TRANSMITAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

ID#29586 Dale:_ 

Address: 1509 Corby St 

Remediation Contractor: Environmental Restoration. LLC Year2011 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

n Video of property (DVD) | | Before • After | | Basement JT^A/t?/^ ^ 

J 2 Executive Summaiy (Final Report) 

Q^ EPA provided property sketch 

^ Signed Access Agreement for subject property 

D Signed Access Agreement for adjacent propert 

UC Restoration Agreement 

D Settlement documents (i.e., for damages or replacement of plants) 

JA Confirmation data 

n Photographs •Befor e •Cre w Photos Q During Excavation j [Sod 

I 13 0-day Sod • 

J ^ As-built sketch 

y r Completion Agreeinent signed by propeity owner 

^ Property close-out check list signed by EPA 

n Discription of areas not meeting ROD cleanup criteria. Contamination left behind 

^0''^Utilities 

0 ^ Property information from Douglas County Assessor's Office 

j A Property access checklist 

^Contac t Log „ 30263382 

Superfund 

. ^ ^ 

EPA COR signature Date 
EPA 

EPA Property Close Out Form 

Omaha Lead Site 

Property #: 29586 Property Address; 1509 Corby St 

Date/Time: Owner's Name: City Of Omaha 

Quads Excavated: F2 Contractor Group; Environmental Restoration (ER) 

Excavation General \i^Mf4 (of Yes No 

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

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

Grading Sod and Vegetation Yes No 

v^ house? 

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

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

period). 

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

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at 30-day time period). 

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

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

Gates, Fences and Retaining Walls Yes No 

1. Do gates open and close freely? (if applicable) 

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

3. ^ Was damage to gates or fences avoided? (if applicable) 

4. Was damage to retaining walls avoided? (if applicabie) 

Foundation, Siding and Gutters Yes No 

1. Was damage to siding or trim avoided? 

2. Was damage to the foundation avoided? yJdOJl.K" ' 11\-{' 

3. Was damage to windows avoided? m 

4. Was damage to window screens or door screens avoided? * i 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? Ali 

2^ Was damage to walkway surfaces avoided? /!> 

Inspection note; 

3 ^pi^jj ZiOit, 

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

EPA Representative Date; /. 'V^/// 
OMAHA LEAD SiTE — EP-R7-09-05 

ENVIRONMENTAL RESTORATION, LLC 

WWW.ERLLC.COM 

o'.*^'"' ^ 

EXECUTIVE SUMMARY: 

29586 1509 Corby St 

NO ISSUES OR CONCERNS ISSUES/CONCERNS 

DETAIL EXPLANATION: 
IRTH One Call Page 1 of 1 

Diggers Hotlin ft irth N«braska 

• : ;(.. 

Home Ticket 

Ticket Creation Logout 

Create Another Ticket Go to Home Page Send Email 

• YOUR TICKET NUMBER IS 2904818. 

Original Call Date: 11/18/11 Time: 7:16 am Op: TIM24186 

Work to Begin Date: 11/22/11 Time: 7:30 am 

State : NE County: DOUGLAS Place: OMAHA 

Address: 1509 Street: CORBY ST 

Twp: 15N Rng: 13E Sect-Qtr: 10-SE-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMOVAL 


Location of Work: LOCATE THE ENTIRE CORNER LOT. 


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


: 29586 


Company ENVIRONMENTAL RESTORATION 


Contact Name TIM SUTTON Phone: (402)451-1314 .v;2267 


Alt. Contact CELL Phone: (402)306-2347 


Work Being Done For: EPA 


Depth of Excavation: 24 INCHES Corner Lot: N Front: N Rear: N 


Involves Tunneling or Horizontal Boring : N Explosives: N 


MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area 

Code 

Service Area Name Contact Phone Numbers 

Utility 

Type 

MUDOl METROPOLITAN UTILITIES 

DISTRICT 

SANDY MUDOl Day: (402) 504 - 7823 

Emerg: (402) 504 - 7970 

OMAHACOF CITY OF OMAHA- RICH/TRAFFIC Day: (402) 444 - 7197 

-rOACCTr- cc:\Mtzo o ^yl A LJ A >^ 

hUp://w\\'w.dhon.org/IRTHOneCall/Ticket/TicketCreation.aspx?VievvTicketrD=898097 11/18/2011 
ENVIRONMENTAL 

^6Sle, ISOi M ^ 

RESTORATION 

Questions to answer at the house 

1 Does the map match the property? V g <;^ 

2 Is there a dog? ^3 0 

3 Is there anything that need to be moved? like a car or boat? ^30 

4 Does the property have easy access? ^(g*? 

5 Is the property Easy, Normal or Hard? ^ ^

6 If no. is there a property we can get access from ?

7 Is soil going to have to be shuttled out? ^ 6 

8 Is the property all hand work? AJ>0 

9 Is there a retaining wall? h O . 

i d Is it in had shape? 

11 Is there under ground line to the garage? ^ O 

12 Is there a sewer clean out? jijf^ 

13 Isthereany hazards in the yard? AJQ 

14 Is the siding old on the house? j>C>T 

15 Try to leave the time frame open when we will be there? A^t 

15 If they need a notice Mark it big on the map. Try to leave it at a 24 hour notice only? AJQ 

17 What kind materials are need for replacement? UO 

18 Is there zoysia grass at the property ( Red flag this prooertv)? i W 

19 Is this property boarder line on routine? ^^ ^ 

20 Is there sentimental item be aware of? IWOML21 Can we use the driveway? ^) 0 0({i\J i t^< ^ 

22 Is the property line marked in the excavation areas? W'^? ' 

Sign 
Contact Information Log 

SAID# 2^5'BCJ. 

Daytime Phone: t^j/c/- ^MJl^OZ^ ^ 

Attempt to contact Date/time Name 

7 ^ 

( ^ oL\!o^Af^S 5//^ / r^'oo fe^ 
Property Access Checklist 

SAID: 

D WORK STARTED ON: / / 

D WORKCOMPELTED ON: / / Property Ad dress: /CT) M^ l 

Owner: [\ L J ^ /)^>uJ ^ 

Renter: 

Address: (/ 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: "^^^^^^W^WFW/V 

Fax: 

Cell/Pager: 

[ 3 Access Agreement Signed:^ 1 f^l P By: M 

Ly Restoration Agreement Signed: S 11 ^ 1 f( By: m ^ 

@ Video Property Before On : 5 //I /JL By: M 

[>^ Digital Photos Before On : 5 /li/i L By: M 

• Video Property After On : / 1 . By: 

) D Digital Photos After On : / / By: 

^ Property Completion Agreement Signed:/.^ 1 ZLl I L By: ^4> 

• Final Report 

Signed: / / By: 

Additional Video or Digital Photo's Taken: 

D Video D Digital Photo On : / By: 

Reason: 

n Video n Digital Photo On 

By: 

Reason: 

n Video n Digital Photo On 

By: 

Reason: 

• Video n Digital Photo On By: 

Reason: 
Consent for Acces A ^ t 

s to Property SAID m

:?fs-s(^ 

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 perform certain environmental response activities upon the following described premises: 

j Owner's Name: /»/ ) ^ Qtl^^ ^ Daytime Phone: ^^rVVV^J^l* ^ 

Address: /^ ^ ^ (}oAj_Sr _ 

Address: ^ 

Addresses of Properties 

Address: covered by this 

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 performed on said property may include the foiiowing 

activities: 

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

activities; 

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

envirormiental 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 environment, 

or to allow others to use the property in such 

Q I do not grant access to my properties ' ^ y I grant access to my properties 

Date Q Signature 

Date 
n 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. 

Qla n I do not agree p ^ I agree i I [ do not agree g ree 

yp.-i^f 

Owner's Signature Date s Signature Date 
% estoration Agreement 

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

contractor activities. This will also ser\'e 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 Address: /^ ^ ^ (J ^ Jy ^ 

Owner; 

Phon^: ^(-fO^ ~ t^i-fLf' LfZ>^ ^ 

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: 

U di gje^.^ ^vi ^ ^^-/->- -^^^^ 

ttem: 

Item: 

Item: 

item: 

Item: 

Item: 

Page 1 of 2 
X kI agree CU 1 do not agree 0i agree CU I do not agree 

Owner'sxS^nature Dat^ ' CoawSSto or's STgfeattire Date 

Attachment 

Page 2 of 2 
12/05/201 1 MON 8:1 9 PAX 

121002/005 

Property Completion Agreement 

This agreement documents the completion of remedial activities perfonned 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. 

'SAW: A^^ ^ ~ ^ 

Property Addre.,: y^g ^ p^J, ^ 

Ovrner; 

Phone vkZZ ^ 1 i 1111 ^2^-^^^' m w 

Restoration Items In Question: 

Item: 

t item: 

Item: 

Item: 

Kem: 

Item: 

Additional Comments: 

rA i Mgree reitoration Is completed, except lu noted •f l I agree restoration (s completed. esG«pt aa noted 

LJ I do not agree restoration Is completed Q I do Dot agree reato ration Is completed 

y^~ 7-^6/ / ^^=.—^^--^-v Owner's «lgiSur e Date Contractor's Sigfiaatur t e t>9itfl 
Douglas Coimty Account Information 

Fage I ot2 

Douglas County, Nebraska Property Record - R1744090000 

Print Reoort 

View Interactive GIS Mao Information is valid as of 2011-3-31 Treasurer's Tax Report 

New Feature <-> <4 >> Subdivision Sales Search 

Owner 

CITY OF OMAHA 

C/O CITY FINANCE 

1819FARNAMST 

OMAHA NE 68183-0000 

Property Informatio n 

Key Number: 4409 0000 17 

Account Type: Ex Government 

Parcel Number: 

1744090000 

Parcel Address: 1509 CORBY ST 

OMAHA NE 68110-0000 

Legal Description: MILLARD & CALDWELL'S ADD LOT 111/2 BLOCK 0 W 34 E 170 FT 34 X 86 5/8 

Value Informatio n 

2010 

2009 

2008 

2007 

2006 

2005 

Land 

$0.00 

$0.00 

$800.00 

$800.00 

$800.00 

$800.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$0.00 

$0.00 

$800.00 

$800.00 

$800.00 

$800.00 

Show All Transactions 

Land Informatio n 

Acres SF 

Units Depth Width Vacant 

0.06 2924.0 0.0 86.0 34.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl7... 4/13/2011 
Douglas County Account Information Page 2 of 2 

The above map is powered by Google, and Is intended to provide a general idea of a property's location. If 

you require a more exact property location, you may use the Interactive GIS Maps that are maintained by our 

office. 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 7... 4/13/2011 
• • 

ENVIRONMENTAL AS-BUILT DRAWING

OMAHA LEAD 

SUPERFUND SITE 

RESTORATIO N Contract* EP-R7-09-05 

111111 29586 

Exterior Paint North An-ow 

Site Sketch 

Omaha Lead Site 

Q>^q n Good - HzJ^r \ r~l Poor 

Samplin g Address : 1509 CORBY ST ^ 3 * '^° ' paint 

Sample Number Lead Cor centration XRF LAB Samples Collected 

RY.^SCPXA-29586 F l Firm ±ai. ppm Q- n 

RYBSCPXA-29586 F2 Date JsS-. ppm • 0 RYCSCPXA-29586 B l Time S h ppm 

RYDSCPXA-29586 B2 

m. ppm • Samples Analyzed 

RDZOCPXA'^2900G GSr 

r?CjZSCPXA-29506 S2 -

ppm 

• • XRF Unit; tOB&^ Book: ^/, A 

ppm 

r?PZOCPXA-20506 H= * ppm • L3 Date: 

Time: 

Numbe of Samples = | ^^ | [ Q ) 

Staff: M<;u/ i: 

Legend: F1 = Front Left, F2 ^ Front Right, 31 = Back Left, B2 = Back Right DZ = Drip Zone, GZ •- Garden, ^2. = Pla^ 

quadra is are as viewedfromthe street, facing property 

OCT 1 4 2010 

SAID #2958 6 

DATE EXCAVATED 11-30-11 


DATE EPA SIGNED OFF 12-8-11 


AREA SODDED 1404 SQ FT 


RCV20OS Crearted: 14-Sep- •• CeeiV.^t O447O1.01.23 

LEGEND 

Quadran Easement Excavated t Excavated Drip Zone Excavated Lead Soil Remaining 
29586 

Omaha Lead Site Exterior Paint North Arrow 

^V'^ ­ HlH r Site Sketch 1 •

•

 Good 

 Poor f 

Samplinq Address: 1509 CORBY ST 0 * Not paint 

Sample Number Lead Concentration XRF LAB Samples Collected 

RYASCPXA-29586 F1 ppm D 

Firm; 

RYBSCPXA-2958 Date: 6 F2 J^S^ ppm 0 D ID'J-^-ZO/O 

RYCSCPXA-29586 Time:  B1 2± ppm 0 D . RYDSCPXA-29586 82 

M ppm B D Samples Analyzed 

n!DZOOr)(A-29!}00 BE- ppm D n XRF Unit: lOBU ^ Book: .?/ ^ r?GZ0CPXA-29506 S2-

ppm D 

D 

Date: RPZSCPXA-20506 PE- ppm D 

D Time: 

Numtjer of Samples = | ^ | | Q | 

Staff: n%jL 

Legend: F1 = Front Left. F2 = Front Rigtit. B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla^ 

Al quadrants are as viewed from the street, fadng property 

OCT1420tiD 

* ^ 

.61 

5V 

^ 

.6Z 

7# 

^ 

I 4-> 

tA 

\\^\.i^^ \ 

fri 

m..'. .F l 

I n\ 

•w ^ 

Re .(^S.^.^t. ;. v 2008 Created: 14-Sep-lO 
29586 

Exterior Paint North Arrow Omaha Lead Site 

Sit • Good VW e Sketch - H2Hr Q Poor \ 

Sampling Address: 1509 CORBY ST luT" Not paint 

Sample Numfcier Lead Concentration XRF LAB Samples Collected 

RYASCPXA-29586 Fl ppm B- D Firm ? £ -mc MW//eiA/ 

RYBSCPXA-29586 F2 SiS ^ ppm 0 Date lG'14-ZOtO n RYCSCPXA-29586 B1 0 Time SU ppm 

RYDSCPXA-29586 82 0 D

Bi__ppm D Samples Analyzed 

RDZOCPXA--29500 B2- D 

r r ppm 

RGZOCPXA-2958 D D XRF Unit: 6 62 - — ppm D RPZ0CPXA.2050G Pi : — ppm D Date:_ IO-20'fO D Time: 

Number of Samples = | ^ Staff: fnv/ 

Legend: F1 = Front Left, F2 = Front Rigtit, B1 = Back Left, 82 = Back Right DZ = Drip Zone, GZ ••Garden, PZ = Pla^ 

Al quadrants are as viewed from the street, facing property 

OCT 14 2010 

.fil..l..6Z 

5 v ; &> 

- ^ b

.r. -tk 

in 

\°\klij^ 

7-

Fl..'. ?.h 

n \ 

-tna^ 

Rev 3008 Cheated: 14-Scp-lO .Qefe^.^t..'. 
ENVIRONMENTAL XRF DATA ENTRY LOG O 

RESTORATION 

SAID #_Si5S^__ DATE U \3o \ ({ 

PROPERTY ADDRESS TIME 

XRF S/N Tt^n^ 

QUADRENT OR SAMPLE AREA 

DEPTH AVERAGE OF RESULTS SHOT #s 

redig 

n F1 

D F2 ^ IJ8i^ ^ 1 fc.? 7 ­ eo4r> 

D B1 

n B2 

n DZ 

n PZ 

n GZ 

n EZ1 fJO B ^ 

D EZ2 

n OTHER 

SAMPLER NAME 
Themio Fisher Scientific Thermo 900 Middlesex Turnpike 

Billerica, MA 01821 

SCIENTIFI C 

AVKRVCK ADDRKSS SAMPLK ARKA OPKRATO R DKPTH NOTKS 

20M-II-3U 15:27 Avg of 637-639 I509corbysl F2 JIMMY 4 final clearance 137.77 ± 20.67 

2011-11-30 15:27 1509corbysi F2 JIMMY 4 final clearance 29586 130.86 ± 20.31 

2011-11-30 15:27 1509corbysi F2 JIMMY 4 final clearance 29586 132.87 ± 20.50 

2011-11-30 15:26 1509corbyst F2 JIMMY 4 final clearance 29586 149.58 ± 21.20 

Page 1 of 1 11/30/11 15:41:08