• • 3 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: :207<^ Y Date: /o//s/^7 

Address: /A33 S. / / S ^ 

Remediation Contractor: Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) 

Executive Summary 

7 EPA-provided property sketch 

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 

7 Photographs 

M As-built sketch 

M Satisfactory restoration signed by Property Owner 

i P 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 County Assessor's Office 

D 

D , 

D ' • • ' " • 

^ ^ # ^ 

40317900 liiiiii 

Superfund 
71 - iz-^b s i( "sr • 

Final Report Property Check List (piease place with each file) 

Hard Copy Information 

Property Check List 

Site Working Drawing Map 

EPA originals Map 

Douglas County Assessor's Map 

Property Contact Sheet 

Agreement 

jT^ Access Agreement 

^ Restoration Agreement 

Miscellaneous Documents 

[+j Final Map irom the Field 

2. Change Orders y^l ^ 

\ ^ XRF Data 

4. Any emails or PO correspondences KJ n 

Property Completion r I 

H Executive Summary 

AS BUILT 

-|57 Property Completion Agreement (j ^ 

4. Any buyout info or reimbursement info P^ I 

5. Check or money order copies ( \p^ 

tHl EPA Property Close Out Form ""^ ' 

tZ7Attached Begin Video 

Electronic Documentation 

Drawings 

1_Q EPA original 

] ^ Working Drawing 

^S r AS Built.vso 

-^ . AS Buih.jpg 

Photos 

V Begin Photos 

-/puring/Excavation Photos 

\ySpd Photos 

w^-Day Sod Photos 

Se^nned Documents 

^•TiH^l Documents 

Executive Summary 

Videos 

'^egin Video 

^y<Ay Movie 
Property Access Checklist 

Property ID: ^ 7 (^ ^ n WOKK STARTED ON: / /_ 

Property A.hlres.s: /^3 3 3 / l^~Sf . n WORK COMPELTED ON: / / 

Renter: Owner: ^7^6Hni/P l Ppl P P 

Address: / MOO pr^r>KUr x (\w . 

Plionc: 

Fax: 

Cell/Pajjer: 

Phone: . ^ /(^^ ^ ^\ ^ ,. ^^^ ^ Additional Information: 

Fax: 

Ccll/Paser: 

0 Notification Letter Sent: By: 

Acccs.s A);recment Siuned: ^ I p lO l Byprm^ iln^iu. Restoration Agreement Siuned: ^ I \ 7 / t) ^ * ^r-'-^irmP^ ^^^W \ 

I I Topsoil Sampling (if applicable) By: 

I I Disposal Sampling (if applicable) By: 

I I Garden Sampling (if applicable) By: 

E Utilitv Clearance Called: 5 I \7 I 01 ^hPfpshjbiA 

\ 3 Video/Plioto.s (Before) On:.Q5i3./^'^ »y-- i^lA^. ^ 3^^ , 0 Video/Photos (During) On:^/_L/i27 By: K O V \ 

0 Video/Photos (After) On:(^/i_5/^ 

^ Video/Photos (3()-Day) On:2L'j3'3I »V= Pfc 

H Property Completion Agreement Signed: y / -^ /6 7 7-R 

I I Final Report Issued: 

Air Monitoring (as applicable) 

n Community d Crew On: / / By: 

Results: 

• Community D Crew On: / / By: 

Results: 

1 1 Community [H Crew On: / / By: 

Results: 

Omaha Lead Site 
Ji (JC Square Footage to be Excavated = 3150 

Property Classification: 800 TotSBSn 2Zone Linear Footage to be Excavated = 0 

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Existing Structure 

» Fence 

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— — —Quadrant Boundary 

- Street Boundary 

c) T ee/S hrub 

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North Arrow 

Scale 

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

Fl •iy^;i'j;.,aj!.,oqiC ir:'; X^-lf I \ B1 ./PWtfS' 

725 miH . -S;v^'• ••,;.*-. • iP/p. 7.*.:':t: '

'pp. im *^^*: P' i '^3 

Omaha Lead Site 

Omaha, Nebraska 

Property Number 

OLS-20767 

Property Address 

1233 S 11 ST 

Post Excavation Concentrations (ppm) 

 B2 PlavArea 

Gar jen_ _ othe r 

D^cription 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; 

OZ, drtp zone (1-3 foot area of soil around the foundation of tfie house). 
Douglas-Omaha, Nebraska GIS Page 1 of 1 f / ^ 3 y //^--% 

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C) Parcels 

g H MILLER KENNETH Q 

1233 S 11 ST 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

2 

Owner 

City 

Owner 

State 

Owner 

Zip 

Sec-TwnRng 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Old 

Assessor 

Site 

New 

Assessor 

Site 

1133290000 ^ 

MILLER KENNETH 

Q 

1233 S 11 ST 

OMAHA 

68108 

1400 FRANKLIN 

AVE #140 

COUNCIL BLUFFS 

lA 

51503 1 

26-15-13 

FOREST HILL 

1 

2 

W 100 S 45 FT 

Valuation 

Information 

Valuation 

Informatipn 

^ SPIDELL BRIAN D 

11233 ERSKIIME ST 

http://www.dogis.org/dogis_alias/dogis/ 4/23/2007 

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http://www.dogis.org/dogis_alias/dogis/main.htm 4/23/2007 
CONTACT FORM 

Property ID # ^01(/1 

Property 

Address: i^^ds-ii'^P 

Initial Contact: Date: Time:_ Action:_ 

Second Contact: Date: Time: Action:_ 

Final Contact: Date: Time: Action: 

Final Action: Transmit to EPA D Other Action: D 

Comment: 

Owner 

Comment (s): 

Site 

f^VOvN^r fi.dveM JV^il W \teMwKCS j Coordinator 

Comment (s): 
ADDITION NO. oOOOO 

CITY LOTS 

LEGAL DE3CR1 

1 3 31 i/6 TT LT-S 5 i 

3 

S 

7 

rzonLOT 6 HALF 

SECT TOWl^ 

LEGAl 

2. 31 1/6 X 132. 

4 

6 

8 

BLOCK 261 

I^SE PLAT Li 117 

3CRIPTI0N' 

EFl-ADFB EF5-PNFB PF6-EAFB 

PARC 3329 OCOO 11 


FB 24 STATUS 2 CLASS R 


EXEMPT 0 EXEMPT TYPE TAX DISTRICT 0100 SID F-


PROP HOUSE HALF DIR STREET NAME TYPE SUFFIX APT AREA SIP CODE 


ADDRESS G1233 3 Cll ST C»a 68108 


OWNER INFORMATION 


NAME KEN??ETH Q*MILLER ETAL DATE OF LAST CHANGE 03-08-200 6 

+ 1400 FRitNKLIN AVE #140 BK/PG OR DOC# 1368/564 

ADDR HC*E3TEAD DELETE 

CITY cour;ciL BLUFFS ST lA ZIP 515CS NON N^UlvIERIC SIP CODE 

CURRENT VALUE HOMESTEAD 

\"EAR DATE LAT©-- IMPR-- --T'JTAL-- PAR RSN NUMBER TI CD PCT \,7iLUE 

1999 05-21-1999 4100 0 4100 SEE 

ADDITION NO. 127 40 LOT 2 HALF BLOCK 1 HALF 


FOREST HILL 3ECT TOWN RANGE PLAT 0117 


nT''5t'*^~'T"D" 

Consent For Access To Property 

RjGHT OF ENTRY TO PREVOSFS 

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: 

^n.U.r\- ry, M'.lUr 

Address: ^2.3 3 s w s>-v ^wsaLa kJ 

Address: 

Addresses of 

Properties covered by Address: 

this Agreement: 

Address: 

Address: ] 

Pimpt^SF (^F RFSP<:)NSF .ACTIVITIES 

The EP.-\ 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 soi! 

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 propert>- has been remediated 

ENVtRONNlENTAL 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 

ttProperty ID» Paee 1 of 2 
•<'/ y 

• 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. 

AGREEMENT NOT TO INTERFERE 

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 property in such a manner. 

Should you have any questions about this program, please contact 

H * grant access to my properties HH I do not grant access to my properties 

A I "f t /^ ^ ^^2^.Ar»JiS-^>^ 

Signature ^^ Date Signature • T Date 

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

Page 2 of 2 

«Property ID» 
m 

Restoration Agreement 

The purpose of this agreement is lo pro\ ide a mutual agreement as lo conditions of propert> prior lo 

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 States En\ ironmental 

Protection Agency (EPA). 

Property ID: ^.OlG' ^ \ 

Property Address: , .^ ^3,0, S w ,sv nm^W^ ^ J ^ a 9L10 R 

^•'"• - ^C.U.r V ^ lYM 1 ie r 

Phone: /^j^ ^ _ .^q ^ -- H^[ K 

On the attached diagram(s) indicate arca(s) to c\ca\atcd and depth of e\ca\ation, location of all known 

utilities, subsurface feanjres. surface structures and landscaping features, access location(s) lo be used b\ 

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

b\ referencing the photo-log number with an arrow indicating direction of ^ icw 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use addrtional sheets as necessary) 

Item: 

Kldfw-^ 

Item: 

item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of tp 
Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

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

(Use additional sheets as necessary) 

Page 3 of ^ 
0^ 

Item 

Pre iMlcting 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 Condition/Type/Species 

\crD 

Square feet C^cn^ GP-JL \ 

o Each 

D Each 

D Each 

o 

Each 

Square Feet 

Page 4 ofJl 
^ ^ 

Page 5 of (^ 
QZcXhec h k 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. 

Q^agree J I do not agree 3+a 2 ree 

^ I do not agree 

Owner's SignatuPlK^ Date ^^9^ 6 of. P Klor's Signature Dau " ^ 

_ ^ ^ 
e y Y.(Lr\r\p< i i a \0\ tbtalQ ^ ^ Square Footage to be Excavated = 3150 

Property Classification: 800 Tota.l ^ :one Linear Footage to be Excavated = 0 

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Legen d North Arrow Omaha Lead Site 

iJ.' vll Concrete Omaha, Nebraska 

(// I Excavated Area Property Number 

OLS-2076 7 I I Lxistin • • - g btructure Scale 

» Fence 

Property Address 1 Incli = 20 feet or 1 grid = 5 x 5 ft 

1233 8 11 8 T 

— Quadrant Boundary — _ Post Excavation Concentrations (ppm) 

Fl R? PlavArpf UUI J 

.;.;!.''it'! •.. ii ' ':••-•'"••••• • F2 DZ Eas£ *men o Tr ee/S irub V / 

Bl Garc jen _ — Othe r 

Description of post excavation areas: F1, front yard left-hand quadrant; F2, front yard rigfit-fiand quadrant; B1. backyard left-hand quadrant; B2, backyard right-hand quadrant; 

DZ. drip zone (1-3 foot area of soil around the foundation of the house). 
ni iCe^ne^ ^Stal^^ k nt Square Footage to be Excavated = 3150 

Property Classification: 800 IT I1S E ;1 Zone Linear Footage to be Excavated = 0 

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Legend North Arrow Omaha Lead Site 1 

ji.v3 concrete Omatia, Nebraska 1 

y ^ ExcavatedArea Property Number 1 

OLS-20767 r ij Existin - •• g Structur - e Scale 

» Fence Property Address 1 1 Incti = 20 feet or 1 grid = 5 X 5 n 1233 S 11 ST k V^ 

• " — " ^ Quadrant Boundary Post Excavation Concentrations (ppm) 

- Street Boundary Fl B2 PlavArea iyd;o-:.,c-..;;..oq!C ir;'" F2 ri7 Paoomen [ 

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[}escnplian of post excavation areas: F1 . front yard laft-tiand quadrant F2. front yard right-tiand quadrant; B1 . backyard leR-hand quadrant; B2.tiackyanl right-hand quadrant: 

DZ. drip zone (1-3 fool ansa of so i around Itw foundation of the house). 
k- PROPERTY CLEARANCE WORKSHEET 

Date Property ID 0%l01\07 l o l(c3 

Property Project Omaha Lead -- Fixed Price Address 1233 S\l^' 

Measurement XRF ID 0/01-51 Count/Time 

Field Shots 

Sho t # Readin g Sampl e Are a Sho t # Readin g Sampl e Are a 

/^^F 726. FlUi-S^­ 0^56 A ^ B7 17-IM'^ 

/.S'? y i i C-,(^ 17-lU" 

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Aliquo t Composit e Reading s Lab Analytica l 

Readin g Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 K ^ (Bag ) Sieved ) 7 

2 1 ' ^ I ^ 2 

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4 izq I Z 3 1 i 

• yCty i XRF Corrected Value—> 

5 ^ - ^ !(use calibration chart or add 

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Sampl e Are a 1^7 Pass/Fai l ? 12-IM" 

I n Sit u Composit e Composit e Analytica l 

Aliquo t Composit e Reading s Lab Analytica l 

Readin g Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 y\7 (Bag ) Sieved ) •> 

2 f=>9i T I 

3 -2.4 fBl 

4 f ^ q 4/ ^ 1 _ -43 1 _ / ^ XRF Corrected Value - > 

5 (use calibration chart or add 

20% to value) 54 ' 

Sampl e Are a PiK Pass/Fai l ? I2WU" 

I n Sit u Composit e Composit e Analytica l 

Aliquo t Composit e Reading s Lab Analytica l 

Readin g Averag e (Drie d & Spil t Sen t 

(Bag ) Numbe r Result s 1 (Bag ) Sieved ) •> 

2 7>C^ 1 

3 -^¥=^ 

4 4-7 4( 

XRF Corrected Value - > 

5 (use calibration chart or add 

20% to value) 

; 51 i 

Sample Area Mm Pass/Fail ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical 

Reading Average (Dried & Spilt Sent (Bag) Number Results (Bag) Sieved) 13: 

Confidential 5/2/07 Page 1 of 2 
2 pv ^ 

3 • 

4 

WM 9 140 • 

XRF Corrected Value —> 

5 (use calibration chart or add 

20 % to value) 75 

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 

5 

XRF Corrected Value - > 

(use calibration chart or add 

20 % to value) 

1 

1 

1 1 

XRF Technician's Signiture 

'MI^^^-^ 

Confidential 5/2/07 Page 2 of 2 
i,;JJL\ Omaha Lead Site—Fixed Price EP-R7-07-05 

g .^^ ^ g Coastal Environmental Group Inc. 

>7~*^^ ^ www.coastalhazmat.com 

^•"-puay ^ COASTA L ENVIRONMENTA L 

C K O U P , ( N C. 

EXECUTIVE SUMMARY: 

20767—1233 SOUTH 11 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 '3150 

Property Classification 800 Total DnpZone Linear Footage to tje Excavated = 0 

Legend Q|_S#: 20767 

Date Excavated: 6/7/07 

Pate USHPA'Si^ni^d Off: 7/10/07 

I ^ Ex-shng S'ructuie Scale 

• — • — • Fence 1 Inch " 20 (eet or 1 grid » 5 x 5 ft 

Pennanent Landscaping 

— — — Quadrant Boundary Post Excavation Concentrations (ppm) 

Street Boundary Fl B2 Play Area "A) I HC5L F2 DZ Easement Q ) 7ntlStmto 81 Garden Other 

OeKTipttan of poat evc«vaaon areM Fl front yard left-Mfitf quadrant F2. front yard rigntJwnd quadrant B1 badtyanj laR-hand quadrant B2. badcyard nght-hand quadrant 

OZ laipzana [l-Stootareaotsc^arounddw^ourdabonortha houaa) 

Legend 

Area not Excavated Dripzone Excavated Quadrants Excavated 


Contract #: EP-R7-07-05 Coastal Environmental Group Inc. 

Property Completion Agreement 

Tliis agreement documents the completion of remedial activities performed on my property. 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: ^7(7 1 

Property Address: ^^Zj ^ <^ /1^ ^ S P 

Owner: 

17-tnntHi PiPl<^ 

Phone: 5 ^ 5-^^76 

Restoration Items in Question: 

II Item: 

Y\?) vkvM^s 'Vv Q.^^os^' &l^^ 

1 Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments 

NCU-S t o Vn<5/u,k/v. >c? ^ , 

(^^^JTL agree restoration is completed, except as noted 

I 1 do not agree restoration is completed 

,S...'L- I-' ) Ll> 

Owner's Si;>na)turc Date Contractor's Signature )ate'^ 

I
aEPA • 

EPA Property Close Out Form 

Property #: yOlb'^ Property Address; l^3?> Sj/'fPf -

Date/Time: Owner's Name: ^-^ 11/177/] 1^11/7 y 

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? 

x y 

Grading Sod and Vecetation 

Yes No 

1. Does the gradmg around the perimeter of the house in excavated areas generally slope away 

i . y from the 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 u/" day time period) 

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

5. Are the joints between 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 property? m^ 

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

Gates, Fences and Retainins Walls Yes No 

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

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) y 

4. Was damage to retaining walls avoided? (If applicable) *;> 

Foundation, Sidinx and Gutters 

Yes No 

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

2. Was damage to the foundation avoided? ^^ 

3 ^ ^ . Was damage to windows avoided? 

4. Was damage to windows or door screens avoided? u* 

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

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? 

y 

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

Inspection notes: 

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

EPA Representatjve^T^^kz^JcC^^^^^'^^lg^ Date: Tyyy/C) 7