TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID^: SX^T L Date: ^H/d S 

Address: 37 ^ A I 3 0 S ^ 

Remediation Contractor: Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

STf Video of propeity (DVD) 

\M Executive Summary 

W EPA-provided property sketch 

M 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.) 

iZ Confirmatioii^lata 

i7 Photographs 

t/ As-built sketch 

y Satisfactory restoration signed by Property Owner 

5/ Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

D Utility clearances 

D Property infonnation from Douglas County Assessor's Office 

D • 

D , 

• 

^fe ^ 

40317780 

iiiiiin 

Superfund 
( 

^

Final Report Property Check List (pieasc place with each nie) ^ ^ 

Hard Copy Information 7^7C7~^ 

1. Property Check List ] 

2. Site Working Drawing Map [ 

,1 FiPA originals Man I 

4. Douglas County Asscs.sor's Map jl 

5. i'roporty Contact Shed | 

Aijrecmenf 

1. Access Agreement 

2. Restoration Agreement 

IVIiiscellancous Documents 

1. Final Map from the Meld 

2. Change Orders 

3. XRF Data 

4. Any emails or PO eorrespondenees 

Property Completion 

1. Executive Summary 

2. AS BUILT 

3. Propeity Completion Agreement 

4. Any buyout info or reimbursement mio 

5. Check or money order copies 

6. EPA Property Close Out Form 

7. Attached Begin Video 

Electroni c Documentatio n 

Drawing.s 

1. EPA original 

2. Working Drawing 

3. AS Built.vso 

4. AS Built.jpg 

Photo.s 

Begin Photos 

During/Excavation Photos 

Sod i'hotos 

30-Day Sod Pholos 

Scanned Documents 

Final Documents 

 Executive Summary 

Viideos 

Begin Video 

2 My Movie 
Property Access Checklist 

PropertylD: ^^^^^; ^ n WORK STARTED ON: / / 

1 Property A.l(lre.s,s: J 5 . ^<^ ^ f ^ ^ ^ n WORK COMPELTED ON: / / 

Owner: jN^^( ^ jj]77^^. 5 Renter: 

Address: Phone: 37(^\ Fax: 

Cell/Paser: / ^ 7z777/ 

Additional Information; .^^„_@S-i^i^./3_^ir_ Fax: 

Cell/Paaer: 

Q r Notification Letter Sent:_^/^/ ^ ^y (^Less 

u p Access A<»reenient Signed: ^/Jf/^l5 r «>••= /^i'L^ X 

"nT Restoration Agreement Signed: 4-/<^/ ^ "">'•• Oh/2y< 1 

1 1 Top.soil Samplin" (if ap|)licable) / / By: 

n Dispo.sal Samplin" (if a|)plicahle) / / By: 

0 Garden Sampling (if applicable) / / By: 

i'70fe>t:-c> 

;@ Utility Clearance Called: t«^ I X 1 qJ , 

^ Video/Photos (Before) On:5_/^/d^^ ^y l4^yr4i^c ^ 

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

D Vide<»/Photos (After) On: / / By: 

n Video/Photos (30-Day) On: / / By: 1 

0 Property Completion Agreement Signed: / / By: 

n Final Report Issued: / / By: 

Air IVIonitoring (as a|)plical)le 

1 1 Community CU Cren 

) 

Results:

On: / / By: 1 

 || 

1 1 Community

Results: 

 EH Cre>y On: / / By: 1 

1 1 Community

Results: 

 CH Crew On: / / By: 

Omaha Lead Site 
32362 

Omaha Exterior Paint North Arrow Lead Site Owner Name: CHARLES LEVERETTE 

Site • Good Sketch Address: 3709 N 30 ST • Poor 

[ J Not paint 

Omaha Lead Site 46130 
Owne Omaha Lead Site r Name: CHARLES LEVERETTE 

Site Sketch Address: 3709 N 30 ST 

Phone: JH.-^5li^5"V^_ W: 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

RYASCPXA-32362 F1 ___7^pp m a 

K'l liiiLHAA-JiJbi ppm D 

RYCSCPXA-32362 Bl ^^ 7 ppm n 

•RYDSCPXA-32362 -62 ~ ppm D D 

ROZSCPXA.32362 -DZ ~ ppm D n 

RCZSCnXA-32362 ~ ppm D n 

RPZGCPXA-323G2 ~ ppm D n 

Number of Samples • ;o? 

^ ^ - ^ - ^ 

y 

^ h' ^97 

A-

B.i.. 

^ 

A 

^ 

y ^ - ^ —Jc T 

;c 

Zi 

F.l. 

-r^H 

L - ^ -¥­

kJ^T^ 

3o.^T 

32362 

Exterio North Arrow r Paint 

• Good 

• Poor 

[~1 Not paint 

Samples Collected 

Firm: f7)^_Gj/fy3 

Date: 

Time: yy9 : US^ 

Samples Analyzed 

XRF Unit: /g3 7 Book: /3 2 

Date: 10-0^4-0 ^ 

Time: AfA 

Staff: J=A_ 

ENTERED 

SEP:t3 2605 

^ 

7­

3D ,^r 

•X 

=7^—^ 

(Dinaha Lead Site 

46130 
Douglas County Account Information 

Page 1 of 1 itonr 

Dougla s County , Nebrask a Propert y Recor d - R182955000 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 1 

Owne r 

WATERS DALLAS J .4Si^ ^ 

3701 N 30 ST 

OMAHA NE 68111-0000 

Propert y Informatio n 

Key Number: 2955 0000 18 

Account Type: Multiple Comm 

Parcel Number: 1829550000 

Parcel Address: 3709 N 30 ST 

OMAHA NE 68111-0000 

Legal Description: MYERS RICHARDS & TILDENS ADD LOT 7 BLOCK 13 N 60 FT LTS 6 & 

Valu e Informatio n 

Land Improvement Total 

2007 $800.00 $0.00 $800.00 

2006 $800.00 $0.00 $800.00 

2005 $800.00 $0.00 $800.00 

2004 $0.00 $0.00 $0.00 

2003 $800.00 $0.00 $800.00 

2002 $0.00 $0.00 $0.00 

Sales Informatio n 

Sales Date: 2007-04-21 

Deed Type: QC Book: 2007 Page: 046075 

Price: $600.00 

Grantor: 

Leverette Charles etal 

Grantee: 

Waters Dallas J 

Lan d Informatio n 

Acres SF FF Units Depth Width Vacant 

0.13 6000.0 0.0 1.0 0.0 0.0 Yes 

Lan d Attribute s 

Attribute Attribute Description 

Improvemen t Info r matio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R18... 9/27/2007 
# 

CONTACT FORM 

Property ID # 7) ;^3l^3L 

Property 

Address: 31o9 ^[ ^ 5^ 

Initial Contact: Date:^/^//l?-Time: Actioionn : /Iffy 

Second Contact: Date: Time: Action: 

Final Contact: Date: Time: Action 

Final Action: Transmit to EPA D Other Action: D 

Comment: 

Owner ' 

Comment (s): 

Site 

Coordinator 

Comment (s): 
/Vfi^^'o

o ^^^Z°

V^'^Tp * ^•^Lno- y

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

 Coastal Environmental Group Inc. 

 www.coastalhazmat.com 

 COASTA L ENVIRONMENTAL 

GROUP , INC . 

EXECUTIVE SUMMARY: 

32362—3709 N 30 ST 

X No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

32362 

Concrete pad is broken 

remove if possible. B1 be 

aware property extends 

about 10' from wooden 

fence. Big tree dig around. 

'"Htaha I tsL 

Date Excavated: 10/23/07 

Date USEPA Signed Off: 12/5/07 

4nl"Ki 

Legen d 

Area not Excavated Dripzone Excavated 

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

Quadrants Excavated 

 Group Inc , 
S3lt EPA 

EPA Property Close Out Form 

Property #: 3Z37^Z. 

Property Address : snb'f Xi 3o S-^ 

Date/Time: Owner's Name: 

Quads Excavated: Contractor Group 

Excavation 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? 

Gradlne Sod and Vefictation 

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 

day time period) 

4. Are sodded areas generally firm and evenly graded? 

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? 

7. 

Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaininj; Walls 

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

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

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

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

Foundation, Sidiof( and Gutters 

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? 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

Was damage to walkway surfaces avoided? 

Yes No 

y 

VA 

Yes No 

y 

i,^-

y 

y 

y 

t y 

y 

Yes No 

/* > 

/ 

y 

hJA 

Yes No 

A/A 

A)!^ 

^i r 

AM. 

V^ 

Yes No 

y 
Inspection notes: 

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

EPA Representativ^g^-7^^^^4^_^^ ^^^.NXZ ^ Date: 772/jr7^7 
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 that no items are in questions, 

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

Property ID: =i)^^^(^ ^ 

Property Addre.s.s: O^'^Q^] ^ p^W \ ' ^ 

Owner: J^^^^ ^ ^^^^- ^ 

Phone: {HQ-^S^Q I - [O,/^^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

I "TTagree restoration Is completed, except as noted 

 I I do not agree restoration is completed 

izMo7 

Owner's Signature Date Contractor's Signature Date 

I
Omaha Lead Site 46130 
^m PROI'ERTY CLEARANCE WORKSHEET 

Date /O -Z3-c:>7 

Project Omaha Lead - Fixed Price 

XRF ID 0107^^1 

Shot # Reading Sample Area 

?l / 6 ^ f 2-97 VCo 

Sample Area 

I n Situ Aliquot Reading 

1 /•>8 

2 7(,7 

3 ?z 

1 72S 

5 &7 

Sample Area 

In Situ Aliquot Readinq 

1 *7/ 

2 5-^ 

3 ?6 

4 U^ 

5 57 

Sample Area 

I n Situ Aliquot Readinq 

1 

2 

3 

4 

5 

Sample Area 

I n Situ Aliquot Readinq 

I 

2 

3 

A 

5 

Sample Area 

I n Situ Aliquot Readinq 

1 

2 

3 

A 

•; 

^7 y-^ 

7^J ^'/^ 

/?/ Z-Z:> 

Composite Readings 

(Bag) 

/ / 8 

/ 7 3 

/f' f 

XRF Coriected Value —> 

(use calibration chart or add 

20% to value) 

F) y-e 

Composite Readings 

(Bag) 

^0 

V

7<5 XRF Corrected Value -> 

(use calibration chart or add 

20% to value) 

Composite Readings 

(Bag) 

XRF Corrected Value - > 

(use calibration chart or add 

20% to value) 

Composite Readings 

(Bag) 

XRF Corrected Value - > 

(use calibration chart or add 

20% to value) _ 

Composite Readings 

(Bag) 

XRF Corrected Value —> 

(use calibration chart or add 

20% to ualue) 

Property ID 

Property 

Address 

Measurement 

3ZZ(oZ 

3109 / / ,-^0-^^ 

Count/Time 

Field Shots 

Shot # 

Composite 

Average 

(Bag) 

/ 5 &

m 

Composite 

Average 

(Baq) 

5io 

10 

Composite 

Average 

(Baq) 

Composite 

Average 

(Bag) 

Composite 

Average 

(Baq) 

Reading 

Composite 

(Dried & 

Sieved) 

J 

Composite 

(Dried & 

Sieved) 

Composite 

(Dried & 

Sieved) 

Composite 

(Dried & 

Sieved) 

Composite 

(Dried & 

Sieved) 

Sample Area 

Analytical Lab Spilt Sent Number ? 

Pass/Fai l ? 

Analytical 

Lab Spilt Sent Number ? 

— 

Pass/Fai l ? 

Analytical 

Lab Spilt Sent Number 

Pass/Fail ? 

Analytical 

Lab Spilt Sent Number 7 

Pass/Fail ? 

Analytical Lab Spilt Sent Number 7 

Analytical 

Results 

Analytical 

Results 

Analytical 

Results 

Analytical 

Results 

Analytical 

Results 

ilSI AUDI I ItlHA l SUt I I \ l l 

XRF Ipchnlrian's Slqnltciro HH nt I) 
1 •» .MK . * • ••'(• i,; ./'Y'- -.'«i«(i.Hjit«'*Jr^'«Wr M 

COASTA L [NVIRONHENTA l 

C R O U f , IH C 

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: 

Owner's Name: A-z^s J, bJ/^r^^ Daytime Phone: 'Tj^ ^ • 7 ^^ ^

Address of Property 37<^f 77 SO^ y 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 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 
f <

# 

COASTA L ENVIRONMENTA L 

CROUP . INC . 

• 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. 

• Allow videotaping and/or photographing of the property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any ofthe 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 

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

%Z<^'a 7 

Signatun 

Date Signature Date 

d l I would like to be present during any sampling that is required. 
COASTA L 

Restoration Agreement 

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

remediation activities. This wil l aiso serve as documentation for the purpose of assuring that restoration 

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

Protection .Agency (EP.A). 

Property ID: J^Z'^6? ^ 

Propertv Address: ^7^ ^ y{ J ^(^^ ( 

0>^ner: ^^^^^^^^5 UyATW^^ ^ 

Phone: 3DQ' y^6 ^ 

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

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

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

bv referencing the photo-log number with an arrow indicating direction of \ iew. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

^*^''"sc— "'spcS'!. s^^r*" "-*.'•'•"" r'^t^'c*£^ '*£-^c 'c '^^ 0''.'''t^'" ^ r3'^'"*'^S''^''!*\ . c , . - . c . 

Item 

CACS

Item: 

 /Ay S J yf(y4i7> 

t^odh T^IT^UA^ 

Item: 

item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of 
COASTA L 

Items To Be Remove d By Contractor During Remediation An d Not Replaced 

(Use additional sheets as necessary) 

Item: /Uoz^yzy 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item; 

Item: 

Item: 

Item: 

Page 2 of 
COASTA L 

Items To Be Removed By Contractor Durinq Remediation An d Replaced 

(Use additional sheets as necessary) 

Item: ^^h 

Item: 

"S^a-K [ ^ 

Item: ^—_ 

(-f^ '^JG^y^O ^ 

Item: 

Item: 

Item: 

y 

i Item: 

1 

1 Item: 

1 

i Item: 

i Item: 

: Item: 

1 

1Item: 

! Item: 

1 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 co\ered with urass. 

Number of nees

trunk diaineter 

 • 2 inch 

/ Each 

• Ni.;:ibier ot' irees 

I trunk diai^ieier 

inch 

Nuiiibcr ill' sprinkler 

.'Lvnci. Contro! \'a!\'es. 

! :n:e:-?. Heads, etc. Each 

Number of and size of 

each yardon Hower bed 

area. Each 

Sauare Feet 

Page 4 of 
COASTA L 

Item Quantity Unit Condition/Type/Species 

.Agreed upon \alue of 

plant materials not to be 

replaced bv contractor. 

Note ihis \alu t «il! be 

used to !s<ue a plant 

\ouche r ui rhe p!-(>per:> 

ooi'i r.t'f. 

77 77 7 

s 

Agreed upon list of plant 

materials thai will be 

replaced by contractor. Be 

\er y specific and detailed. 

l:-,c!ude :•; ^kelcll .••!' •••..c;-.-

i-:,ch plant '.\il! be pl;.cru 

.'• V .r.c •.vn:i^vu'! 

y-y 07f 

Each 

i J

1 .Agreed upon

1 propen \ :o be

w ith grass sod. 

i •.-L.^-.-- -.•.. 

 /­ area of 

 replaced 

6( 

ft 

SF 1 

1 

1 

1 

i 

-A.fea of C;t_\ or County 

I propertN to be iar.dscaped 

I per their recMiremetiis. 

Page 5 of 
r 

COASTA L 

Additional Comments / Instructions: » , /___ , / . ,,k_A, *? ^s -o 

/f^/l T'O A/7^0l ^ y/M^ // ^ /c/6«p r o -yyyty^'^''^ ^^y^yyy 

yr^^e.r^^^/0'y-^y^^y 

^' ^ -fl ^/uiJiO^ Ayoali?yi -tJ^t/Ayfc3 

/A^ -ny<yy-^ ^"^^ . 

- ^/!>^,yyy ^^^taz/rm^ (^/^'^ ^ 

• 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. 

[ / l agree EH I do not agree 

'/jd ^ "^-ty-o 7 

Ow ner's Signature Date Contractor's Signature 

Page 6 of.