TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: \^^MV Date: 

^ rv i^ 

Address: >^ll ( l^CNfH ^ < 

Remediation Contractor: Coastal Environmental Group_ Year: 200J 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Siunmary 

EPA-provided property sketch 

/ 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

/ 

Restoration Agreement 

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

Confinnation data 

Photographs ^)C(^MV^ X % t h^cC^fC^n 

As-built sketch 

Satisfactory restoration signed by Property Owner 

IB ' 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

V. 

Utility clearances 

PropertyjirfSfn^tion from Douglas County Assessor's Office 
^ m U 

Property Access Checklist 

Property ID: j (^9jj^ JD^ 

PropertyAddress:-^;^;g^j^,j.|p;^. <|^ 

n

D

 WOBK STARTED 

 WORKCOMPELTED 

ON:

ON:

 /

 /

 / 

/ 

O^vncr: Mr\y^QriP. CQrmmA 

Address: 

Plione: 

Fax: 

?M\'VM\p 

CelMPngen 

Renter 

Phone: 

Fax: 

Cell/Pagen 

Additional Information: 

D Notification Letter 

fj^ Access Agreement 

^ Restoration Agreement 

D Topsoil Sampling (if applicable) 

D Disposal Samplmg (if applicable) 

D Garden Sampling (if applicable) 

j ^ Utility Clearance 

]3C. Video/Photos (Before) 

D Video/Pbotos (Dnring) 

D Video/Photos (After) 

n Video/Photos (30-Day) 

D Property Completion Agreemoit 

n Final Report 

Sent: / / 

Signed: ^/3D/Q9 . 

Signed: ^/fiD/CE l 

/ / 

/ / 

/ / 

cMt&.lQ_i ±_iC9 

On:^i3D.(M 

On: I I 

On: / / 

On: / / 

Signed: / / 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

By: mjslrPi 

By: 

By: 

By: 

By: 

By: 

By: 1 

Air Monitorine (as apDlicabie] 

O Community Q Crew 

Results: 

On: / / By: J 

D Community

Results:

 Q Crew On: / / By: 

j 

D Community

Results: 

Q Crow On; / / By: J 

Omaha Lead SKe 
• • 

Douglas County Account ^|£ana^on Page 1 of2 

Douglas County, Nebraska Property Record - R1220080000 

Print Report 

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

New Feature ^ -> • • Auto Sales Search 

Owner 

CORCORAN MARJORIE 

ETAL 

3328 HICKORY ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 2008 0000 12 

Account Type: Residential 

Parcel Number: 1220080000 

Parcel Address: 3328 HICKORY ST 

OMAHA NE 68105-0000 

Legal Description: GRIFFIN & SMITHS ADD LOT 8 BLOCK 0 W 54 1/2 FT S 1/2 SUB 2 OF 54.5 X 132 

Value Informatio n 

Land Improvement Total 

2009 $6,800.00 $154,600.00 $161,400.00 

2008 $6,800.00 $154,600.00 $161,400.00 

2007 $6,800.00 $154,600.00 $161,400.00 

2006 $6,800.00 $126,200.00 $133,000.00 

2005 $6,800.00 $126,200.00 $133,000.00 

2004 $6,800.00 $126,200.00 $133,000.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.16 7260.0 1.0 132.0 55.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=R12... 9/30/2009 
• • 

Douglas County Account In tJ|u*n|g^on Page 2 of2 

4^0^ 1 ^ 

H '" ! " «540«q.ft­

'01 

r»«Ftcot •HI 

l i e 

J TWO STORY Bsirrt aioc* 8 rt 

77S0S.F. 

i,',main.i.tj.i.iiM».t.-w»iii.'U'jrjM.Hi3aaa 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1681.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Good 

Unit Type: Condition: Good 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 7.0 

Exterior: Masonry Common Brick Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gambrel Stories: 2.0 

Floorcover: i Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1926 0 0% 1926 82 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Block 8 ft 775.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 480.0 

Porch Open Slab 214.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R 12... 9/30/2009 
• • • • 

CONTACT FORM 

Property ID # /f^f 

Property 

Address: 53ullAcLtfS7 

Initial Contact: Date: t// f Time: f^S l Action ^ _ 

Second Contact: Date: ^ ^ ^ Time: /'^/y Action: 5^>^ tt///' a 

Final Contact: Date: Time: Action: 

Final Action: Transmit to EPA D Other Action: D 

JA A \Mr^¥'//Jo .AA^SurCy 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 
Page 1 of2 

^ 

Create Another Ticlcet |i :-::?JpypJr!ll Internet J SendEmajl ] 

• YOUR TICKET NUMBER IS 2376746. 

Original Call Date: 10/01/09 Time: 7:58 am Op: ELIZABETH18790 


Work to Begin Date: 10/05/09 Time: 8:30 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3328 Street: HICKORY ST 


Twp: 15N Rng: 13E Sect-Qtr: 28-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: 4 FT Comer Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVELS MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVELS LEVEL3 COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/1/2009 
Page 2 of2 

^ 

0PPDGPR6 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=<RESULTS... 10/1 /2009 
OLS#: 19348 

( ^ As-Built Drawing^ 

Date Excavated: 10/9/09 

Date USEPA Signed Off:12/1/09 

COASTA L Omaha Lead Superfund Site Area Sodden: 3060 so ft 

r Name: /yiCLTjorig A.. Cct^JOXtj.^n Omaha Lead Site Date: -^////o l 

Address: i i ry s r Site Sketch Time: 

Phone: /^P ? 

n ^ f 

Team / ^ K A^/Ul^' ^ ^/^^BV\D# /95^ g XRF Code 7^S 

Sample Number Lead Concentration Confirmation Sample 

/'/Ye s D No C5I J ^ / X a ppm /T^Yes O No I? 

^ ^ ppm /7/Yes a No IS 

ppm /?2Yes, a No >21 

^b'j^t-sz. ppm /?ZYes CD No ?2 

ppm Yes n No n 

ppm Yes n No •

GZ3 =

INSITU

 283 PP

S W

M @

/ EPA^ss

 1" r 

a 

.=3

,ti.t€Mmr,if. -yl 

Legen d 

Concret Drip Zone Excavated e Quadrants Excavated 

Area replaced with Area replaced with 

Sod Rock/Mulch Area lef t bar e 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
l l 10/1 ^ 5 \liClco/Lf ^ M ^ 

3OTe»-AktJr\'orig^ ;}, CotCotta ^ omaha Lead site Date; 1Y///O 3 North Arrow 

Jdress:^SZ^ Hlch>iy~Si- Site Sketch Time 

l47f(o/u <U 
mSL Aft 

Name: MttJrv'orie. A^ CoV<^\tsn Omaha Lead Site Date: ?////fo 3 North Arrow —i 

Site Sketch Time: 

Phone: /^c>7)^'^l'^7</ ^ 

r-- ^ 

f47Ka/ y 6 ^ s:x7 
Name: Uh L C<?t<U^tt»fT Omaha Lead Site Date: '9///^ 3 North Amnv 

Address: at y S t Site Sketch Time: 

Phone: 

f 

Team "^^V / 7/U< ^ ^ ^ BVID# fCf^^ ^ XRF Code /B S 

Sample Numt>er Lead Concentration Confimiatkxi Sample 

>g ^

\ + Pi-p ' " -^^^

 ppm 

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 ppm 

ppm 

ppm 

/^/Yes a

/:ZYes D

• /7/Ye8 O

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Yes •

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 No • 

^ 

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COASTA I 

IHVIItONKi »tTAt 

C « O tl r I tt C 

Consent fcF Access To PropeFty 

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: 

Owner's Name: Ml^PJ^l^U • n X OYi&lo^A Daytime Phone: '^^ \ ^lA[ / ^^ ' 

Address of Property 

covered by this 

Agreement: '^7^^ Vhc^^^l ^ < 

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, vinll 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 confinn 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 atl 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 aiso 

agrees to: 

Page 1 of 2 
.<^"'"*^t . 

COASTA L v ^ tNVmONHtKTAl < ^ 

« 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; 

e 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. 

«t 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 (402) 991-1199 

0 I grant access to my properties D I do not grant access to my properties 

. ,:.r? (LM.^i 7 09 

Signature Date 

Q I wouici like to be present tiuring any sampling that is required. 

Page 2 of 2 
COASTA I 

Restofcdtson Agreement 

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

remediation activities. This will also serve as documentation fbr the purpose of assuring tiut restoration 

activities are completed to the satisfection of the property owner and the Um'ted States Environmental 

Protection Agency (EPA). 

TdW 

Property Address: 552.ft HfCHonjia 

I Owoen Mnif^Or\g. C.nYCJnrti/\ 

Phone: 3^\,^0^7XX\ 

On the attached diagiam(s) indicate area(s) to excavate, surface structures and landscaping features and 

access locationCs) to be used by the contractors. Indicate distances, depths, material types, etc. 

Photographically and Videographically document the existing conditions ofthe property and the Insement if 

necessary. 

Items to be Removed by the Owner before Start of Remediation: 

The lenoval. storaqe, disposal, and/or return of these items Is the Owner's responsibility. 

Hem: 1 

n u n c ^ > 

Kem: ^ — 

ttem: 

^ ^ - ^ 

Item: ^^,^^ ^ 

items to be Removed by the Contractor During Remediation and Not Repiaced 

Item: 

V'ou ^ e-v\ U J ^' — " ^,,-'­ ^ 

Item: 

__ ^ ^ ^ ^ 

ttMTi: ^^^-^ ^ 

Kem: 

- ^ ^ 

Page I o f ^ 
COASTA L 

C k (. O I 

Kerns to Be Removed By Contractor During Remediation and Replaced 

Item: 

ttem: 

^^'7 1^1 y H ^ VT 

ttem: 

j \J\^t ho^ ^ ^^ \^| 

Lands(»ipe Inventory 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

tnmk diameter 

Number of trees <= 2 inch 

tnmk diameter 

Numtwr of Sprinkler 

Zones. Control Valves, 

Timers, Heads, etc 

All.ith !i sketch ol ills' 

sprinklci t;!v'.>ui 

Number of and size of 

area. 

AiMili ;t skoicli ol rdiiiivi.' 

MZi-s nnd loc;iiii>iis 

Agreed upon value of plant 

materials not to be 

teplaced bv contractor. 

Voir II>'' Miitic «ill ni 

csri' 10 li'.ui .1 |i)Hni 

\niii.;ii'r 1(1 llie |;ro()fil> 

i>« ner. 

Easement Area, to be 

excavated 

Quantity 

•v 

\ 

r 

\ 

7 

Unit 

Quadrants 

Each 

Each 

Condition/Type/Species 

^i/( ; Cii^'i 

Each 

Each 

Square Feet 

S 

Each \^ U \K'(th4^^e^ 

Page 2-" ^ 
COASTA L 

! Additional Comments / Instnictkms: 

I 

\ 

Q 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, tndudirtg foundation cracks or fissures. 

P^I agree O I do not agree 

Cohtractor's Signatare Date 

Page 3 of. 
BVID#jaMX 

XRF PROPERTY SAMPLE SHEET 

Date 

Project 

XRFiD# 

Shot# 

4ia fc 

\i^n 

Average

Shot# 

n?ii 

'^H 

1?§ 1^0 

Average

Shot# 

Average 

Shot# 

Average 

lab sample # 

3E ap: 

Omaha lead FP Znd year option 

Reading 

?>4'&-t 1 ^ 

ZD M JiCL 

ia. 24 0 't l ^ 

Reading 

71.'?^ ± \9 

i Q I i- -LO 

X M l ^ 18 

?il2 t 73 

Sample area 

.£1 

Depth 

Sample area 

CnI3 

Depth 

\ 

Address 

Sample time 

sample length 

Shol# 

3331 

335 

laoo. IMl 

Average

Shot# 

nqi 

n°i3 

n^M n^^ 

 Zg ^ t 2 D 

Reading Sample area 

Depth 

RETEST AREAS 

Reading Sample area 

Depth 

Average

Shot# 

Average 

Shot# 

Average 

Lab result Sample area XRF Avg. 

Signature/ 

am/ imp m 

30 sec 

Reading Samplearea 

^ 1 ^ t 2,H 

?>^'i ± 7_2 M 

^H ' - 7 2. Depth 

?>1^ t 7 i 

 ?^H0 t 22 

Reading Sample area 

1141 n 

i-J(« + )l« G.14 

UP 2 t u^ Depth 

n o 1 ili) 1 

 p ? ^^ /L? 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

'm. 

Prim V\^\m\:0^(y}ce^p^ 
BVID# iq^MR 

XRF PROPERTY SAMPLE SHEET 

Date in-q- m 

Address ^-Klf. H>(^.lcO>^^p^ 

Project Omaha lead FP 2nd year opUcn Sample time am/pm 

XRFiD# sample length 30 sec 

Shot# Reading Sample area Shot# Reading Sample area 

7-I30 Q'^t O y^\\% '2n±'g "2M^ iSTTl ^ £m. 7-iiq umi \ D7. 

')\'^'r 44^ E H Depth riT D 7^i ^ Depth 

2\3 ^ iiL l.\%\ ^\b^^ K 

Average iZf ^ ± Y \ 

Average f4 \ j : H 

Shot# Reading Sample area Shot# Reading Samplearea 

2.\a^ I I S t ^ 2^2AD. 25^^ ?,7. •2l2l£> 

\7^ t m R7 '2\^1 % \ 

7.11 1 Depth Depth l^M+ l^S J2A1 Depi 

7-\?? I'n^t l ^ H X]L2I I'a^t I'p 

Average m 15 

Average 2\ \ 1 \% 

Shot# Reading Samplearea Shot# Reading Samplearea 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

lab sample # Lab result Samplearea XRF Avg. 

fnCMl^ ^ 

9\nn\» ^ Cfmp S 
i^SL\ Omaha Lead Site—Fixed Price EP-R7-07-05 

IJ^^^ ^ ° Coastal Environmental Group Inc. vl 

V~*^ ^ www.coastalhazmat.com 

^PHO^" ^ COASTA L 

C lO V p . IN C 

EXECUTIVE SUMMARY: 

BVID #19348-(3328 HICKORY ST) 

~x\ No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 

-COASTAL TO CLEAN UP THE MUDDY DRIVEWAY. (COMPLETED 11/7/09) 

-COASTAL REPAIRED THE CONCRETE CRACKS ON THE DRIVEWAY. (COMPLETED 

4/15/10) 
m 

KtfiLa 

EPA Property Close Out Form 

Property PropertyAddre,3r^>^?^ fi HH^KD ^ j.^ - ff; i'^gS^ft , 

Date/Time 

Quads Excavated: Yy^ Y^l D ^ Contractor Group T CH'^r n ^ qrCiJ p • 

Excavatlo Yes No a Geacral 

1. ir necessaiy, were the correct quadrant(s) excavated and restored? 

i 7 2.

 If necessary, were the correct areas or drip zone excavaied aod restored? 

GradlDg Yes No Sod aad VenetatloB 

1. Does Ihe gmding around the perimeter ofthe house in excavaied areas generally slope away 

from tbe house? 

ly 

2. Has sod been Wd bi all areas that were excavated? y^ 

J. Doe

day tim

s Ih

e

e

 period

 sod appea

) __ 

r to be generally healthy and growing? (Only evaluate if inspected at a 30 

^ 7

4. Alt sodded areas generally firm and evenly graded? 17 

5. Ar

tim

e

e

 th

 period

e Joint

) 

s between the sod strips generally tight? (Only evaluate if inspected at a 30 day K

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

ly ' 

7. Was damtge to landscaping or plant materials avoided? Lx' 

Gates, Fences and Retatalag Walls Yes No 

I 1. Oo gates open and cloiie freely? (Ifapplicable) U ^ 

2. Were all gates or fences taken down during restoralion activilies reinstalled? (If applicable) 

\y' 

3. Was damage to gales or fences avoided? (Ifapplicable) \y 

4. Was damage to retaming walls avoided? (Ifapplicable) 7 

Foundation, Sidiag and Gatlers Ves JNo 

\. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

Was damage to windows avoided? 

4 Was damage to windows or door screens avoided? 

5 Was damage te downspouts or downspout extensions avoided? 

y- Sidewalks and Driveways (Coacrete) 

Yes No 

1. Was damage to driveway surfaces avoided? 1\ 

2. Wai damage lo walkway surfaces avoided? p' 
m fH. 

Ort'oers comments: 

rjn.^pection notes: 

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

EPA Representiitive / )m ^ /J^J^ . / ^ Date:/^/7/^^ ^ 7 
I

# 

Property Completion Agreement 

ihis agieemenl documenls Ihe complelion ol remedial aclivmes perloimed on my properly My signalure 

will designate ihai I am satisfied with Ihe restoration of my propeily. and thai no items are in questions, 

now, or al any lime in (he future, except (hose Kerns listed below, ifany 

Property rO: \O^O^VJ^ ^ 

Property Address: ^?^ ^ ^ W{c)kiSf\ \ S^ . 

Owner: \A(>r^r^\<^ tarcnr(xr\ 

^""^ Mo?.. 3^V- Q\L^\P 

Restoration Items in Question: 

Item: 

JCL ^ e_it2&. ¥- Item: 

Item: 

Item: 

Item: 

Item: 

L 

ts d r « i^ 

CoUiUor^ tU/i / 1 e> J''r'^^ ly ^^^ 

 I I nyrcc ic.^toralion if, complcltd, except as nnteri 

I. I I rto nol «(>rtc rcstorjition is complelcrl 

OwVr' s Sicnatiit-V—- Drttc / Contrarloi's Sicnaliirc Dale