TRANSMITTA L of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID #: 2a^5?M Date: H-V-W 

Address: 99\- 7 (Q ic\ <ui 

Remediation Contractor: Envrionmenta l Restoration, LLC_ Year: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) .^^efore DAfter D Basement D 

JZT Executive Summary (Final Report) 

/0 EPA-provided property sketch 

0 ^ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

Restoration A-greement 

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

^ Confirmation data 

^ . Photographs 2J Before DCrew Photos^Durin g Excavarlcn D 3od 

-jaOO-dav £od>g Nt Sop Afg //OM^OCUA/^^ /^^AJMA) fii^dT^ 

) / As-built sketch 

yZT Completion Agreement signed by Property Ov/ner 

Dr Property close-out check list signed by EPA 

• Description of areas not meeting ROD cleanup criteria 

^0r Utility clearances 

[y Property information &om Douglas County Assessor's Office 

>zr Property access cliecklist 

^ y 30261858 

X Contact Log 

^ Xlr^.-h /^- ^ Superfund 

~ Environmental Restoration Signature Date 

//)'/'/-/ / 

Date 
EPA 

EPA Property Close Out Form 

Omaha Lead Site 

Property #: I^'ttS^^ Property Address: 2.'gV"l S^. \C^A-0 

Date/Time: Owner's Name: UTT^V / pFgg,<-J 

Quads Excavated:]] IBZ _ Contractor Group : Environmental Restoration (ER) 

Excavation General 

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

2. If necessary, were the correct areas of drip zone excavated and restored? \i/jiP(H\T loT 

Yes

y y 

K l 

 No 

Grading Sod and Vegetation Ves No 

house? 

2. Has sod been laid in all areas that were excavated?

y 

 C-lOX ADA\Q^'^£.~ ^ / 

3. Does the sod appear to be generally healthy and growing? (Only evaluate ifinspected at 30-day time 

period). 

4. Are toddad areas generally firm and evenly graded? y 

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? \ ^ 

7. Was damage to landscaping or plant materials avoided? 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) 4­ 3.

 Was damage to gates or fences avoided? (ifapplicable) 

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

Foundation, Siding and Gutters 

Yes No 

1. Was damage to siding or trim avoided? 

2. Was damage to the foundation avoided? 

Was damage to windows avoided? "mu^ 

ur 

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

4: 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? AM 

2. Was damage to walkway surfaces avoided? \!lk 

Inspection notes: 

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

EPA Representativer"^^^ S^ yUyyL Date : W// 
/ JQ.^ \ Omaha Lead Site—EP-R7-09^5 

iJi^iiVrfC f Environmental Restoration, LLC 

\ , ,<<^ www.crHc.coim 

\rntyfEXECUTIVE SUMMARY: 

29884 2817N19AV 

No Issues or Concerns Q Issues/Concerns 

Detail Exnlanntinn­
rage i or t 

"> 

[ Create Another Ticket ^ [ Back to Irth Internet ] ( Send Email ] 

• YOUR TICKET NUMBER IS 2668836. 

Original Call Date: 2/04/11 Time: 7:40 am Op:. ADAM24186 


Work to Begin Date: 2/08/11 Time: 8:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2817 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 


: 29884 


: RESENDING DOE TO WORK EXTENDING 


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: 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 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNE IC QWEST LOCAL NETWORK ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 2/4/2011 
rage i oi i 

"> 

[ Create Another Ticket ] [ Back to Irth Internet ] |[ Send Email ] 

YOUR TICKET NUMBER IS 2667198. 

Original Call Date: 1/26/11 Time: 3:47 pm Op: ADAM24186 


Work to Begin Date: 1/28/11 Time: 4:15 pm 


state: NE County: DOUGLAS Place: OMAHA 


Address: 2817 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 
 : 29884 


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: N 


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: 

Emera: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNE 1C QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http ://www.dhon.org/irthinteraet/DH ONNoticeCreation/MessageText.asp?ret-<RESULTS... 1 /26/2011 
Contact Information Log ;)'?ss'^ SAID# 

Daytime Phone: J / Q • J^/ ^ / ^ j / '^j ^ 

PropertyAddress: Pg| 7 ^ . (<fB^ -hiJ^ 

Attempt to contact Date/time Name 

/2 />-/o / 0^oi> 

g 
Property Access Checklist 

SAID: ;?^^ ^ 

Property~Address: ^ SrlO Aj l ^ ^'C -

D

D

 WORK STARTED

 WORK COIVIPELTED

 ON: __/__/ _ 

 ON: / / 

Owner; Renter: 

Address: Jlno M /'/'^^ Phone: 

Fax: 

Cell/Pager? 

Phone: (/67,-^</G ­ 3 H jr ' Additional Information: 

Fax: 

Cell/Pager: 

^ ^ Access Agreement Signed: 12-1 6^1 /6 

©Restoration Agreement Signed:/Z­ I Off 110 

Q'^de o Property Before On •.)'L lo ^ li b 

[^l^-fllgital Photos Before On -.12- lolf I l o 

n Video Property After On 

n Digital Photos After On 

QT Property Completion Agreement Signed: ^ I ^ I I f By: /^Z) 

n Final Report Signed: / / By: 

Additional Video or Digital Photo's Taken: 

n Video D Digital Photo On : / / By: 

Reason: 1 

n Video n Digital Photo On : / / By: 1 

Reason: 

D Video D Digital Photo On : / / By: 

Reason: 

n Video n Digital Photo On : / / By: 

Reason: 
Consent for Access to Property SAID# J^l^s' / 

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 enviroiunental response activities upon the following described premises: 

Daytime Phone: %2,--3'iU-3if 9^ 

Address: ^^ ^ ^ / ^ ^^i ^ ^ ^ 

Address: 1 

Addresses of Properties 

Address: covered by this 

Agreement: Address:

 1 

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 

environmental response; 

c. Plarming 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 

'fCuXUj^ 1,/jlAjy/^ I7.,i^%0 IS 

Signature Date Signature Date 
Additional Comments / Instructions: 

^/fc*-f -^^ 

BP 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. 

IjM I agree Q I do not agree ^ \ I agree HH I do not agree 

Owner's Signature Date Contractor'sSignature 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 owner and the United States Environmental 

Protection Agency (EPA). 

SAIP: J^il^d-f 

Property Address: ^9'/ 7 / V / ^ ^9^ ^ 

Owner: ^^; ^ f?^^ / 

Phone: y^^-,^/^ . y^V/" ^ 

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 repiaced: 

Itemy] 

Ail (MfGL u>A3^.J0b ^M ) / / 4, ^Cu^Jeyi 

Item: 

Item: 

Item: 

Item: 

Item: 

1 Item: 

Page 1 of 2 
\y\ I agree UU I do not agree j^ I agree CH I do not agree 

Owner's Signature Date 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, ifany. 

sA»p: j^l'ffFW 

Property' Address Address: ^^/y3(r/^H Jl / / / ^ ^€ ­

Owner: 

Phone: 3^^^^^/ ^ ^ 

Restoration Items in Question 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

\j^ \ agree restoration is completed, except as noted .J'HTagree restoration is completed, except as noted 

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

fjJX^/jyy ^ Z-7-2-g// -y^ ^ Okl^^^ J'f. / ' 

Owner's Signature Date Contractor's Signature Date 
Douglas Coimty Accoimt Infaak ion Page I of2 

Douglas County, Nebraska Property Record - R2206880000 

Print Report 

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

New Feature ->->• • Subdivision Sales Search 

Owner 

PERRY RUTHIE L 

2820 N 19 AVE 

OMAHA NE 68110-0000 

Property Informatio n 

Key Number: 0688 OOOO 22 

Account Type: Residential 

Parcel Number: 2206880000 

Parcel Address: 

Legal Description: 

2817 N 19 AV 

OMAHA NE 68110-0000 

SHERWOODS SUB DIV LOT 5 BLOCK 1 60 X 81 

Value Informatio n 

2010 

2009 

2008 

2007 

2006 

2005 

Land 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

$500.00 

Land Informatio n 

Acres 

0.11 

SF 

4860.0 

Units 

0.0 

Depth 

81.0 

Width 

60.0 

Vacant 

Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R2... 11/19/2010 
Douglas County Account InfiMt ion Page 2 of 2 

Ohio St 

POWERED BV 

Map data 60010 Googtei 

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 Interactive GIS Maps that are maintained by our 

office. 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp ?accountno=R2... 11/19/2010 
ENVIRONMENTAL AS-BUILT DRAWING 

OMAHA LEAD SUPERFUND SITQ^ 

RESTORATION 

Name 

Address 

Phone: 

frrry _ ^ Omaha Lead Site 

Site Sketch 

Date: Up^y O 3 

Time: ^ .'•5'S^/w 

North Arrow —i 

Team A ^uz/'^h'pUtLAcM/H. h BVID # ^jf^ B j XRF Code fSQ ^ 

Sample Numtier Lead Concentration Confirmation Sample 

/?yASC/^y A

/?Y3 3CPXA

 ­ c^3f%f^u 

 -saasi­ £33.

-^7 3V<S a

yj-- /

 t3a 

 t33 j£ 2 

 ^3J 9 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

ppm 

^'<»Yes JS? 

f5<?,<9Yes CD 

Yes O 

Yes 

No 50 

No Jj? 

No JB 

No c : 

No O 

No Q 

L£GENO ^ 

Quadrant axcavatxl Drip Zona Excavated Cootaflfiination Left Bahind 

r>».«*.^.« u. CO OT nn nc Ca«« •• v ^ »«••«%.^»«#«« I 0^tf*4^»i^4!« « v« I I ^ 
AZ> 

Name: , . . . Omaha Lead Site Date: UQ6/d3 North Arrow 

Site Sketcti Time: *? .'5:^/w 

Phone: 3^(0 - 2 y/ ^ 

Team / I ^u/fi^fpk/rLP^L^H. h BVID # 3^/? g / XRF Code /(S Q VSample Number Lead Concentration Confimiation Sample 

£33^ t3 ^ No ^ /?yB8CP)( A •e.'^H^H­ dHQ No jJ5 -7 ^ ppni ^^rs No JS • t ^ l ppm -y-yy -^:-=^ ppm ^'/^Yes JS? No Q 

ppm |5;?,<9Yes a No n 

ppm Yes a No • 

ppm Yes 

RYDSCPLA-29884 

Lab 

571 ppm y^ ^ ijdLole, PizoP^erV Xs ii.6^ggfV 

^ e H ^ 

)( - M t5^i>^^ 

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Y-­ 578 tie vjry 5-? 

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Name: /fTrv / Omaha Lead Site Date: UD6/d 3 North Arrow —i 

Address: ' 3^/ 7 A^ /^^ / Site SItetch Time 

Phone: 3y(c - gy/5? 

Team / \ ^lj/'^^f>pk/^P,ch/H.h BVID # 3^/? g / XRF Code /<5Q ^ 

Sample Number Lead Concentration Confirmation Sample 

^ry\6cpxyt - eac^a^ £ 3 ^ 

-Ta f ppm ;^i(&Yes • No ^

^HG 

• No J>5 -Yu k PP"^ S 7 6 

^^^YS CD No ^ -f^ Q ppm yj-f -^^^=^ ppm 

^'' ^ Yes No • 

f9^,fcYes • No • ppm Yes • No •

ppm Yes •

ppm RYDSCPLA-29884 

Lab 

571ppm 

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ENVIRONMENTAL XRF DATA ENTRY LOG 

RESTORATION 

2^J_^ SAID# 

PROPERTYADDRESS 

^ :??/ 7 ^(• f?- ^ AK 

QUADRENT OR SAMPLE AREA 

redig 

n 

n 

n 

n 

n 

n 

n 

a 

D 

D 

SAMPLER NAME 

DEPTH 

Fl 

F2 

81 ?' 

82 ?

DZ 

PZ 

GZ 

EZl P 

EZ2 

OTHER 

"^aA / y^t:U-€f^ \ 

o 

DATE ,:? \ ? \/ r 

TIME 

XRF S/N -3^72'^ 

AVERAGE OF RESULTS SHOT#s 

5Py--5'P7 

3//i^ ? 5^j^ ­ sTJS 
Tliermo Fisher Scientific ThsiTITIO 900 Middlesex Turnpike 

Billerica, MA 01821 

SCIENTIFI C 

A\',KK.\C;K Ani)ui;s.s SAMI'LKAIIICA OI'KUAIOK NOTKS SAID 

I 2011-02-09 11-.04 Av« of 532-534 2817n 19 av . EZ RON surface final clearance 311.32 ± 29.32 

2 2011-02-09 11:04 2817n 19 av EZ RON surface final clearance 29884 276,10 ± 27.70 

3 2011-02-09 11:04 281711 19 av ! EZ RON surface final clearance 29884 323.01 ± 30.06 

4 2011-02-09 11:03 2817 n 19 av EZ RON ; surface final clearance 29884 334.84 ± 30.18 

5 2011-02-09 10:55 AvB of 528-530 281711 19 av n2 RON 8 final clearance 96.02 ± 17.73 

6 2011-02-09 10:55 2817n 19 av B2 RON 8 final clearance 29884 105.23 ± 18.10 

7 2011-02-09 10:55 2817n 19 av Q2 RON 8 final clearance 29884 86.87 ± 17.10 

8 2011-02-09 10:54 2817n 19 av B2 RON 8 final clearance 29884 95.96 ± 17.99 

9 2011-02-09 10:51 Avg of524-526 2817n 19 av Bl RON 8 final clearance 45.95 ± 14.08 

10 2011-02-09 10:51 2817n 19 av Bl RON 8 final clearance 29884 47.96 ± 14.30 

II 2011-02-09 10:50 2817n 19 av Bl RON 8 final clearance 29884 38.47 ± 13.39 

12 2011-02-09 10:50 2817n 19 av Bl RON 8 final clearance 29884 51.43 ± 14.56 

Page I of 1 02/09/11 15:07:15 
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