TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ^77 ^ Date: "^j 11 [o l 

Address: /J30 S //) Sh 

Remediation Contractor: _Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

[j/ Executive Summary 

[1/ EPA-provided property sketch 

K Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

M Restoration Agreement 

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

^ Confirmation data 

Photographs -

M As-built sketch 

sK Satisfactory restoration signed by Property Owner 

M Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas Coimty Assessor's Office 

D 

D . 

D " • ' • • . ' • " • ' • 

7//1/07 

40317901 

liilill 

Superfund 
Property Access Checklist 

Property ID: P07^5 ' 

Property Address: fQ^T^Q J ^ /Qfi . ^ f 

n

n

 WORK STARTED

 WORK COMPELTED

 ON:

 ON:

 /

 /

 / 

/ 

0>vner: [.U11 /fa/} ! c)0h/Wh ^ > 

Addre.s.s: ^^-^ ^ S./O^J f 

Plume: 3^5'Lpll l 

Fax: 

Cell/Pager: 

Renter: 

Phone: 

Fax: 

Cell/Paj^er: 

Additional Inlorniation: 

• Notification Letter 

r-iU Access Aj^rcemcnt 

[j - Restoration Agreement 

n Topsoil Sampling (if applicable) 

n Disposal Sampling (if applicable) 

n Garden Sampling (if applicable) 

"^/Utility Clearance 

S ' Video/Photos (Before) 

n Video/Photos (During) 

D Video/Photos (After) 

n Vi<leo/Pliotos (3()-Day) 

1 1 Property Completion Agreement 

HH Final Report 

Sent: / / 

Signed:^ i'dt) 1 O l 

Signed: 6 1 9-^1 C7 

1 1 

1 1 

1 / 

Called: 319 7 lO ^ 

On: U> Ip^l ^ 

On: / / 

On: / / 

On: / / 

Signed: / / 

Issiietl: / / 

By: 

By= lVaru)5 

B.y: jUarcc o 

By: 

By: 

By: 

^yPTJ^iP^ 

By: 0d A 

By: 

By: 

By: 

By: 

By: 

Air Monitoring (as applicable) 

n Community \Z\ Crew 

Results: 

On: / / By: 

1 1 Community

Results: 

d Crew On: / / 1 

cn Community

Results: 

 CU Crew On: / / By: 

Omaha Lead Site 
Total Qi^^i t Square Footage to be Excavated = 6587 

Property Classification: 800 • Totl^R ) Zone Linear Footaqe to be Excavated = 0 

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Legend North Arrow Omaha Lead Site 

Omatia, Nebraska [*._:] Concrete 

|// ^ Excavated Area Property Number 

OLS-2077 5 

L I Existing Structure Scale 

» Property Address Fence 1 Incti = 30 feet or 1 grid = 5 x 5 ft 

1230 S 10 ST txV i 

— Quadrant Boundary — Post Excavation Concentrations (ppm) 

- Street Boundary F1 B2 PlavArea m m ^mtm^ ^ 

v m j ¥ 

< •; > Tre e/Shru 3 X iiPmf ^ E31 1 Gar( Jen oth er. 

Description of post excavation areas: F1. front yard left-hand quadrant. F2, front yard right-hand quadrant; Bl, backyard left-hand quadrant; B2, backyard right-hand quadrant; 

DZ, drip zone (1-3 foot arsa of soil around the foundation of the house). 
Print Preview Page 1 of 1 

idSOS./O^S'i'. Douglas County-Omaha, NE 

ParcellD

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

Sec-TwnRng 

 1133300000 J^^^^ ^ 

JOHNSTON 

WILLIAM J Addition 

1230 S 10 ST Block 

OMAHA Lot 

68108 Legal 1 

Legal 2 

P 0 BOX 3871 Legal 3 

OMAHA Legal 4 

Old 

NE Assessor 

Site 

New 

68103 Assessor 

Site 

26-15-13 

FOREST HILL 

1 

2 

E 164 S 56.3 FT 

http://webarc.co.douglas.ne.us/dcassessor/details.asp? 

PARCELNB=1133300000 

http://webarc.co.douglas.ne.us:8080/RealWare1/details.do? 

id=R 1133300000 

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 = 539 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 4/23/2007 
Parcel Search Page 1 of 1 

Results 1 - 3 of 3 

B ^ Parcels 

Q ^ JOHNSTON WILLIAM J 

1230 S 10 ST 

Parcel ID 

Owner Name 

Property Address 

City 

Zip 

Owner Address 

Owner Address 2 

Owner City 

Owner State 

Owner Zip 

Sec-Twn-Rng 

Owner Address 

Addition 

Block 

Lot 

Legal! 

Legal 2 

Legal 3 

Legal 4 

Old Assessor Site 

New Assessor Site 

1133300000 ' ^ 

JOHNSTON WILLIAM J 

1230 S 10 ST 

OMAHA 

68108 

P 0 BOX 3871 

OMAHA 

NE 

68103 

26-15-13 

FOREST HILL 

1 

2 

E 164 8 56.3 FT 

Valuation Information 

Valuation Information 

ffi MARLOWE CAROLYN A 

1230 S 108 ST 

© SPECK ALICIA 

1230 S 110 ST 

http://www.dogis.org/dogis_alias/dogis/parceiSearch.aspx?govUser=false&validUser=false 4/18/2007 
¥^"7 (^ ^ 

CONTACT FORM 

Property ID # A.c^R-S' 

Property 

Address: \^2>^ <;. \P ^ gj . 

Initial Contact: Date: ^j lo IQ^. Time: A/yp Action: O-IIL^S /]t> A/M,i:icj\ 

Second Contact: Date: ,'i\yA[<r> Time: 113.0 Action: L^q Pr^n7^o.c^ic^y, 

Final Contact: Date: cf/e^jo^ Time: /c>3c Action: 5,Vr.L-^ ../vt^v o^c>^^^ 

(Lit^ i Grt. Final Action: Transmit to EPA D Other Action: D ^/V" 

Comment: 

Owner 

Comment (s): 

Site ii> n 'Soh^sJ^j^ /Z3M S. lo**^ 

Coordinator 

Comment (s): 

I'.yi PA. \CC^^ [,H^rk­
£% 

Consent For Access To Property 

RIGHT OF ENTRY TO PRFMLSI-S 

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 

r^ [pyPyy^y// 

Address: \Vio f. ( ^ ^ ^ 

Address: 

Addresses of 

Propertie Address: s covered by 

this Agreement: Address: 

1 

Address: 

PURPOSF OF RFSPONS F ACTIVITIFS 

The EP.A is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of arsenic and/or lead and may pose a health hazard The soil 

will be removed and the excavated area(s) will be replaced with clean materials and 

restored This work is being performed under the Omaha Lead Site Superfund Site 

remediation program. 

An EPA representative 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. 

ENVIRONMI-:NTAL RI^SPONSE ACTION.S 

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: 

«Property_ID» Paee 1 of 2 
lt% 

• 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 perform the work if EPA is unable to obtain such access; and 

• Allow videotaping and/or photography of the property including exterior and 

interior areas of buildings. 

AORFFM[;NT NOT TO INTFRFFRF-: 

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 which would tend to endanger the health or welfare of the Grantees 

or the environment, or to allow others to use the propeny in such a manner. 

Should you have any questions about this program, please contact 

[^ I grant access to my properties 3 ] 1 do not grant access to my properties 

yy.y3P.3^ rr/^r/y 

Signature Date Signature Date 

I 11 would like to be present during any sampling that is required. 

Page 2 of 2 

«Property_ID>: 
Restoration Agreement 

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

remediation activities. This will also sene as decontamination for the purpose of assuring that restoration 

activities are completed to the satisfaction of the property owner and the United Slates En\ ironmental 

Protection Agency (EPA). 

Property ID: T?K^ 

Property Address: (f^"3t» ^ ' I «^ ^ 1 ^ 

0>>ner: \^(a[/ ^ J^Tni^f ^ 

Phone: Qoi- -ync bn 

On the attached diagram(s) indicate arca(s) to c\ca\alcd and depA of e\ca\ ation. location of al! known 

utilities, subsurface features, surface sU^ctures and landscaping features, access location(s) lo be used b\ 

contractor, and the direction of North. Indicate distances, depths, maierial t> pes. etc Indicate digital photos 

b\' referencing the photo-log number w ith an arrow indicating direction of \ icw. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

Item: 1 1 Ii I 

^ ^ hie __ — 3> \ 

Item: ^^^y ^ 1 

Item: 

y 

^ 

Item: 

Item: y 

Item: y y Item: 

!p 

Item: y Paae 1 of C? 
Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

Item: 

Item: 

Item: 

— y> 

Item: ^ y 

Item: / 

Item: y 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item: / 

Item:/ 

• / 

Page 2 of if? 
Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 
1 ^ ^ 

Item 

Pre-e.xisting property area 

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. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Specles 

^ 2 ^%7 / [j(\)^^ 

fl l U Square feet 

i^^ri 

y Each 

^ ^ . . ^ ^ 

t 

y Each 

L 

y Each y^ 

Each 

y Square Feet 

^y-^ 

Page 4 of \0 
Item 

Agreed upon value of plant 

materials not to be 

replaced by 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 

by the contractor. 

Agreed upon area of 

propeny to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

Area of City or Countv' 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area (s) 

« 

Quantity 

•3 

3 

[y 

Unit 

$ 

Each 

y 

Condition/Type/Species 

x^ 

SF 

Hvi­| 

SF 

Page 5 3 
Additional Comments / Instructions: 

f^^i/f- f^«-nH^ 4­

ko\// 

- \piAA<^,t h\77^^ ^ ^ ^" ^ 

n 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 n I do not agree Dlag do notjagree 

/y^yp^^yp ^ « , t. ..-- yyrU 

of [ f Owner' )ate s Signfature Date Page 6 ot \ ^ /factor's Signaijije 
Property Classification­ 80C 1 (

1r 

Tota. 

nt Square Footage to be Excavated = 6587 

.p Zone Linear Footaqe to be Excavated = 0 

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Legend NorthArrow Omaha Lead Site 

Omaha. Nebraska 1^ 21

 Concrete 

y/ ] ExcavatedArea Property Number 

OLS-2077 5 

Existing Stmcture 

Scale 

Property Addres s • •

 Fence 1 Inch = 30 feet or 1 grid = 5 X 5 ft 1230 S 10 ST !vVN 

• Quadrant Boundary 

Post Excavation Concentrations (ppm) 

Fl B2 PlavArea -

 Street Boundary HydioGcuLoqic ?nr SPSk f ? n 7 Easement j I 

[

Tre e/Shm b \ • Pidl ^ 

Iii' _ Garc ten oth er. 

<P 

— - 1 

Description o( post ejcavation areas: F1. front yanj left^wnd quacirant; FZ (rorl yanl right^iand quadrant Bl. backyarel len.^iand c^iadrant; B2. backyard rigmjiand quadrant 

OZ. drip zone (1-3 lioot area of soil around the foundation of the house). 
'RC?t.P.'y ClE.^RfiNCE WORKSHEE* >%•• 

Date nioicnjm Property ID 3onnp 

Property Project Omaha Lead -- Fixed Price Address 1230 3 10-^ 

Measurement XRF ID 0(07-51 Count/Time 

Field Shots 

Shot # Reading Sample Area Shot # Reading Sample Area 

751 uCL EIZEMl 

jn^Ci -2^1 

T4-5? J ^ 37 iz-(u 

777 3 0 ?' 17-iM 

Sample Area Pass/Fail ? Bl l2-(q" 

I n Situ Composite Composite Analytical Aiiauc t Composite Readirgs Lab { Analytical Readinq Average ] (Dried & Spilt Sent (Bag) Number! Results (Bag) I Sieved) | ? 

J 2 ^ JllU 

3Z. 10 

^ Ii. XRF Corrected Value --> I .(use calibration c!-art o- i d 13 SC.'fc tc value) 

Sample Area ^y Pass/Fail r

I n Situ lomposite ! Composite Anaiyticatj >- - ' ^ > *- Cc^pcsite Re; c.r.cs Lab Readir .tnatytica: o Average ' (Dried & 'spiltSent i (Eac) Nwmfce­

^m 

Resu'tf fBao) i Sieved) i ? 

Ui^ c9b\ A^9 

XRF Correctefl Value —> 

(use calibration cha t or ace 

20»'c to value) 

3lb 

Sample Area BZ Pass/Fall ? }zm- I n Situ Composite Icmposite Analytical Aliquo t Composite Readings Lab i .Anaiytico! 

Reading Average (Dried & Spilt Sent (Bag) Number! Results zz: fBag) Sieved) 

.5Z. 3: .A?. id_ 31 Z ^ 

I XRF Correrted Value --> 

33 |(use calibration chart or ado 

120% to value) 

31 

Sample Area P) 12-IW Pass/Fail? 

I n Situ Composite Composite Analytical 

Aliquo t Composite Readings Lab Analytical 

Reading Average (Dried & Spilt Sent Number Results (Ba SJ (Bag) Sieved) •> 3(. 

Confidential :e : :* 

1 

1 
^ ^ 4 n 30 

XRF Cci^Ke d Value —> 

l^ (use caMDratio caMDrat 

n chart or add 

ZPqfc t o value) 38 

Sample Area Pass/Fail ? 

Aliquot 

1 

I n Situ 

Reading Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent 

•> 

Lab 

Number 

Analytical 

Results 

2 

3 

4 

c 

XRF Corrected Value —> 

(us e calibration chart or add 

20<Vfc to value) 

1 1 

XRF .ec^.P-'.c'a'^ s 5' 

Confidential 
XRF D.t.ILl' CA.L'.ERATION WORKS-.EET ,j; 

°"- ai'Pp Projec t Omaha Lead -- Fixed Pr;ce 

XRF 10 0(0-7-^51 

Measurement Count/Time 

Calibration Verificaticn Checks 

Reading Blank Lew Med Hiqh 1 

"-j e VcL e CO from :8. 9 com 5532.3 ?cm 1 

:2C % 22.7 oc m 1394.4 oc m 5638.4 pern 

1 SCVc 1 c 1^ re m 

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RESTORATION CHANGE ORDER 

OMAHA LEAD 

Property ID # 1oin( 

Property Address |^>P S- W*^ 4r 

Owner Name Wll/H^Vwi 'C5^1^>c^ 

Date ^ "K^l 

Comment s 

TO 4^'^a ^ \Aih '^^ iM-^ifiCo /^^> c '-r ivA^nV (ibtovii^7 lA^/firm iji>/h7<£^i^ 

^1 

Owner Signature //y. 

Contractor Signature 
X 

iyML\ Omaha Lead Site—Fixed Price EP-R7-07-05 ° J^^^L l Coastal Environmental Group Inc. 

Sy^^ ^ vwww.coastalhazmat.com 

%«,att^ COASTAL ENVmONHENTAl 

C H 0 U P , INC . 

EXECUTIVE SUMMARY: 

20688—1230 s. 10^" ST 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Total Quadrant Square Footage to be Excavated ' 6S87 

Property Classlflcation 80C Total Drip Zone Linear Footaqe to be Excavated = 0 

1 • 1 

— - • ­

- • 

: . r 

L 1 -L 1 

1 ; • . ' ^ i 

B1 = 10PP M 1 • '• •: y \ 1 1 1 

[,_•....„ > ' 3 

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Legend OLS#:20775 { NorthArrow Omah a Lea d Site 

Omaha. Nebraska 

'7 - Date Excavated:6/9/07 i • ^ 

Dal e U S EPASigfte dOff:7/2/07 ^ ^ Propert y Numbe r 

OLS - 2077 5 

existing Struc L _J ure Scale 

Propert y Addres s 

1 Inch = 30 ifeet or 1 grid = 5 X 5 n ' ^ 123 0 S 10 S T 6? g<Qjj ,=...«.. = ... ,.=..>.^=p,..M 

— — Quadrant Boundary Pos t Excavatio n Concentration s (ppm ) 

F1 R? Plav Area - Street Boundary v^/= '•*yd.r.*:«.r.inO'f. ''' ' 

Tre< !/St irut ) X < > • >v*« y B 1 _ C>arc en o t h er 

- 1

Descriplian al post excavabon area% F 1. front yard left-hand quadrant F2. front yard nght-hand quadrant, Bl , backyard ien-har>d quadrant B2 backyard nghl-harxl quadrant 

J OZ. drip ztxie (1-3 tool area of soi anMjnd the (oufKlation of Ihehouae) 

Legen d 

Area not Excavated 'yj Dripzone Excavated 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l

Quadrants Excavated 

 Group Inc . 
Property Completion Agreement 

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

signature will designate that 1 am satisfied with the restoration of my property, and that no items are in 

questions, now, or at any time in the future, except those items listed below, if any. 

Property ID: ^0^^6 

Property Address: 19-^3 SP0\^^P. Owner: UJilliani dohpsivyj Phone: ^P5-(j?7/ l 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

I M l agree restoration is completed, except as noted 

 I I do not agree restoration is completed 

Owner's Signature Date 

I
SEPA • 

EPA Property Close Out Form 

Property #: 9377'5 Property Address: /^i 3 0 ^./O^^- h 

Date/Time: Owner's Name: / J ) I /117/171 J O h /idl ) n 

Quads Excavated: Contractor Group 

Excavation General 

Yes No 

1. If necessary, were the correct quadrant(s) excavated and restored? y ' 

2. If necessary, were the correct areas of drip zone excavated and restored? ^ ^ 

Grading Sod and Vesetation Yes No 

1. 

Does the grading aroimd the perimeter of the house in excavated areas generally slope away y from the house? 

2. 

Has sod been laid in ail areas that were excavated? 3 

3. 

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

y day time period) 

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

5. Are the joints between the sod strips generally tight? fOnlv evaluate if inspected at a 30 day 

time period) -S^TYV..*. "Sr^x-^j tTk ^ II' ^ A-OTI*-^ 

0 \ 0 

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

7 ». 

Was damage to landscaping or plant materials avoided? ^j ^ 

Gates, Fences and Retaining Walls Yes No 

I. Do gates open and close freely? (If applicable) fJk2.

 Were all gates or fences taken down duringrestoration activities reinstalled? (If applicable)y(;A 

3. Was damage to gates or fences avoided? (If applicable) i /J A 

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

Foundation, Siding and Gutters Yes No 

1. Was damage to the siding or trim avoided? f)^ 

2. Was damage to the foundation avoided? |J A 

3. Was damage to windows avoided? \ f^ 

4. Was damage to windows or door screens avoided? tJV 

5. Was damage to downspouts or downspout extensions avoided? AK 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? ^ ^ 

2. Was damage to walkway surfaces avoided? /JA 
Owners comments: 

Inspection notes: 

iJ ^ ^/lihu-^ ^ ^ 

Removal and restQralion_activates complete including the 30-day sod warranty: 

EPA ^t^xQstmi>iyy>7jAz7.^^^Jiajuh^^^^ Date: 77^/ 6 J