TRANSMITTA L of OMAH A LEA D SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID a: filnf Date: <^//^ ^ 

Address: 4J^1 ^ Ma2^X\ S h 

Reinediation Contractor: Coastal Environmental Group_ Year: _2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

vf Video of property (DVD) 

M Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

5/ Restoration Agreement 

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

M Coniirmation data ^__^ -. 

^ Photographs 

4/ . As-built sketch 

M Satisfactory restoration signed by Property Owner 

S/ Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas Covmty Assessor's Office 

D 

D , 

D 

^/^^^•^^J^^^ ^Hi^ 

ignaturi 

40317679 

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

H^rd Copy Information 

/\ . Property Check List [ 

y^'$>\\.Q Working Drawing Map 

3. EPA originals Map 

.x4r Douglas County Assessor's Map 

^,5<^Property Contact Sheet 

Agreement 

^•'-I'^^cccss Agreement 

'"L . Restoration Agreement 

iVIiscellaneous Documents 

--'-^rrT^nal Map fi'om the Field 

^ . Change Orders 

,/3-r^RF Data 

\^ . Any emails or PO correspondences 

Property Completion 

1. Executive Summary 

2. AS BUILT 

^..3<Hf*i'0perty Completion Agreement 

v^i^ . Any buyout info or reimbursement info 

^^^Check or money order copies 

.,-^rrliPA Property Close Out Form 

^.w^Attached Begin Video j 

Electroni c Documentatio n 

Drawings 

EPA original 

•^Working Drawing 

3. "As Built.vso 

4. AS Built.jpg 

Photos 

Begin Photos 

L JS. During/Excavation Photos 

\ Sod Photos 

' X 30-Day Sod Photos 

Scanned Documents 

' Final Documents 

•2 Executive Summary 

Videos 

t\ Begin Video 

My Movie 
Property Access Checklist 

PropertylD: 'M H ^ D WORK STARTED ON: / / 

Property Address: I] 1^ ^ ^ V^W^Ql^ H ' n WORKCOMPELTED ON: / / 

0>vner: Jf^^ \-\ C^t ^ 

Renter: 

Address: Phone: 

Fax: 

Ccll/Pagcr: 

Ph„ne: 1^52 (,(,1- \^0^T, Additionai Information: 

Fax: 

Cell/Pager: 

n Notification Letter Sent: / / By: 

52 Access Agreement Signed: [p l.\[p 1 ^ 1 By: f 0 

0 Restoration Agreement Signed: ^ 1 IV l (r\ By:^^f/\ 

im Topsoil Sampling (if applicable) 1 1 By: 

r~l Disposal Sampling (ifapplicable) 1 1 By: 

1 1 Garden Sampling (ifapplicable) 1 1 By: 

tZl utility Clearance Called: \o il ^ /tT] By:MM \UMl tr/^iGi^^f/^t 

EJ Video/Photos (Before) On: nl li:,! a l 

"•^ file W) 

• Video/Photos (During) On: / / By: 

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

D Video/Photos (30-Day) On: / / By: 

n\ Property Completion Agreement Signed: / / By: 

1 1 Final Report Issued: / / By: 

Air Monitoring (as applicable) 

n Community CH Crew On: / / By: 

Results: 

im Community [H Crew On: / / By: 

Results: 

CH Community CD Crew On: / / By: 

Results: 

Omaha Lead Site 
nt Square Fod^Hto be Excavated = 730 

Property Classification: 8' 'one Linear Footage to be Excavated = 136 

Desaiption of post excavation areas: F1. front yard left-hand quadrant; F2, front yard right-hand quadrant: Bl, bad<yard left-hand quadrant; B2, backyard right-hand quadrant; 

DZ, drip zone (1-3 foot area of soil around the foundatton of the house). 
Print Preview Page I of I 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

1618280000 

RICHTER 

THOMAS P 

4388 MASON 

ST 

OMAHA 

68105 

4388 MASON 

ST 

OMAHA 

NE 

68105 

Sec-Twn-Rng 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Assessor 

Website Link 

20-15-13 

LEAVENWORTH HEIGHTS 

0 

184 

45X108 

http://douglasne.mappingonline.com/DouglasCoNe/static/accountinfo.jsp? 

accountnQ=R1618280000 

Disclaimer: Map and parcel data are believed to be accurate, but accuracy is not Map Scale guaranteed. This is not a legal document and should not be substituted for a title search, 1 inch = 82 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis aIias/dogis/printPreview.aspx?PrinlOptData=Douglas County-... 6/8/2007 
Propeily ID # 

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

! 

Site 

Coordinator 

Comment (s): 

' 

CONTACT FORM 

^//7 ^ 

/^3g8 hjiason si^ 

 Date: O/v/ol Time: ^f<^3 

 Date: Time: 

 Date: Time: 

 Transmit to EPA D 

Action: U^iLi^'^^fi^' 

Action: 

Action: 

Other Action: D 
^111 ^ 

COASTA L ENVIRONMENTA L 

G It 0 U P , INC , 

Consent For Access To Property 

RIGHT OF ENTRY TO PREMISES 

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: ^*^ JS/'<^h~^r' ^ Daytime Phone: lf.o2^U/-i^?^ 

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 compietion, 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 satisfactonly completed. The Grantor also 

agrees to: 

Page 1 of 2 
: ^ 1 

COASTA L ENVIRONMENTA L " 1 . PROl* ^ CROUP . INC . 

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; 

Ifthe property is rented, assist EPA in obtaining tenant approval for access to the 

property to perform the work. 

Allow videotaping and/or photographing ofthe 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 (877) 234-6270. 

¥I grant access to my properties D I do not grant access to my properties 

Signature Date Signature Date 

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

Page 2 of 2 
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 of the property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: 'f^\ \"~|<^ 

Property Address: ^')^ ^ W h m <A< 

Owner: ^ ^ U^fMH -

Phone: 

On the attached diagram(s) indicate area(s) to 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. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

The removal, storage, disposai, and/or return of these items is the Owner's responsibility. 

Item: . « 

^ - ^ — ^ 

Item: 

Item: / ^ 

Item: X ' 

Item: ^^ ^ 

Item: y ' 

Item: ^ ^ 

Item: 

^ 

Page 1 of. 
COASTA L ENVIRONMENTA L 

CROU P IN C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

^I/I/ITVI I WI . 

\fmj \lp\Yh ^ ^ 

Item: / 

Item: / 

Item: / 

Item: / 

Item: 

/ 

Item: 

/ 

Item: / 

Item: / 

Item: / 

Item: / 

Item: 

/ 

Item: 

/ 

Item: / 

Item: 

Page 2of. 
^^^^m ^m^ 

COASTA L 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: / 

Item: /i 

701^ 

Item: . 

VO^cb ^ ifm^i^ f(/p |Vca;« QMI^1^ —- ^ 

Item: V 

) 

Item: / 

item: / 

Item: / 

Item: / 

Item: 

/ 

Item: / 

Item: 

/ 

Item: 

/ 

Item: /' 

Item: / 

Item: y 

Page 3 of. 
COASTA L 

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 sketch of the 

sprinkler ia\out. 

Number of and size of 

each garden/ flower bed 

area. 

.\nacli a sketch of relative 

sizes and locations. 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Species 

Square feet '(7^1 ^ 

X7 Each i7^y 

\^9\ll Each 

Each 

G 9-^7 ^ 

Each 

Square Feet 

Page 4 of 
COASTA L ENVIRONM I N TA L 

CROU P IN C 

Item Quantity Unit Condition/Type/Species 

Agreed upon value of 

plant materials not to be <l^ Uw%n. replaced bv contractor. 

$ Note this value will 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. Each 

Include a sketch of were 

each plant vvill be placed 

by the contractor. 

Agreed upon area of 

property to be replaced 

with grass sod. 

SF 

Include a sketch of the ftf 

area(s) to be replaced with 

grass sod. 

Area of City or County 

property to be landscaped 

per their requirements. SF 

Include a sketch of the 

area (s) 

Easement Area, to be SF 

excavated 

&T^f^^f T^r 

Page 5 of 
COASTA L ENVIRONMENTA L 

CROU P INC . 

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. 

U agree n 1 do not agree 

^ 

[P^y^ \Um^ bM^ 

Owner's Signature Date 

Page 6 of. 
I rt Total Q^^unantt Squar Squaree Fod^Hl Fod^Hioo be Excavated = 730 

Properly Classificalion: 8< Tolal O^Konwnee Linea Linearr FooS! FooSfee ttoo be Excavated = 136 

..i ' :-.r -t— t • 

as '|..-.'^.*i.+S-.-vi;';-_'*r; 

Ljaii lltv:.!5.fe 

_ -X 

---r ­

3^i^4-^ 

kiL...t!'i^lli 

1 ! 

[3g5:i:Ti: 

M M f-MMfa^ M H 

-•-•i— 1 

^'tl L ^ P[lj^t4 

a^ ":. ^.!^^.^ f i 

Mason Street 

Legend NorthArrow Omaha Lead Site 

Concrete Omaha, Nebraska 

j/^A

i i

 Excavated Area 

Existing Structure Scale 

Property Number OLS-21179 

>s5i;

•—•— •

 Permanent Landscaping 

Fence 

1 Inch « 20 feet or 1 grid = 5 x 5 ft Property Address 

4388 MASON ST 

Quadrant Boundary Post Excavation Concentrations (ppm) 

Street Boundary Fl . 

F2 

B2

DZ

 Play Area 

Easement 

(Q) Tree/Shrub 8 1" Garden Other 

Desa«3tion of post «xcavatton areas Fl . front yard left-riand quadrarrt. F2. fror^t yard rigrtt-hand quadrant: B1. badcyard lefl-f\and quadrant. B2, t>ackyard ngtit-hand quadrant, 

o z . drip zone (1 -3 foot area of so^ around ttMi foundation of the house). 
Total C ^fcSquare Foe lO be Excavated = 730 

Property Classification: 80i Total L Linear Footage to be Excavated = 136 

pV4l^«l^S• 

Description of post excavation areas: Fl, front yard left-hand quadrant; F2, front yard right-hand quadrant; Bl, bacl<yard left-hand quadrant: B2, badiyard right-hand quadrant; 

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

PROPERTY CLEARANCE WORKSHEET 

Date W M Property ID ^ 

Property Project Omaha Lead -- Fixed Price Address 

Measurement XRF ID 0107-51 Count/Time 

Field Shots 

Shot * Reading Sample Area Shot * Readin g Sampl e Are a 

3^ 

^ ^ ^ ^ i ^ 

Sampl e Are a ^'.Su 3 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 (Bag ) Sieved ) -> 

2 

3 +• k^ ^ 4 -3^ 5;;^ XRF CorrectecfValue - > 

5 (use calibration cliart or add 

2 0 % to value) 

/^r 

Sampl e Are a 0?: i^ - /c|" 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 (Bag ) Numbe r Result s 1 (Bag ) Sieved ) 7 

2 i ^ ^ 3 

4 'A-f­ b"] (jp O 

XRF Corrected Value -> 

5 (use calibration chart or add 

2 0 % to value) ^ ( ^ 

Sample Area Pass/Fai l ? 31 ^'^" I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical eadinq Average (Dried & Spilt Sent (Bag) Number Results (Bag) Sieved) 

loT- XRF Corrected Value --> 

(use calibration chart or add 

lod- 2 0 % to value) m± 

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 (Bag ) Numbe r Result s 1 (Baq ) Sieved ) 7 

2 

3 

4 

XRF Corrected Value - > 

5 (use calibration chart or add 

2 0 % to value) 

Sampl e Are a 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 (Baq ) Sieved ) ? 

2 

3 

4 

XRF Corrected Value —> 

5 (use calibration chart or add 

2 0 % to value) 

i;u AUDI non/ii sntu s // XRF Technician's Signiture m i 1)1 II 
ID#: ,^^ ^ ^^^x / 5 T 

Date: 7/3^ ' 

N ame: C^^ ^ ^ 

Description: 

0/=- ymf/^^^^^tt^ s /y^ ^ TT) /?u/^:r'^ 1/777 ^ <>/^P^' 

y r 4AJ7 ^.a^77^ALS7'^7/ TW/CfSTT" ^7j<7^;d^6t^. 
"tPBoTP ' 

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

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L ENVtRONMENTA L 

C H O U P , IN C 

EXECUTIVE SUMMARY: 

21179—4388 MASON ST 

I I No Issues or Concerns X Issues/Concerns 

Detail Explanation: 

PO was issued a gift certificate #2544 from Indian Creek Nursery in the amount of $150.00 for mulch 

and rock which were removed from the property due to remediation activities. 
SEPA 

Wl A Property Close Out Form 

Property #: '7-7l7' 7 Property Address: j/^f ^ A7J:><! ^ 

Datc/rinc : Owner's Nane: ^/O/i ^ /€/c^f^:7 ^ 

Quads Excavated: Contractor Group 

Eicavatloa Genenl Yes No 

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

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

t / 

Gradioc Sod and VetetatioB Yes No 

1. Does the grading around the perimeter ofthe house in excav ated areas generally slope a^^ay 

from the bouse? i ^ 

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

3. Does the sod appear to be generally healthy and growing? (Onlv evaluate .f inspected at a jO 

day time period) l y 

4. Are sodded areas generally firm and evenly graded? i ^ 

5. Are the joints between the sod strips generally tight? (Only esaloate if inspecied at a }0 day ^ tinK period) 

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

\ \ 7.

 Was idairage to landscaping or pla.nt materials avoided? ; j ^ 

Gales, FCDCCS and RciaiDint'^alb Ves .No 

'. Do gates apcn a.nd close freely'' (Ifapplicable) 1 

1 

2. Were all gates or fences taken down during restoration activ ities reir.£ta!!ec? ,:f applicable) ^ 

3. Was damage to gates or fences avoided? 'Ifapplicable) • ^ 

4. Was damage tc retaming v»-a]ls avoided? i,!f applicable) V*^ i 

FouDdation, Sidiat aod Gutters ^ es Nc 

1. Was damage to the siding or trim avoided? » ^ 

2. Was damage to the foundation avoided? ^ 

3

 Was damage to w indows avoided? , y 

^ 4

 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or dov^Tispout extensions avoided? < ^ 

Sidewalks and Driveways (Concrete) \ « No 

1. Was damage to driveway surfaces avoided? ^ 

2. Was daraage to v*al3cwa\ surfaces avoided? w ^ 

I 
(Owners coroments: 

Inspecticn cctes: 

A. Ol— 

Remc\£l and restcration acii\ates corr.r'ete includine the 30-dav sod •>->• arr2.n^ • 

^v/­ ate' ^ ^ 
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 questions, 

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

PropertylD: ^//Z ^ 

Property Address: ^^fj ' /g/^r^/ 7 

Owner: --f^ ^ J^fC^rT^Z -

Phone: ^^/ , jff ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

[yj.! agree restoration Is completed, except as noted 

 I I do not agree restoration is completed 

9A/o7 

Owner's Signature Contractor's Signature ^ liate 

I
# 

Omaha Lead Superfund Site 

Miscellaneous Landscaping Replacement Certificate 

Property Owner Tom Richter 

Property Address 4388 Mason ST 

Property Identification Number 21179 

Material Removed Replacement Value 

Flower bed area $150.00 

Trees 

Itemized - shrubs/bushes 

Total $150.00 

The acceptance of the replacement certificate and the signature below is fiall 

acknowledgement by the property owner that this is a fair and reasonable compensation 

for plant materials removed during remediation activities, but not planted or installed by 

the government or it's contractors. 

The total amount of $ 150.00 has been received by the owner in the form of a gift 

certificate, #2544 , to be utilized at Indian Creek Nursery . 

/T. iz4^ —cy^ V w ^ 

Property Owner's Signature Date Contractor's Signature Date