TRANSMITTA L of OMAH A LEA D SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: .^nS ^ • Date: ^/^/pB/ 

Address: ^JU-^^ T^Aar/^s Si~ 

Remediation Contractor: _Coastal Environmental Group_ Year: 2007 

SOIL REMEDL^TION 

PROPERTY FILE FOLDER DOCUMENTS 

y Video of property (DVD) 

y Executive Summary 

EPA-provided property sketch 

y Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

M Restoration Agreement 

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

E'^ Confirmation data 

M Photographs 

^ As-built sketch 

M 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 . 

D • " 

^737773 ^^'4^^«^^^^^^^''^ ignature ^"^ ' ^ Date 

40317770 

Superfund 
Final Report Property Check List (Please place with each tiie) 

Har d Cop y Informatio n

i. Property Chccic [.ist /^^^^ ^

2. Site Working Dfawing Map 

^. IAPA originals Map 

4. Douglas County Assessor's Map 

,S. Property Contact Sliect 

^ . ;/ 

 (iic^^ ^ 

Afjreenient 

1. Access Agreemciif 

2. Resloration Agreement 

Miscellaneous Documents 

1. Final Map from the Field 

2. Change Orders 

,1 XRF Data 

4. Any emails or PO correspondences 

Property Completion 

1. Executive Summary 

2. AS BUILT 

3. Propetty Completion Agreement 

4. Any buyout into orreimbursemenl inlo 

5. Cheei< or money order eopies 

6. liPA Propeily Close Out Form 

7. Attached Begin Video 

I

7

•^

'!

F^Iectronic Documentatio n 

l)rawin<!;s 

1. HPA original 

2. Working Drawing 

.1 AS Built.vso 

4. AS Built.jpg 

Photos 

 Begin Photos 

 During/Fxeavation Photos 

 Sod I'hotos 

 -^()-F)ay Sod i'holos 

'

^

Scanned Documents 

 Final Doeumenis 

 lixeeulive Summary 

I

2 

Videos 

 Begin Video 

My Movie 
e 

tQP^ 

Property Access Checklist 

Property ID: £57*54 - n WOUKSTARTliD ON: _ 

n wokKcoMPELiI:D ON:_ -y-1 1 Properly Address: 2^2 2 CAoT )e S '^•^• 

Renter: Owner: p^^^ , ^<a ^S^rVLt'-l-k _ _ J 

Address: ( Plione: 

Fax: 

Cell/P:ifjer: 

Phono Ailditioiial Iniormatioir. : B?>G'8ll 5 

Fax: 

Cell/Pauer: 

Q INotificatloii Letter Sent: / / By: 

P^ Aeeess Aj^reenient •Signed: \ 0 1 t 1 O l B>=CjKr;^ 

K . Kestoration A}>reeinent Signed: 1 0 1 ^ 1 O l «>^ChrvS ­

1 1 Topsoil Sani|)liiiti (if applicable) 1 1 By: 

1 1 Disposal Sampling; (if a|)|)licahle) 1 1 By: 

1 1 Garden Sainplin*; (it applicable) 1 1 By: 

„ 10/It »-Y Z.%o jj ^ Ulility Clearance Called: 10 /l 2 / 07 J 

Ij ^ Video/Photos (Betbir) On:_L0/_^ / 0 1 ^y N^r4\f..-f+-' 

D Video/Photos (Duiinji) On: / / By: 

D Video/Photos (After) On: / / By: 

D Video/IMiotos (3(I-Day) On: / / By: 

1 1 Pro|)erty Completion A<>reemenf Signed: / / By: 

1 D Final Re|M)rl Issued: / / By: 

Air IVIoiiiloriii^ (as applicable) 

1 1 Community CU Cre« On: / / By: 

ResuKs: 

1 1 Commuiiit.\ CU Crew On: / / Bv: 

Resid<s: 

C] Community • Crew On: / / By: 

Results: 

Omaha Lead Site 
p^^ 07o/7t7^r710/ ^7^€^7<7 7S ^ ^5y2 3 - /5~<^J AJ S 3 

Z5-13H 

Omaha Lead Site 46130 
# 

• Z5n3\ 

H Name: t>kv«-f/>-t SmiZ-A Oinaha Lead Site Date: t ^fs/a f North Arrow [• 

Address: 3 aa 3 ^///faiSs t f Site Sketch Time: /2 •• 3 5" 

Phone: S-S"6- Stt S 

^ 1 

Team g.s y^<^ 7f^* ^ BVID# or? 3 7 XRF Code /0 3 7 goo K : / 3 2 

Sample Number Lead Concentration Confirmation Sample 

ppm /^/Yes ° No ^ 

gVBSC/>XA-2573 W 

ppm f?Yes n No ra^ f^Vg$^:/OxA-2S73 W 

ppm /J/ Yes a No ^ 

I^Vb-5cfiy.A-zsi3H 3 1 ^ 

ppm ^Ye s l=> No I3r 

ppm -T55- S - Nu D 

ppm 'Ves P NO D 

ppm Yes • Nu • 

El 

rr-flfiTr 

i A! fi^ocfi ENfTEBEB

t^/^i*c:f 

— +• > — 

-j i— 

.».. 

I 0163 'i 3/6i -•j »•- f t h 

i i 8» I i 32- I 

4 - i - d _i / _ -J. L j t r 

5jv (TTs'TT V 

li 

r £e>toCn 

I i • r 

j'tt^A^ t M"**- — 

u^yttK 

ci+A/txes 

Omaha Lead Site 

46130 
Douglas County Account InJfcriatio n|^ £ n Page 1 of2 

Dougla s County , Nebrask a Propert y Recor d - R202881000 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 

Owne r 

SMITH DWAYNE E 

3220 CHARLES ST 

OMAHA NE 68131-0000 

Propert y Informatio n 

Key Number: 2881 0000 20 

Account Type: Residential 

Parcel Number: 2028810000 

Parcel Address: 3220 CHARLES ST 

OMAHA NE 68131-0000 

Legal Description: PROSPECT PLACE LOT 11 BLOCK C E 30 FT 30 X 127.5 

Valu e Informatio n 

2007 

2006 

2005 

2004 

2003 

2002 

Land 

$2,100.00 

$2,100.00 

$2,100.00 

$2,100.00 

$2,100.00 

$0.00 

Improvement 

$18,100.00 

$18,100.00 

$18,100.00 

$5,500.00 

$5,500.00 

$0.00 

Total 

$20,200.00 

$20,200.00 

$20,200.00 

$7,600.00 

$7,600.00 

$0.00 

Sales Informatio n 

Lan d Informatio n 

Acres 

0.08 

SF 

3810.0 

FF 

30.0 

Units 

1.0 

Depth 

127.0 

Width 

30.0 

Vacant 

No 

Lan d Attribute s 

Attribute Attribute Description 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R20... 10/5/2007 
Douglas County Account In|jmation Page 2 of2 

3220 CHARLES ST 

lifflO 

l-iti) Proot 

BTRfJ 

BumH 0ioc*i n It 

RANCH 

Click to Enlarge Image CI ick to Enlarge Image 

Square Footage: 808.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Low 

Unit Type: Condition: Average 

Owner Occupied: No Condo Square Footage: 0.0 

Built As: Ranch Rooms: 4.0 

HVAC: Forced Air Units: 1.0 

Exterior: Frame Siding Baths: 1.0 

Interior: Drywali Bedrooms: 1.0 

Roof Cover: Composition Shingle Stories: 1.0 

Roof Type: Gable Foundation: Block 

Floorcover: Allowance Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1895 0 0% 1895 109 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 808.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch End Screen 20.0 

Porch Slab Roof Ceil 128.0 

User NEW ROOF AND WINDOWS 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R20... 10/5/2007 
Douglas County NE GI8 Map 

Oisdaimer:This map is not guaranteed 

to be accurate, correct, current, or 

complete and conclusions drawn 

are the responsibility of fhe user. 
Property ID #

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 'Z ^ "73 ^ 

-^TTT^ 7f/^/^/ysS7^ 

 Date: y// ^ Time: 77<7^ Action: /WvW^^^ ^ 

 Date: Time: Action: 

 Date: Time: Action: 

 Transmit to EPA D Other Action: D 
X 

• 

/lfi^ \ Omaha Lead Site—Fixed Price EP-R7-07-05 

S ^^^ ^ ° Coastal Environmental Group Inc. 

Sy^^^y www.coastalhazmat.com 

%PRoit^=' COASTA L ENVIRONMENTA L 

C B O U F , IN C 

EXECUTIVE SUMMARY: 

25734—3222 CHARLES ST 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

2513H 

— Name: p'*M.'^/i< Smft- h Omah a L»aci Sita MoilhAirwr Site 5tc<!tch Time: r-2 - 3i ^ 

/ ^ 

i Tea m <-.a y^< ^ yf*' ^ BVIDS a 3~? 3 V _ XRF Code ^o 3 7 J&SJJC : / ^ 2 

Sample Number 

Lead Concentration ConMmatio r Sampl e 

£ i pp«n /HYes a No ° ^ fZt&SceXA-'Z5-f3 S f?Y9 « C3 p pm ^ 

k No 5 ^ <j/ Yea a ppni JLUe- A*Ye« CD No ^ 

PP«Ti No car ppr-i Nu P ­ ppi n Tes a WB P 

p p m Ttw a •Nu P 

IHl 

^ii.1 iiii i j^'iuyrrr: i ftf^^'C 

Dig around all trees 

remove the 2' wall and 

concrete if possible. 

OLS#: 25734 

46nD Orassht Date Excavated: 10/27/07 

Date USEPA Signed Off: 12/5/07 

Legend 

Are a no t Excavate d Dripzone Excavated 	 Quadrants Excavated 

Contract #: EP-R7-07-05 Coastal Environmental Group Inc. 

S l ^ EPA 

EPA Property Close Out Form 

Property #: S-^ l Z7 \ Property Address: ^ 2 2 . 2 CJl/ipjr i-^5 S^^k 

Date/Time: Owner's Name: pinjc^ypi ? "^p^/fTi ^ 

Quads Excavated: Contractor Croup l^/rsrj':. ^r a \ 

Excavation General Yes No 

1. If necessary, were the correct quadrant(s) excavated and restored? 7 

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

Grading Sod and Vecetation 

I. Does the grading around the perimeter ofthe house in excavated areas generally slope away 

from the house? 

Yes 

i / 

No 

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) y 

4. 

5. 

Are sodded areas generally firm and evenly graded? 

Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) 

y 

y 

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

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

Gates, Fences and Retaininj; Walls Yes No 

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

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

3. Was damage to gates or fences avoided? (If applicable) /(i4 

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

Foundation, SidinK "i d Gutters Yes No 

I. Was damage to the siding or trim avoided? /Ul 

2 Was damage to the foundation avoided? TA 

3. Was damage to windows avoided? A/A 

4. Was damage to windows or door screens avoided? 

\^^ 

5. Was damage to downspouts or downspout extensions avoided? A/f 

Sidewalks and Driveways (Concrete) Yes No 

I. Was damage to driveway surfaces avoided? t ^ 

2. Was damage to walkway surfaces avoided? y 

\/G^cyify^ lo-f 
Owners comments: 

Inspection notes: 

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

EPA ^^Vi^s.QTM\v^y7SL^27!z^^^^a^t<.i:jL^ Date: 
.^.^^m! " ^'^m 

Property Completion Agreement 

Tills 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: Uy,- J ^y[ -

Propcrty Address: -^2-2- 2 C}\n r \e \ ^ \ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

I agree re.sloration is completed, except as noted 

 I I do nol a^ree restoration is completed 

.f\^^.zf^y.^ 17(7-7 yyTyyy. y^n 

(Twncr'.s Signatifrc Date "^ ^ Contractor's Signature Date ' 

I
y,-^) r^^jf "y 'O ^ •^oy^::> 7yo / AJ ^ ^ ^ / 

1 q I zgao TM tyy e yy^^^ i Z5-13H ' 

Name: t>w/Q«|/i.g Sm't-t-h Omaha Lead Site 

Address: 3 a J a ^fy/jutss -sr Site Sketch 

Phone: 5^(a - Btl ^ 

Team '• Cj, y^rvt / ? ^ ^ BViD#_a_£2l_j L 

Sample Number Lead Concentration 

£7 

ppm IZl/e>5C/>)CA-Z5l3H 

ppm 

ppm B l ^ 

ppm 

ppm 

ppm 

ppm 

Date: n 7/s/a ^ North Arrow 

Time: tl'-'i ^ 

^ 

5 \e^FF: LA D<\f« •- tO-J-^S' T"^e.-/>/^ 

_ XRF Code lo3 7 BoolC : 13 2 

Confirmation Sample 

/t/Yes • No 2 ^ 

f^2 Yes [^ No ^ 

^/ Yes n No ra^ 

^Ye s n No ra' 

T5S- - B - -Ntr - B ­

-Y65 D NU D 

YbS • Nu D 

13 

Omaha Lead Site 46130 
% PROPERTY CLEARANCE WORKSHEET 

Date Property I D Id'ii'Ol 25-73y 

Property Project Omah a Lead - Fixed Price 3ZZZ C/^U^ ^r Address 

Measuremen t XRF I D 0107-5 1 Count/Tim e 

Fieid Shots 

Readin g Sampl e Are a Sho t # Readin g Sampl e Are a Shot # 

£2A- eA -5,^ MJ. ^ ll •/ yw J^L. fi< 2-V j mSampl e Are a eA-S I n Sit u Composit e Composit e Analytica l 

Aliquo t Composit e Reading s 

L a b Analytica l 

Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 

1 (Baq ) Sieved ) 7 

2 l y 3 "^7 b8 4 z l XRF Corrected Value —> 

,5 (use calibration chart or add 

2 0 % to value) 

73 

Sampl e Are a Ft 2.'^ Pass/Fai l ? 

I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s L a b Analytica l Readin g Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 ? £,Z (Baq ) Sieved ) 

2 ( 93 3 / lol . (ob 4 35- 3G XRF Corrected Value - > 

5 n (use calibration chart or add 

15 2 0 % to value) 

Sampl e Are a Rl 7,-H Pass/Fail ? 

I n Sit u Composit e Composit e Analytica l 

Aliquo t Composit e Reading s L a b Analytica l Readin q Averag e (Drie d & Spil t Sen t (Bag ) Numbe r Result s 1 ^B (Baq ) Sieved ) 7 

2 1^0 9/ 

4 

3 Ct ^7/6 77 I f i Jv XRF Corrected Value --> 

5 115 (use calibration chart or add 

2 0 % to value) 

7fc 

Sampl e Are a Pass/Fai l ? 

I n Sit u Composit e Composit e Analytica l Aliquo t Composit e Reading s L a b Analytica l Readin q Averag e (Drie d & Spil t Sen t 

1 (Bag ) Numbe r Result s (Bag ) Sieved ) ? 

2 

3 

4 

XRF Corrected Value —> 

5 (use calibration chart or add 

2 0 % to value) 

Sampl e Are a Pass/Fai l ? 

I n Sit u Aliquo t Composit e Composit e Analytica l Composit e Reading s Readin q L a b Analytica l Aupranf> (Drie d & Spil t Sen t (Bag ) 1 Numbe r Result s (Baq ) Sieved ) 7 

2 

3 

4 

XRF Corrected Value —> 5 (use calibration chart or add 

2 0 % to value) 

iii i AUDI I IIIHAI mi l I t I I 

XRF Technician's Siqniture Nffll l II 
\T^^ > COASTAL ^ •rt*' EHVmONMiNTAl CROUP , INC . 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

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

Environnnental Protection Agency (EPA) or its authorized representatives, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

following described premises: 

Owner-sName:^^^ ^ Daytime Phone: ^^ ^ ' ^ f ^ '^ 

^7^7777 

3-^r z yi/Ty/i^^^^^ ^ T Address of Property 

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 
m> •

 • # 

%"••***% • COASTAL ••Si, ..«C IMVttONMIHTAl 

' t PHOT* c a o u r . i >. c 

• 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 of the 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 

piIg grant access to my properties

 D I do not grant access to my properties 

Signsiture / Date I | Signature Date 

CU I would like to be present during any sampling that Is required. 
COASTA L 

Restoration Agreement 

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

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

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

Protection Agency (EPA). 

Property ID: Z- ^ V'S H 

Property Address: ^-^" ^ ^ 7'y7A7^7^ ^ * S T 

Owner: TTyuTiUyJ ^ ^yt^yry i 

Phone: 

On the attached diagrain(s) indicate area(s) lo 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 t>pes. etc. indicate digital photos 

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

Itenris To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these items is tne Owner s responsibility. 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: y 

iy>Ky7^y:7y/^ 7P ^6^3766 ^ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of 
COASTA L 

Items To Be Remove d By Contractor During Remediation An d Replaced 

(Use additional sheets as necessary) 

Item 

oi> 

Item: 5 o/U 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of 
COASTA L 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones. Control Valves. 

Timers. Heads, etc. 

Anach a skeich of tlie 

sprinkler Iavout. 

Number of and size of 

each garden/ flower bed 

area. 

.Atiacli a sketcli of relaiixe 

sizes and locations. 

Quantity Unit Condition/Type/Species 

Square feel 

t 

7^ Each 

I 

y Each 

7 Each 

y Each 

Square Feet 

Page 4 of 

1 
Item Quantity Unit Condition/Type/Species 

Agreed upon value of 

plant materiaLs not to be 

replaced bv contractor. 

Note this \alue will be 

used to issue a plant 

\oucher to the property 

owner. 

Agreed upon list of plant 

materials lhal will be 

replaced by contractor. Be 

very specific and detailed. Each 

include a sketch of were 

each plant will be placed 

b\ the contractor. 

Agreed upon area of 

propeny to be replaced 

with grass sod. 

SF 

liU'ltide a sketch of the 

aiea(s) to be replaced \\ith 

Lirass sod. 

•Area of City or County 

property lo be landscaped 

per their requirements. SF 

Include a ^kei^'i"! of tlic 

area (s) 

Easement .Area, to be SF e.\cavated 

Page 5 of 
COASTA L 

Additional Comments / Instructions: 

• 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. 

0^ agree n I do not agree 

^./yTyy^^yJsU? TLy-y - /y//a- 7 

Owner's Signature Date Contractor's Signjmire Date 

Page 6 of.