TRANSMITTAL of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: P77<:. a Date: U-\-l \ 

Address: <^^^ ^ A/- /' A A^M^ 

Remediation Contractor: Envrionmental Restoration, LLC_ Year: _2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

jX " Video of property (DVD) ^^^^fore DAfter D Basement D 

— X Executive Summary (Final Report) 

X EPA-provided property sketch 

Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

X^ Confumation data 

y f Photographs /Q Before DCrew Photos_,J2^uring Excavation D Sod 

J2^0^ay Sod D 

^ As-built sketch 

X Completion Agreement signed by Property Owner 

j X Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Office 

Property access checklist 

„ , , 30261895 

Contact Log 

Vacayi' ' ^7 ^ Superfund 

Envirotimental Restoration Signature Date 

/a-iZ' / /

Date 
EPA 

EPA Property Close Out Form 

Omaha Lead Site OU#2 

Property#: ^?76>a PropertyAddress: tP^^f A/ /f'^7h ^ 

Date/Time: Owner's Name: %^ 7 T^rry 

Quads Excavated: FIjFJ.'BljBS Contractor Group : Environmental Restoration (ER) 

Excavation General ^fjIX'Jlh^ I oT " Yes No 

1. Ifnecessary, were the correct quadrant(s) excavated and restored? y 2. Ifnecessary, were the correct areas ofdrip zone excavated and restored? 

Grading Sod and Vegetation Yes No 

house? y

2. Has sod been laid m ail areas that were excavated? y ^ 

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? \ y ^ 

5. Are the Joints between the sod strips generally tight? (Only evaluate ifinspected at 30-day time period). 

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

7. Was damage to landscaping or plant materials avoided? i y 

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) itM 3. Was damage to gates or fences avoided? (ifapplicable) 

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

Foundation, Siding and Gutters Yes No 

1. Was damage to siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? \J/lM(\i' JrrE 1 ^ 4. Was damage to window screens or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? ^ ^ 

2. Was damage to walkway surfaces avoided? KW 

Inspection notes: 

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

EPA Representative Date: 3/^U^ H ^ 
fjQl^\ Omaha Lead Site—EP-R7-09.05 

5 -S^feji- ^ Environnfiental Restoration, LLC 

\2. Jp www.crllc.com 

EXECUTIVE SUMMARY: 

29762 2809N19AV 

X No Issues or Concerns Q] Issues/Concerns 

Detail Fynlanarinn: 
[ Create Another Ticket ") [ Back to Irth Internet ] Send Email | 

• YOUR TICKET NUMBER IS 2670466. 

Original Call Date: 2/10/11 Time: 4:46 pm Op: ADAM24186 


Work to Begin Date: 2/14/11 Time: 5:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2809 Street: N 19TH AVE 


Twp: 15N .Rng: 13E Sect-Qtr: 10-NW-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 


: 29762 


Company : ENVIRONMENTAL RESTORATION 


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


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


Work Being Done For: epa 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


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 CITY OF OMAHA-TRAFFIC.SEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emera: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT 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... 2/10/2011 
Contact Information Log 

SAID ^^n ^ 

OwneVs Name: Daytime Phone: V^Z-i^f/-<^yg^ ^ [ ' C -

Property Address: J}St7c£^ / ^ ' 

1 

Attempt to contact Date/time t Name 

/Z-^'/o ^// Z 

& 

r-O- /5 /AJ 4-/Ww^iiM./) ^/W) ^ 

po) I^^lOpl? c^'i^,fri^sj ^ iZ^Jiyo j //" ^ 7 J 
Property Access Checklist 

SAID: 7^'(l^'t n

D

 WORKSTARIED 

 WORK COIVIPELTED 

ON: 

ON: 

Address: <^ S3^ oWo 

Phone: c^2--^^/ ­ <^^^ ^ 

Fax: 

Cell/Pager: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

B^^Access Agreement 

CS^estoration Agreement 

[Q/Vldeo^roperty Before 

Q^,<B^al Photos Before 

n Video Property After 

n Digital Photos After 

>Q^Property Completion Agreement 

O Final Report 

Signed:^//^// ^ 

Signed:/Z- //^ / ^O 

On •.lLl.^119 

On -.a^iii ll ^ 

On : / / 

On : / / 

SignediS* /^ h if 

Signed: / / 

By: fi x 

By: ^ ^ 

By: ^m^ 

By: p ^ 

By: 

By: 

Byf^O 

By: 

1 

Additional Video or Digital Photo's Taken: 

n Video D Digital Photo 

Reason: 

n Video

Reason: 

D Video

 D

 D

 Digital Photo 

 Digital Photo 

/ By: 

By: 
# 

Consent for Access to Property SAID# ;2f76^ 

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 following described premises: 

I Own Oer' i 

s Name: ll>he^4- Peyr Daytime Phone: ^Z-'^fZ-^f ^

KM^ : JZ^^ ^ /U / ^ ^" ^ 

Address: 

Addresses of Properties 

covered by this Address: 

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 of the 

environmental response; 

c. Planning 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 envirormient, 

or to allow others to use the property in such 

[ grant access to my properties Q I do not grant access to my properties 

Signatur ignature e ' Date Signature 

Date
# 

• Check this box if own^r does not want E.R. to enter the residents to document interior 

foundation walls and pclssible 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. 

• I agr6e n I do not agree I 11 agree n I do not agree 

Owner's Signature Date Contractor's Signature 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 ovsoier and the United States Environmental 

Protection Agency (EPA). 

SAID: ;?f76^. PropertyAddress: 2 ^ f / / /^^ ^ 

Phone: H(ny 

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: 

(ccce ^ 1 at^g^s k>\\\\ I^JaJ ^o^\ ^ ^ocl, Item 

Item: 

item: 

Item: 

Item: 

Item: 

Page 1 of 2 
iQ l agree EH I do not agree JyfJ agree EH I do not agree 

Owner's Signature D/te Contractor'^ Signature Date 

Attachment 

Page 2 of 2 
# 

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 ftiture, except those items listed below, ifany. 

SAID: 2^nio7^ 

Property Address ^aaress:: / 29 Py)^' / I /^'^" ^

Owner: 

Phone: ^^ ^ ^^<J^^ ^ 

Restoration Items in Question: 

item: 

item: 

Item: 

item: 

Item: 

Item: 

Additional Comments: 

L 

|/_fi agree restoration is completed, except as noted ]yf \ agree restoration is completed, except as noted 

I I I do not agree restoration is completed I 1 I do not agree restoration is completed 

lUZM^ 

Owner's ^natiu e -v i Date Contractor^ Signature Date 

wJiXc.^ I 
Douglas Coimty Account Information Page 1 of 2 

Dougias County, Nebrasica Property Record - R1745130000 

Print Report 

View Interactive GIS Map Information is valid as of 2010-8-16 Treasurer's Tax Report 

New Feature -* Subdivision Sales Search 

Owner 

PERRY ROBERT N 

4337 OHIO ST 

OMAHA NE 68111-0000 

Property Information 

Key Number: 4513 0000 17 

Account Type: Residential 

Parcel Number: 1745130000 

Parcel Address: 2809 N 19AV 

OMAHA NE 68110-0000 

Legal Description: MILLARD & CALDWELL'S ADD LOT 36 BLOCK 0 N 48.25 W 106 FT 48.25 X 106 

Value Informatio n 

Land Improvement Total 

2010 $500.00 $0.00 $500.00 

2009 $500.00 $0.00 $500.00 

2008 $500.00 $0.00 $500.00 

2007 $500.00 $0.00 $500.00 

2006 $500.00 $0.00 $500.00 

2005 $500.00 $0.00 $500.00 

Land Informatio n 

T Acres SF Units Depth Width Vacant 

0.11 5088.0 0.0 48.0 106.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 8/21/2010 
Douglas County Account Information Page 2 of 2 

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http://doug!asne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 8/21/2010 
ENVIRONMENTAL AS-BUILT DRAWING 1 

OMAHA LEAD SUPERFUND SITE 

RESTORATION 

Name: /^4-*v Pear-^ f 

Address: ZSCT /b''/ f -4^'< 

Phone: 

Team &-/Ln ///^twvcgr^ (yi-t ^ > BVID #

Sample Number 

7^> ^ 

i^2^ 

I^^^^XA m2 ^ - erp^pFXA - 2-'=y7^2^ 

Omatia Lead Site Date: 6 ' ^ <^¥ North Arrow 

Site Sketch Time: /^V / 

t ' 

^(y ^ Z^J^ Z XRF Code 

Lead Concentration Confirmation Sample 

^LA. 

^'Yes a No ^ 

^ ^ ^ ppm 

ppm -fZYes a No ^ 

S'Yes C3 No ^ ^/( ^ 

ppm BtYes 1^ No 1 ^ 

ppm Yes C3 No CD 

ppm Yes a No CD 

ppm Yes • No • 

H^ ppm 

Omaha Lead Site 

46130 

Quadrant ancavattd 

Dflp Zono Excavatod Contaminallon luift Bohind 

C!*%«aii^^%«4Mi«rf%««*'«l D^^#«*««i^««4a^^»% I I 1^ u. CD DT nn nc 
Name Omaha Lead Site Date: G- 2--0</ North Arrow : Mik(rl riar y f 

Address: 2607 A) Z'/ ^ ^ Site Sicetch Time: /^?-V/ 

Phone: ^y^ ' "^ty y 

Team ge/u/f-^^ ^^fiyUi£^ (yy^ ^ BVID# 297Q>2 XRF Code 30^ 

Sample Number Lead Concentration Confirmation Sample 

_ 1 ^ ppm I'Yes n No ^- ^ 

^1*7 ppm •fZlYes D No ^ 

^K ppm i^'Yes n No ^ 

A ^ ppm B£-Yes I ^ No ^ 

ppm Yes n No Q 

ppm Yes n No n 

ppm Yes • No • 

- ^ 

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Omaha Lead Site 46130 
Name: M^IHHH 7iirr\/ / Omaha Lead Site Date: Co' ^'<^¥ North Arrow 

Address: Z807 /i;7 ? ^ ^ Site Sketch Time: 0-^ / 

Phone: ir-yV'^ty T y

£_ 

Team M.<r/7^^ftyrdC , ^ fyy^y BVID# 2n(o2 XRF Code 3cy^ 

Sample Number 

Lead Concentration Confirmation Sample 

^yAc;cpyA-2f 7<^2L ^172=. ppm ^'Yes a No ^ 

ppm •J >- le s '—• No ^ 

0 ^ ppm (3'Yes n No ^ 

g.'t^pS^FVA - 25^76^ 

A 

No 121 ppm B^Yes n 

ppm Yes n No D 

ppm Yes n No n 

ppm Yes • No • 

Omaha Lead Site 

46130 
0 ENVIRONMENTAL XRF DAI A ENTRY LOG 

L^^^c^ J 

RESTORATJON 

SA1D# 2SK.-\{ol. 

PROPERTYADDRESS 

^^0 ^ N\- \ ^ M; 

QUADRENT OR SAMPLE AREA 

DEPTH 

redig n a 

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SAMPLER NAME '^%(\m\rS. 

DATE 

TIME 

XRF S/N 

AVERAGE OF RESULTS 

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SHOT #s 

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SCIENTIFI C 

AV:KK.\C;K.

Avg of 868-870 

Avg of 864-866 

Avg of860-862 

Avg of 856-858 

 ADDUK.S.S

2809 n 19 nv 

2809 n 19 av 

2809nl9av 

2809nl9av 

2809 11 19av 

2809nl9av 

2809 n I9av 

2809 n 19 av 

2«09nl9av 

2809nl9av 

2809nl9av 

2809 n 19 av 

2809 n 19 av 

2809 n 19 av 

2809 n 19 av 

2809 n 19 ov 

 SAMI'LIOAIIKA

B2 

B2 

B2 

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Bl 

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F2 

F2 

F2 

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Fl 

Fl 

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jiminy 

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jimniy 

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jimmy 

jimmy 

jimmy 

jimmy 

jimmy 

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N();i;i:S SAID

final clearance 

final clearance 29762 

final clearance 29762 

final clearance 29762 

final clearance 

final clearance 29762 

final clearance 29762 

final clearance 29762 

final clearance 

final clearance 29762 

finnl clearance 29762 

final clearance 29762 

final clearance 

final clearance 29762 

final clearance 29762 

final clearance 29762 

 I'h 

381.14 

408.63 

366.09 

368.69 

59.56 

70.99 

53.85 

53.84 

47.55 

42.07 

48.29 

52.27 

182.72 

189.27 

175.03 

183.85 

± 

± 

± 

± 

± 

± 

± 

± 

i 

± 

± 

± 

± 

± 

± 

± 

31.14 

32.07 

30.76 

30.59 

15.01 

15.89 

14.58 

14.55 

13.53 

13.19 

13.57 

13.83 

22.66 

23.22 

22.11 

22.65 

Themio Fisher Scienlific 

900 Middlesex Tumpike 

Billerica, MA 01821 

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2011-02-17 13:37 

2011-02-17 13:37 

2011-02-17 13:37 

2011-02-17 13:35 

Poge 1 of 1 02/17/11 14:01:18 
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