../ ' 

TRANSMITTA L of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: 22/?^ Date: ^f/^ 6 

Address: 333 ^ O ^ / ST " 

Remediation Contractor: Coastal Environmental Group_ Year: _2007_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

B Video of property (DVD) 

4\ Executive Summary 

EPA-provided property sketch 

fi] Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

H Restoration Agreement 

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

4 Confirmation data 

Photographs _^ _ 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas Coimty Assessor's Office 

D 

D , 

D •• ' 

^^.^<!^^/0^^^<gdJft^ ^ 

ignatur^ 

40317724 

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

Hard Copy Information 

—t^^roperty Check List 

—^T'Site Working Drawing Map 

—3: EPA originals Map 

,.-4r'15ouglas County Assessor's Map 

--5r~Property Contact Sheet 

Agreement 

,r---trAccess Agreement 

-2rRestoration Agreement 

Miscellaneous Documents 

1. Final Map from the Field 

2. Change Orders 

3. XRF Data 

4. Any emails or PO correspondences 

Property Completion 

.^•'•'^rExecutive Summary 

^^A S BUILT 

.^^-3T Property Completion Agreement 

f\B^ - Any buyout info or reimbursement info 

7]f^ 5. Check or money order copies 

\y/(). EPA Property Close Out Fonn 

l/l . Attached Begin Video 

Electronic Documentation 

Drawings 

^^.-'tT' EPA original 

-^-ZT^Working Drawing 

- ^ AS Built.vso 

A T AS Built.jpg 

Photos 

/--^egin Photos 

^During/Excavation Photos 

^^o d Photos 

/-30-Day Sod Photos 

Scanned Documents 

^^.^---Final Documents 

^--'-Executive Summary \ . 7 ^^ 

Video s —^ L^^ ^ 

/^egin Video--l):=^^5cc;s;^=s^;^^=^57?rr^^ 

"'j:::i^My Movie 
Property Access Checiclist 

Property ID: /^^/^ ^ n WORK STARTED ON: / / 

Property Addrcs.s: p^-j^ ^ ^ ^/^S f n WORKCOMPELTED ON: / / 

0>vncr: (iQ^^ f tir^-tl A Renter: 

Address: ^ ^ 5 . ^/^St ^ Phone: 

Fax: 

Cell/Pagcr: 

Phone: ^/// ­ yQ^Cj Additional Information: 

1 Fax: 

Cell/Pager: • 

D Notltication Letter Sent: / / By: 

S Acces.s Agreement Signed: j5_/^/i2 7 «>•= /Uara) 5 

Q Re.storation Agreement Signed: 5 1 QBl O l »•>'= Mrx^D3 n Topsoil .Sampling (irapplical>lc) 1 1 By: 

n Dispo.sal .Sampling (if applicable) 1 1 By: 

d l Garden Sampling (ifapplicable) 1 1 By: 

H i Utility Clearance Called: T / 30 l Cf ^y-^n67kic^ 

E I Video/Photos (Before) On: ^l33lJ7 l B.y= ITJ'OIA. 

H^Vidco/Photos (During) On: U 1 ^r /O'l B.y: /Zi6K 

0 ^ Video/Photos (After) On: 1^ 1-1 /(f^ \ir.[UoiA 

n V><leo/Photo.s (3()-Day) On: / / By: 

Q ^ Properly Completion Agreement Siened: b l 7 1^ 1 B.V: /Z/C^ \ 

CH Final Report Issued: / / By: 

Air IVIonitoring (as applicable) 

LH Community CH Crew On: / / By: 

Results: 

D Community Q Crew On: / / By: 

Results: 

CH Community CH Crew On: / / By: 

Results: 

Omaha Lead Site 
Total Q^^^ t Square Footage to be Excavated = 1439 

Property (Classification: 1200 # Tota^ ^ Zone Linear Footaqe to be Excavated = 0 

i ; i i i i 1 i 1 1 1 / J 

/ fm Vi.l>^,^ \A/ ^ / \ )o v i. ^r ^ i :rVA( 7V^ * / ­ f. -V////^ ^: ^ 

7 M 7 7 / 

7 

/ / O/^ 

7' *-­ 7777//A 

^ ^ ^777^^ • <i 

QK A*< 

'Z/^143 9 sq.ft 0'. • 

|/yO-1420,ppm'

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'A|yV^%^% 

Ci^P 7777 'A 7/yy / i 

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-v../ ' r1^ 1 •i y 

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^^^^ - ^^^^ 

South 21 Street 

Legen d North Arrow Omaha Lead Site 

Concrete Omaha, Nebraska 

[Vl l 

\VA Excavated Area Property Number 

w Existing Structure OLS-22195 M Scale 

• Fence Property Address ' 1 incti = 20 feet or 1 grid = 5 x 5 ft 

B?\ •7Q Permanen 835 S 21 ST t Landscaping fWi - Quadrant Boundary Post Excavation Concentrations 5 (ppm) 

- Street Boundary F1 B2 Plav Are ~,i,-y.>^in^,~: x^m P2 n7 FaQpmpn t i ^ c) T ree/S hrub \ /(V.1^ < * • 81 Gar den_ _ othe r 

Description of post excavation areas: Fl, front yard left-hand quadrant; F2, front yard right-liand quadrant; Bl, backyard left-hand quadrant; B2, backyard nght-hand quadrant; 

DZ, drip zone (1 -3 foot aiBa of soil around the foundation of the house). 
Print Preview Page 1 of 1 

^WQ 5 Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 1 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

Sec-TwnRng 

1745440000 

GREEN 

ROBERT B 

835 S 21 ST 

OMAHA 

68108 

4315 S 22 ST 

OMAHA 

NE 

68107 

22-15-13 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Old Assessor 

Site 

New 

Assessor 

Site 

MILLARD PLACE 

1 

16 

50X132 

http://webarc.co-douglas.ne-us/dcassessor/details.asp? 

PARCELNB=1745440000 

http://webarc.co.douglas.ne.us:8080/ReaiWare1/details.do? 

id=R1745440000 

Disclaimer: Map and parcel data are believed to be accurate, but accuracy is not „ Sralp 

guaranteed. This is not a legal document and should not be substituted for a title search, . . . *_ _._ , . 

appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 4/25/2007 
CONTACT FORM 

n/L\^< Property ID # 

Property 

Address: 

Initial Contact: Date: s a Time: 1 -Polt^ Action: ^U*^^ If^L^^ W «^ ^ 

Second Contact: Date: Time: Action: 

Final Contact: Date: Time:^ Action: 

Final Action: 

Transmit to EPA D Other Action: D 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

\lC^ (jMhi Y^m< C47^ ^H-^l'U} 

t^ /L5| A/to. (A ^ \WSb^ V ?^^ HM^ 

^/f1 ^/ftt*, ^ Hwf«i ^'l ^ ''^^1 Af< Wi'^^ 
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: ! u\ ']0'> ^ 

'l/l ^ 

Address: r 

Address • /I r : C 14^^ ^ 7 ' I^Clhf4,6f- ) Addresses of 

Propertie Address: s covered by r --. this Agreement: Address: 

« < 7 ^ur ^^ KMw^) 

Address: 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA is requesting access to collect soil samples and remove soil that contains 

elevated concentrations of arsenic and/or lead and may pose a health hazard. The soil 

will be removed and the excavated area(s) will be replaced with clean materials and 

restored. This work is being performed under the Omaha Lead Site Superfund Site 

remediation program. 

An EPA representative 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 Grrantor 

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: 

«Property_ID» Page 1 of2 
•

 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 if EPA is unable to obtain such access; and 

• Allow videotaping and/or photography of the property including exterior and 

interior areas ofbuildings. 

AGRFEM!-:NT NOT TO INTFRFERF 

The Grantor agrees not to interfere or tamper with any ofthe 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 ofthe 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 

I grant access to my properties CD ' do not grant access to my properties 

Signature Date Signature Date 

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

Page 2 of 2 

«Property_ID: 
ip^ 

Restoration Agreement 

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

reniediaiion aclivilies. This uil l also serve as decontamination for the purpose of assuring tliat 

restoralion aclivities are completed to the satisfaction of llie property owner and tiie United States 

Environmenial Protection Agency (EPA). 

Propertv ID: TPfAQ ^ 

Property Address: (7t / L, 'y^<^^ C^^ 

Owner: p^^ip ( (^ |L^ ^ 

Phone: \^\^ 107^1 

On the attached diagram(s) indicate area(s) to e,\cavated and depth of excavation, locatioii of all known 

utilities, subsurface features, surface structures and landscaping features, access locatioii(s) to be used bv 

contractor, and the direction of North. Indicate distances, depths, material t^pes. etc, I:idic;ite digital pliotos 

hv referencing the photo-log number w ith an arrow indicating direction ofv iew. 

Item s T o Be Ramove d By Owne r Befor e Start Of Re.medisticr; : 

(Use additional sheets as necessary) 

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

Item: 

\o-i^ < 

^ 

^ y Item: 

Item: ^^ ^ 

y Item: 

y / " 

Item: y^ 

Item: y ^ 

Item: y ^ 

Item: y ' (o Page 1 of_ 

1 
^m^ 

Items To Be Removed By Contractor During Remediation An d Not Replaced 

(Use additional sheets as necessary) 

Item: 

Item: 

Ti)>nf y^yf v^ %ii 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

/ 

Item: 

Item: 

Paqe 2 of (/ 
Items To Be Removed By Contracto r During Remediation An d Replaced 

(Use additional sheets as necessary) 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of (f 
^ 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-existing propeily area 

that is covered uith grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees • = 2 inch 

tnmk diameter 

Number of Sprinkler 

Zones. Control Valves. 

Timers, Heads, etc. 

Attach a sketch of ilie 

sprinkler lavout. 

Number of and size of 

each garden'' flower bed 

area 

Attach a sketch of relative 

si.^es and locations. 

Quantity 

Vh 

H 

r 

li^ 

Unit 

Square feet 

Each 

E.uh 

Each 

Each 

Square Feet 

Condition/Type/Specles 

[LOTM 

Page 4 of ( / 
Item 

Agreed upon value of plant 

materials not to be 

replaced bv contraclor. 

Note this value will be 

used to issue a plant 

voucher lo the property 

owner. 

Agreed upon list of plant 

materials that v^ill be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of vvere 

each planl will be placed 

by the contraclor. 

.Agreed upon area of 

property to be replaced 

vv-iih grass sod. 

Include a skeieh of the 

area(s) lo be replaced with 

grass sod. 

Area ofCitv or Couniv 

propenv lo be landscaped 

per iheir requirements. 

Include a sketch of the 

area (s) 

. 

Quantity 

^ 

h"] 

'^1^ 

Unit 

$ 

Each 

SF 

SF 

Condition/Type/Specles 

' 

1 

• 

Paoe 5 nf b 
Additionai 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. 

Q^i I ajiree I 11 do not agree Di^ g I I I do not agree ;i2ree 

7J^^^K!A^ce^7M-^ 

Owner's Signature Date Page 6 of. ictor's Signature Date 
---

« r Total Quadranl^ l ire Footage to be Excavated = 1439 

Property Classification: 1200 Total Drip Z^r e Unear Footaqe to be Excavated = 0' 

^ 1 1 / 

1 / i 

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So uth 2)1 Sitre et 1 

Legen d North Arrow Omaha Lead Site 

Concrete Omaha, Nebraska 

VA Excavated Area Property Number 

Existing Structure OLS-2219 5 Scale 

» Fence Property Address 

b^ 

1 Inch = 20 feet or 1 grid = 5 x 5 ft 

835 S 21 ST Permanent Landscaping 

Quadrant Boundary Post Excavation Concentrations (ppm) 

Udr y V • Oui-oq C IIK.' 5^. F2 Ease !men ; • D Z _ — t

O Tr ee/S hrub ^ B1 Garc len _ Othe r 

Description of post excavation areas: Fl, front yard left-hand quadrant: F2, front yard riglit-hand quadrant; B1, backyard left-liand quadrant: B2, backyard riglnt-hand quadrant: 

DZ, drip zone (1 -3 foot area of soil around the foundation of the house). 
PROPERTY CLEARANCE WORKSHEl 'm> 

2zqs 

83^^21^'^ 

Date 

Project 

XRF ID 

Shot * 

^ \ n 

Aliquot 

1 

2 

3 

4 

5 

Aliquot 

1 

2 

3 

4 

5 

Aliquot 

1 

2 

3 

4 

5 

Cinlm\m Property ID 

Property Omaha Lead -- Fixed Price Address 

Measurennent 

C3l0~]'5l Count/Tlnne 

Field Stiots 

Reading Sample Area Shot # 

8Z-4#^ ^ Bl t.-^" 

Sample Area ?/\ h'9^'^ 

I n Situ Composite Composite Readings Reading Average (Bag) l l T (Bag) 

¥A U^ 

-DCj f94 ^2 141 qp) 

XRF Corrected Value ~ > 

?6 (use calibration chart or add 103 2 0 % to value) 

Sample Area 

I n Situ Composite Composite Readings Reading Average (Bag) (Bag) 

XRF Corrected Value ~ > 

(use calibration chart or add 

2 0 % to value ) 

Sample Area 

I n Situ Composite Composite Readings Reading Average (Bag) (Bag) 

XRF Corrected Value ~ > 

(use calibration chart or add 

2 0 % to value ) 

Reading 

Composite 

(Dried & 

Sieved) 

Composite 

(Dried & 

Sieved) 

Composite 

(Dried & 

Sieved) 

Sample Area 

Pass/Fail ? 

Analytical Lab Spilt Sent Number 

Pass/Fail ? 

Analytical Lab Spilt Sent Number ? 

Pass/Fail ? 

Analytical Lab Spilt Sent Number ? 

Analytical 

Results 

-

Analytical 

Results 

Analytical 

Results 

Sample Area Pass/Fail ? 

I n Situ Composite Composite Analytical Aliquot Composite Readings Lab Analytical 

Reading Average (Dried & Spilt Sent Number Results (" oas i 1 (Bag) Sieved) 

Confidential 5/2/07 Page 1 of 2 
k— , 

1 2 

3 w A w

A 

4 

XRF Corrected Value - > 

5 (use calibration chart or add 

2 0 % t o value) 

Sample Area Pass/Fail ? 

Aliquot 

1 

I n Situ 

Reading Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent 

•> 

Lab 

Number 

Analytical 

Results 

2 

3 

4 

XRF Corrected Value ~ > 

5 (use calibration chart or add 

2 0 % t o value) 

USE ADDITIONA L SHCCTS I f 

XRF Technician's Signiture NEEDED 

/Ylt XAT ^ 

Confidential 5/2/07 Page 2 of 2 
^ 

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

S J^^^ ' I Coastal Environmental Group Inc. 

V^'^T ^ www.coastalhazmat.com ^ 

^"tPRoi*^ COASTA L ENVIRONMENTIkt. 

CROUP . INCEXECUTIVE SUMMARY: 

22195—835 SOUTH 21^^ ST 

^ No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation 

# 
As-Built Drawing 

COASTA L Omaha Lead Superfund Sf TO 

Total Qua(jrant Square Footage to be Excavated = 1439 Property ( DIassiflcatlon: 1200 Total Drip Zone Linear Footage to be Excavated = 0 

1 1 1 1 I 1 1 1 1 i : i 1 1 ; 1 1 1 1 1 1 : 1 

^ 

„,...^,.. . A J 

B1 = B2PPM 1,^^^^^^^^^1 

r^ i 1^ . - -^ V^^^^^^^^^^^^^^^^^^ l 

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1 ^t 1 

i^i^^^^^^^^^^^^^^ M I 

;. > ;f^^^^^^^^^^^^^^ H 

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, 

1 

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• 

> 

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! 

South 21 Street 

Legend OLS#:22195 North Arrow Omah a Lea d Site Omalia. Nebraska Date Excavated: 6/4/07 

Date USf led Off: 6/8/07 Propert y Numbe r 

Kisiing OLS-2219 5 SUi i_ ^ c jcture 

Scate 

Propert y Addres s 1 Inch = 20 feet o n grid = 5 X 5 fl 

b^V^ 8 3 5 S 2 1 S T g^ ^ . >r.,,,= ..= .,. ,.=..v.i.^,>...M 

— Quadrant Boundary — _ Post Excavation Concentrations (ppm) - Street Boundary 

P1 R7 Plav Arpa ^yflfr)(..V)l iHj.. K.i F2 riZ Easement T ee/S hrub >, 

W,v*** B l Gar Jen _ oth e r _ li5P^/I ^ 

c DescrptKXi of post excavation areas F 1, frort yard lett-hartd qModrant: F2. frant yard rignt-hand quadrant. Bl , backyard left-hand quadrant B2. backyard right-hand quadrant, 

DZ. drip zon* (1 -3 foot araa of soil around the foumtotfon of tha hom*) 

Legend 

Area not Excavated |/yyj Dripzone Excavated QQQ^ Quadrants Excavated 

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

EPA Property Close Out Form :s7. 

Property #: .2^/^.6 ^ Propert Property Address Address:: ^^jS ' S'^/^S A 

Datc/TlBc: Owner's Name: 

Quads Excavated: Contractor Group 

Excavatk>n General Yes No 

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

2. If necessa'y, were the correct areas ofdrip rone excavated and restored? 1 / 

Grading Sod aad Vctctatioa Yes No 

1. Does the grading around the perimeter ofthe house ir excav ated a.'-eas 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 if inspected at a 30 

day time period) -S'*-" >vc>l^5 

4. Are sodded areas generally firm and evenly graded? 1 / 

5. Are the joints between the sod strips generally tight? (Only evalaate if inspected at a IOday •X time period) 

6. Was the property graded such that water w ill not pool on the prc^pei} ? y 

7. Was damage to landscaping or pla.nt materials avcided" 

1 y \ \ 

Gates, Fences and Rcuinint >^alls Ves .No 

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

2. Were all gates or fences taken down duri.ng rrstoration activ i:ies re^ns'^iiec? .ifsprl icabie) , i ^ 1 

3. Was damage to gates or fences avoided? (If applicable) ly ^ ! 

1 t 4.

 Was damage tc retaining walls avoided? (Ifapplicable) 1 i ^ i 

Foundation, Sidiaf and Gutters 

Ves N c 

I 

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

2. Was damage to the foundation avoided? f) ^ 

3. Was damage to windows avoided? ON 

4. Was damage to windows or door screens avoided? K)^ 

5. Was damage tc dovMispouts or downspout extensions avoided? pK 

Sidewalks and Drtveways (Concrete) 

Ves No 1 

1. Was damage to dri vew ay surfaces av oided? ^)f^ / 

/ 2.

 Was damage to walkwav surfaces avoided? 
1 

Owners comments: 

Inspection notes: / , • / i , ^ S 

VooVi«^Q (joe^ VU) -(• C^|5|«^« 

Removal and restoration acti\ates corr.p'.ete including the }0-da>' sod •^'^arranrv-: 

EPA Representative^;^^ Date: ^ oAr ^ r^^ J 
«ER^* 

Property Completion Agreement 

This agreement documents the completion of removal activities performed on the below listed property. 

The property owner's signature indicates that the property owner is satisfied with the restoration ofthe 

subject property, and that no items are in question, now, or at any time in the future, excluding any 

remaining sod warranty (30 days total) except those items listed below, if any. 

1 Property ID: '^m6 

Property Address = ^35 ^ ^.ffitSt- Owner: 'fhoblrf (::7r7-t-7 

Phone: ui^-^od") 

Restoration Items In Question: 

Item: , .. 

jZ.: 'i \ YT^ ^ '-\ 

item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

v\\ I agree restoration is completeci, except as noted above. 

 I I do not agree restoration is completed 

Irl-'^ 

Date 

I