TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: hq^ ^ Date: ^ | t ^ [ f fi 

Address: i^l ^ ^ >3 ^ ^ f 

Remediation Contractor: Coastal Environmental Group_ Year: _200fi_ 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

( / Video of property (DVD) 

W Executive Siunmary 

U EPA-provided property sketch 

y Signed Access Agreement for subject property 

-P' Signed Access Agreement(s) for adjacent property 

\ l Restoration Agreement 

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

J ^ Confirmation data 

C/ Photographs V 1 ^ ^ V ^Ct^n^- ^ X f^ S^^rtfl^t n 

A As-built sketch 

A 

Satisfactory restoration signed by Property Owner 

A 

Property close-out dieck list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

^ 

Property information from Douglas County Assessor's OfHce 

^\U\L„ 

ate 

30054834 

Superfund 
p 

Property Access Checklist 

Property ID: \'\4^^ 1 

D WORKSTARTED ON: / / 

D WORK COMPELTED ON;. 

Property Address: 2-\ZL > S ^^ ^ 

-J—l — 

Renter ^'^''- VouGOUrN ^soyv^rcl 

Address: ^ 

Phone: 

Fax: 

Cell/Pager. 

Phone: 2J-i 6 6^}

Additional Lnformation: - ^ ^ 

Fax: 

Ceil/Pager 

D Notification Letter 

Sent: / / By: 

^ T Access Agreement 

Slgncd:3/|>£/ ^ ^y-0j3C^xe^ 

S^Restomtion Agreement Siene6:3^imfJ2S By: (V}cert^ 

D Topsoil Sampling (If applicable) 1

 1 By: 

D Disposal Sampihig (if applicable) 1

 1 By: 

D Garden Sampling (if applicable) 1

 1 By: 

0 ^ Utility Clearance 

Called: ^/^y^Q Q By:C|/2^/09 

Qf Video/Photos (Before) OK3_I2^ I ^ ^y-^-r\\x^K}siar\€\\ 

i ^ Video/Pbotos (Daring) On: ^ / / By: 

D Videort'hotos (After) On: / / By: 

D Video«»hoto« (30-Day) On: / / By: 

Q^vProperty Completion Agreement Signed;/! ifl^io' ^ By: 

' D Final Report Issued:

 / / By: 

Air Monitorfne (as amilicablel 

D Community QCrcw On: / / By: i 

Results: 

D Community QCrew On: / / By: . ReSDhs: 

0 Commnnity QCrcw On: / / By: 

Results: 

Omaha Lead Site 
CONTACT FORM 

Property ID # 

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

V^\C\i(\xd 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

\^q^ ^ 

a-\2(.o S-3^?>^ 

 Date: Time: Action: 

 Date: Time: Action: 

 Date: Time: Action: 

 Transmit to EPA D Other Action: D 

^^Z--\^X'^ O^ ^'^'b-U)\^^ 
Douglas Coimty Account Inforra||io >rra||i n Page 1 of2 o 

Douglas County, Nebraska Property Record - R2540610000 

Print Report 

NEW Feature - Parte! Dimensions available @ scale 0-50 f) west of 52nd St - VlO W O n Ma p Information is valid as of 2009-9-15 Treasurer's Tax Report 

New Feature •* •^ •<* Auto Sales Searcti 

Owner 

VAUGHN RICHARD J 

ETAL 

2126 S 33 ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 4061 0000 25 

Account Type: Residential 

Parcel Number: 2540610000 


Parcel Address: 2126 S 33 ST 

OMAHA NE 68105-0000 

Legal Description: WINDSOR PLACE LOT 14 BLOCK 0 50 X 140 

Value Informatio n 

Land Improvement Total 

2009 $6,600.00 $148,800.00 $155,400.00 

2008 $6,600.00 $148,800.00 $155,400.00 

2007 $6,600.00 $148,800.00 $155,400.00 

2006 $6,600.00 $119,800.00 $126,400.00 

2005 $6,600.00 $119,800.00 $126,400.00 

2004 $6,600.00 $119,800.00 $126,400.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.16 7000.0 1.0 140.0 50.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25... 9/17/2009 
Douglas County Account Infornjrtipn Page 2 of2 rn|^ o 

y 

aiff 

, 2 1/2 STORY UNFINISHED »­

nm Floor looaosq. TH.O Su- n sfTty 

•-'IJ 

S V 

WV \ii f 

k i t N » M •• TM TMSF .nti^n- CLICK TO ENLARGE IMAGE 

CLICK TO ENLARGE IMAGE 

Square Footage: 1786.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Good 

Built As: 2 1/2 Story Unfin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 7.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: Drywall Battis: 1.5 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Gable Stories: 2.5 

Floorcover: Allowance Foundation: Block 

Sprinlder Square Footage: 0.0 

Year Percent Adjusted Year 

year Built Physical Age Remodeled Remodeled Built 

1918 0 0% 1918 91 

Detail Type Detail Description Units 

Add On Unfinished Attic W/floor 985.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 985.0 

Fixture Additional Fixtures 1.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Fixture Bath Half 1.0 

Garage Detached 720.0 

Porch End Screen 210.0 

http://dougIasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R25... 9/17/2009 
Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2372244. 

Original Call Date: 9/24/09 Time: 4:57 pm Op: ELIZABETH18790 

Work to Begin Date: 9/28/09 Time: 5:30 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 2126 Street: S 33RD ST 

Twp: 15N Rng: 13E Sect-Qtr: 28-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLETUIS TO: (877)662-4211 


: UNSURE OF CORNER LOT 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name: ELIZABETH Phone: (877)662-4210 


Work Being Done For: COASTAL 


Depth of Excavation: 4 FT Comer Lot: N Front: y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVELS MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Plione Nuniber Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVELS LEVEL3 COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/24/2009 
Page 2 of2 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day:

Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHO>fNoticeCreation/MessageText.asp?ret=<RESULTS... 9/24/2009 
OLS#: 17999 

•As-Built Drawing Date Excavated:10/7/09 

Date USEPA Signed Off: 12/1/09 

COASTA L Omaha Lead Superfund Site ENVIRONMENTAL Area Sodden: 1746 sa ft G n O U r . IN C 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with Area left bare 
 Sod ' ' 
 Rock/Mulch 

Contrac t #: EP-R7-07-05 Coasta l Environmental Group Inc . 
^Ii-y SFgi.^ue^ 

^ 5 T^AiyCAA/^ Omaha Lead Site Date: P/AA/^ ^ North Arrow ime: 

Address ,sy;//7C. y 3?y-A vr Site Sketch Time: /:?^ f : _^_ ^ ^ 

Phone: 4^Z , -A^fA l ~ TJz ^ 

Team ;^!^Xg-.-<l^^^^^BVID # AA?? 9 XRFCode '^oqSample Number Lead Concentration Confirmation Sample 

2

6 

7 

 P-V6>S6PXA ­ l^q<? 

& 

ppm 

ppm 

ppm 

ppm 

ppm 

P / Yes D

/ 2 Yes C^

„ / Yes •

^ ' Yes n

^^Ye s n

Yes n

t^ ^ Yes_^Q.

 No

 No

 No

 No

 No

 No

 No

 ^ 

 ta ^ 

 [3- ^ 

B ^ 

ra^ 

a 

• 

S^oTJA is>4^ ^ *6fi[sni4^ 
U ^('^ V 3FgWlCb6^8\»r£ 

Name . Omaha Lead Site 

Address JSs:: ^AV ^AJC^^ Y

Yf, . 3?P A Site Sketch 

Phone: 4<^7 -JT-/ ? ~-772 ^ 

% 
Omahalead Sits Date: ^ - NorthAnow - i 

Address: j^>J< d St ^^^J-J i Site Sketch Time: 

Phone: <07-JT-/ ? ~ "T^z ^ 

fe^ 

Team >ec<><gi:^^^f^^^BVID # Ay9f 9 XRFCode I'Zolf 

Sample Numt>er Lead Concentration Confirmation Sample 

ppm / ^ Yes D No ^ \ 

ppm / 5 Yes O No 0 ^ ig.vc^cPxA - xvukk ^g3 I t ppm a / Yes n No H — f?1^<l ppm No Q — RPZSCPXA •• ff<>^1 ppm : ^ 2 Yes ° No ca ^ 

ppm ^ ' ^ Yes • No a 

ppm Yes • No • 
>*«'»t*lir: 

COASTA l 

INVIRONHIItTAt 

6 t O tl P INC 

Consent fot 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 representetives, collectively 

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

following described premises: hs^q 

Owner's Name: 

\/no^n Pi'rii^rrJ I ?^h-5^5M 

Address of Property 

covered liy 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 

worit 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 woric 

before it begins. Once the woric is finished, the Grantor will be asked to review the woric 

and confinn that rt 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 ail 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: 

Pagel of2 
..^^'L*'"*, 

COASTA L A tPtVtaOHMtltrAL 

*'••< •ROI**' 

« « O U » I It c 

« Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

e 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; 

c 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 perfornn the woric. 

c 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 

Environmentai Group, at (402) 991-1199 

K' I grant access to my properties 

D I do not grant access to my properties 

ignature y J ^ A A Signature 

Date 

D I would like to be present during any sampiing that is required. 

F>age2of2 
^iCA HLh 

COASTAl . 

Restofatson Agreement 

Tiie puipose of this agreement is to provide a mutuaJ agreement as to conditions ofthe property prior to 

remediation activities. This will also serve as documentation fbr the purpose of assuring tiiat restoration 

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

Protection Agency (EPA). 

Property ID: I - ^ QQ ' 

Property Address: ^1,( I ^ <^ . "^^^^ ^

o^" ^ \/(x^.^QvV^^ '^sCVAax'^< 

Phone: 2-MD^qf ^ 

On Ae attached diagram(s) indicate ai«a(s} to excavate, surface structures and landscapirig features and 

access locatiQn(s) to Iw used liy the contractus. Indicate distances, depths, material types, etc. 

Photograpliically and Videographiedly document the existing conditions ofthe propeity and the l)asement if 

necessary. 

Items to be Removed by the Owner befbre Start of Remediation: 

The lemoval. storage, oi&posal, and/or return of these items is the Owner's responeibility. 

%iv)aM pl/on-b ^Vpe ^r,^M 

Item: 

Item: 

Items to be Removed by the Contractor During Remediation and Wot Replaced 

Item: 

Item: 

Hem: 

Item: 

Page l o f *) 
COASTA L 

Items to Be Removed By Contractor During Remediation ancf^Replac:ed_ 

I Item: 

^i L (M D ^ : 

Ram: 

J^DJ 6i P^ 

Item: 

< 

I Item: 

I 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing proper^ area, Quadrants that will be excavated, that <by 

is covered with grass. 

Number of trees > 2 inch Each 

• \ 

trunk diametoNumber of trees <= 2 inch Each 

\ trunk diameter 

Number of Sprinkler 

Zones. Control Valves, pOCJO^Ail^a^ y

Eadi Timers. Heads, et c 

Aiiach n skeicli ol iW 

vpr'rklci linmi; 

Number of and size of 

each garden/ flowo- bed Each 

area. V

Square Feet 

AtUuli Cl skclcli 111 ri!;ilivi" 

<i/i'S nnd loc;iiii>ns 

Vs. 

materials not to be 

replaced bv contractor. t 

\CIf Ihi"' \HIIIC Mill hi. 

usrC Wl li'UK .1 TIHR! 

\oiicJU'r 1(> lhe |}ri.i|)cri\ 

o« ner. 

Easement Area, to be Eacfa %r»djaiA *^i2A'uLiirH3 

excavated 

Page 2 - ^ 
# 

C O A S '» A L 

i Additional Comments / Instructions: 

i 4<Vo \o'iU ^oj^'^^f\vXJ-&r %)/i^^ 

L. 

/ 

Q Check the txuc if Owner (toes not want CEG to document intefior foundation walls and possible 

pre-existing damage. By checddng this box CEG is not responsible for any damage done to the 

interior of house, biduding fburtdation cracks or fissures. 

O I do not agree 

Dat Ifitee /A Qihtractor* ^htractor*s Signatu Simnr r ' Date 

Page 3 of / 
BVID W^'^^l 

XRF PROPERTY SAMPLE SHEET 

Date 

Project (0-n-o ^ 

Omaha lead FP 2nd year option 

Address 

Sample time 

•-LIU rs. ^e sK 

am/pm 

XRFID# 

Shot# 

^foZT 

'2JD2H 

-zpzg ijoT-fs 

Average

Shol# 

^^O . 

:5i / 

322L. 

3 ^ 3 

Average 

Shot# 

Average 

Shot# 

Average 

1 lab sample # 

•a.2,0qrci 

Reading

g o o f- 1^ 

e^ot /

TTT^ ^ 

-ZJO^ "^ n 

 P-^i ^ -^ I | 

Reading 

/ z^^ <^ 1^ 

/ zg *' \<\ 

\2^\^'i^ 

Reading 

Reading 

Lab result 

 Sample area 

^Y> A 

Depth 

±1 

Sample area 

^ \ 

Depth 

Sample area 

Depth 

sample length 

Shot# 

-zo^fe 

'ZOZPi 

'2£>'ic> 

'2.C>^f 

Average

Shot# 

?>fe •^^T 

??g> 

Average 

Shot# 

Average 

RETEST AREAS 

Sample area Shot# 

Depth 

Average 

Sampie area XRF Avg. 

Signature_ 

30 sec 

Readini Sample area 

T^r ^ s ^ 

202 -in ^ ^ 

Depth I Li, ^n 

-25/ ^( ^ in! 

 'Z^f ^ ^ i ^ 

Reading

i n t ^2J 

/ ^ < ^- ^ 

tn? . 1^ g.i 

n> i:^ 

no*-^! 

Reading 

Reading 

 Sample area 

^ ^ 

Depth 

Sample area 

Depth 

Sample area 

^ 5 

y ^ A Depth 

y / 

Print: \U\^f67 M/mV^ 
m 0 

j^*"'^'* -

i^mL\

I }^^y. I

\y^y^ •*HP„OT« ^

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

 Coastal Environmental Group Inc. www.coastalhazmat.com COASTA L INVIIONHENTAL 

G I O U P. IN C 

EXECUTIVE SUMMARY: 

BVID #17999-(2126 S 33 ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
EPA 

EPA Property Close Out Form 

Property #: Yl^^^ . — Property Address: — - ^ ^ 

Datc/Tlroc: 

Owner's Name:. .i^/y^. 

Quad Contractor Group s Excavated: 

Excavatio Yes No n GcHeml 

I. If necessatyi were the correct quadrant(s) excavated and restored? 

2, If necessary, were the correct areas ofdrip zone excavated and restored? 

L.-^ 

Grading Sod and Vegetation 

Yes 1^0 

1. Does the grading around the perimeter ofthe house in excavated areas generally slope away rr from the house? 

2. Has sod been laid in all areas that were excavated? i7" 

3. Doe

day tim

s th

e

e

 period

 sod appea

) ___^-

r to be generally healthy and growing? (Only evaluate if inspected at a 30 

_ r^­ 4. Are sodded areas generally Finn and evenly graded? r^ 

5. Are the joints l>etween the sod strips generally tight? (Only evaluate if inspected at a 30 day y^ time period) 

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

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

Gates, Fences and RctaJnlng Walls 

Yeess N. y

 (Ml 

1. Oo gates open and close fieely? (Ifappiicable) 

2. Were all gates or fences talcen down during restoration activilies reinstalled? (irapplicable) y

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

4. Was damage to retaining walls avoided? (Ifappiicable) "6^ 

Foundation, Sidiag and Gutters 

Yes No 

1. Was damage to the siding or trim avoided? y 

2. Was damage to the foundation avo>ided? y 

Was damage to windows avoided? y_ 

4 Was damage to windows or door screens avoided? y 

5. Was damage to downspouts or downspoul extensions avoided? 

Sidewalks and Driveways (Concrete) Yes No 

1 Was damage to driveway surfaces avoided? r/. 2. Was damage to walkway surfaces avoided? z^ 
'Ort'Dcrs comnients: 

Inspection notes: 

Removal and restoration aclivales complete iiicluding the 30-day sod warranty: 

EPA Representative JAo ^ n/:liL y Date: /xjl f^JKll 
L 

« ( 

Property Completion Agreement 

riiis agreement documents the completion of remedial activities perioimed on my properly My signature 

will designate that I am satisfied with the restoration of my properly, and thai no items are in questions, 

now, or al any lime in Ihe futui-e, except Ihose ilems listed below, ifany 

Property ID: nqO{( ^ 

Property Address: 2,\^.\ D t S ?>? ) S ^ 

O^nc: K\cVlO>y?XMaUC|\A. A 

Phone: 2M0'F)Olff^ 

Restoration items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

I N 1 fl|>rcc I'CsrorAlion it compleled, cxccpi as noted 

[_J I rio not aurec rtstorittian is compleleri 

(7(ft/Af/4 AA Y/^ ^ K-l/pOf Cn^oA^^j'^^ iiliU ^ 

Owner's Signatiiir A j Date ontiarloi' s Signature Date