TRANSMITTA L of OMAH A LEA D SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: 77//>&7e Date: S/n/O^ 

Address: ^^ / DaTO/lJ?/r S>h 

Remediation Contractor: Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

B^ Video of property (DVD) 

M Executive Summary 

s7 EPA-provided property sketch 

S/ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

y Restoration Agreement 

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

0 Confirmation^iata 

[M Photographs 

j / As-built sketch 

y Satisfactory restoration signed by Property Owner 

y Property close-out check hst signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas County Assessor's Office 

D 

D , 

D • •• 

^hk^ 

40317773 

liillllilillll 

Superfund 
Final Report Property Check List (piease place with each tiic)

Hard Copy Information ^ 

\ . Property Check List 

• ^ Site Working Drawing Map 

3^ EPA originals Map 

' 4.\Douglas County Assessor's Map 

SV Property Contact Sheet 

-Agreement 

1. Access Agreement 

XT?.estoration Agreement 

Miscellaneous Documents 

1. Final Map from the Field 

2. Change Orders 

X^CRF Data 

4. Any emails or PO correspondences 

Property Completion 

1. Executive Summary 

2. AS BUILT 

3xPropci1y Coinpletion Agreeinent 

4. Any buyout info or reimbursement info 

5. Check or money order copies 

V \ ^ EPA Property Close Out Fonn 

X^ttached Begin Video 

Electroni c Documentatio n 

Drawings 

^ . EPA original 

\ •- Working Drawing 

.3. AS Built.vso 

4. AS Built.jpg 

Photos 

Begin Photos 

During/Excavation Photos 

Sod Photos 

30-Day Sod Photos 

Scanned Documents 

' Final Documents 

7 • Executive Summary 

Videos 

^ Begin Video 

2, My Movie 

 ^^^ 6 y 

^ JTs/oT^ ^ 
Property Access Checklist 

Property ID: ^ A A , /^ ^ Q WORK STARTliD ON: _/ /_ 

Prop^Mly Achlrc^^^ ^ / T&Cg^_^"l W ^ ^^^'^"^ COMPELTED ON: / / 

Renter: 

.AddiTss

'^^.""•^-AoAje^

: 

^ UACKSC^ -

Plione: 

1

Fax: 

Cell/Pasiei 

A<klitional liil'ormatioir. 

•^So^cP/^-s?/!: 

Fax: 

Cell/P:i«'cr: 

• ^ Notification Letter Sent: 7)0

 /[^/. ^ ^ytUiy^ 

§ ^ Access Ajjreement Siiined:/0 I tbiCf } ^y CJyz\5 

H'^ Restoration Agieement Sit>ned: //Jl IIDIG' ^ 

I I Topsoil Sam|)lin<; (if applicable) I I By: 

I I Dis|)osal Sampling; (if applieahle) Bv: 

I I Garden Sain|)lin<i (if applicable) Bv: 

- ^ Utility Clearance 

Called: /O/^/C ^ ^y 0 ^ /0l^/l3 0 7'7/US^ ^ 

S 3' Video/Photos (Before) 0»^/2/^Zl7 ^jiMyzyxU Video/Photos (Durinji) On: Bv: 

D Video/Photos (After) On: / / Bv: 

D Video/Photos (3()-Day) On: / / . Bv: 

I I Property Completion A<j;reeinent Sijined: / Bv: 

n Final Report Issued: / Bv: 

Aiijyionitorint; (as applicable) 

1 mi Conununity CU CreM- On: / / Bv: 

Results: 

1 L J C(»inmunit.y JU Cien On: / / J Bv: 1 

Results: 

1 Cl CoinmiMiitv CD Crc« On: / / Bv: 

Results: 

i

Omaha Lead Site 
^"^^ / ^/^58 ^ ^6/j h y^ccts7 yMy^^ ) 

Name: L^YirXfl ^ rv\t\l^J ^ Omaha Lead Site Date: 6n-VS-C> 3 North Arrow 

Add ress^yy o -> \ T V rILV^< - & ^ Site Sketch Time: \ b '. I'S oci>\ 

Phone: 4^ - '^'^t - \1<=.*Z i 

Team C^Oo\c^ \ ^^Uy^e^vVUA. BVID# ^L.{^\ % XRF Code 1 'So ^ 

Sample Number Lead Concentration Confirmation Sample 

Lab 

•2&Q>\S 

'ZC.yH<rK 

RYDSCPLA-26618 

A 738 ppm 

%k^i: ^ PP"^ 

^e±3 j PP"; 

MeO^y j ppm 

ppm 

ppm 

^»Yes

\Ye s

Yes

Yes

 n 

a 

n 

• 

No I5D 

No 1 ^ 

No g 

No l-l 

No ^ 

No O 

No • 

i: "SeSvS^JX ^^/\o4 ^ I -^qjz^ .^.....^ 

46130 
Name: 1 JP^*NP^ r^Al^j ^ Omaha Lead Site Date: ftn-VS-C>3 North Arrow —i 

Site Sketch Time: Vt>: 1*5 o.* ^ 

Phone: 4n2 - 3Mt ~ ^2S S I 

Team C>^Oo\<i l ^Uy^t^VC-ow BVID# :?C-U\ ^ XRF Code 1 ^ Q ^ 

Sample Numtier Lead Concentration Confirmation Sample 

^»Yes tu No 50 

^ e s IP­

^Yes n No g 

^ e s 53 No D 

]l^±r 7 m ^Ifes a No ^ 

llgfgg ppm n No

 pppm 

ppm Yes • No O 

ppm Yes • No • 

RYDSCPLA-26618 Lab 

738 ppm 

! i : i; i 

^ V Ua A\\« ^ I li i^U*-^ Pel l

±1 

l i 

.4... - f­

• S i • i . ! ! y'^ 11 n/ ^ - 7 -X—^. .._...—^ .^, . —

- i- ~ -^L----iU- .^^ . 

04-

i -V 

• ^ i 

aM 

P ^ 

L:2L.J­

- ^ .;t . 

3770±^3 

....}. ^ ~ 

^\JAg.oafMg - SiAe...>|aii^j lawnvacc^ i •4VCC 

i!L)ie^U-^i:^..4h.J.. 1 

46130 
.Douglas County Account Information Page 1 of2 

Dougla s County , Nebrask a Propert y Recor d - R194653000 0 

Print Report Information is valid as of 2007-8-24 View on Map Values not finalized until after Board of Equalization Treasurer's Tax Report 

Owne r 

JACKSON ANDREW -f^W=¥=?^fz^ 

2421 DECATUR ST 

OMAHA NE 68111-0000 

Propert y Informatio n 

Key Number: 4653 0000 19 

Account Type: Residential 

Parcel Number: 1946530000 

Parcel Address: 

Legal Description: 

2421 DECATUR ST 

OMAHA NE 68111-0000 

PARKERS ADD LOT 4 BLOCK 12 W 1/2 30 X 128 

Valu e Informatio n 

2007 

2006 

2005 

2004 

2003 

2002 

Land 

$900.00 

$900.00 

$900.00 

$900.00 

$900.00 

$0.00 

Improvement 

$50,600.00 

$50,600.00 

$50,600.00 

$7,900.00 

$7,900.00 

$0.00 

Total 

$51,500.00 

$51,500.00 

$51,500.00 

$8,800.00 

$8,800.00 

$0.00 

Sales Informatio n 

Lan d Informatio n 

Acres 

0.08 

SF 

3840.0 

FF 

30.0 

Units 

1.0 

Depth 

128.0 

Width 

30.0 

Vacant 

No 

Lan d Attribute s 

Attribute Attribute Description 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 10/11/2007 
.Douglas County Account Information Page 2 of 2 

2421 DECATUR ST 

,y""'.a (5*1 

60' " . ^ 

SOl-fil FIDO- 4 5'/ :.o 

so / 

B»mrt Bio^K S fl 

668 (1 

110 

Tin 

End S«k<l WsH t«IO 

;(jrr 

TWO STORY 

Click to Enlarge Image Click to Enlarge Image 

Square Footage: 1344.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Fair 

Owner Occupied: No Condo Square Footage: 0.0 

Built As: 2 Story Rooms: 6.0 

HVAC: Forced Air Units: 1.0 

Exterior: Frame Siding Baths: 1.0 

Interior: Drywali Bedrooms: 3.0 

Roof Cover: Composition Shingle Stories: 2.0 

Roof Type: Gable Foundation: Block 

Floorcover: Allowance Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1888 0 0% 1888 116 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 686.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch End Solid Wall 140.0 

Porch Slab Roof Ceil 30.0 

User Partial Basement 329.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl... 10/11/2007 
Propeity ID # 

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

yy^ys 

yy / 7'^^^^y ^-y 

 Date: /4</^ Time: 777 7 Action: '77^/77^ 77y^>^yt/r 

 Date: Time: Action: 

 Date: Time: Action: 

Transmit to EPA D Other Action: n 

^yzy 7^y^^72^ ^7^ 

/^M7^y727 ^ yy7yyy-'y^y^7^^^£f^ ^ 

y<-^/^i74yy^ 
lfiL, \ Omaha Lead Site—Fixed Price EP-R7-07-05 {ttk^ ^^^y I Coastal Environmental Group Inc. ^^^^ ^ 

V^^^^ * www.coastalhazmat.com 

^•>i.f^y COASTA L ENVIRONMENTA L 

C H O U P . IN C 

EXECUTIVE SUMMARY: 

26618—2421 DECATUR ST 

^ No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
As-Built Drawing 

COASTA L » , maha Lead Superfund Site 

OLS#: 26618 

Date Excavated: 11/12/07 

Date USEPA Signed Off: 11/29/07 

Legen d 

Area not Excavated Dripzone Excavated y^ m Quadrants Excavated 

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

46130 
^4EPA 

EPA Property Close Out Form 

y ^ ^ Tyrr^Ay, ^ 

Property tt: c7^/y,7. , Property Address: 

Date/Time: Owner's Name:. 77.07^1^yy7-

Quads Excavated: Contractor Group 

Excavatio Yes No n General 

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

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

Grading Yes No Sod and Vegetation 

1. 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 a 30 l y 

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 a 30 day 

time period) l y 

6. Was the property graded such that water will not pool on the property'! 

7. Wjis damage to landscaping or plant materials avoided? y 

Gates, Fences and Retaining Walls 

Yes No 

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

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

3. Was damage to gates or fences avoided? (If applicable) o y 

4. Was damage to retaining walls avoided? (If applicable) (7 ^ 

Foundation, Sidiocand Gutters 

Yes No 

1. Was damage to the sid'mg or trim avoided? l y 

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? y 

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

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

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? z^/A 

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

Inspection notes: 

l^ytz^ 7)0/^-

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

EPA Representati>^-7^^^^^^^<^^,3,Xigf' Date: ///^f/^/ 
^ ^ ^ 

Property Completion Agreement 

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

will designate that I am satisfied with the restoration of my property, and thai no items are in questions, 

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

Property ID: ^^ / / g 

Property Address ^ ^ ~ : ^;)^^^^^ ^ ^ ^ 

Q-'^--^ ,7)ndl,y,y U^.^y<l^-^rr^ 

^'^^-^••^d^)yi4y^}7 

Restoration Items in Question: 

'*^'"' fky^ (^{y^ ^w ihzyi^-'y^t o\ Vn/yy. h\Uy. ^z ^ 

' &ky [jChT^t [yTilhOfy^ /ZoTL^ 

Item: 

Item: 

Item: f 

Item: 

li^lTaaree resloration is completed, except as noted 

 I I do not ajjice resloration i.s complelcd 

/iA.r,.^^\nin^^ 

Owner's Sign^lHre Date Contractor's Signature Date 

I
777cch 7^y7es7 yl^^ \ 

Name: \.r,x\i\o . rAtUeK" Omaha Lead Site Date: 6"l - VS"C^3 North Arrow 

Address^^j^-SA O f r afci^^^<"^ ^ Site Sketcti Time: Vt)'. t ^ o».r>'\ 

Phone: 4^^ - "^^t - ^ :2 <=,<;. 

I 

Team C^Oo\c^ \ ^U^>e^V<.-J». BVID# ;^C-U\ ^ XRF Code 1 SO ^ 

Sample Number Lead Concentration 

Confirmation Sample 

oy/^CVYA-2(777.\B 

P»Yes ^ No 50 W7B'y=FYiy3^<^ 

fiYes n No ^ 

«nYes a No g 

«A'es ^ No '-' 

\l&0±y7 ppm Olives a No ^ 

ppm Yes a No CD 

ppm Yes n No n 

RYDSCPLA-26618 Lab 

738 ppm 

iN\U & f^lU^ 

M* X l i . X ! >«• ^ K- r ^14-4—iUikzi-^-fsk 

3^? 

.h-U-C-ZlS-CB'^ 

46130 
PROPERTY CLEARANCE WORKSHEET (p^ 

Date 

Property ID ll'l2'O l 

Z(;U^ 

Property Project 

Omaha Lead -- Fixed Price Address zt/z/ /O^^^TW s r 

Measurement 

XRF ID 

0107 51 Count/Time 

Field Sliots 

Shot # Reading Sample Area Shot # Reading Sample Area 

h<i ?0t eA-/7 

?^y A72 D i \Z-H 

.??z l i . F l <»'(e 

3»Z 1,11 Bz V-fc 

Sk i 219 Bl iX- H 

Sample Area tA-^/ 

I n Situ 

Composite Composite Analytical 

Aliquot Composite Readings 

Lab Analytical 

Readinq Average (Dried & Spilt Sent 

(Bag) Number Results 1 (Baq) Sieved) ? 

2 

U^i 

3 l o l I9f 

4 ^ zot> 

XRF corrected Value --> 

5 (us

IQV

e

o

 calibratio

 to value) 

n chart or add 

W

Sample Area bz U-/V Pass/Fai l ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings 

Lab Analytical 

Readinq Average (Dried & Spilt Sent (Bag) 

Number Results 1 

(Baq) Sieved) ? 

2 

PL 

4 

3 

i ? / l o l n z XRF Corrected Value - > 

5 (use calibration chart or add 

2^f 2 0 % to value) 

Sample Area Fl 1-6 Pass/Fai l ? 

In Situ Composite Composite Analytical 

Aliquot Composite Readings 

Lab Analytical F^eadinq 

Average (Dried & Spilt Sent (Bag) 

Number Results 1 

(Baq) Sieved) 7 h 2 SK Ll 

3 

70 ^ 9 

4 d 7fe fi XRF Corrected Value --> 

b (,1 

(use calibration chart or add n 

2 0 % to value) 

Sample Area V^z H't^ Pass/Fai l ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings 

Lab Analytical Readinq 

Average (Dried & Spilt Sent (Bag) 

Number Results 1 

(••/ (Baq) Sieved) 7 

2 70*^^ fc7 

3 (oO (^(t 

4 hi- (^Y 

tt XRF Corrected Value —> 

5 (use calibration chart or add 

yi 2 0 % to value) S5 

Sample Area %\ yi M Pass/Fai l ? 

Aliquo In Situ 

Composite Composite Analytical t Readin Composite Readings 

Lab Analytical q 

Average (Dried & Spilt Sent (Bag) Number Results 3531 

(Bag) Sieved) 7

m 

tJX­ ZOH 300. i4_ XRF Corrected Value —> 

IH<\ 

(use calibration chart or add 

2 0 % to value) 3S0 

XRF Technician's Signiture 
( # 

COASTA L 

%• y ENVKONtlENTkL 

C R O U f , INC . 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

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: 

A^iye 

Owner's Name: Daytime Phone: r ^ ^ ^ jAyso/u •2/7 • 5K/S 

Address of Property zy y T^eyyu^ s r 

covered by this 

Agreement: 

PURPOSE OF RESPONSE 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 ancJ 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 
VT**^^ * COASTAL *^ . ** C ENVI«ONMENT*l ^BO T CROUP . IN C 

• 

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 antd 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. 

• 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 tend 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 (712) 352-0188 

y O I grant access to my properties D I do not grant access to my properties 

/Signatur T^ZizyjihtTmy e ^ \777y Qate^3^^^ Signatur y e Date 

iignature yy ^ Qate,^..^' ^ S 

CU I would like to be present during any sampling that is required. 
Restoration Agreement 

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

remediation activities. This will also ser\e as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction ofthe property ouner and the United States Environmental 

Protection Agency (EPA). 

Property ID: ^<^^/ ^ 

Property Address: 2^(/2 y 77^^/^ZV/ ^ ^ ^ 

Onner: ^^^^ g /y^^^jT^X y 

Phone: ^7^'^?77 

On the attached diagram(s) indicate area(s) to excavated and depth of e.\ca\ation. location of all known 

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

contractor, and the direction of Nonh. Indicate distances, depths, material t}.pes, etc. Indicate digital photos 

by referencing the photo-log number uith an arrou indicating direction of \ iev\. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

storage, crisposal. and/or ret^.-r cf t!-:ese iter^s is the O-.v^srs 'espo-sibility. •.e rerncvi 

Page 1 of 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

3/774-1/ ?17U^7TS AuS TSUH^S 

Item: 

Item: 

Item: 

Item: 

Item: 

' Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of 
COASTA L 

CHOI.* * • •» C 

Items To Be Remove d By Contractor During Remediation An d Replaced 

(Use additional sheets as necessary) 

Item: 

5a]) 

Item: 5,'0)U 

Item: 

^^y>C^ // ^ ^i7P^y/y b 

item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of. 
COASTA L 

Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity Unit Condition/Type/Species 

Pre-exisiing property area, 

that will be excavated, that Square feet 

is covered with "rass. 

I 

Number of trees > 2 inch Each 

trunk diameter 

Number of trees • = 2 inc 

:.ch 

trunk diameter 

i Number of Sprinkler j 

! Zones. Control \''a!\'es. j 

\ rimers, i^.eads. etc. Lach 

;..k ILT !.V. Out. 

Number of and size of 

each garden flou er bed 

area. Each 

Page 4 of 
Item Quantity Unit Condition/Type/Species 

Agreed upon value of 

plant materials not to be 

replaced bv contractor. 

Note this \alue will be 

used to issue a plant 

\oucher to the propert> 

ow ner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

\er\' specific and detailed. Each 

Include a sketch of were 

each plant v\ill be placed 

b\ the coniracUT. 

.Agreed upon

propertv to be

with iirass sod. 

 area of 

 replaced 

SF 

.A.rea of Cir_\ or Countv yge 

propenx to be landscaped 

per their requirements. j)y7^/'^i^ 

sF 

Easement .Area. lo be 

e\ca\ated SF 

Page 5 of 
^ 

COASTA L CNWIROMHINTA L 

C H O U P . IMC . 

Additional Comments / Instructions: 

^ ^e^ly^ysr ev^y-^^^ y cy JsA7, 

yy/rr /^-tp/^^c-^. 

- 7^1/ 4- ^ F^ZJC ^ A-/CDU/7b T77^ T^eT^-rtf . 

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 do not agree 

. fo a/o7 

Date( Date