TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

-> 1^ SAID *:_M. Date: 

Address: Q^l < ]M\ll\^>cy^ ^ f 

Remediation Contractor: _Coflstal Environmental Group_ 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

4 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

•cr 

•fr 

Restoration Agreement 

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

Confinnation data 

Photoglyphs (jC^A'llovn V ff t I^^Q^fttW^ 

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 

tr . Utility clearances 

Property infonnation from Douglas County Assessor's OfTice 

Year; 200i r 

V 

V' N 

Signature )ate 

30054779 

Superfund 
» • « • 

Property Access Checklist 

Property m : j<l)pj(L | 

Property Address: ^^^^,•||f^rV ^ 

D

D

 WORK STARTED 

 WORK COMPELTED 

ON:

ON:

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/ 

/ 

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^^"^ KrcA Rij?^gy^ 

Address: 

""""^ ^n^. .^n^. 5^<r.r 

Fax: 

Cellffager. (^^Q ^ ^9^ 9 

Renter 

Phone: 

Fax: 

Cell/Pager: 

Additional Infonnation: 

D NotHIcfltion Letter 

^ Access Agreement 

j2v] Restoration Agreement 

D Topsoil Sampling (if applicable) 

D Disposal Sampling (if applicable) 

D Garden Sampling (if applicable) 

^ Utility Clearance 

t3^Video/Photos (Before) 

0 Video/Pbotos (Dnring) 

D Video/Photos (After) 

D Video/Photos (30-Day) 

[^Property Compietion Agreemat 

D Final Report 

Sent: / / 

Signed: JQ./X/(2 . 

Signed: _/i/J_/ ^ 

/ / 

/ / 

/ / 

Callcd-iiL/3_<39-

On; [D / r3 / q 

On: / / 

On: / / 

On: / / 

Siffted: JJ_J^IJ2 $ 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

By:

^yBy: 

By: 

By: 

By: 

By: 

 \n\^ ; 

 Aiop ^ 

Air Monitorine (as apoiicable) 

DCommonlty DCrcw 

Results: 

On: / / 1 1 

D Commnnity

Results: 

 DCre w | On: / / By: 1 

DConmranfty

Results: 

 QCrcw On: / / By: 

Omaha Lead Site 
Douglas Coimty Accoimt I ii£ujM|ion Page 1 of2 

Douglas County, Nebraska Property Record - R1816060000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - VJeW DO Ma p Infomiation is valid as of 2009-9-15 Treasurer's Tax Report 

New Feature ^ ^ ^ Auto Sales Search 

Owner 

ROSENER KENNETH P 

ETAL 

4415 WILLIAM ST 

OMAHA NE 68105-0000 

Propierty Informatio n 

Key Number: 1606 0000 18 

Account Type: Residential 

Parcel Number: 1816060000 

Parcel Address: 4415 WILLIAM ST 

OMAHA NE 68105-0000 

Legal Description: MORTON MEADOWS LOT 4 BLOCK 3 54 X 138 

Value Informatio n 

Land Improvement Total 

2009 $6,800.00 $165,400.00 $172,200.00 

2008 $6,800.00 $165,400.00 $172,200.00 

2007 $6,800.00 $146,600.00 $153,400.00 

2006 $6,800.00 $146,600.00 $153,400.00 

2005 $6,800.00 $146,600.00 $153,400.00 

2004 $6,800.00 $108,200.00 $115,000.00 

Sales Informatio n 

Sales Date: 1997-06-04 

Deed Type: Book: 2064 Page: 079 

Price: $98,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.17 7452.0 1.0 138.0 54.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl8... 9/17/2009 
Douglas County Account In£arB||tio ^^HHtj n Page 2 of2 

Building 1 

4415 William St 

RANCH 

.J 1 •SW 

• r vr 

»f» 

^^L_p^L_r 1 "S*"**-

CLICK TQ ENLARGE IMAjgE CUCK TO ENLARGE IMAGE 

Square Footage: 1820.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: I Average 

Unit Type: Condition: : Good 

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

HVAC: Central Air to Air Rooms: I 8.0 

Exterior: Frame Vinyl Untts: ! 1.0 

Interior: Plaster Baths: 2.5 

Roof Cover: Composition Sliingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: I Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1925 0% 1925 83 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Blocl< 8 ft 1050.0 

Basement Minimal Finish 650.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Fixture Bath Half 1.0 

Garage Detached 484.0 

Porch Slab w/Steps 16.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R18... 9/17/2009 
Page 1 of2 

Create Another Ticket; Back to Irth Internet '. Send Emaij J 

YOUR TICKET NUMBER IS 2388326. 

Original Call Date: 10/17/09 Time: 1:16 pm Op: ELIZABETH18790 


Work to Begin Date: 10/21/09 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4415 Street: WILLIAM ST 


Twp: 15N Rng: 13E Sect-Qtr: 29-NW 


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: 4ft Corner Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


BSHPCLKS CXCATV MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number Utility Type 

BSHPCLKS NEBRASKA HEALTH SYSTEM NA 

Day: 4025523460 

Alt: 4025523347 

Emerg: 4025595111 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Ait: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/17/2009 
Page 2 of2 

OPPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/17/2009 
OLS#: 19814 As-Built Drawing Date Excavated: 10/28/09 

Date USEPA Signed Off: 11/10/09 

COASTA

ENVIItONMENTA

L 

L Omaha Lead Superfund Site Area Sodden: 21 so ft C R O U r , IN C 

f­ Name: A^e/)n*/A ^^Stf^iC r 

Addres: 

Phom 

ess: VV/^ " h7?l lj(i£U43=3 i'l . 5-6SS 

Omaha Lead Site 

Site Sketch 

Date 

Time: ^ North AiTow

) 

—1 

Team %«•>, \ ICin/tt'^ jCr^i ^ BVID # I' ^ ^/ V XRF Code ^^Ol . 

Sample Number Lead Concentration 

l/>^±^S 

i n ± 1^ 

iUI±&<^ 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

Confirmation

'^i'Yes a 

/^ZYes d 

S l Yes a 

^ZYes CD 

^2rYe s n 

6 Yes n 

Yes • 

 Sample 

No n 

No n 

No Q 

No D 

No n 

No • 

No • 

DZ = 61 PPIVl @ 6" 

EA=146PPIV1@1" 

Legend 

Concrete m 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 . 
i 

a {6ji 

Omaha Lead Site Date: V^ North Arrow 

Addres f ^ 15' h/:l l U n>uj> J-/ , Site Sl<etch Time: M 

Phone^ 7<g^)>5-5'6-5"4SS 

CA^^ H^^ ^ 

^5W 

Team r«.u //<Jw/e^/<^<^/ ^ BVID# /* ? W y XRF Code ^^CZ . 

Sample Number Lead Concentration Confirmation Sample 

l^$ ± g / 

//y 113 

i5>l±- ^ lBh±'ZO' 

fUI±i ^ 

^ICi±^G 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

F/Yes

/^ZYes

/g l Yes

^2.Yes

.^2^Yes

. G Yes

Yes

 n

 CD

 n

 1^

 n

 n

 •

 No I^J 

 No n 

 No CD 

 No f^ 

 No n 

 No D 

 No • 

"1)0 fO ^ 5Q3> 

Wuu^^i^ isr. 
I Name: KeAn^jl ^ fCc^^^e r Omaha Lead Site Date: 1 IjlO J North Arrow 

Address^"^/S'\f:\\x ^ y ^ S-f. Site Sketch Time: ' lA^ O 

Phone^ *fO^^S^(.>~^(^SS 

C^U Mi^A^ 

Team ^ o \/ C MC* \ J Crcy / Q BVID # / ^ W V XRF Code .5:^(3' Z 

Sample Number Lead Concentration Confirmation Sample 

evA.^cPk:AM^gf^ 

ppm '"''Yes D No I ^ 

^ ppm /^ZYes n No [^ E /5/±.-^ 

ppm ^/Ye s n No n IBI±'2C^ 

ppm ^ZYe s [=J No ^ 

ppm *^2rYes D No n 

^ ^lh±^Q > ppm . G Yes D No n

ppm Yes • No • 
Name: /^^n^V A jg^Stf^er 

Address: VV/g " h/.-</r<i*vua S-f. 

Ptione^VtfaTa-S-6-5-y6s ' g 

Omalia l.ead Site

Site Skatcti

 Date: 

 Time?i : ^ NorttiAnrow

) 

—i 

Team %*,u IjCiut'xjCr^i ^ BVID # /^^ N XRF Code 5^0-2 . 

Sample Number Lead Concentration Confirmation Sample 

m 

Ta ti 3 

/5>£<ZZ 

f^SI±£ ^ 

f-lfi±'^C> 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

F/Yes

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 D 

 1=] 

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a 

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No ^ 

No a 

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No • 

No • 
.^^'^IT'V 

COASTA l IHVlRONHIhTA l 

C R 0 (I r . > N C 

Consent for Access To Propefty 

RIGHT OF ENTRY TO PREMISES 

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

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

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

following described premises: l^^)/ / 

Owner's Name: Daytime Phone: 

Address of Property ^jt/ i ^/V<r*~-^ ^" ^ covered by this yy/? Agreement: 

PURPOSE OF RESPONSE A 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 
.,^«'"'>, 

I 

COASTA L tttVI«OHH»KTA l \^-^A CROU P IN C 

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

piles, dog houses, etc; 

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

to save; 

c 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. 

o 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 tentl 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 

^ grant access to my properties 

D I do not grant access to my properties 

Signature 

Date 

Q I wouid like to be present during any sampiing that is required. 

Page 2 of 2 
4 

Restoration Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions of the properly 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: /^•^/• ^ 

Property Address: ^ ^ |<^ V>^)lL/frv^ ?-^ 

Owner: ^^^./v 

Pbone: *3^\a- S ^ ^ 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 lemovai. storage, disposal, and/or return of these itoms Is the Owner s responEibiiity. 

Kem: 

'""^n.-i* / / 1 ly<h^^ 

Kem: 

Kem: 

Kem: 

Items to iae Removed by the Contractor During Remediation and Wot Replaced 

^ ^ 

L (( ^U^A 

Kem: ^ 

Kem: 

Kem: 

Page 1of 7 
p 

COASTA L 

Items to Be Removed By Contractor During Remediation jand Replaced^ 

Kem: 

Kem: ^ 9 

Kem: 

Kem: 

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. 

Attach il sketcli ul tlie 

.'•r''''''l»lci tiiv'.nii. 

Number of and size of 

each gardeiv/ flower l>ed 

area. 

AlliRh ;i skcich ol a-!;nivf 

>i;'t's nnd loc;llilVI^ 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

N'OIr Ihi" \H1IIC \\ill ni 

usrc' 10 is;iii il ;)lHn; 

louciu': Id the |3ro|)Cii> 

ui< ner. 

Easement Area, to be 

excavated 

Quantity 

^A 

5 

/ 

y.^') 

Landscape Inventory 

Unit 

Quadrants 

Each 

Each 

Each 

Each 

Square Feet 

S 

Condition/Type/Species 

Each \ y^"^—^-CA'''-^y->\ 

^ Page 2 of. 
# 

COASTA L 

Addftional Comments / Instructions: 

^-Gheck the tx)x rf Owner does not want CEG to document interior foundation vralls and possible 

pre-existing damage. By checking this t)ox CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

r~ll do not agree 

CAQRdf) Ibntractor's Signatare Date 

Page 3 < 
• 

BVID , M^H 

XRF PROPERTY SAMPLE SHEET 


Date /0-2^-DH Address ^t/K^W///,o.rvN<; .'=:iProiect Omaha lead FP 2nd year option Sample time am/pm 

XRFID# sample length 30 sec 

Shot# Reading Sample area Shot# Reading Sample area 

9 6 IG<^ ^ U ^ o 3Vitt i 

'St, \tfn±\ n e <^ W/ /6Wt/ 8 PH. 

tZH t If : Depth ^2 . YLJ ^ 10 Depth eo 

1 " 

Average /V6 ti c Average C>l ±12 . 

Shot# Reading Sample area Shot# Reading Sample area 

6 0 iiizjtia QiZ. 

6-2, « 5 c It / Depth Depth 

0 R iF^^i n '^- ^ ^/ t w (^' 

qy^ ^ / ^ 

8 3 1>2.7J^^ ^ 

Average / 7 "^ w Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth y ^ Depth l 

X / 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

Signature, 

Print \KHALn V^r^s 
X 

* A 

ii^A^\ Omaha Lead Site—Fixed Price EP-R7-07-05 

I J^^ ^ ° Coastal Environmental Group Inc. ^^^^ ^ 

Sr^^y^ www.coa8talhazmat.com ''^ ^ 

%PRO^" ^ COASTA L 

INVIIONHtNTAL G I 0 U P, INC ' 

EXECUTIVE SUMMARY: 

BVID #19814-(4415 WILLIAM ST) 

No Issues or Concerns Issues/Concerns 

Detail Explanation: 
dEm 

« 

EPA Property Close Out Form

Property #: _ 

miff „^,,^.mxMM£ Property Address:* 7; ^ "s^

DatcHlmc: 

Owncr'ii Name: Name:.

. iJa/S.^-Q MJS.-**J.. ... J r J .y\,' j>. 

Quad! Excavattd; £)'g- . ^ ^ 

Contractor Group A^ftr9^,yf7t^ Qnyr-U Pyj 

Excavatioi Yes No i Generat 

I. If necessary, were the correct quadrant(s) excavated and restored? 

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

Grading Sod and VegetatloB Yes JNo

1. Does the grading around the perimeter ofthe house in excavated areas generally slope away 

from Ihe house? 

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

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? (Only evaluate if inspected at a 30 day 

time period) y 

6, Was the property graded such that water will not pool on the propert>'' y 

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

Gates, Fences and Retaining Wails 

Ves No 

I. Do gates open and close freely? (Ifappiicable) [ y 

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

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

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

Foundation, SidinKand Cutlers 

Yes JWo 

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

2. Was damage lo the foundation avoided? Y 

3. Was damage to win<k>ws avoided? 

4. Was damage tc windows or door screens avoided? - ^ • 

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

Sidewalks and Drivcwayi (Concrete) 

Yes No 

1. Was damage 10 driveway surfaces avoided? ^ 

2. Was damage to walkway surfaces avoided? T?' 
Owners comments: 

•

Inspection notes: 

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

EPA Representative / jCTh iJOy^A ^ D-dXt.jI/fO/0? 
Property Completion Agreement 

Ihl i agreement documenis lhe compielion of remedial acliviiies perioimed on my properly My signature 

will designale ihal I am satisfied wilh the restoration of my propei'ly, and thai no items are in questions, 

now, or at any lime in Ihe future, except ihose ilems listed below, ifany 

Property fD: miE 

Properly Add,,.,. ^t^f< r Q ),• liUs^>M •=. "^ T 

Owner: 

'"• jAO ^ ^^serl^d/ ^ 

Phone: ^?7r? - J/a^ ^ 

Restoration Items in Question: 

Item: 

Hem: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

lyTTlnirc c (c.^torflfion K coniptcced, except KS nolert 

[_) I rto not Jt^'rec rcsioratinn i i completed 

nfisfini'sS SignRliir Sipnaliitc c OAIC 
Property Owner Satisfaction Survey -^^2003 

Omaha Lead Superfund Sit S / lOC n r-,. 

2008 ^^^^f^f=UND oivisioi Remediation Contractor: Coasta Coasta l Environmentai Group . V 

Property Identifier Number:, mi 

Property Address: ^^1 5 SAtZ- Properly Owner's Wame: 1/f^J^ r-^fi^g^t'^'t — 

(above information to be filled out by remediation contractor prior lo delivery of form lo Property Owner) 

Instructions to Property Owner: 

This form is provided to you as a means of trying to capture your level of satisfaction with the 

worl( of ttie above-identified remediation contractor, as applicable to the soil cleanup action at your 

property. The U.S. Environmental Protection Agency (EPA) is very interested in your opinion regarding 

the worl< performed by its contractors. This form is intended to provide an easy means for you to 

express your opinion about the work performed on your property. 

Please indicate your level of satisfaction with the contractor's worit by selecting a numerical 

rating {ranging from 1 to 10) using the following rating scale, then please sign and date the form and 

return it to the USEPA in the attached self-addressed & stamped envelope, (additional comments may 

also be provided in the space below, at the option of the property owner.) 

9-10 "excellent" 

7-8 "very good" 

5-6 "acceptable" 

3-4 "poor" 

1-2 "very poor" 

Property Ovvner's Satisfaction Ratine Regarding Contractor's Work 

5 ( ^ 

8 3 

7 2 

6 1 

Additional Comments from Property Owner (optional: continue to back of paee If neededl 

Property Owner's Signature: Date:_ ^ /f/^^