TRANSMITTA L of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: 27)^I7L Date: lo/lSJdY 

Address: jX^l S" / / S T 

Remediation Contractor: _Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

7 EPA-provided property sketch 

W Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

W Restoration Agreement 

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

M Confirmation data 

W Photographs • 

B^ As-built sketch 

\ ^ Satisfactory restoration signed by Property Owner 

m 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 , 

n ' •• ­ ­ • 

4 ^ 

40317906 iiiili 

Superfund 
aO^IZ - '^^ ^ M St. 

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 

llj Access Agreement 

•t^Restoration Agreement 

Miscellaneous Documents 

D J Final Map from the Field 

2. Change Orders 

g ] XRF Data 

4. Any emails or PO correspondences 

Property Completion 

iT^Executive Summary 

2. AS BUILT 

121 Property Completion Agreement 

4. Any buyout info or reimbursement info 

5. Check or money order copies 

t ^ EPA Property Close Out Form 

•^T^Attached Begin Video 

Electronic Documentation 

Drawings 

jTI EPA original 

[XJ Working Drawing 

t3\ AS Built.vso 

4. ASBuilt.jpg 

Photos 

VBegin Photos 

During/Excavation Photos 

\/Sod Photos 

y30-Day Sod Photos 

Scanned Documents 

Final Documents 

vExecutive Summary 

Videos 

"^gi n Video 

^•^y Movie 
Property Access Checklist 

Property ID: ^c ? t\ \ 2 - B'WOR K STARTED ON: 05/ j 7/ C<j/ 

Propcrty Address: \2.'2-\ %> \\ ^ V n WORK COMPELTED ON: / / 

Owner: MamCV j P\'rtr\ ^CC/\uSs ^ Renter: 

Address: c^-J 2,-1 ' pf e r^^ ^ VQ^CAJ - Phone: 

Fa\: 

Cell/Pager: 

Additional Information: Phone: ^Ql, ^ >MSS - -2- 3 "2 ^ 

Fax: 

Cell/Pager: 

r i Notification Letter Sent: By: 

0 Accc CCC.S. s S Agreement Signed: 05A U lO l By: iX^r^^ \ A 

\ y Restoration Agreement Signed: oS / II, /pH By: 

I I Top.soil Sampling (if applicable) By: 

I I Disposal Sampling (if applicable) Bv: 

I I Garden Sampling (if applicable) -e^nfeV^t-rtrr By: T'» ''^^^•-^^ 

0 1 M litv Clearance Called: J2_/£2/iZ7 B.v: / rfsnt^ 

Q ^ Video/Photos (Before) On:£v5/jn/_^ n ^: ^TTTUTP^i P^AP 

n Video/Photos (During) On: Bv: 

H ^ Video/Photos (After) On:^/£L/_QT ^y- QycX ^ 

Q ^ Video/Photos (30-Day) On:J_iy7i/Xn By: djcjrx 

0 ^ Property Completion Agreement Signed: 7 / f) iCJ ^y- e h f y ^ 

I I Final Report Issued: Bv: 

Air Monitoring (as applicable) 

• Community Q Crew On: / / By: 

Results: jj 

ICH Community Cl Crew On: / / By: 

Results: 

n Community CU Crew On: / / By: 

Results: 

Omaha Lead Site 
c 1-^1 C^^ ' 

i M i ^—' ^ uc /u^ / Total Qi^^i t Square Footage to be Excavated = 1672 

Property Classification: 800 Totffl^Pp Zone Linear Footage to be Excavated = 0 

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Legend North Arrow Omaha Lead Site 

[5^:;^] Concrete Omaha, Nebraska 

\y/ \ ExcavatedArea Property Number 

LkJ 

R>S 

fcxisting Structure 

• Fence 

Scale 

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

OLS-20912 

Property Address 

1221 S 11 ST 

— — —• Quadrant Boundary y^ \ Post Excavation Concentrations (ppm) P 1 P O DlQwAm o 

udi y T I^I H - s • • MHJ!..0 F2 DZ Eas smen t

o Tr ee/S hrub v^ ; — B1 Gar( Jen_ Othe r 

Description of post excavation areas: F1, front yard left-hand quadrant; F2, front yard right-hand quadrant; Bl, backyard left-hand quadrant; 92, backyard right-hand quadrant; 

DZ, drip zone (1-3 foot area of soil around the foundation of the house). 
Ck 

Consent For Access To Property 

RIGHT OF ENTRY TO PRFMI.SFS 

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: 

Na^^C^ Ann f(\tLcn lAA'^t ^02-' M<;<: ~ "2-7)8 M 

Address: I2_^t ^ IV S f (^fyyakg N ^ 

Addresses of 

Address: l^-Z-^ S 1\ s ^ C^v^^aU^ Nje^ 

Properties covered by Address: 

this Agreement: Address: 

Address: 

PURPOSE OF RFSPONSF AcTivrrii:.s 

The EP.A. 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 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. 

ENVIRONMI^NTAL RESPON.SE 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: 

«Property_ID» Page 1 of 2 
£% 

• 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. 

AORFEM}-:NT NOT TO IN rERFF:RF 

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 

HL I grant access to my properties 

I I I do not grant access to my properties 

CP3h\''M-a77tj^ ^AcUi 

JL ^ 

Date Ignature 

Date 

^rop€^rU j (^k)i . ^ y 

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

Page 2 of 2 

«Property ID: 
i^ 

Restoration Agreement 

The purpose of this agreement is to pro\ide a mutual agreement as to conditions of property prior to 

remediation activities. This will also serve as decontamination for the purpose o f assuring that 

restoration activities are completed to the satisfaction of tlie property ouner and the United States 

Environmental Protection Agency (EPA). 

Property ID: " X O <^ \ "2 -

Property Address: UCL\ ) WO- . -V 11 5^ f - ri<v\ ;^Wa. N/ ^ <^^I0 ^ 

^""" = K) ;^rNC ^ ' a^r . M^^^°^ ^ 

Phone: L^ ^ j _ ^ -"MC^ - "^ S 5^ ^ 

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

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

contractor, and the direction ofNonh. Indicate distances, depths, material t}pes. etc. Indicate digital photos 

bv referencing the photo-log number v^ith an arrow indicating direction of v iew. 

items To Be Removed By Owner Before Start Of Remedisticr:: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of thesa items is the Owner's rssponsibility. 

Item: 

MorvC, 

Item: \ 

Item: 

\ 

Item: 

\ 

Item: 

\ 

Item: 

\ V 

Item: 

Item: 

Page 1 of U> ^ 
{^0^ 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

VJitf^*-

Item: V 

Item: \ 

Item: 

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Item: X 

Item: 

\ 

Item: 

Item: 

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Item: 

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Item: 

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Item: 

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Item: ' \ 

Item: 

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Item: 

Item: 

Page 2 of 6^ 
Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

Mo 

Item: 

Item: 

Item: 

Item: 

Item: 

\ 

Item: 

Item: 

\ 

Item: 

\ 

Item: 

\ 

Item: 

\ 

Item: 

\ 

Item: 

Page 3 of L> 
v ( ^ 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-existing property area 

that is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Ndiiiber of trees • = 2 inch 

trunk diameter 

Number of Sprinkler 

Zones. Control Valves. 

Timers. Heads, etc. 

Attach a sketch of the 

sprinkler Iavout. 

Number of and size of 

each garden' flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Quantity 

z 

^ 

\vl* 'N€-

P 

Unit Condition/Type/Species 

. Square feet 

Each 

Each 

Each 

Each 

Square Feet 

Page 4 of k> 
Item 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Note this value v.\\\ be 

used to issue a plant 

voucher to the property 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

by the contractor. 

.Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

Area of Citv or County 

propeny to be landscaped 

per their requirements. 

include a sketch of the 

area (s) 

Quantity 

0 

0 

\-lo o 

3 

Unit 

$o 

Each 

SF 

SF 

Condition/Type/Species 

Page 5 of k. 
Q^hec 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. 

\3fl agree I I I do not agree 0^1 I agree I I I do not agree 

d^'U. ^W~l 

Ov>nei^ Signature Date Page 6 of [ ^ •-tctor's Signature Date 
; « I 

Mtbuift u» M • ^ 

Tota (^ ^ it Square Footage to be Excavated = 1672 

Property ( ;iassificaUon: 800 W ^ To^ ^ > Zone Linear Footage to be Excavated = 0 

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Legend North Arrow Omaha Lead Site 

Omaha, Nebraska | i ^ Concrete 

y/ \ Excavated Area Property Number 

OLS-20912 E_ Existing Structure Scale J • Fence Property Address : 1lnch = 20 feet or 1 grid = 5 X 5 ft 1221 S 11 ST ixVS 

^ ^ ^ Quadrant Boundary Post Excavation Concentrations (ppm) 

- Street Boundary Fl B2 PlavAree ^ HydrO-oi^wL'Xlit. ITr 

C 

t 

Tr ee/SI irub X -p, ^ l ^ i Y Bl Garc Jen_ _ Othe r 

Description o( post excavation areas: Fl . front yam left.hand quadrant: F2. frant yard rigM.hand quadrant Bl , tiacltyard left.^iand quadrant B2. tiackyard right^iand quadrant 

OZ. ithp zone (1-3 foot area of son anxnd the foundation d ttie tiouse). 
PROPERTY CLEARANCE WORKSHEE 

Date 

C)[t\() Property ID l ,\f)l- Property Project Omaha Lead -- Fixed Price Address I77.(SII 5T 

Measurement XRF ID oiai~5i 

Count/Time 

Field Shots 

Shot # Reading Sample Area Shot # Reading Sample Area 

.^SR 64 pS7 Z-4" 

^/•o- ? \ 0 \ P>\ 4Yr-

Sample Area P,?_ Z-4" Pass/Fail ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings 

Lab Analytical Reading 

Average (Dried & Spilt Sent (Bag) 

Number Results 1 13 ^ (Bag) Sieved) ? 

2 1 (ol 

^f^ 4 A

17 1

 . CoCr

 3 R

> 

 1 54

1 / XRF Corrected Value—> 

5 I '(use calibration chart or add 

l20 % to value) 

w ^ 

Sample Area p^ \ 4-(^ ' 

Pass/Fail ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings 

Lab Analytical Reading 

Average (Dried & Spilt Sent (Bag) 

Number Results (Bag) Sieved) ? 1 T « 

2 ^ « 1 r. s 

3 [ M 1 A^ ini

114 9 ^ 1 

t U 1 1 j 

•—jro XRF Corrected Value —> 

5 

^ ^ (use calibration chart or add

2 0 % to value) I2if ' 

Sample Area 

Pass/Fail ? 

I n Situ 

Composite Composite Analytical Aliquot Composite Readings 

Lab Analytical Readinq 

Average (Dried & Spilt Sent (Bag) 

•> 

Number Results 1 ! (Bag) Sieved) 

2 

3 

4 

XRF Corrected Value - > ; il ] 5 

(use calibration chart or add 

2 0 % to value) i !! ' 

Sample Area Pass/Fail ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings 

Lab Analytical 

Reading Average (Dried & Spilt Sent (Bag) 

Number Results 1 (Bag) Sieved) 7

Confidential 5/2/07 

Pace 1 of 2 
2 ^ * 3 ^ 

4 

w • 

XRF Corrected Value —> 

5 (use calibration chart or add 

2 0 % t o value) 

1 

Sample Area Pass/Fail ? 

Aliquot 

1 

I n Situ 

Reading Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent 

7 

Lab 

Number 

Analytical 

Results 

2 

3 

4 

5 

XRF Corrected Value ~ > 

(use calibration chart or add 

20 % to value) 1 

VSE iDEITICr^' L 5-:f ; . " 

XRF Technician's Signiture ^EEEED 

/Y\\,/r\Q^ 

Confidential 5/2/07 Pace 2 of 2 
X 

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

Coastal Environmental Group Inc. 

vvvvw.coastalhazmat.com *> y COASTA L ENVHtONHENTA L 

CROUP . INC . 

EXECUTIVE SUMMARY: 

TH 20912—1221 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 = 1672 

Property Classification: 800 Total Drip Zone Linear Footage to be Excavated = 0 

l i l 1 1 1 ! - • • 

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i I 1 1 i 1 x 1 1 1 1 1 - South 11 Stree ! ! ' ' ' ' t t i l l ! 

Legend OLS#'20912 ' NorthArrow Omaha Lead Site 

Omatia. Nebraska 

• Dat^ Exdavated: 6/6/07 i - ^ ^

Dat Property Numbe r e USEFASIqhed Off: 7/1P/Q7 

OLS-20912 isting Structure 

cr Property Address 

J E> Scale 

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

b<VJ 

1221 S 11 ST 

5 ^ , ^,,,.0,.^.,. .^.........OK.,,^ 

— — _ Quadrant Boundary Post Excavation Concentrations (ppm) 

- Street Boundary Fl B2 PlavArea 

/'\ (9^1 T H<3L F2 DZ Easemen 

Tr ee b nnjD -fV*-^ Bl Garc )en_ Ottier 1 y •*« Oescrvtton of posl eircavancn areas ^1 . Iront yard lefttiand quadram. f 2. trort yard nght-nar^d quadrant. Bl. backyard len-hand quadrant B2. backyard nght hand quadrant. 

DZ. dr^> rone (1 -3 foot area at ^o* around ttne loundafjon ol tlie houne) 

Legen d 

^ 

Area not Excavated Dripzone Excavated Quadrants Excavated 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group In c 
Property Completion Agreement 

This agreement documents the completion of remedial aciivilies performed on my properly. 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, if any. 

Property ID: PC3[79_ Property Address: 1P9TY7T[W3F. Owner: Nanc a 7PtPiu/r3 

Phone: P5'D'^ - 9-3't7>^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

p^ I iigrcc rcstoi-ation is completed, except as noticd 

 I I do not agree restoration is completed 

VyMyi' ^ 

Da^c ' Contractor^ Signature 

I
aEPA • 

EPA Property Close Out Form 

Property #: PCPtig- Property Address: l^-^-l ^/( y 3P -

Date/Time: Owner's Name: KlCinCL j /U{ieiUjN 7 

Quads Excavated: 

Contractor Group y 

Excavation General 

Yes No 

I. If necessary, were the correct quadrant(s) excavated and restored? y 

2. If necessary, were the correct areas of drip zone excavated and restored? y 

Grading Sod and Vecetation 

Yes No 

I. Does the grading around the perimeter of the house in excavated areas ger lerally slope away t ^ 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 ^ 

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 L ^ 

time period) 

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

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

Gates, Fences and Retainini; Walls 

Yes No 

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

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

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

4. Was damage toretaining walls avoided? (If applicable) y^ 

Foundation, SidinK and Gutters 

Yes No 

1. Was damage to the siding or trim avoided? AIA' 

2. Was damage to the foundation avoided? fi" ­

3. Was damage to windows avoided? 

> 

4. Was damage to windows or door screens avoided? <0^ 

5. Was damage to downspouts or downspout extensions avoided? M>r 

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 Representaliv€^^^^.^^^;^^^e^^,h74:2^ Date: 7//6'/ ^ 7