TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: nl^l l Date- ^//(/Z£>07 

Address: 23Q( S 31 SW f 

Remediation Contractor: Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

M Video of property (DVD) 

w Executive Summary 

0 EPA-provided property sketch 

0 Signed Access Agreement for subject property 

D Si^ed Access Agreement(s) for adjacent property 

W Restoration Agreement 

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

s/ Confirmation data 

W Photographs bei<KC ^ S)cl 30'0(i J 

0^ As-built sketch J 

M Satisfactory restoration signed by Property Owner 

M Property close-out check list signed by EPA y/- ^ ^ 0 j 

D Description of areas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas County Assessor's Office 

^ flM^LdupOA. 

D 

f Dsnd 

40317115 lllliiiil 

Superfund 
Property Access Checklist 

Pioiicitv ID: /76// 

PiopcMtv Addicss J . ^ i ~ S 3 I S t 

n

n

 ^^ORKST^,RTED

 WORKCOMPELTED

 ON 

 ON 

/ / 

OVMICI BLC dxr\ Hc>or-^ 

Add less 

Phone 

F.i\: ^y^^hx^SdSs:!­

Cfll/Paucr 

Rcnlei 

Ph(mc 

Fax 

Coll/P.i«'oi 

Additioii.il Iniui in.ition 

L ] \ of if nation Lcttci 

^S \(.n.'ss \<"u'cmcnl 

! j ^ Restoiation \<4ieeiiieiit 

! ( Topsoil Sainplini; <i> applitiihle) 

LJ Disp<»sal Sampliiii; (it applicahle'i 

d ] Gaideii .Sainpliiii; (if appliiahle) 

^ litihfv Cleaiance 

Sent 

'^luned

Siiiiicd

Called 

Bv 

 IQ I Z^//)?- ! Bv 

 <V'' /p- / ^/ j Bv 

Bv 

Bv 

Bv 

Bv 

n

O

n

D

 N ideo/Photos (Befoie) 

 \ ideo/Photos iDiiiinu) 

 Ni(leo/Photos(Aftei I 

 \uleo'Pliolos(3(l-Dav) 

On 

On. 

On 

On 

Bv, 

Bv 

Bv 

Bv 

n Piopertv Completion A'j;r eeineiK Si'^ned­ / Bv , 

1 1 Final Repo rt Issiii d / / Bv. 

All Moniloiin<; ( 

1 1 Communitv 

1 Results: 

as applual 

D Crew 

)le) 

I 

i On / / Bv 

1 n Communitv 

, Results. 1 

nc.evv 1 

1 On / / Bv 

LJ CominiiiiKv • Cie,, On / / Bv __ _ . ( 

1 ResultsOmaha Lead Site 
Property Access Checklist 

Property ID: lli^H n WORK STARTED ON: / / 

Propertv' Adilrcs.s: D WORKCOMPELTED ON: / / S^o/^.'3l^^f 

Owner: 

Renter: lUtcian /UoDZ-e 

Addrcs.s: (_/ 

Phone: 

Fax: 

Cell/Paj^er: 

Phone: 

Additional Inl'orination: 301-/0^^ 

Fax: 

Cell/PaRcr: 

D Nolificatioii Letter Sent: / / By: 

\SL Acces.s Agiecmcnt Signed: Q) 1 i9~l OZ By= /l/ci^z 

Q - Restoration Agreement Signed: LP 1 /cZl 0 ^ B.V= /Z/Z y 

CH Top.soil Sampling (if applicable) 1 1 By: 

n Disposal Sampling (if applicable) 1 1 By: 

n Garden Sampling (if applicable) 1 1 By: 

~ ^ Llility Clearance Called: {p 1 f? 1 C^ ^yZl nSllZM 

• ^ Video/Photos (Befoie) On:_i^lZ[/nZ ^r./ZiZl^ 

D Video/Photos (During) On: / / By: 

0 Vidco/Photos (After) On:\Su/^/ ^ By: <UQ> N 

n Video/Photos (3()-Da.v) On: / / By: 

1 1 Property Completion Agreement Signed: / / By: 

n Final Report Issued: / / By: 

Air Monitoring (as applicable) 

n Community O Crew On: / / By: 1 

Results: 

1 1 Community CH Crew On: / / By: 

Results: 

CH Community CD Crew On: / / By: 

Results: 

Omaha Lead Site 
Totali Jrant Square Footage to be Excavated = 921 

Property Classification: 800 TotT I Zone Linear Footaae to be Excavated = 82 V<:r 

Legend 

•—•—• 

o 

Concrete 

Excavated Area 

Existing Structure 

Fence 

Pennanent Landscaping 

Quadrant Boundary 

Street Boundary 

Tree/Shmb 

Description of post excavation areas: Fl, 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 area of soil around the foundation of the house). 

North Arrow 

Scale 

1 Inch = 20 feet or 1 grid = 5 x 5 ft 

..^W S'^v 

O Fl . '.¥ HG L 

-*i*i h ~ 

F2 

B1 

Omaha Lead Site 

Omaha, Nebraska 

Property Number 

OLS-17611 

Property Address 

2301 S 31 ST 

Post Excavation Concentrations (ppm) 

B2 Play Area 

DZ Easement 

Garden Other 
Property ID #

Property 

Address: 

Initial Contact :

Second Contac:Vt .

Final Contact 

Final Action: 

Comment: 

Owner 

Comment (s). 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 i^V-UW 

^V 

g ^ cpy. ^ ^ \ 

 DaiQ: Z/^2'/o? Time: /^f66, U.-> Action: LzP-f- l^o^x.^,, 

 Date:^/l^ ~Time:V4x^f^ Action: UiZ li^'^. 

Date: Time: Action; 

Transmit to EPA D Other Action: D 

\o\c\ "l't( / '^li ^ v^i"^'^ l ^ "^^^ 

N'^Cl^ IHv b?'f V ^ Y\{z^ 

'W^ I'k'fv ^ f{t1i/H^ fVio^)h,\ C K 
v^-<>'"•'" ; 

•" rniiv'"' 

Consent For Access To Property 

RKiHTOI'ENTRYTOPRIvMISIvS 

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

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

enter and perform certain enviioninental response activities upon the following described 

premises: 

Owner's Name: 

Daytime Phone: 

/Tr, ^ 

Address: „ 5 . f>^' ' II 

Address: 

Addresses of 

Address:

' Pi'operties covered by 

this Agreement: 

Address: 

Address: 

PuRPosi; Ol' Ri':spoN8ii AcTivrni'S 

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

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

will be reiTioved and the excavated area(s) will be replaced with tlean inaterials 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 tliat the property has been remediated. 

ENVIR()NMI:NTAI, RIJ.SPON.SI; ACTIONS 

F3y signing this Access Agieement, the Grantor is granting the EPA, its employees, 

contractors and subcontractors the right to enter the propeity, 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 agiees to: 

«Pj:opcrt;y T.D» Page I of 2 
' Remove obstiuctions including boats, liaileis, vehicles, playscape items, wood 

piles, dog houses, etc, 

" Remove llowei bulbs oi plants that the Grantoi oi the Gianlor's tenant mav wish 

to save, 

" VVatei and maintain leplaccment vegetation, including feililizci application, as 

ncccssaiy subsequent to an initial watenng penod by EPA, 

Abide by health and salety guidance piovided by EPA, 

li'thc piopeity is rented, assist CPA in obtaining tenant appiovai for access to the 

piopeity to perlbim the woik if EPA is unable to obtain such access, and 

• Allow videotaping and/oi photogiaphy of the pioperty including exteiioi and 

inteiioi aieas ofbuildings 

A(.RI I VII NI Noi To INII Ri i Ri 

The Giantoi agiees not to mteifeie or tamper with any ofthe activities oi v^-oik done, oi 

the equipment used to peifoim the activities, oi to undeilakc any actions icgaiding the 

use of said propeilv which would lend to cndangei the health oi welfaie ofthe Giantco-­

01 tfie enviionment, oi to allow otheis to use the pioport\ in such a mannci 

Should you ha\c any questions about this piogiam, picase conlacl 

gtiiji I I I do not giant access (o m\ piopeitics t access (o my pioperties 

Smiialiirc Date 

nL_l I vvouki like to be picsent duiiiig anv sampling that is leqtiiicd 

Page 2 of 2 

« P..ope : r / _ 11' 
Restoration Agreement 

The purpose of this agreement is to provide a nnilual agreement as to condmons of propertv prior to 

remediation aclivilies This will also serve as decontamination for the purpose of assuring that 

restoration activities are completed to the satisfaction of Ihe propertv owner and the United Slates 

environmental Protection Accncv (EPA) 

Propertv ID 

Property Address 

^Irt/ Z . 31 5C-

Owner 

f (t-p.<t^ zn ^CtJt , 

Phone 

f -^e^^-^mfe- ?)0l'l0^ 6 

On the attached diagrani(s) indn.aie area(s) to excavated and depth of excavation location of all known 

utilities subsurlace features, surface structures and landscaping features access locauon(>,) to be I'sed b> 

contractor and (he direction of North lndii.ate distances depilis niaierial rvpes etc I idic,;te C^'L-'UII plK''ti.^^ 

b> referoncuig the photo-log nu.iiber vMlh a'l arrow indicating direction of v lew 

Items To Be Removed By Owner Before Start Of Retr^edict'or;, 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these items is the OA-ner's rssponsibihty 

Item 

DUnfl^mc^Sk ) o V.Z. Item. 

\ 

Item ^^ ^ 

Item y^ ^ 

Item / 

Item / 

Item / 

Item. 

Paqe 1 of /) ^ ^ 
l«* 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

\\^icW [^ \z ~ -^T ^ <^:kz. OtiA^^A^ a.^'k 

Item: 

5 o f U^aO^i^/ . \^A^ L Xo^cA. , HiA^ ^ A.V /Z^,ci-..r 

Item: 

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Item: Z 

Item: Z 

Item: y ^ 

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Page 2 of i£ 
Items To Be Removed By Contractor During Remediation And Ho 

(Use additional sheets as necessary) 

Item: 

(X-\)C /ZnrJ^s A/i,^ L?^;r]c iVo S z A/.f.A ^ 

Item: 

[LM^z) 

Item: / ^ 

item: / 

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Item: Z 

/ Item: 

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Page 3 of. k 
Km 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity 

l'ic-c\i,sling ]-)ic)pcrly arcii 

tlinl i,s covered vvilh griis,'^. 

Niiinbcr ol' trees > 2 inch 

trunk dinnictcr 

[ 

2 

Nuniher (if trees <= 2 inch 

trunk diameter \ 

/ 

Number of .Sprinkler 

/ones, Cciiitrol Valves, 

Timers, 1 lends, etc, 

Allaeh a skeleli ii\ the 

s|innklei- layoiil. f 

Number of and si/e of 

each garden/ I'ldwcr bed 

area, 

Allaeh a skeleh of relalive f 

1 Unit 

Square feet 

Condition/Type/Species 

liach 

Z>^ynZ{ 1 

I inch 

I'ach 

\ 

liach 

.Square I'eet 

sizes and iDcalunis. 

Page 4 of ^ 
((0* 

Item Quantity Unit Condition/Type/Species 

Agreed ii]ion value ol' 

]ilanl malerials nol Ic be 

rejihicccLby eontiaclor. 

Niiie I Ills \aliie will be 

irsed 1(1 issue ;i plaiil 

viiiiehei 1(1 Ihe propeilv 

o\\ iiei 

Agreetl upon list of planl 

malerials Ihal will bo 

replaced by coniracior. He 

veiy speeific and delailed. I'inch 

Ineliide a skeleh ol were 

e.-ieli pl.iiil will be placed 

b\ tlie eoiiti.K'loi 

Agreed upon area of 

]ii'o|ieity lo be replacetl 

Willi grass sod, 

S¥ 

Inelude a skeleh ul Ihe 

arca(s) lo be u-plaeed wilh 

i:rass si ul 

Area ofCilv or C:ouiily 

pro]ierlv lo be landscapcil 

per their rec|uireinenls. ShIiieliiile ;i skeleh >'!' ilie 

area I si 4t? 

ot. WWv.S,t ' h ' 

Page 5 ofi^ 
K0^ 

Additional Comments / Instructions: 

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. 

0 1 agr C] I do not agree tgicc n I do not agree agree 

/fj^^zlop zzm 1 cK- c \i^m 

Ovvner'sfiisnatur Date Coiwractor's Signature Date 

Page s of \ j 
Total ' Nirai It Square Footage to be Excavated = 921 

Property Classification: 800 1 Tot ^ one Unear Footaae to be Excavatec "^T i F : 

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Legend NorthArrow Omaha Lead Site 

fV' •'A ConoEte Omatia. Nebraska 

[/"/ j Excavated Area Property Number 

OLS-17611 f 1 Existing Structure Scale 

•—•— • Fence Property Address 1 Inch = 20 feet or 1 grid = 5 x 5 tt 2301 S 31 ST K ^ Permanent Landscaping 

^ ^ ~ • Quadrant Boundary Post Excavation Concentrations (ppm) 

- Street Boundary 

Fl B2 Plav Area KydroGed-ijch: i;K F2

 n 7 Fa!u»m(>nt c l^i? ) T ee/St vub \ «Pr -(S ^ 

Bl Gan Jen I othe r 

Oesixiption of post excavation anaas: F1 , front yard left-hand quadrant F2. (rant yard right-hand quadrant 81 . bacdiyaid left-hand quadrant B2, backyard right-hand ciuadrant; 

DZ, drtp zona (1-3 foci area of soil around Ihe foundation of the house). 
= RCFERT"r CLS^kRANCt rtui-^:-i.i, '.^ 

Date ocopjn^ Property ID 1-7& I 

Property Project Omaha Lead -- Fixed Price Address ^3o i •=5 3|s-r 

Measurement XRF ID Count/Time 

Field Shots 

Shot # Reading Sample Area Shot # Reading Sample Area 

0{01-5\ 

^ SEC3 i SX r g^ ^-/4" 

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Sample Area f^~/ X ) Pass/Fail ? 

Aliquot 

1 1 

I n Situ 

Reading Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent 

7 

Lab 

Number 

Analytical 

Results 

2 1 ; *R~7 r-^ / 1 

1

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(use calibration ctart c- -li i 

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I I n Situ I Composite I Composite Analytical Miqjc t Cc-"pcsite Readiros Lab I Analvticol I Reading i I Average > (Dried & Spilt Sent (Bag) Numbe.-! Results I (Bag) i Sieved) 7 

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(use calibration chart or ace 

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Sample Area P Pass/Fail ? I /»-^" 

I n Situ Composite Composite Analytical Aliguot Composite Readings Lab Analytical Reading Average (Dried & Spilt Sent (Bag) Number Results 

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2 1 1 1 T l 1 

3 1 5(Jo 1 1 1 

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XRF Correacd Value --> 

^ 7 (use calibration chart or add 

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Sample Area | Pass/Fail ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Reading Average (Dried & Spilt Sent (Bag) Number Results 1 (Bag) Sieved) 7

Confidential 5,2,07 cece 
3 

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XRF Corrcd^^alu c - > 

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Aliquot 

1 

I n Situ 

Reading Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Drie d 8. 

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Analytical 

Spilt Sent 

? 

Lab 

Number 

Analytical 

Results 

2 

3 

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XK,c To^>-,ric 31 s S gpitu'e 

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Confidential 
XRF Dt^lLY CALlEFATION WORI-S-EET 

Date cxolr^jm- Projec t Omaha Lesij -- Fixed Price 

XRFIDOiQ7-5/ 

Measurement Count/Time 

c clibrEtion Verification C^e; ;ks 

Reading Blank Low Med HiQh 1 

~rue Value v.. J frW ^ 18 9 CD-^ 1.52 C Dcm 5532 0 ppm I 

:2C% 22 7 ppm \59 ^ ^ DDm £633 4 pcm | 

1 80% 15 1 rem 529 6 :ipm •i-lS 5 :c ^ 1 

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X 

COASTA L ENVIItONMENTAL 

CROUP . IN C 

Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

vvww.coastalhazmat.com 

EXECUTIVE SUMMARY: 

17611—2301 S. 31'* STREET 

No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 
^ As-Built Drawing 

(ffiiaha Lead Superfund sR 

Total Quad-am Sc-jare Footage lo E< Excavated = 921 

Property CHwilicatKW), 800 Total Dnp Zone bnear Footage lo be Excavated » 82 

Legend 

Are a no t Excavate d }f//A Dripzon e Excavate d tXXM Quadrants Excavate d 

Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc . 
Property Completion Agreement 

This agreement documents the completion of remedial aclivilies perfonned on my properly. My 

signature will designate thai I am salisficd wilh the restoration of my properly, and ihal no items arc in 

questions, now. or al any time in ihc future, except those items listed below, if any. 

Pnipcrty ID: ini£ii 

Property Address: p-y^Di s. ,^/f s-h. Owner: l\zUoan Mooz^ 

Phone: W^'/09f5 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

^;.| iiKiT i O restonition is eompletetl, except as noted 

 I I do not aprec restoration is completed 

Owner*^ij;nalur c 7 Date ^!7niTractor's Signature Date 

I
>»tKA 

CTA Property Close Out Fo f 

Property #: _ nbll Property Address: 9^30 1 O^ Ol- ^ ST -

Datc/Tlmc: Owner*! Name: AUa/JJ ) MOOr-t ^ 

Quads Excavated: Contractor Croup ^ 

Excavation Gencnl Yes 

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

u^ 

2 If necessafy, were the correct areas of dnp zone excavated and restored'' *^ 

Gradin£ Sod and VcceUtion Yes 

1 Does the grading around the penmeter ofthe house m excavated areas generally slope away 

from the bouse? i - ^ 

2 Has sod been laid m all areas that were excavated'' • ^ 

3 Does the sod appear to be gcnerall) healthy and growing'' (OnK evaluate if inspected at a 30 

day tmie penod) t ^ 

4 Are sodded areas generally firm and evenly graded'' L ^ 

5 Aje the jomts between the sod stnps generally tight'' (Orl> e\ aluate if inspected at z 30 da\ 

u^ tiniK penod) 

6 Was the property graded such that water v* ill not pool on the prooeny'' 

%^ 

7 Was damage to landscapmg or plant TT-.aienais 2vo>ded'"' 1 — 

Gmlirv FCDCCS anit RcUinint >^a)is Yes 

1 Do gates open and close freeh "^ (If applicable) u^ 

2 Were all gates or fences taken doNv-n during restoration acti\ "les reipctc,iied" :,If apclicable) 1 — 

3 Was damage to gates or fences avoided'' (If applicable) t ^ 

4 Was damage to retaming walls avoided'' (If applicable) tJiFoundation, SidiDKand Gutters \es 

1 Was damage to the sidmg or tnm a\ oided'' u2 Was damage to the foundation avoided'' . ^ 

3 Was damage to windows avoided'' L ^ 

4 Was damage to windows or door screens avoided'' l ^ 

5 Was damage to dovMispouts or dow-nspout extensions avoided'' t ^ 

Sidewalks and Driveways (Concrete) Yes 

1 Was damage to dnveway surfaces avoided'' iJ4^ 

2 Was damage to waUrwav surfaces avoided'' ^ 

No 

No 

No 

No 

No 
Owners comments: 

Inspection notes: 

Remc\al and restoration acti\ates coT'p'ete inc'udirg the 30->:!a\ sod warrantA 

EP.A Representativ^6-y^Ii^^X^C^^^^«^^=4^^^ 7-/^-^7