TRANSMITTAL of OMAHA LEAD SI i 

SOIL REMEDIATION FILE FOLDER 

SAID #: 50Sq Q Dafg. 

Address: \^^V Gor-teNj ^A . 

Remediation Contractor: Environmental Restoration, LLC_ Year: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) _^efor e DAfter D Basement D 

JZ Executive Sunmiary (Final Report) 

y Z EPA-provided property sketcli 

Zu Signed Access Agreement for subject property 

• Signed Access Agreement(s) for adjacent property 

/ A Restoration Agreement 

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

^ Confirmation data 

ZA Photographs _^^efore DCrew Photos G^uring Excavation • Sod 

X30-day Sod D 

A ^ As-built sketch 

Completion Agreement signed by Property Owner 

Property close-out check list signed by EPA 

Description ofareas not meeting ROD cleanup criteria 

Utility- clearances 

y Property information from Douglas County Assessor's. Office 

Property access checklist 

30261911 ^ "7""; ,_,

 liiillHilil 

A ^ Ug^^^-/ - /o- r Superfund 

tnvironniental Restoration Signature Dit? 

iSt'/^'f/ 

Date 
EPA 

EPA Property Close Out Form 

Omaha Lead Site 

Property #; SO^^ O 

\%1. \ CJDI~>OSA % V . Property Address: 

Date/Time: Owner'sName: \ADO&>Vt=»<N or\^\AgA\ 

Quads Excavated: F l /F 2 Contractor Group : Environmental Restoration (ER) 

Excavation General 

\j/7^/iJr IDT Yes No 

1. Ifnecessary, were the correct quadrant(s) excavated and restored? Z ^ 

2. tfnecessary, were the correct areas ofdrip zone excavated and restored? 3E 

Grading Sod and Vegetation 

Yes No 

I. Does the grading wound tho pfrrimutsr of tho housa.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 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 30-day time period). 

6. Was the property graded such that water will not pool on the property? l y 

Was damage to landscaping or plant materials avoided? . X 

Gates, Fences and Retaining Walls 

Yes No 

1. Do gates open and close freely? (ifapplicable) 

2. Were all gates or fences taken down during restoration activities re-installed? (ifapplicable) • M ^ 3.

 Was damage to gates or fences avoided? (ifapplicable) 

4. Was damage to retaining walls avoided? (ifapplicable) 

foundation, Siding and Gutters Yes No 

I. Was damage to siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? MO.IUiA' iai fr 

4. Was damage to window screens or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

Yes N.D 

1. Was damage to driveway surfaces avoided? HJk 

2, Was damage to walkway surfaces avoided? i Z 

[nspection notes: 

Remedial and restoration activities complete including 30-day sod warranty: 

EPA Representative /9/J^t£0>^A/^y^X<^ 

Date: ^V^AD/ / 
y'"'^^<. 

Omaha Lead Site^EP-R7^9^S 

Environmentat Restoration, LLC 

'*. j ^ www.erltc,c<»n 

EXECUTIVE SUMMARY: 

50590 1821 CORBY ST 

No Issues or Concerns Q] issues/Concerns 

Detail Exnlanafinn­
Page 1 of 1 

"> 

[ Create Another Ticket ^ [ Back tolrth Intemet ] [ Send Email ] 

YOUR TICKET NUMBER IS 2707705. 

Original Call Date:

Work to Begin Date:

 4/08/11

 4/12/11

 Time:

 Time:

 6:56 am

 7:15 am 

 Op: TIM24186 

State: NE 

Address: 1821 

County: DOUGLAS 

Street: CORBY ST 

Place: OMAHA 

Twp: 15N Rng: 13E 

Twp: Rng: 

Legal Given: C 

Sect-Qtr: 10-SW 

Sect-Qtr: 

Type of Work: Lead Soil Removal 

Location of Work: LOCATE ENTIRE PROPERTY 

Remarks: FAX ALL CLEARS TO: (402)451-1069 

: SAID # 50590 

Company : ENVIRONMENTAL RESTORATION 

Contact Name: TIM SUTTON 

Alt. Contact: 

Phone: (402)451-1314 x2267 

Phone: (402)306-2347 

Work Being Done For: EPA 

Depth of Excavation: 24 in Corner Lot: N Front: N

Involves Tunneling or Horizontal Boring : N Explosives: N 

CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 

 Rear: N 

Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY MUD

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITYOFOMAHA-TRAFFICSEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRJCT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 4/8/2011 
I'age 1 ot 1 

"> 

[ Create Another Ticket ] [ Back to Irth Intemet ] [ Send Email ] 

• YOUR TICKET NUMBER IS 2691640. 

Original Call Date: 3/22/11 Time: 10:13 am Op: ADAM24186 


Work to Begin Date: 3/24/11 Time: 10:45 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1821 Street: CORBY ST 


Twp: 15N Rng: 13E Sect-Qtr: 10-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: Lead Soil Removal 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)451-1069 


: SAID # 50590 


Company : ENVIRONMENTAL RESTORATION 


Contact Name: ADAM Phone: (402)451-1314 


Alt. Contact: Phone: (636)288-9616 


Work Being Done For: EPA 


Depth of Excavation: 24 in Corner Lot: N Front: N Rear: N 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY MUD Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RICH/TRAFFIC Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNE 1C QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 3/22/2011 
Contact Information Log 

SAID#6br^O 

im^io_ Owner's Name:./,,3, ^ ^^y^x r,^ ^ Daytime Phone: ^Tr " ^// ' l^( > 

II Property Address: /^2. / Co^Jh/ ? -ST­ 1 

1 1 

Attempt to contact Date/time Name 

^.« r A\s<^ OJ-* il'Gi o iZ-Gco :T-/f2:1^-11 & 

\ ^c^kJl/XA j poo r 3-l-'li 

Ho^h^ j/i^/^U ^ Z'l-K W> 

r 
Property Access Checklist 

SAID: /^<^^ 0 D WORK STARTED ON: _/ l_ 

Property Address:/g^; ^^^ g ^ D WORK COIVIPELTED ON: I I 

Owner: rAf^j^is^Ngi^i^t/ f(r.^<M, ^ f"^^ '•*'"*"= 

Address: Phone: 

Fax: 

Cell/Pager: 

Phone: Additional Information: 

Fax: 

Cell/Pager: 

I7T Access Agreement Siened:*^ / c2/l ( By: ^i ; 

Q^Restoration Agreement Siened: r , IKSZH. K By: © 

[2 r Video Property Before On :J:J/J^/U . By: £ 3 

•'-T)igital Photos Before On •.j:^/m.'JL By: t ^ 

n Video Property After On : / / By: 

D Digital Photos After On : / / By: 

" ^ Property Completion Agreement Signed: . ^ / f 1 I f By:/ ^ 

n Einal Report Signed: / / By: 

Additional Video or Digital Photo's Taken: 

n Video n Digital Photo On : / / By: 

Reason: 

D Video n Digital Photo On : / / By: 

Reason: 

D Video n Digital Photo On : / / By: 

Reason: 

n Video n Digital Photo On : / / By: 

Reason: 
Consent for Access to Property SAID# Sb'A^ 

RIGHT OF ENTRY TO PREMISES 

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

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

and perform certain environmental response activities upon the folloving described premises: 

Owner's Name^ 7i^<iftn A/CW-iOl^ Daytime Phone: 

Address: /y^f (WU/ 

Address: 

Addresse ^ s of Properties 

Address: covered by this 

Agreement: 

Address: 

Address: 

PURPOSE OF INVESTIGATION 

The purpose of the remedial activities is to remove all soils at the property which are 

contaminated with hazardous substances, in particular lead at concentrations greater than or equal 

to 400 parts per million (ppm). 

REMEDIAL ACTIONS 

The environmental response actions to be performed on said property may include the following 

activities: 

a. Taking photographs and/or video of the property before, during, and after remedial 

activities; 

b. Locating equipment and machinery on-site in preparation for and in the course ofthe 

envirormiental response; 

c. Plaiming and implementing the removal action on or near Grantor's property. 

d. Obtaining samples from Grantor's property; 

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 

I grant access to my properties 

Q I do not grant access to my properties 

Signature Date 
Additional Comments / Instructions: 

D Check this box if owner does not want E.R. to enter the residents to document interior 

foundation walls and possible preexisting damage. By checking this box E.R. is not responsible 

for any damage done to the interior of house, including foundation cracks or fissures. 

n I do not agree J ^ I agree n I do not agree 

Contractor'srSignature Date 
Restoration Agreement 

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

contractor activities. This will also serve as documentation for the purpose of assuring that restoration 

activities are completed to the satisfaction of the property ovmer and the United States Environmental 

Protection Agency (EPA). 

SAID: ^or^A) PropertyAddress:/^^/ ^^^ ^ . ^ 

Phone 

On the attached diagram(s) indicate area(s) to be excavated and depth of excavation, location of all known 

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

contractor, and the direction of North. Indicate distances, depths, material types, etc. Indicate digital photos 

by referencing the photo-log number with an arrow indicating direction of view. 

Items to be removed by Contractor and not replaced 

Item 

htp/(^C/ <J / /u/cu liJiH oU'l Sd'///UO^o^J J 

Item: 

Item: 

item: 

item: 

Item: 

(tern: 

Page 1 of 2 
n I do not agree i^I agree Q I do not agree 

^--^- w y/^yr\ 

Contractor's Signature Date 

Attachment 

Page 2 of2 
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 

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

SAID: 

• Gos-- "70 

PropertyAddress: ^^^ / ^q^^ f ^STJ 

Plione 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

\j/y^\ agree restoration is completed, except as noted Jjd I agree restoration is completed, except as noted 

I I I do not agree restoration is completed I I I do not agree restoration is completed 

Qa^jCt^Ibr-^ S-^-\ \ •^ sA Iff \.i^<\ Owner's Signature ignature Date Date * Contractor's S 
Douglas County Account Info^^^tion Page 1 of2 

Douglas County, Nebraska Property Record - R2030580000 

Print Report 

View Interactive GIS Map Information is valid as of 2010-11-16 Treasurer's Tax Report 

New Feature -•-•- • Subdivision Sales Search 

Owner 

MCKELL 3 HOUSTON 

ETAL 

PO BOX 11784 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 3058 OOOO 20 

Account Type: Residential 

Parcel Number 2030580000 

Parcel Address: 

Legal Description: PRUYNES SUB DIV LOT 32 LOT 2 BLOCK 0 30 X 78 

Value Informatio n 

Land Improvement Total 

2010 $200.00 $0.00 $200.00 

2009 $200.00 $0.00 $200.00 

2008 $200.00 $0.00 $200.00 

2007 $200.00 $0.00 $200.00 

2006 $200.00 $0.00 $200.00 

2005 $200.00 $0.00 $200.00 

Show All Transactions 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.05 2340.0 0.0 78.0 30.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 11/19/2010 
Douglas County Account Info'^^-'tion Page 2 of2 

The above map is powered by Google, and is intended to provide a general idea of a property's location. If you 

require a more exact property location, you may use the Interactiye GIS Maps that are maintained by our 

office. 

http://doug!asne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 11/19/2010 
ENVIRONMENTAL 

AS-BUILT DRAWING ^ 

OMAHA LEAD SUPERFUND ^ 

RESTORATION 

^0530 

Omah a Exterior Painl North Arrow Lea d Sit e Owner Name: Tejshc t /Jcxit^So/^ • Good Sit e Sketc h Address: /gZ. ^ Cer4>if S-/-­ • Poof 

Phone: H: g yo-Vg'gg'w : r~l Not paint 

Sample Number Lead Sample 

Samples Collected LAB Concentration Coltecfed Firm: 

RYASCPXA-5-0ir=)0 F l ppm •

Date \//i//o^ ­ RYBSCPXA-SVPg-go F2 ppm n Time: 

RYCSCPXA-fe-O^^O B1 

ppm n Samples Analyzed RYDSCPXA-Sro5^0 B2 

ppm D -RDgOCrXA- -DZ 

ppm D n 

XRF Unit: /O3 7 Book: / 3 ^ 

RGgCCPXA ppm D 

n 

Date: _ n I 3 -0<a 

-Rpzscpyj ^ -ez ppm D 

Time: ^yy / 

Staff: Number of Samples = j t j 

AA. 

Legend F1 = Front Left, F2 = Front Right, B1 = Back Left. B2 = Back Right OZ = Drip Zone, GZ = Garden. PZ = Play 

AH quadraftts are as vietwed from the street, facing property 

SAID # 50590 ""^• ^ 

330 

DATE EXCAVATED 4-20-11 

DATE EPA SIGNED OFF 5-4-11 

AREA SODDED 1496 SQ FT 

Rev 4-

CowtaiwinaHon Uf t Bahlrtd Quadran DfiD Zone Excavatad t oxcavatcd '. 

Cn<>i»'«x~«'~»*'~i o*.»»»»»»«»*i'«»« I ' r* r«^^*.'.A« u. CO o t nA nc 
so^ao 

Omah Exterior Painf North Arrow a Lead Site Owner Name: • Good Site Sketch Address: /^Z ( Cojrhjf_.S±^__ 

Phone: H: ? 5-0 - VS'gS" ^ 

j~~| Not paint J 

Lead Sample Samples Coiiected Sample Number LAB Concentration Collected Firm 

RYASCPXA-S^O^^^O F1 ^6 2 ppm 

D Date \/h/,loT 

RYBSCPXA-S»5"?0 F2 ppm D Time 

RYCSCPXA-ST^^O B1 zof^ ppm 

Samples Analyzed RYDSCPXA-S^S^tJ B2 ppm n 

tJZ ppm D D XRF Unit- /O37 Book; 

138 

RGzecpy^A 6 ^ ppm D D Date: _ 1-3 •OQi 

•fiPZSCP.XA • -.^Z ppm D D Time: j^zzL D Staff: Number of Samples = | i^ AA. 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ - Drip Zone, GZ = Garden, PZ = Play 

AH quadrants are as viewed from the street, facing property 

Ot-HaiMff 

Rr/4 046Hl-f>l23 ­
'i'.a^*«»i'iiwii*i'*. --J V 

^Q5S O 

Owner Name: 

Address: 

Omah a Lea d Sit e 

Site Sketc h 

Exterior Paint 

• Good 

• Poor 

North Arrow 

Phone: ^j_3^^.'/i^S5- ^ f~) Not paint \ 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

 fP M ~ 1L/C\'//2I . 

RYASCPXA-S'^^*?*? Fl 

RYBSCPXA-S»£r<?0 F2 

RYCSCPXA-iHJ^O 81 

RYDSCPXA-52> 5^ ^ B2 

ZO?i 

fZ( p 

ppm 

ppm 

ppm 

ppm 

a 

D 

n 

D 

Date 

Time 

Vh/JoT 

r^ZS 

Samples Analyzed 

-ftOZOCrXA:

ROZSOPXiA 

 DZ 

-e*­

ppm 

ppm 

D 

D 

D 

D 

XRF Unit: 

Date: _ 

(O^ y Book:

/-3-g & 

 /? g 

•«PZSCPXA • -PZ ppm D D Time: P'zyi 

Number of Samples = ' LJ 

J 

Staff: AA. Legend: F1 = Front Left. F2 Front Right. Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ Garden, PZ = Play 

AH quadrants are as viewed from the street, facing property 

-"' ^ mi'^:\ 330 

aiiHaiLN^ 

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it 

^ 

mi Caltt,f 

5T 

h n 

H^Z s s / 

31^ 

Coifcvj' 5T ReY4- 045MI0I23 
C ENVIRONMENTAL XRF DATA ENTRY LOG 

RESTORATION 

SAID#S&?>^ 0 DATE •4 \z.c>\ ^v 

PROPERTYADDRESS TIME 

19:7-V do r 

^ &-r 

XRFSm '^^13' ? 

QUADRENT OR SAMPLE AREA 

DEPTH AVERAGE OF RESULTS SHOT#s 

redig 

n F1 \^S: i 2-1 '77---!;=^ 

n F2 - ^ 

n B1 

D B2 

n DZ 

n PZ 

n GZ 

a EZ1 •4- 7^gtO t 2.-1 g^~g 7 

n EZ2 

n OTHER 

SAMPLER NAME ~ 3 •'So.ro.vc^ 

^ 
Thermo Fisher Scientific Thermo 900 Middlesex Turnpike 

Billerica, MA 01821 

SCIENTIFI C 

1 line SAID Ai)i)ui:.s.s SA , AUKA OI'K.llAIOIl 

1 2011.04-20 13:45 50590 1821 corby st Fl JIMMY llnal clearance 157.53 ± 21.19 

2 2011-04-20 13:45 50590 1821 cort>ysl Fl. JIMMY final clearance 200,57 ± 23.53 

3 2011-04-20 13.46 50590 1821 corby SI Fl JIMMY final clearance 206.19 ± 23.84 

4 2011-04-20 13:46 1821 corby sl Fl JIMMY final clearance Avg of 72-74 188.10 ± 22.85 

5 2011-04-20 13:49 50590 1821 corby sl F2 JIMMY final clearance 184.50 ± 21.81 

6 2011-04-20 13:49 50590 1821 corby st F2 JIMMY final clearance 193.37 ± 22,41 

7 2011.04-20 13:50 50590 1821 corby SI F2 JIMMY final clearance 183.18 ± 21.69 

8 2011-04-20)3:50 182) coibysl F3 JIMMY Unal chaisnce Avg of 76-78 )S7.02 ± 21.97 

9 2011-04-20 13:57 50590 1821 corby St EZ JIMMY surface final clearance 292.33 ± 27.03 

10 2011-04-20 13:57 50590 1821 corby st EZ JIMMY surface final clearance 281.45 ± 26.31 

II 2011-04-20 13:58 50590 1821 corby sl EZ JIMMY surface final clearance 296.22 ± 26.% 

12 2011-04-20 13:58 1821 corby st EZ JIMMY surface final clearance Avg of 84-86 290.00 ± 26.77 

Page 1 o f 1 04/28/11 14:51:44 
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