TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ll/?&^ l • Date: jojnfiQo? 

Address: 271U/Z DP^A Cirri^ 

Remediation Contractor: Coastal Environmental Group_ ' Year: _2007_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

1/ 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Si^ed Access Agreement(s) for adjacent property 

, 0-

Restoration Agreement • -. 

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

Confirmation data 

Photographs \)PCUA^ QXOa.CA^a(\ ^ UDJI^JL . 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA '/l2 J 27)0 7 

Description of areas not meeting ROD cleanup criteria a 

Utility clearances 

a '•'. 

Property information from Douglas County Assessor's Office 

v^^^g^^^ (JrAzZ^"' 

V/7 ^ 

40317090 

Superfund 
GS-I- 2.7^2. Dean C^vdei 

Final Report Property Check List (Please place with each fUe) 

Har d Copy Information 

rn Property Check List 

pT] Site Working Drawing Map 

3. EPA originals Map 

^4\ Douglas County Assessor's Map 

[Sj Property Contact Sheet 

Agreement 

L[Access Agreement 

27 Restoration Agreement 

Miscellaneous Documents 

I Q Final Map from the Field 

2. Change Orders 

p i XRF Data 

4. Any einails or PO correspondences 

f 

Property Completion 

tQExecutive Summary 

AS BUILT 

Property Completion Agreement 

4. Any buyout info or reimbursement info 

5. Check or money order copies 

|6] EPA Property Close Out Form 

J7\ Attached Begin Video 

Electronic Documentation 

Drawings 

v 1. EPA original 

v^. Working Drawing 

v6. AS Built.vso 

V4. AS Built.jpg 

Photos 

VBegin Photos 

V During/Excavation Photos 

Sod Photos 

/ i 0-Day Sod Photos ((a(Z) 

Scanned Documents 

^Final Documents 

Vtxecutive Summary 

Videos 

^^egin Video 

My Movie 
Property Access Checklist 

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

n WORKCOMPELTED ON: / / Property Ad<lrc.ss: ^Zb^/XCU J CZrPJ-C 

Owner: \/l^f^Q ^ ^fimZS S Renter: 

Address: Phone: 

Fax: 

Ccll/Piijicr: 

'•""«==

Fax: 

 73/'77^7 Additional Information: 

No yuizs. oncZlu-euJOi). 

Ccll/PaRcr: 

^ Notification Letter Scnt:i2l/ ^IJ ^ By: 

^ Access Agrccnicnt Sinned: Q: 1 ' 5 1 0 1 By: fdc y 

I T Restoration Agreement Signed: i ^ / S 1 O l By: jfUcU 

n Top.soil Sampling (ifapplicable) 1 1 By: 

n Disposal Sampling (if applicahlc) 1 1 By: 

CH Garden Sampling (ifapplicable) 1 1 By: 

S i Utility Clearance Called: b 1 6 1 O l ^y^-Trhi'iyy\ ^ Video/Plioto.v (Before) On:(^/_^/_QZl ^r-fiicy 

S Video/Photos (During) Ou:Q2_li2j 0 1 «•v=?^f^>^ 

1^ Viileo/Photos (After) On:Qz/B./_Ql B.V: R.-cK 

^ Video/Photos (3()-Day)((bO^ Ou:_2L/^'^ljn By: "R^clv 

^ Property Completion Agreement Sinned: " 7 1 ^ 1 O l «>= ?,' CJA 

\Z\ Final Report Issued: / / By: 

Air Monitoring (as applicable) 

n Community CH Crew On: / / By: 

Results: 

l~1 Community CD Crew On: / / 1 

Results: 

CH Community CH Crew On: / / 1 

Results: 

Omaha Lead Site 
Total Q^^Hbquar e Footage to be Excavated =1617 

Property <Classification: 800 4p Tot^HKon e Linear Footaae to be Excavated = 0 

! 

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Legend North Arrow Omaha Lead Site 

WZ\ Conaete Omaha, Nebraska 

l/'/ l Excavated Area V Property Number 

OLS-16841 f • " \ Existing Structure Scale 

•—•— • Fence 

Property Address 1 Inch = 20 feet or 1 grid = 5 x 5 ft 2762 DEAN CIR [xjx^ Permanent Landscaping 

• Quadrant Boundary Post Excavation Concentration 3 (ppm) 

- Street Boundary F1 B2 Plav Are T\-A^rJ^^.-,.- ^ F2 n7 Easemer t 

Tree/SI-irub 

c l^l l ) \ S/Pro»* «f B1 Gar jen_ Othe r 

Description cf post excavation areas; F1, front yard left-hand quadrant; F2. front yard right-hand quadrant; Bl. backyard left-hand quadrant; B2. backyard nght-hand quadrant; 

DZ, dnp zone (1-3 foot area of sal around the foundation cf the house). 
^Ht-.l'^'J;'35J' -W^ 

Print Preview Page 1 of 1 

Douglas County-Omaha, NE m^\ 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

Sec-TwnRng 

0523860000 

HARNESS 

VERNON L 

2762 DEAN CR 

OMAHA 

68105 

2758 DEAN 

CIR 

OMAHA 

NE 

68105 

28-15-13 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Old 

Assessor 

Site 

New 

Assessor 

Site 

• . . 

ARBOR PLACE 

4 

14 

38 1/3X113.5 

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

PARCELNB=0523860000 

http://webarc.co.douglas.ne.us:8080/RealWare1/details.do? 

id=R0523860000 

Disclaimer: Map and parcel data are believed to be accurate, but accuracy is not Map Scale guaranteed. This is not a legal document and should not be substituted for a title search, 1 inch = 173 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 5/3/2007 
^ 

CONTACT FORM 

Property ID # 

AdH:

Initial Contact:

Second Contact:

Final Contact:

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

//yy 

 ^7^^ iZa^ Cir mhn4^) 

 Date: 5/.?o/o? Time: ii3o Action: Le-P-I- Alt-<>'VKc 

 Date: Time: Action: 

 Date: Time: Action: 

Transmit to EPA D Other Action: D 

Appf. (^-^^^^(^lllOD 
,.0"'^'ir 

•M. 

'•'•• ' l'IM,l<' ' 

Consent For Access To Property 

RKJIITOI'ENTRY TO PRI:MISI;.S 

(iiantor (tlie property owner) con.sents to and authorizes llic United Stales Bnvironmenlal 

Proleclion Agency (El'A) or its autliorized representatives, colleclivcly ihc Grantee, to 

enter and perform certain environmental response activities upon the following described 

premises: 

Owuer'.s Nniiic: 

Daytime SMionc: 

0^g<:^o^ JU,/^/^'^^'^'^ 7.A^i>t 77Y9 

Addrcs.scs of 

' Properties cover

thi.s Agreement: 

ed by 

Address: 

^7& 3 

Address: 

Address: 

Address: 

\><Lr^^ C^ty. 

Address: 

PDRI'OSI' Ol' R|':SI'()NSIJ: ACTIVITII;S 

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 matenals and 

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

remediation program. 

An EPA representative will contact the Grantor in-pcison to discuss Ihe work to be 

performed, the Grantor will have an opportunity to review and appiove the planned soil 

removal, and restoiation 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 

(Vom I'PA thai the property ha,s been remediated. 

ENVIRONMIiNTAI, Rl':.SPON.SI{ ACTION.S 

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: 

«Propoi;l'.y ID» Page I of 2 
*l»p>­

' Remove obstructions including boats, trailers, vehicles, playscape itcm.s, wood 

piles, dog houses, etc; 

" Remove nowcr bulbs or plants that the Grantor or Ihc Grantor's tenant may wish 

to save, 

* Water and maintain replacement vegetation, including fonilizcr application, as 

necessary sub.sequent to an initial watering period by EPA, 

' /\bide by health and safety guidance provided by EPA, 

• If the property is rented, assist EPA in obtaining tenant approval for access to the 

pioperty to perform the work if EPA is unable to obtain .such access; and 

/\llow videotaping and/or photography of the property including exterior and 

interior areas ofbuildings, 

A(IRI:I-:.MI:NT NOT TO lNTi:Rn:Ri-: 

Ihe Grantor agrees not to interfere or tamper with any ofthe activities or work done, or 

the equipment used lo perform the activities, or to undertake any actions regarding the 

use of said property which would tend to endanger the health or welfare ofthe Grantee:; 

(M- the environment, or to allow others to use the property in such a manner 

Should you have any questions about this program, plea.se conlacl 

0 1 I g?-an? access (o my propertie.s

 CH I do not grant access <n my propenics 

ZZ,.^ZZ^.^ ^ Z>. /.'^-Jioor 

Signature Date Sigiialiire Date 

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

Page 2 of 2 

Kpropprr. y II'.': 
Restoration Agreement 

The purpose of this agreement is lo pro\ide a mutual agrccnicnt as lo conditions of properly prior to 

remediation activities. This will also serve as dccoiitaniiiialion for liic purpose of assuring thnt 

restoration aclivilies are coniplcled to the satisfaclion of liic properly owner and the United States 

En\ ironinenla! Protection Accncv (EPA). 

PropertylD: |^^g^ , 

Property Address: ^^^ ^ ^^ ^ ^,.^ ^ 

OtClNi.cp^ IIA/I^KI.L.'-,'', 1 

""" " ^^>^l„„?^ ? .. . 

On the attached diagrani(s) indicate nrea(s) lo excavated and depth of excavation, location of all knoNvn 

utilities, subsurface features, surface structures and landscaping features, access locaiion(s) to be used b> 

contractor, and the direction of Nonh. Indicate distances, depiiis. material t>pes. etc. indicaie dig:!;-.! pliotv-s 

b\ referencing the photo-log niiniher with an arrow indicating direction of \ iew. 

Item s T o Be Ramove d By Owne r Befor e Star i O f Re:r.ed;at:cn : 

(Use additional sheets as necessary) 

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

1 Item: 

r)A>4-K.v>^ 4t^ h t r>7r")ut.K ' 

Item: 

1 Item: ^-- ^ 1 

Item: y 

1 Item: / 

1 Item: / 1 

1 Item: y Z | 

1 Item: 

Page \ o\ \^ „ ^ ^ 
^(p* 

Items To Be Removed By Contractor During Remediation Anrj JitofcfieBteeed 

(Use additional sheets as necessary) 

Item: 

C z K r bsL fpcJ- ^j^^cJy Item: 

c\k- \^L , <c_-a >V o ^ C/^cZr^ ^/V V 

Item: ^— ­

1 Item: y ^ 

Item: 

• / 1 

Item: 

/ 

1 Item: / 

Item: 

/ 

Item: / 1 

/ ! 

I Item: 

/ 

Item: 

/ 

Item: / 

Item: / 

Item: 

X 

Item: -^ ' 

/ 

Page 2 ofj^ 
Item: 

Item; 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

item: 

Item: 

Item: 

% 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

C^-^NC c o i^a^" J C ^ '^ f.Sr-f %^r . f 4-rv 

T 

: ^ * -^ ^ yy-a^S 

^ 

Page 3 of i t 
Landscape Inventory 

(Use additional sheets as necessary) 

Item Quantity Unit Conditlon/Type/Species 

I'ro-c.sisliiig properly :irc;i 

.ScuKirc I'ccl lli;il I.s cm'cra i wilh j:r;i.s.s. 

un 

Nunilicr of liecs > 2 inch o-covi, <:ScJv\^. -U' I'iicli 

Irniik (liiiniclcr 

I'iich 

liunk (haniclcr 

f 

Nuniliei' of Sprinkler 

/.ones. C'onlrol V;\lvcs. 

Timers. I Icails. elo. I'iaeh 

,\II:K-| I .1 ;.ki1>ll ii f Ihr 

spiiiikKi i^i\ mi l 

Niinibci" of and si/.c ol' 

each jiiiiiien/ flower lied 

area. I'nch 

.Sciuiire l''ecl 

•\ll;ieli :i ski'lell of irl.ili\r 

si/es :iiui iiKMlioii:. 

Page 4 of A l 
Item Quantity Unit Condition/Type/Species 

Agreed upon value

plant malerials luil lo

replaced In' coniracior. 

 of 

 be 

Nol e Ihls \:lliir will luuse d In I..MK­ ;l plillll 

\oiklii i 111 ihe pii'piil v 

M W ne i " '' • • 

Agreed upon lisi of planl 

malerials Hint will tic 

re|ilaced by eonlraelor. Ho 

very specific ami delailed. I'ach 

Iiu:llkle :l .-.ki'l* ll ul wri c 

e:uli pL'iiil w ill I T phiee d 

l'\ ihe eolllKielnl 

Agreed upon area of 

propeilv lo lie replaced 

wilh grass ,sod. 

Ineliule ;i skeleh "I llu 

aiea(s) In be rephued w illi 

grass sod 

tl> 

SV 

Area of C'ily or Clonnly 

properly lo lie landseapetl 

per Iheir re(|uiremenls. ,SF 

ilieiiukai e.'i I s) 

 .1 ::keleii of Ihe 

Page 5 of U 
Additional Comments / Instructions: 

t,oe_^ ^ PL/'C C-xJ­

'Ot. 

H^hec k 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. 

Bl"*!ugrcc O I do not agree Di.^ agree n I do not agree 

Onncr'.s Signature Dale Coiitriietor'. Contmctor'.ss .Siuniiltir .SiKiiiiltircc Date

Page 6 of \ J 
footage to be Excavated = 1617 

ar Footaqe to be Excavated = 0 

Legend 

'. ; Concrete 

Ea Excavated Area 

m S Existing Structure 

•—•— • Fence 

i'N ^ Permanent Landscaping 

— — — Quadrant Bourxjary 

Street Boundary 

( y Tree/Stwub 

NorthArrow 

Scale 

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

.^'•^ . 

F l . 

F2 

B1 

Omaha Lead Site 

Omatia. Nebraska 

Property Number 

OLS-16841 

Property Address 

2762 DEAN CIR 

Post Excavation Concentrations (ppm) 

B2 Play Area 

DZ Easement 

Garden Other 

I?escrip(ion of post excavalion areas: F1 . front yard left^-fiand quadrant: F2, front -.-?-; '^r^.'iand quadrant; B1 . t^ackyard )eft.hand quadrant; B2. backyard rigtil-tiand quadrant; 

DZ. drip zone (1-3 fool area of soil around the foundation of Itw house). 
PRCF=RT\ C'.E.JiRANCt 'A'UhM-.Li i ^ -

Date 

Project 

XRF ID 

0/01221/n 

Omaha Lead -- Fixed Price 

0/01-51 

Property ID 

Property 

Address 

Measurement 

Count/Time 

l/o/} ^ 

21/PZ /yy^/ y 

Shot # 

Hi ! 

Reading 

/ ^ R i

Sample Area 

 lo-X'^ 

Field Shots 

Shot # Reading Sample Area 

1 1 

Aliquot 

2

Sample Area 7^) l^-^" 

I n Situ 

Reading 

J ^ 

Composite Readings 

(Bag) 

1^' ^ : ^ I 

^ 4 / 3 

J2 1 _3_L 

^a. XRF Corrected V»lue -- >

,(use calibration chart o'jc d

lO" ^ t c value) 

I 

' 

Composite 

Average 

(Bag) 

/ ^ 

$IZ 

Composite 

(Dried & 

Sieved) 

Pass/Fail ? 

Analytical 

Spilt Sent Lab 

Number 

Analytical 

Results 

*.liqjc t 

^ 

-; 

^ 

Sample Area

i I n Situ ' _ .. ; 1 Readtng 1

1 '

'

1 1

:

 1 

^ .. « J­ Cc-rpcsite Readir.cs ^ 

 (Bag) 

1 

! 

t 

i

1 1 Composite 

t Average 

i (Bag) 

1 

Composite 

(Dried & 

1 Sieved) 

Pass/Fail ? 

Analytical 

Spilt Sent 

•> 

1 

Lab 1 Analytical 

Nurr.ber! Results 

i 1 

1 i 

1 |XRF Corrected Value—> 

(use calibration ct-.art or adC = •'

1 1 

20<Vc tc value) 1 I 1 

Aliquot 

-^

2

3

4 

5

Sample Area 

I n Situ 

Reading 

I 

Composite Readings 

(Bag) 

1 ' 

i 1 

XRF Corrected Value --> 

 (use calibration chart or add 

2 0 ^ to value) 

Composite 

Average 

(Bag) 

1

Composite 

(Dried & 

Sieved) 

\

Pass/Fail ? 

Analytical 

Spilt Sent 

•> 

1 

Lab Analytical 

1 

1 

Sample Area Pass/Fail ? 

I n Situ Composite Composite Analytical Aliquo t Composite Readings Lab Analytical Reading Average (Dried & Spilt Sent Number Results ( Bfls ; 1 (Bag) Sieved) 7

Confidential 5/2/07 cece 1 
5 

3 

4 , . ^ j 

XRF Correcte^^Bue — > 

(use callbrati^^hart or add 

20<H> to value) 1 * 

Sample Area Pass/Fail ? 

Aliquot 

1 

I n Situ 

Reading Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Drie d & 

Sieved) 

Analytical 

Spilt Sent 

> 

Lab 

Number 

Analytical 

Results 

2 

3 

4 

XRF Corrected Value - > 1 

5 (use calibration chart or add 

20%b to value) 

: 

; ( 

y.R.^ Technic'an s S aritu'e 

Confidential = ':'2 7 'cC c ^ Z-' i. 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

vvvvw.coastalhazmat.com 

COASTA L ENVIRONMENTAL 

GROUP , IN C 

EXECUTIVE SUMMARY: 

16841—2762 DEAN CIR 

X No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 
^ As-Built Drawing jSL 

COASTA L Omaha Lead Superfund Site 

Total Quadrant Square Footage to be Excavated =1617 

Property ClassHicalion: 800 Total Drip Zone Linear Footage to be Excavated = 0 

Dcscriplion ol posi «N09vabon areas f1 . hontyardlen-htindquadranr F2 Iront yard nghl-lwHl quadrant; Bl. twckywd left-hand quadrant BZ.bacityard nght-hand quadrant. 

OZ. drip zona (1-3 tool araa ol srrf around Ilia loundabon cllha houaa) 

Legend 

Area not Excavated \/yy\ Dripzone Excavated QQQi Quadrants Excavated 

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

# m

Property Completion Agreement 

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

signature will designate thai 1 am satisfied with the restoration of my property, and that no items arc in 

qucslions, now, or at any time in the future, except those items listed below, if any. 

[PropertylD; ^ ^^ ^ 

Property A<l.lrcs.s: ^^^ ^ ^^ ^ ^_^ 

iik. 

Onncr: \iti.y\c.K^ U Ag.jA.-uc;C 

Phone: 

Ho^> "^^^V-^^H^ 

Restoration Items in Question: 

Item: 

i Q o i|i>^'~. \ ^ v 

Kem: 

item: 

Item: 

Item: 

Item: 

, J 

Additional Comments: 

\_cpyw-i-~^ "T-<^ ' LT-LVWU J^ I <*^ 

01 agree rrstomtion i.s completed, except as noted 

I I do not apree restoiatjon is completed 

^ /e^/vx Hm^y^^^ ^ lUln •V 

Owner's Signature Date Ounractor'.s Signatu Dale re 

I
&EPPi 

% A Property Close Out FoD^i m 

Property #:. f/^ ^4 (

 Property Address: ^^70^ . p^d ^

Datc/TlBc: Owner's Name: 

Quads Excavated: Contractor Group 

Excavation General 

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

2. If necessa.'v, were the correct areas of drip zone excavated and restored? 

Grading Sod and Vesetation 

1. Does the grading around the peruneter ofthe house in excavated a-^eas generally slope away 

from the bouse? 

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

3. Does the wd appear to be generally healthy and growing? (Onlv evaluate if inspected at a 30 

day time period) 

4. A n sodded areas gcnerallv fum and evenly graded? 

5. Are the joints between the sod strips generally tight? (Only e\alaate if inspecied at z 30 day 

time period) 

6. Was the property graded such that water viill not pool on the propeT} ? 

7. Was damige to landscaping or pla.nt rrialerials avoided? 

GMICS, Fences aaii Rcuininf nalto 

1. E>o gates open and close freely? (Ifapplicable) 

L. 

Were all gates or fences taken down during rtsioraiion acti\. ties reir.iialled? :,.T applicable) 

3. 

Was damage to gates or fences avoided? (Ifapplicable) 

4. 

Was damage tc retaining v-alls avoided? ^If applicable) A/A 

Foundation, Sidiit and Guttcn 

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

2. wi s damage to the foundation avoided? ^ ^ 

3. Was damage 10 windows avoided? fj/ ^ 

4 Was damage to windows or door screens avoided? K)/V 

5. Was damage to downspouts or downspout extensions avoided? J A,

Sidewallu and Driveways (Coacrete) 

1. Was damage to driveway surfaces avoided? 

2. Was damage to wallowa\ surfaces avoided? 

 <3,r<i. U 

Yes No 

u ^ 

U ^ 

Yes No 

^ ^ 

t ^ 

^ 

« ^ 

l ^ 

Ves No 

t ^ 

• ^ 

1 ^ 

Ves N'C 

| 

Ves No 

y 

y 

1 
^J^lf^f T 

[ Owners comments: 

Inspection nctes: 

Removal and restoration acii\ ates complete including the 30-dav" sod •^arrantA-: 

EP.A "^txir^^tvmx^^ry^tyi^^ Date: 7/z^/z)7