TRANSMITTAL of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SA1D#: ^t)'S^lp'^ Date: 

Address: \^^^ ^ ^b Av. 

Remediation Contractor: Envrionmental Restoration, LLC_ Year: _2010_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) ^b^efore D After D Basement^ ZJU h?^f1^M y 

^ ^ Executive Summary (Final Report) I h^^CMyj/, 

^H , EPA-provided property sketch 

^B ^ Signed Access Agreement for subject property 

• Signed Access Agreement(s) for adjacent property 

^H ^ Restoration Agreement 

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

^^S ^ Confirmation data 

S. Photographs _ ^ Before D Crew Photos N During Excavation D Sod 

^ 30-day Sod D 

N. As-built sketch 

^ ^ Completion Agreement signed by Property Owner 

hi Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

" ^ Utility clearances 

^ S ^ Property information from Douglas County Assessor's Office 

^'•^Ss Property access checklist 

"^^^ Contact Log 

30260589 

D 

Superfund 

Environmental Restoration Signature Date 

^ EPACORsignature ~/ y Date 
jQy-i Omaha Lead Site—EP-R7-09-05 

^^^ ^ J Environmental Restoration, LLC 

^ www.crllc.com • 'I ,.ma-i^^ 

EXECUTIVE SUMMARY: 

20263-1315 S 30 AV 

^^""f^n No Issues or Concerns Q Issues/Concerns 

Detail Explanation: 
EPA 

EPA Pioperty Close Out Form 

Omaha Lead Site 

Property #: :^t)au>3 PropertyAddress: \3>) ^ ^ 3 ^ m 

Date/Time: Owner's Name: CSovC^ ^l^rw » 

Quads Excavated: JJ) Contractor Group : Environmental Restoration (ER) 

Excavation General Yes No 

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

2. Ifnecessary, were the correct areas ofdrip zone excavated and restored? ^ 

Grading Sod and Vegetation Yes No 

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

house? ^ 

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

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

period). 

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

5. Are the Joints between the sod strips generally tight? (Only evaluate ifinspected 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? ^ ^ 

Gates, Fences and Retaining Walls Yes No 

1. Do gates open and close freely? (ifapplicable) /vTA 

2. Were all gates or fences taken down during restoration activities re-installed?

3. Was damage to gales or fences avoided? (ifapplicable) 

 (ifapplicable) A/^ 

^ y 

4. Was damage to retaining walls avoided? (ifapplicable) A/i 

Foundation, Siding and Gutters Yes No 

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

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? ^ 

4. Was damage to window screens or door screens avoided? y ^

5. Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Inspection notes: 

Yes 

^ 

y 

No 

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

EPA Representativ Date: 
ENVIRONMENTAL 

RESTORATION 

RESTORATION CHANGE ORDER 

OMAHA LEAD 

Property ID # 2ot(J h 

Property Address / 3 f^ t> • "^Z^ A\J€ 

Owner Name J/gc^ L • SAATTS 

Date 6?'^'- '0 

Comments 

/ ^ ojf'/^ ife/v>oug (ji: ^ rgocT i:c^ <m^ <l^f>l 

-rke cr^^cy fw 7^^ t^zT ^^e at^ rMr ^2(^7y^ y^ , 

U'li A/r,7- Cyr'urcy SAJ^I^ A^^<r o^Jce^ ^ r ^A^^ /5g"<^ 

(Zy/^v^^ 

Owner Signature *^y ^ I­

^ —y 

Contractor Signature 
Page 1 of2 

"> 

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

YOUR TICKET NUMBER IS 2497473. 

Original Call Date: 5/19/10 Time: 2:02 pm Op: TRACY24186 


Work to Begin Date: 5/21/10 Time: 2:30 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1315 Street: S 30TH AVE 


Twp: 15N Rng: 13E Sect-Qtr: 28-NE-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: Excavating the entiire property 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)4 51-1069 


: SAID #20263 


Company 

Contact Name 

Alt. Contact 

ENVIRONMENTAL RESTORATION 

TRACY BRISTOW Phone: (4 02)4 51-1314 

Phone: (314)504-4874 

Work Being Done For: EPA 

Depth of Excavation: 12 Corner Lot: 

Involves Tunneling or Horizontal Boring : 

CXCATV LEVEL3 MUD02 OMAHACOF 

N Front: Y

N Explosives: N 

0PPDGPR6 QLNNEIF 

 Rear; 

Service Area Contact Phone Nuniber Utility Type 

Day. 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITYOFOMAHA-TRAFFIQSEWER RJCH/TRAFFIC Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthinternet/DHONNoticeCreation/]VlessageText.asp?ret=<RESULTS... 5/19/2010 
Page 2 of 2 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day:

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 5/19/2010 
 1 

Contact Information Log 

SA8D# o?OP0.3 

^^^^ 6/6''3GQ S 

Owner'sName: "^ajcJP— ^/niV s Daytime Phone: ^ ^iPC^^ ' 

1 Property Address: 13^ 3 5- ^^' ^ •7W<

Attempt to contact Date/time Name 

i3l-^7^ l 

^-d-^lZi y^SA ^ /e.^ 

^-afe-/o 1^ " ^7 ifc'^ e^ydynyyZo>\. 

' 
Property Access CheckSist 

SAID: ^03Ct 3 

PropertyAddress: 12/ S -5­ "30^/\^y. f n WORK COMPELTED ON: / / 

Owner: ^ 3^cf c Sv^t^J ^ Renter: 

Address: „ r\ Phone: 

Fax: 

Cell/Pager: 

Phone: '=f^'^C^< / Additional Information: ' 

Fax: 

Cell/Pager: 

[33 Access Agreement Signed: S^ 7c?i^ / (t> By: <^l^ 

[i^ Restoration Agreement Signed: ^ i^J> ll O By: (U ) 

bd' Video Property Before On : ,c; / ,<; / /.-t) By: A. 

0 Digital Photos Before On :^/^/jD . By= / ^ 

• Video Property After On : / / By: 

n Digital Photos After On : / / By: 

0 Property Completion Agreement Signed: C o ll 7 / / O By: ^ 

n Final Report Signed: / / By: 

Additional Video or Digital Photo's Taken: 

D Video n Digital Photo On : / / "B, : 

Reason: 

D Video • Digital Photo On : / / By: 

Reason: i 

D Video n Digital Photo | On : / / By 1! :

Reason: j 

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

II Reason: 

Omaha Lead Project Work Plan Page 1 of 19 
Consent for Access to Property 

PO303 

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 perfomi certain environmental response activities upon the following described premises,: 

Owner's Name: \joictc_ J/vt//-^ DaytimePhone: ^// - J^<l5y 

Address: L3/S 5' 30 ^ I'^o ^ 1 

Address: 

Addresses of Properties 

covered by this Address: 

Agreement: Address: 

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 perfomied on said property may include the following 

activities: 

a. Taking photographs and/or video of the property before, during, and after remediai 

activities; 

b. Locating equipment and machinery on-site in preparation for and in the course ofthe 

enviromnental response; 

c. Planning 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 enviromnent, 

or to allow others to use the property in such 

I grant access to my propertks 

[U I do not gramt access to my properties 

Signature 

Date 
y^ 

ro 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. 

R^-I agree n 1 do iiot agree I I i agree \//\ I do not agree 

Contractor's Signature Date 
Restoration Agreennent 

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). 

SAID '• 3^03-C^3 

PropertyAddress: /^^ S S - ZTC ^ A"*^ 

Owner: -JZ^J ^ ^r^f-fs. . . . 

Phone: f^^.^Pog ^ 

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 replaced; 

Item: 

/P/QC-C yy i -^ ^ t^/ ^ > ^nc i 

fem: 

St5m: 

Stem: -

Etem: 

Stem: 

8tem: 

Page 1 of 2 
agree O I do not agree Q I agree I 11 do Slot agree 

ier's Signature 

^Z^yllL 

Date Contractor's Signature Date 

Attachments 

Page 2 of 2 
' -~-t-—-- - J ——..--j - — - -^j- . 

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. 

SAID: P0^6 3 

Property Address: / 3/ 3 S > .Jto ^ /ft*<. 

Ow "^'•^ '^^c ^ J/^^/j -

Fhone; Jyi ^ y^0^< / 

Restoration Etems in Question: 

Item: 

Item: 

Item: 

Stem: 

item: 

Item: 

A rtriit/ir^.....% f^..\w\matyCfG ' 

PTl agree restoration is completed, except as noted Tsl I Egree restoration is completed, except as noted 

 I I do not agree restoration is completed j I I do not agree restoration is completed 

(oyyy7 7 j^,- ^ yyi^yy^A . /o'/^y/) 

Over' s Signature Rstp. mtractor's Signature Bate 

I
LyuLiiitas «^uLmiy Account inrormalion Page 1 of 2 

Dougla s County , Nebrask a Propert y Recor d - R123791000 0 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nci St - Vie W On Ma p Information is valid as of 2009-12-31 Treasurer's Tax Report 

New Feature ^ '-^ ->• Auto Sales Search 

Owne r 

SMITS JACK L 

ETAL 

534 COOPER RD 

ASHLAND NE 68003-5505 

Propert y Informatio n 

Key Number: 3791 OOOO 12 ­

Account Type: Muitiple Res 

Parcel Number: 1237910000 

Parcel Address: 

Legal Description: 

1315 8 30 AV 

OMAHA NE 68105-0000 

HANSCOM PLACE LOT 19 BLOCK 11 50 X 150 

Valu e Informatio n 

2009

2008 

2007 

2006 

2005 

2004 

^ 

Land 

$6,800.00 

$6,800.00 

$6,800.00 

$6,800.00 

$6,800.00 

$6,800.00 

Improvement 

$58,500.00 

$58,500.00 

$58,500.00 

$60,200.00 

$60,200.00 

$60,200.00 

Total 

$65,300.00 

$65,300.00 

$65,300.00 

$67,000.00 

$67,000.00 

$67,000.00 

Lan d Infor m atio n 

Acres 

0.17

SF

 j 7500.0

 j Units 

j 1.0 

Depth 

150.0 

Width 

50.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.isp?accountno=R 12... 1 /18/9010 
i^uugias <._.uuniy Account miormauon I'age ZOt 2 

...iW:./..-. TWO STORY 

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fi-i i fl^V! 

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TMJi i ~-%.Lr ^ 1 

B?»«.* £*)f»'tl ^ 

ssssrmnsnEM^^minxm^ssn 

CLICK TO ENLARGE IIVIAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1940.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 9.0 

Exterior: Frame Shingle Units: 2.0 

Interior: Drywall Baths: 2.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1883 0 0% 1883 127 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 934.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Porch Slab Roof Ceiiing 149.0 

Porch Slab Roof Ceiling 56.0 

User 2 UNIT CONVERSION 1.0 

User codei 25tomodel 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12... 1/18/2010 
ENVmONMENTAL AS-BUIlLT DRAWING 

HA LEAD SUPERFUND SITE ^ ^AA ! 

RESTORATION 

uarc\^.j^y L s y^ys 

Address; /?/. ? .-<.> '^D ^ J 

Phone. y^^^-y^^^.^/i^</ 

Oma,Via Lead Site 

Site SIcetch ' 

Date: li^SL^S^ 

Time: /^''..S'f-i 

North fsrraiN 

.^ _ h 

—__ _ 

y^yyyyy ^ BVID # ^^^ -^ /:= 3 XRF code ^ ^ ^ o ^x- Leaid Concentration Confirmation Sample 

'yyZfJZj pp;;; 

-rSOl'ft ~p / ppm 

/in-t<^S ' ppm 

ppm 

y / Yes

^^Yes

?5 > Yes

1:1 Yes

I'i-Yes

 a 

a 

S 

a 

• 

No tZl--

No a:— 

No C3— No ra^ 

No la- ^ 

No CD 

ppm Yes a No • 

Yes • 

Pnvironmental Restoration LLC 
r 

f-iameyAck L S j^y ^ Omaha Lead Site Date: 7^^7-0: 3 North Arrow 

Address SiteSketch Time; yi^.S'yi : /?/•< .-<.•. -^t) ^ J 

Phone: </y^~7^ i ^Ml}< l ^:r^ 

BVID ty^2 ) y 6^'3> XRF Code ^^^ O 

Lead Concentration Confirmation Sample 

I im U ppn y y Yes n No E ^ 

/^Ye s • No D: ­

yyf / PP'n ^ . Yes a No t2— 

No EJ--' 

No la ^ 

Yes Q No • 

Yes • No • 

'Wy-f/ g: I^Yes n 

Omaha Lead Site 46I3( 
(t y c;2«i.'-w*' ^.jv> l y 'y 

Omaha Lead Sitf Date: y.y7~^: 3 Nortti Arrow 

Site Sketch Time: /y^'^ y Address: /-r^.< -y.s y^F) ^ J '^^r Phone: .^/^^-^^y^^g/^^ y u\U'^UD-g"- (yy[\ 

Team -ryy2(J/,Jy2/y^y^AAj'7- BVID#^<^ J^^3 !' XRF code ^ii a 

Lead Confirmation Sample Sample Concentration Number 

9yHK\c.?YK~^o^(y. y / Yes D No ^^ ^ 

No ^^31­ /=:^ Yes n 

??> No car­ Yes • 

No ra-^ /.^''^ T / '^ ppm ? ^ Yes O 

No fS- ^ \ \ ^Xi^i<p ^ ppm 

ppm Yes No CD LJ 

ppm Yes • No • 

/SJ 

yy^' QSi T ^ ^Z£%1 

ty yi 

1 : ^ .1:2. 

3y zo -] Qci 

YyzysTii' -Nf=- ^ 

-„..„.K 

z^ ^ L l$ 0 r\ j 

W3 

m -UT^-. ^ 1 - 0 

tef^-^ - = 2Jinil V k^-i pr-Y-"it^- DI 

Timf'r) I W -P^ 7 • J""-—•-^•- ; ' - • * - - " • - — ' -*f—rr—tT-rrf j 

.c^c^:±:2igL 4i/>J^{fF K 

^ !; 

< Ay c m •«!••••; . Bvj i 

4y y%y yg /\ / t 

yy<y ci y4 y y \ Ay 

Omaha Lead Site 

46 
c 

EiWfr?©MMEEM?AL XRF DATA ENTRY LOG 

i?.SSTORAT!l©INl 

SAID #_^Q2yy/ ^ DATE fo \ M \ \ ^ 

PROPERTY ADDRESS TIME 

XRF S/N 

QUADRENT OR SAMPLE AREA 


DEPTH AVERAGE OF RESULTS SHOT #s 

redig 

D Fl 

a F2 

D 81 ±1 I5<, t 2 \ \^y-l-\^^ 0 

n B2 

D DZ y z~)S-i z n \<,s-i-isrr^l 

n PZ 

n GZ 

n EZ1 \\?H.t z \ ^^7yy • I'^i^B­

• EZ2 

OTHER 

SAMPLER NAME V '^^^-c^^\\^A.^.-,.'^^^or<.(-^v^• 
Themio Fisher Scientific Thermo 900 Middlesex Tumpike 

Billerica, MA 01821 

S C I E N T 

AVi;HAGI' AODRKS-S SAMPl.K AKI: A lOI'r.KA IO K 

1 2010-06-04 14:01 Avg of 1585-158 •1315s30av EZ 

2 2010-06-04 14:01 1315 s 30 av EZ 

3 2010-06-04 14:01 1315 s.30 av EZ 

4 2010-06-04 14:00 1315 s 30 av EZ 

5 2010-06-04 13:51 Avg of 1581-•158: ; 1315 s 30 av DZ 

6 2010-06-04 13:51 1315 s 30 av DZ 

7 2010-06-04 13:51 1315 s30av DZ 

8 2010-06-04 13:50 I315s30av DZ 

9 2010-06-04 13:48 Avg of 1577-1571 ; 1315 s 30 av Bl 

10 2010-06-04 13:48 1315s30av Bl 

11 2010-06-04 13:48 131Ss30av Bl 

12 2010-06-04 13:47 1315 s 30 av Bl 

JIMMY surface final clearance 163.52 ± 21.34 

JIMMY surface final clearance 20263 .148.04 ± 20.74 

JIMMY surface fmal clearance 20263 164.05 ± 21.42 

JIMMY surface final clearance 20263 178.49 ± 21.87 

JIMMY 6 fuial clearance 275.14 ± 26.85 

JIMMY 6 final clearance 20263 263.22 ± 26.19 

JIMMY 6 final clearance 20263 275.20 ± 27.06 

JIMMY 6 final clearance 20263 286.99 ± 27,31 

JIMMY 4 final clearance 155.23 ± 20.94 

JIMMY . 4 final clearance 20263 149.22 ± 20.66 

JIMMY 4 final clearance 20263 140.69 ± 20.12 

JIMMY 4 final clearance 20263 175.77 ± 22.04 

Page 1 of 1 06/04/10 14:23:11 
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