TRANSMITTA L of OMAH A LEA D SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: /7/<^ I97&^ Date ^ : 

Address: /^<^ / S i '^^2 T 

Remediation Contractor: _Coastal Environmental Group_ Year: _2007_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

B ^ Video of property (DVD) 

B^ Executive Summary ^ ­ ;L 

B ^ EPA-provided property sketch 

E ^ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

W Restoration Agreement 

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

y Confirmation data 

^ y Photographs ' 

As-built sketch 

M Satisfactory restoration signed by Property Owner 

M Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas County Assessor's Office 

D 

D , 

D -• ' '•••• • " • • 

40317852 

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

Hard Copy rnformation | 7^^/

X Property Check List | /y(yl

yi . Site Working Drawing Map I 

T C EP A originals Map k 

y^. Douglas County Assessor's Map 

^^r Property Contact Sheet 

/ 7&~> 

^ t^S"' 

O 

AgKc€nient 

^^^-''^Tj^i^css Agreement 

yy . Restoration Agreement 

Miscellaneous Documents 

1. Final Map fi-om the Field 

yybn-d.n'gQ 0rders^\ 0 

3. XRF Data 

pyiK^vj emails or PO a)rrespondencesY\|^y^_ 

Property Completion 

i. Executive Summary 

2. AS BUILT 

/5 . Property Completion Agreement 

.>4f Any buyout info or reimbursement infofv\.CAy^. Check or money order copies 

/yy^? A Property Close Out Form 

yf. Attached Begin Video 

y 

y 

4 

Electroni c Documentatio n 

Drawings 

y C EPA original 

y . Working Drawing 

3. AS Built.vso 

4. AS Built.jpg 

Photos 

Begin Photos 

During/Excavation Photos 

Sod Photos 

30-Day Sod Photos 

2 

Scanned Documents 

Final Documents 

Executive Summary 

y y

' ^

Videos 

 Begin Video 

 My Movie 
t .S' # 

Property Access Checklist 

PropertylD: 1^7(^ 5 D WORK STARTED ON: / / 

Property Address: j *^ "^ 1 n WORKCOMPELTED ON: / /

^ Z ^ ^+. 

Renter: Owner: Cr\J<.i-Cc l fAfX.^ ^ 

Address: ' Phone: 

i6Z \ ^ 2 ^ Si- - Fax: 

Cell/Pager: 

Additional Information: 

Phone: 7op, - 279 . Z . 

Fax: 

Cell/Pager: 

1 ^ Notification Letter Sent: / / By: 

r x Access Agreement Signed: S / 17 / C J By: 

Q Restoration Agreement Siened: 8 t Z \ 1 C7 By: 

r~l Topsoil Sampling (if applicable) 1 1 By: 

ED Disposal Sampling (if applicable) 1 1 By: 

• Garden Sampling (if applicable) 1 1 By: 

H Utility Clearance Called: 8 / 2 4 / O' l 

^y„ ^ Video/Photos (Before) On: / / By: 

n Video/Photos (During) On: / / By: 

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

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

nn Property Completion Agreement Signed: / / By: 

n Final Report Issued: / / By: 

Air Monitoring (as applicable) 

O Community CH Crew On: / / By: 1 

Results: 

1 1 Commimity EH Crew On: / / By: 

Results: 

EH Community EH Crew On: / / By: 1 

Results: 

Omaha Lead Site 
ii*' „ Property Classification:

i 

 800^ ^ 

1 

\A^' 5 JL Ckptiri 

Aliev 

^H l Quadrant Square Footage to be Excavated 

^Ha l Drip Zone Linear Footaqe to be Excavated 

= 793 

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Omatia, Nebraska 

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 Excavated Area 

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• Fence 

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Property Nunnber 

 OLS-1976 5 

Property Addres s 

 1521 S 25 ST 

 Post Excavation Concentrations 

 B2 Plav Are? 

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

DZ, dnp zone (1-3 foot area of soil around the foundation ofthe house). 
Name: /\r;.r/^ / /^>4 7 ^ Omaha Lead Site Date: -/-/( > ' ^ 3 North Arrow 

Addressiy ::^.^ / r^^ -J? ^ %Jr Site Sketch Tme: f(3' ^ 

Phone: 7y s •».•' ^/i? T <'/<<'<P- t * ^ 

i&avn y/./^ y BVID# ^V7/. ­ < XRF Code / 30¥ 

Sample Number Lead Concentration Confinnation Sample 

7.30 i^vf g: 

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 Yes

 Yes

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No

No

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 Yes

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Dougla

s County NE GIS Map 

LEGEND 

Minor StreeU 

y 

f M 

Ha]or Streets 

M*|afStf«eti y 

Interctate* 

X Mmtain 

Parcels • parcel 2 

Hydro B 

DrtVMibyWehGUiDEl 

Disclaimer: Ttiis map is not guaranteed 

to be accurate, correct, current, or 

complete and conclusions drawn 

are the responsibility of the user. 
f 

# 

Property ID #

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 |^7G S 

i'DZ\ S 2.'b S t 

 Date: Time: Action: 

 Date: Time: Action: 

 Date: Time: Action: 

 Transmit to EPA D Other Action: D 

y-^(cS 

1 
I

'•UrnKr fc,W-ftL''m 4Mj«<"(lt)r'A; (k , m 

y^°i'^^^. Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

V • j ^ www.coastalhazmat.com COASTA L %- y ENVIKONMENTAL 

G R O U V. IN C 

EXECUTIVE SUMMARY: 

19765—1521 S 25 ST 

I No Issues or Concerns X Issues/Concerns 

Detail Explanation: 

PO was issued a gift certificate from Indian Creek Nursery # 2566 in the amount of $150.00 for flower 

bed area removed during remediation activities at the property. 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Ibid Ouadrant Square Foolage k> be EiicariratEd - 793 

Propeity CbsEfllcalkn: 900 Tlilal DUP Zone Unear Footaqe to De Excavated - 102 

DZ replace with soil only 

and remove plants and do 

not replace. PO will removed ; 

all small plants she wants 

and remove stone and place 

it on the porch. 

7^^"^^ . pL5#: 19765 

Date Excavated: 10/30/07 

^featte US§f»A'§iinla Off: ^M27tok 

- • Fenoe 

Pefmanem LandGcapng 

Quadrani Boundary 

Streei Boundacy 

C ^ Tiee'snruD 

^fjaarmm. fti, tea^*M MMMnd ^ 

OZ, «<iitm a ;i-3 lb«CBnHafafiaMBii«d«M4»tnaMiei*«tVM MuM ^ 

Legen d 

Area not Excavated ^^yy\ Dripzone Excavated KK^ Quadrants Excavated 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
^ EPA 

EPA Property Close Out Form 

Property #: //y^^^ . Property Address: —(P ^ ^^y, ^

Date/Time: Owner's Name:. ^<^^/g ^ if^^^ 

Quads Excavated: Contractor Croup (jy(\<n'(}l\^ 

Excavatio Yes n Ceneral 

I. If necessary, were the correct quadrant(s) excavated and restored? y 

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

CradinK Sod and Vegetation 

Yes 

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

2. 

Has sod been laid in all areas that were excavated? y

3. Does the sod appear to be generally healdiy and growing? (Only evaluate if inspected at a 30 

day time period) 

4. 

Are sodded areas generally fuin and evenly graded? y ^ 

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

time period) 

6. 

Was the property graded such that water will not pool on the property? y ^ 

7. 

Was damage to landscaping or plant materials avoided? t y 

Gates, Fences and Retaining Walls Yes 

1. Do gates open and close freely? (Ifapplicable) 

/\/^ 

2. Were all gates or fences taken dovm during restoration activities reinstalled? (Ifapplicable) ty 

3. Wasdamage to gates or fences avoided? (Ifapplicable) 

A)A 

4. Wasdamage to retaining walls avoided? (Ifapplicable) 

//A 

Foundation, SidiDKand Gutters 

Yes 

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

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? l y ^ 

4. Was damage to windows or door screens avoided? 

y ^ 

5. Was daraage to downspouts or downspout extensions avoided? 

y 

Sidewalks and Driveways (Concrete) 

Yes 

1. Was damage to driveway surfaces avoided? Ky^ 

2. Was damage to walkway surfaces avoided? 

y 

 '" " 

-

 No 

No 

No 

No 

No 
Inspection notes: 

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

EPA Representative„^--7^2k^^A.;^^^^^X^^?^— Date: ///y^/o 7 
Property Completion Agreement 

This agreement documents the completion of remedial activities performed on my property. My 

signature vvill designate that I am satisfied wilh 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. 

Property ID: 7<^^Z ^ 

Property Address -yn / ^ Z'y^r 

Owner: (2£iy<ry ^ ^JTZ -

Phone: yoH' ZvQ'T.-

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

^^^^Sl agree restoi-ation is completed, except as noted 

I 1 do not agree restoration is completed 

Date ' Contractor's Signature 

I
Omah a Lead Superfund Site 

Miscellaneous Landscaping Replacement Certificate 

Property Owner Crystal Matz 

Property Address 1521 S. 25 ST 

Property Identification Number 19765 

Material Removed Replacement Value 

Flower bed area $150.00 

Trees 

Itemized 

shrubs/bushes ft 

Total $150.00 

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

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, # Z^py". to be utilized at Indian Creek Nursery . 

-yy// ^ 7/'3-^-7 

Propgty Owner's Signat Date Contractor's Signature Date 
INDIAN CREEK NURSERY 2566 

Omaha's Best Kept Gardening Secret 

303 North Saddle Creek Road 

Omaha, Nebraska 68131-2229 

(402) 558-5900 Gift Certificate 

IN THE AMOUNT OF: ^:^^£i^y77:^y^li^7yy 

7 

ISSUED TO: {yty^h i TfUt y COMPl.rMKNTSOF: 0^*1^^!^^^^ QU^tAym.^njL.Jl^ 

EXPIRATION DATE: /^" S -CS ^ 

Authorized Signature 

t y I^T^r- /^/ S^^^y 
PROPERTY CLEARANCE WORKSHEET 

Date Property ID /O -3/-0 7 /97&r 

Property Project Omaha Lead -- Rxed Price Address /S'ZI S. 2 5^-^^ fr -

Measurement XRF ID 0107-51 Count/Time 

Field Shots 

Shot * Reading Sampl e Are a Shot # Reading Sample Area 

b2. 12'N 8n WL 3?25 W112. -e2_ m 

Sample Area DZ iz-N 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical 

Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Baq) Sieved) 7 

2 3^:6 

3 /^< / 

1 537 5y/ XRF Corrected Value --> 

5 (use calibration chart or add 

2 0 % to value) 

ni 

Sample Area BA'\j J Pass/Fai l ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical 

Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Baq) Sieved) 7 

2 l o t 

3 / ? / IZZ 

A / 3 3 XRF Corrected Value --> 

5 (use calibration chart or add 

I5i 2 0 % to value) 

Sample Area Pass/Fail ? ^1 H'L 

In Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical 

Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 3f/ (Baq) Sieved) 

2 (f.7. 

95 

3 ^3 J Z I 

4 36 39 sr XRF Corrected Value - > 

5 25- (use calibration chart oi add loS 1 

2 0 % to value) 

Sample Area h i f/'O Pass/Fail ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical Reading Average (Dried & Spilt Sent (Bag) Number Results I 78 

(Baq) Sieved) 

2 f5 i/a 

3 1 Vi- 6^ 4 f / / / XRF Corrected Value —> 

5 (use calibiation chart or add 

I h 2 0 % to value) 2(i 

Sample Area Pass/Fail ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical Readinq Average (Dried & Spilt Sent (Bag) Number Results 1 (Baq) Sieved) 7 

2 

3 

4 

XRF Corrected Value —> 

5 (use calibration chart or add 

2 0 % to value) _ 

\ n { ADDIIIONA I SHHI S t l 

XRF Technician's Siqniture Uf f IU n 
/''•^Z'^ i^VG 5 

COASTA L ENVIRONMENTA L 

CROUP . 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 Daytime Phone 

y^y-no^^Xl^D~ ^ -yM.1. L.ui-1 •E-.^aa.i^.T-Jufc H ..d.ii -i— u h.-j-Mjmr^r T. Mnn.--T-Yi i nm-m.i . „m,.t.mm nrn.nit^iTo 

Address of Property y?-~{ 5. 7 ^ 'sy. covered by this 

Agreement: ^ryrsya,hJ^ (-^foS 

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 
vV^ «.P 

COASTA L -w .1.- ENVIRONnENTA L 

•' t PBO-1*"^ GROUP . 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; 

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 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. 

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

~^ Date Signature Date 

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

Page 2 of 2 
COASTA L 

C N O U ^ IN C 

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 ofthe property owner and the United States Environmental 

Protection Agency (EPA). 

PropertylD: iq^^l^ ^ || 

Property Address: i K / t C Z^ ^^ sy 

^""^••^ Ct,^sU /v\y^ 

Phone: ^^ , ; -j^S-ZlfiT . 

On the attached diagram(s) indicate area(s) to e.xcavated and depth of e.xcavation. 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 Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

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

Item: 

y i %(r^il p/w^ 4 ylo^jt^e-tz^'s 

Item: 

'S V 0 WJi KJbX \L vJ«N^ 

Item: / 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of. 
COASTA L 

c n o u r . IN C 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

^ n S^/"/ ^\0yy \y\r btLJ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of. 
 _

COASTA L ENVIRONMENTA L 

CROUP . IN C 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

yo]i 

Item: 

So 0 

Item: 

1>-r •^.-i-/ . Sol i >>^^.Ll^ MfJ^sJ p . S'civi-ltus,''^ 

Item: * 1 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

—, . 

Page 3 of. 

—J - .:'iA<>jiA n •,:•. .•-•:....^. .J-. • 
1 

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 la>out. 

! 

Number of and size of 

each garden/ flower bed 

area. 

.Attach a sketch of relative 

sizes and locations. 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Species 

113 Square feet 

f Each 

f Each 

f Each 

Each 

Square Feet 

/ 

Page 4 of. 
COASTA L INVINONME N T A L 

CROU P INC . 

Item Quantity Unit Condition/Type/Species 

Agreed upon value of 

plant materials not to be 

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. 

Include a sketch of were 

each plant will be placed 

by the contractor. 

Agreed upon area of 

property' to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

Area of City or County 

propert>' to be landscaped 

per their requirements. 

Include a skeich of the 

area(s) 

Easement Area, to be 

excavated 

hy 

y $ 

/-illt^jU^^' 

/ 

Each 

193 SF 

^ 1 

SF 

SF 

Page 5 of. 
_^_. . ._-,.^ X 

 

COASTA L 

rNVIRONMCNTA L 

CROUP . IN C 

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. 

0Taagree n I do not agree 

^/-^/-J7 i/fyt—y^yrf] / 

Owner's Signature V Date /Corftractor's Signature 

Page 6 of.