45,000.00 

Total 

$66,400.00 

$66,400.00 

$66,400.00 

$66,400.00 

$50,700.00 

$50,700.00 

Sales Informatio n 

Sales Date: 2006-06-26 

Deed Type: 

Price: 

TRDM 

$0.00 

Book: 2006 Page: 075294 

Grantor: Pusch Jan E TR 

Grantee: Pusch Jan E 

Valid/Invalid: Invalid 

Exclusion Reason: Family Sale 

Sales Date: 1991-09-10 

Deed Type: 

Price: 

WD 

$0.00 

Book: 2006 Page: 064302 

Grantor: Pusch Jan Etal 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accotmtno=Rl6... 9/17/2009 
Douglas County Account Ia£3rja|tio Ij^rjaati n Page 2 of 3

Grantee: Pusch Jan Tr 

Valid/Invalid:

Exclusion Reason: 

 j invalid 

Lan d Informatio n 

Acres 

0.11 

SF 

4995.0 

Units 

1.0 

Depth 

111.0 

Width 

45.0 

Vacant 

No 

Improvemen t

Building 1 

 Informatio n 

3V 

SWisq." jtr 

Ali i 

i'*"f4§ifir 

1 i n STOR* FIMSHEO 

Bimni eioa t * »M 0 tq • 

CLICK TO ENLARGE IMAQE CUCK TO ENLARGE IMAGE 

Square Footage: 946.0 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: I 5.0 

Exterior: Frame Siding Units: •' 1.0 

Interior: ' Drywall Baths: 1.0 

Roof Cover: ! Composition Shingle Bedrooms: 2.0 

Roof Type: [ Gable Stories: : 1.5 

Floorcover: Allowance Foundation: 

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 624.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R16... 9/17/2009 
• • 

Douglas County Account I :^|nn|don Page 3 of3 

Porch End Screen 160.0 

User Attic Full Finish 302.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R16... 9/17/2009 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet j[\:Send EmaN_^ J 

• YOUR TICKET NUMBER IS 2369313. 

Original Call Date: 9/22/09 Time: 8:12 am Op: ELIZABETH18790 


Work to Begin Date: 9/24/09 Time: 8:45 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4335 Street: LEAVENWORTH ST 


Twp: 15N Rng: 13E Sect-Qtr: 20-SW 


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: Y 


Involves Txmneling or Horizontal Boring : N Explosives: N 


ALT872 BSHPCLKS CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


UNITEOM UNOTEL 


Service Area Contact Phone Nuniber UtiUty 

Type 

ALT872 WINDSTREAM COMMUNICATION NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

BSHPCLKS NEBRASKA HEALTH SYSTEM NA 

Day: 4025523460 

Alt: 4025523347 

Emerg: 4025595111 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/22/2009 
• • 

Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

QLNNEIC QWEST LOCAL NETWORK NA 

UNITE PRIVATE NETWORKS LLC UNITEOM OMAHA 

ANDREW UNOTEL UNIYERSITY OF NEBR/OMAHA TAYLOR 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Day: 4025543599 

Alt: 4025543036 

Emerg: 4025542648 

http://vmw.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/22/2009 
OLS#: 22149 As-Built Drawing Date Excavated:9/30/09 

Date USEPA Signed Off: 10/19/09 

COAST A L Omaha Lead Superfund Site Area Sodden: 918 sq ft 

22149 

Omaha Exterior Paint North Arrow Owne Lead Site r Name: JAN ERIC PUSCH 

Sit [2^Good e Sketch Address : 433S LEAVENWORTH ST • Poor Phone : H: W: I I Not paint 

Omaha I^ad Site 46130 

Legen d 

Concret e Dri p Zone Excavate d Quadrants Excavate d 

Area replaced with 

Sod ^ ' 

Are a replace d wit h 

Rock/Mulch Are a lef t bar e 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
ll ^ h • • 22149 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: JAN ERIC PUSCH [0^Good Site Sketch Address: 4335 LEAVENWORTH ST • Poor 

Q Not paint 

Omaha Lead Site 46130 
rAi^lk)6^rfi ^ u-1 22149 

Omah a Exterior Paint North Arrow Owne Lea d Site r Name: JAN ERIC PUSCH [g^Good Site Sketc h Address: 4335 LEAVENWORTH ST Q Poor 

Phone W: : " Q Not paint i 

Sample Number Lead 

Concentratio B^rajj n . 

Sample 

Collected LAB 

Firm:

Samples Collected 

 fVl^ S A^.// ) •/4 

RYASCPXA-22149

RYBSCPXA-22149

RYCSCPXA-22149

RYDSCPXA-22149

 F1 

 F2 

 Bl 

 B2 

\ > ^y ppm 

1353 ppm ; PI 

J i ppm 

\SA 

D 

D 

D 

D 

Date 

Time 

///3>>/0H 

5: Q 

Samples Analyzed 

RDZSCPXA~22149 DZ D XRF Unit: % \\ Book: ^ ^ ^ 

ROZOCrXA-22140 G2> ppm D D Date 

RPZ3CPXA-22149 P2­ ppm D 

Number of Samples = | 5 i

D 

O 

Time 

Staff: 

B 

^al ^ 

B: £

Omaha Lead Site 46130 
22149 

Omah Exteiior Paint NorthArrow Owne a Lead Sito r Name: JAN ERIC PUSCH [B^oo d Site Sketch Address: 4335 LEAVENWORTH ST 

D Poof 

Phone: Hi WL _ Q Not paint 

Omaha Lead Site 46130 
#371 P.002/DOB Fron:COASTAL ENVIRONNEHT/ B77 662 4211 h/2009 10:41 

j'''l!'*'«, 

i' COASTA l rirna»ii M «1«i & ».D« r • » c *^.«*t ^ 

Consent fei Access To Properly 

RjtSMT OF EhfTRY TO PREMISES 

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

Environmental Protectian Agenc)' (EPA) or tts authorized representatives, collectively 

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

fcltowing described premises: 

Owner's Kama; Daytime Phone: 

T o n R. PuSc/ i 7.^^-^?^C /3/2-9^7 9 

Addittsa or Property 

covered by this 

ABToemant: 

i 33S heoL/enuACrih. 

PuRPDsg OF RESPONS E ACTIVITIES 

The EPA is requesting access to collect soil samples and rentove soil that contains 

elevated concentrations of lead and may pose a health hazard. The area(s) will t>e 

excavated to remove contaminated soil. The removed contaminated soil will be 

replaced wtth dean materials and the area wtii be restored to its originBl condition. This 

work is lieing performed under the Omaha Lead Superfund Site remediation program. 

A representative of Coastal Environmental Grotip, contracted by USEPA, will contacl 

the Grantor in-person to discuss the work to be perfonned. the Grantor will have an 

opportunity to review and approve the planned soM removal, and restoration work 

ttefore it begms. Once the work s finished, the Grantor will be asked to review the work 

and confirm that it is complete and meats with the Grantor's approval. Upon 

completion, the Grantor wrill receive written documentation from EPA that the property 

has been remediated. 

ENVIROWMEHTAL RESPONSE ACTIONS 

By s^in g 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, fbr the sole purpose of performing the work This access shall 

remain in effect until the work has been satisfsctorily completed. The Grantor also 

agrees to: 

PageiofS 

JO Bfied )i :a i B^ouies a 
#371 P.003^006 FroaiCOASTAL ENVIRONNENT Hi 877 662 4211 /2009 10:41 

< # 

.*­ ^ 

C&ASTA L \'.y'^ 

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

piles, dog houses, etc; 

Remove flower bulbs or plants that the Grantor or the Gra itor's tenant may wish 

to save; 

Water and maintain replacement vegetation, including fi^rlilizer applx:ation. as 

necessary subsequent to an initiBi M.*atering period by EPA 

Abide by health and safety giidsnce provkled by EPA: 

If the property is rented, assist EPA in ot}tairur)g tenant ipprovel (or access to 

the property to perform the work. 

Allow videotaping and/or photographing of the property. 

AGREBXENT NOT T O 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 woukf tend to erxfanger the healtti or 

welfare of the Grantees or the environment, or to allow others to use the property in 

such a manner. 

Should you have any questkins idiout this program, please contact Coastal 

Environmental Group, at (402) 991-1199 

(Si grant access to my propertim D t do not grant tceeaa to rny properties 

' ) 

(^ILM. Date Siflnatufo Date 

O I would like to be present during any sampling thai is required. 

Page 2 of? 

io Bfied H >ai a:;ou»]i a 
n/2009 1C:41 #371 P.004/006 
 FroB:eOASTAl ENVIRONHENTi 877 662 4211 


R«©torat50!"i Agreemsrtt 

The putpose of this agceemem is to provide a mutaal agreement as to conditions of the propenj' prior lo 

reraediation activitieB. This will also serve as documentation fbr the prnpose of assuring that restonttion 

activities are completed io tlie satisraaion ofthe property owner and the United States Envirorvnental 

Proieetion Agency [E?A). 

I Praperty n>: iq . Ow««r: -r^> t Pu-ir. k 

On tlte attached diagmn(s) indicaie aru(t) to excavate, snrfaee stnicfjics and landscaping raatures and 

access kxiition(s} no be nsed by the coatracUns. Indicaie distances, depths, material lypes, etc. 

Photographicany and Videographically docunwnt the existing conditians ofthe proper^ and the basement if 

necessary. 

itema to be R«moved by the Ownar before Start of Rennediation: 

rr>e fafnoval.stofa!;e.i>g>potei, anri/oi r^Wittx of tHespitoms is ;h«>Owners '•esponeibiliiy 

A w StA/y^l^ V^Uh/vVs 

I Kem: 

Item: 

ItBm: 

ttama to be Removed by the Contractor During Rernediation and Wot I 

^wSu-JlPy^ ^ L.«p>t €«8HtKiO 

Itent: 

jltam: 

, ^ 

Page 1 of, 

JO Bfied s tax e^ooioH a 
From:COASTAL ENVIRONHENTi B77 662 4211 mU2009 10:41 #371 P.005/006 

COASTA L 

tteme to Ba Removed By Conbactor During Remediattgn andBgBJa.cgd 

J Item: 

• - ^ ^ ^ ^ ­

• itsm: 

;^D " 

i ttenr: 

Itom: 

Landscape Inventory 

Item Quantity Unit Condition/Type/Speciee 

Pre-existing ptopeny area, Quadrants that will bc excavated, ihat 

is covend with gn» . 

Number of tiect > 2 inch Eadi 

trunk diameter 

Number «f trees <•= 2 inch Eaeh 

tmnk diamder 

Number of Spritdckr 

Zones. Control Valves. ^n.^ 

c^^ Each Thners. Heads, etc. 

•Mc,-!!.!* ;i slrir' " ul llitf 

Nsnber of aad size of 

each garden/ flower bed each 

area. Square Fbet 

Agreed upon >«]iie of plant 

materiak oal jo ^ 

ceplac^bv contractor. 

1 '•err i.'-.f iHJiic «ili Hi 

• Oin:'!.' . ll- -lit i;-.;'K-: \ i 0 '• 1' •: 1*. t 

Eascmem Area, to be 1 •• 1 

excavated > BMttt j

1 1 I 

Pago 2 of. 

30 ete d s iQI B:)C)a]e8 a 
Fron:COASTAL ENVIR0NMEN1 877 662 4211 Aei/2O0 9 10:41 #371 P.006;006 

C O •. I. -I A t. 

Addittenal Comments rinstmetionB: 

e -pErJw^rrs wMfo; Voconj ' 

Q CtiBGk tvna hn» » r>iM^«|- ni ^ rip« ifflpt qg ^ to dotynent interior foundation walls and possible 

pre-existing damage. By dhstMng this tax CEG is nbt reaponsifaltflDr eny damege done to the 

interior of house, indudiris foundador crscitt or fissures. 

f agree O i do not agree 

\)g^^ ^ CSICL \p\tA' ^ ^raceQ?>r> ^i^iln^ 

OttoirVSigMtare USte dbsiractor'sSlgDature SatT 

PageSof. 

JO a£Bd s <ai o^ouiss a 
BVID # S^/H ^ 

XRF PROPERTY SAMPLE SHEET 

Date 

Project 

XRFID# 

Shot# 

^^^2^2SZ 

2^ 

Average

^/.b£>7of 

Omaha lead FP 2n(1 year opilon 

Reading 

3r. ^ ^ lof ^At 

Sample area 

iSZ 

Depth 

 {i^^j Q 

Address 

Sample time 

sample length 

Shot# 

-/^G ^ 

^ 

/?A2y 

/KMotage

f^^Zyr LeA\f£j/\ tti/ntiL

am/pm 

30 sec 

Reading 

^j i ^ ll? 

//?^->^/3 

A^^.-i I T 

Sample area 2F 

Depth 

1I±. ADTp J y / yA 

 ^ f 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

ShGt# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading 

RETEST AREAS 

Sample area Shot# Reading Sample area 

Depth Depth 

Average 

lab sample # Lab result Sample area XRF Avg. 

Average 

Signature. ^/mm 

Print Z^Kh^ti ^ C(^rp^s 
iJSkLj\ Omaha Lead Site—Fixed Price EP-R7-07-05 

I ^^^^ ^ I

^%y^yA

 Coastal Environmental Group Inc.

 www.c6a8talhazmat.com 

M ^^ y 

^PBoT*" ^ COASTA L INVIIONHtNTA l 

C a o U P. IH C 

EXECUTIVE SUMMARY: 

BVID #22149-(4335 LEAVENWORTH ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: • ^^ ^ 
4

P 

'SSt EPA 

EPA Property Close Out Form 

Property #: 9_X\'-\ ^ . . 

Datc/Tlmc: Owner's Name:. iJ6.>YA'U. 

Quads Excavated: ftt -V V^ T Contractor Group C 'Y\V)t ^onirienf 

Excavation General 

1. If necessaiy, were the correct quadnuit(s) excavated and restored? rf] 

2. if necessary, were the conea areas ofdrip zone excavated and restored? r^ 

Gradin Yes No g Sod and Vegetation 

1. t3oes die grading around the perimeter ofthe house in excavated areas generally slope away rr fiom the house?

 ^_____ _ 

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

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

day time period) _ ^ y 

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

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

time period) 

6. Was the property graded such that water will not pool on the propert}'*] \y 

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences aad Retaining Walls 

1. Do gates open and close freely? (If applicable) zA 

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

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

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

Foundation, Sidiag and Gntlers 

Yes No 

1. Was damage to the siding or trim avoided? A 

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? y 

 Was damage to windows or door screens avoided? 

ry"­ 5.

 Was damage lo downspouts or downspoul extensions avoided? 

Sidewalks and Driveways (Concrete) 

1. Was damage lo driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 
Ovvner •P- s comments: 

Inspection notes: 

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

EPA Representative Uh ^ [jAly L P-tAt: l<^//f/(^f 
Frcm:COASTAL ENVIRONNENTAL 877 662 42 n 10/16/200 leTSoi 9 11:02 #436 P.002/003 

^ 

Property Compietion Agreement 

Dil i Bijiccmer.i bocumcnJs. the compkSiOn ot rcmedwl acliwiics perlOtmed nn my properly My smnaiuit 

win rtejignale thai 1 am satisfied with the roeioralion of my properLy. and thai nt> items arc in qucsiio«« 

now. or »t any !une in Ihc future, cxccpi those iieins Ittted below, ifany 

Pinpcity ID: J.3 . I H Oj 

Property AcMrc^r ^ 7,-.>«r Ce<^V>e^-x<.>t.'Aik 5V 

Owner: ^a. ^ (? , 

Ph^ie: Ato>>n-$'f - JLtfLto 

Restoration lt«ins in Question: 

ItBin: 

hem: 

Item: 

(tatn: 

Hem: 1 

Item: 

1 

AtfdiMonat Conrunonis: 

Cr^^CA . P^ J m-rcr I rirorklion l> comprcictf, occpf •» >"»•»<• 

nI ita «M iKrcc rftfpraiiim it compklcti 

OwiieVJf SiBn»fiijr Date Conttarlar' s Siritaiwrc OrZ* 

30 efiad H sai ettouea a