TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: j5Z>(^4fe Date: Z/zy/pB 

Address: /^d(^ S / / SH 

Remediation Contractor: _Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

0 Video of property (DVD) 

Executive Summary 

0 EPA-provided property sketch 

[y Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

0 Restoration Agreement 

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

-0 Confirmation data 

Photographs 

M As-built sketch 

lY Satisfactory restoration signed by Property Owner 

s / Property close-out check list signed by EPA 

D Descriptionof areas not meeting ROD cleanup criteria 

D Utility clearances 

D Property information from Douglas Comity Assessor's Office 

D 

D , 

D 

7lyilds> 

Dafe 

40317835 

Superfund 
S'iyy^ } su y Final Report Property Check List (Please place with each file) 

• ^

2

•—*­

-4;-

Jiard Copy Information 

v K Property Check List 

^ \ Site Working Drawing Map 

rNk EPA original.s Map 

\ ^ Douglas County Assessor's Map 

Jv Property Contact Sheet 

^Agreement 

„ \ Access Agreement 

AXestoration Agreement 

Miscellaneous Documents 

I\Final Map trom the Field 

2. Change Orders 

\ XRF Data 

4. Any emails or PO airrespondences 

Property Completion 

1. Executive Summary 

2. AS BUILT 

N3. Property Completion Agreement 

4NA.ny buyout info or reimbursement info 

5. Check or money order copies 

\ EPA Property Close Out Form 

Tv^Attached Begin Video 

Electroni c Documentatio n 

^Drawings 

•\r::,^ EPA original 

2 \ Working Drawing 

y AS Built.vso 

" ^ AS Built.jpg 

Photos 

 Begin Photos 

 During/Excavation Photos 

 Sod Photos 

 30-Day Sod Photos 

Scanned Documents 

Final Documents 

Executive Summary 

Videos 

Begin Video 

My Movie 
] 

Property Access Checklist 

Property ID: ^0(^^4 5 n WORK STARTED ON: _/ /_ 

Propert n WORK COMPELTED ON: / / y Address: (^^ ^ ^ n «^^ 

Owner Renter: : l\fX^fQS , Clo^VOl^cio . 

Address: Phone: 

H-Of Fax: o ^ 1 I S>t. Cell/Pager: 

Phone: yS3 ' 4-^1? ) Additional Information: 

Fax: 

Cell/Pager: 

^ Notification Letter Sent: / / By: 1 

S Access Agreement Signed: fe /2S/ 0 7 By: 

^ Restoration Agreement Signed: S 1 2-5/ 61 By: 

CD Topsoil Sampling (if applicable) 1 1 By: 

1 1 Disposal Sampling (if applicable) 1 1 By: 

CH Garden Sampling (if applicable) 1 1 By: 

0 Utility Clearance Called: _E_/2A/ 0? 

[H Video/Photos (Before) On: / / By: 

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

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

1 D Video/Photos (30-Day) On: / / By: 

CH Property Completion Agreement Signed: / / By: 

1 1 Final Report Issued: / / By: 

Air Monitoring (as applicable) 

I I Community CH Crew On: / / By: 

Results: 

I I Community CH Crew On: / / By: 

Results: 

I I Community CH Crew On: / / By: 

Results: 

Omaha Lead Site 
yy t 1^7^4-50 Total Quadrant Square Footage to be Excavated = 37 

Property Classification: 800 Tnta^rj tamriE p Zone Linear Footaoe to be Excavated = 0 

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Legend 

Concrete 

yy ] To Be Excavated 

I I Existing Structure 

•—•— • Fence 

K/Oi Permanent Landscaping 

— — — Quadrant Boundary 

Street Boundary 

y Tree/Shrub 

South 11 street 

-t~ 

"i y 

Noilh Arrow 

Scale 

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

,<,•!*' ' Sto , 

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F2 

Bl 

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Omaha Lead Site 

Omaha, Nebraska 

Property Number 

OLS-50648 

Property Address 

1406 S 11 ST 

Post Excavation Concentrations (ppm) 

B2 Play Area 

DZ Easement 

Garden Other 

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

DZ, drip zone (1 -3 foot area of soil around the foundation of the house). 
w Tot ^ Idrant Square Footage to be Excavated = 37 

Property Classification: 800 TolP TriD Zone Linea r Footaqe to be Excavated = 0 

1 

— 

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; " 95{ ppn­ 1 'i,,;..•].' , ••,-' . ' a 1 •,"• . .*?•. , ­ •"•:'• . 

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So uth 1 stre( it 

i 

1 Legend North Arrow Omaha Lead Site 

Omaha, Nebraska P H Concrete 

ly A ^° ^^ Excavated Property Number J 

OLS-50648 hxisting btructure Scale 

. ^ Property Address 

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

lyVS 1406 S 11 ST 

— — — Quadrant Boundary Post Excavation Concentrations (ppm) P 1 n 9 DIQ\ / Aro a Street Boundary ;^) T HGL 

F2 DZ Easement o Tree/Shrub Bl Garden Other 1 

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

DZ. drip zone (1-3 foot area of soil around the foundation ot the house). 
Omah Exterior Paint North Arrow a Lead Site Owner Name: ATKtQ S C<3i\/ada (3^Good Site Sketch Address: J^_a^/7i3l ^ • Poor 

Phone: ^733-^31 3 w (55Q^- V(2CX) ceK Q Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

_ RYASCPXA-.5"0CV(S Fl 

RYBS€f%A=tfD(S-»^d~^ 

BXGSC£XA-50S^i(!^-S* 

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 pom 

 ppm 

 ppm 

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Date:

Time:

 _ 

 /Z^QO j?^^^ 

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Samples Analyzed 

npzcc-P9(A'5:;&<g-^-pz­

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—

ppm 

 ppm 

 ppm 

D 

D 

D 

D 

D 

D 

XRF Unit: 90 Z 

Date 

Time 

fg-Ofi 

PM 

Book: iny 

Number of Samples = \ j Staff: M<;w^ 

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

EMTEBBD 

JUN Og 2001 

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.5 It; 5V Rev 4 O4«I4i.0]23 
CONTACT FORM 

Property ID # 

Property 

Address: 

Initial Contact: 

Second Contact: 

Final Contact: 

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

5^<^^t 

i40G 3 \l ^•+. 

Date: Time: Action: 

Date: Time: Action: 

Date: Time: Action: 

Transmit to EPA D Other Action: D 

: 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. 

www.coastalhazmat.com 

COASTA L ENVIRONMENTA L 

CROUP . IN C 

EXECUTIVE SUMMARY: 

50648—1406 S 11 ST 

X No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 
- --

As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Total Quadranl Square Footage to be Excavated = 37 Property Classification 800 Total DriD Zone Linear Footaae to be Excavated = 0 

1 < ' 1 i 

1 ' 1 , 1 1 i . . 1 

i 1 1 i M 

\ 1

1 1 

i ' l 1 : 1 

! 1 1 1 1 

1 1

 ' ' i 1 L ._, -J I ^ ^­ i 

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1 

1 

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J : 1 '1 y u ;> ,^^K ' n. '*.'BBife' 

1 • 

i r 1 1 1 . 1 

1 

r ' " • 

i 

*jfe- r 1 1 1 1 1 

>JK -!,•• i F1 = 222 PPM 1 

= i ^ ^ [ 

C 1

Ei 

• . . » \ • " 

1 37 sq « 

1 -:• y y '• |958ppm . • '1 •••"} • 

• • : ^ . ' i " • : ••" • 

r • • »•* : 

.-. " .".' • : > ' v'i-^'', 1^11 . ^•p;:ii„4:^.i:i,4t4P:^ y^'y:-. L.-JVI 

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•**•"• i t 

""^ 1 1 D o not so d 

SoMtt] 1 Street 

! 

: i ^ i 

OL .S#: 50648 

Date Ext :avated: 8/27/07 

i 

Cate USEPA Signed Off: 9/7/07 

Legend North Arro w Omaha Lead Site 

=VJfj Concrete Omalia. Nebraska 

V A To Be Excavated Property Numljer 

OLS- 50648 Existing Structure Scale 

1 Property Address Fence 1 Incti = 20 feet or 1 grid = 5 X 5 It 

B?5S 1406 S 11 ST 

1 ^ "~ Quadrant Boundary Post Exes ivation Cor icentrations (ppm) 1 ' O . w

 HGL . F1 B2 

• Vftn^f w lllOO i ji i Vi 0 ^ / •• F2 32 Ease ment o Tr 9e/Sh rub 

' 81 — Gard en Dthei 

DCTCfplion ol po«t «c«v»tion nrvic F1, tfont yard lptt-h»nd qu»df»nt. F2 Iront yiird right-Nind quadrint. Bl, buckyard left.hand quadiani, B2, backyard righl-hand quadranl 

DZ, drip zone (1 -3 toot ar«a of aorl around the loundalion of the houae) 

Legen d 

Area not Excavated Dripzone Excavated Quadrants Excavated 

Contrac t # : EP-R7-07-05 Coasta l Environmenta l Group In c 
t PA Property Close Out Form 

Property #: ^07^^P > Property Address: 7^7) ^ S 77^ ^ 

Date/Time: Owner's Name: >f>C/A^/^^ y/7t7/7/X4 

Quad Contractor Croup i Excavated: 

ExcavatioB General Yes No 

1. If necessary, were the correct quadranl(s) excavated and restored? y 

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

Gradini Sod and Vc«etatioB Yes No 

1. Does the grading around the perimeter ofthe house in excav ated areas generally slope away y from the bouse? 

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

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

day time period) 

4. Are soddtd areas generally fuTTi and evenly graded? y 

5. Are the Joints between the sod strips generally tight? (Only e^aloate if inspecied at a 30 day 

time period) 

6. \^ as the property graded such that water w ill not pool on the properry '^ y 

~. Was damage to landscaping or p!a.nt Tiateriels a^ oided" y 

VJMIC V FCDCCS an« Rcuinint vVaib 

Ves No 

1 1 !.

 Do gates 9pcn and close Sreiy':' ([f" applicable) 

y 1 1 Were all gates or fences taken down during restoration ac.iv'. ties -ei^.s•^l!^d•? .if applicable^ 

1 

^- y \ \ 

1

Was damage to gates or fences avoided? 'If applicable) 3. ^ 

^ 1 Was damage tc retaining u-alls avoided"? vlf applicable;! 

I 1 

Foundatton, SidiaK and Gutters 

•^ es No 

1. W'as damage to the siding or trim av oided? i J ^ 

Was damagi to the foundation avoided? / /A 

3. Was damage to w indows avoided? ^ A 

4 Was damage to windows or door screens avoided? \i^ 

5. Was damage to dovNitspouts or dov^nspout extensions avoided? ^ l ^ 

Sidewalks and Drtveways (Concrete) 

Ves No 

1. Was damage to drivev^ay surfaces avoided'; Ht^ 

2. Was damage to v^allcway surfaces avoided'? y 
Owners comments: 

[nspec-tien Qctp«: 

TU'u^-y^ a^"^^'^^ ^'"^' 

R£mc\ al and :esicr2ti:n aci^ ales con".p'ete including ihe I-0-da\" sod ^varrant}: 

EP.A. Representati n.Qtf f--7'<^7 
Property Completion Agreement 

Thks agrccnicnl docimients the completion of remedial activities perfonned on my properly My 

sigiialiiie will designate thai i am satisfied with the restoration of my properly, and that no ilems are in 

qiicslions. now. or al any lime in ihc riitine, except those ilems listed below, ifany. 

Property ID: tyQ^j/^ ^ 

l>to|Hi(yA.I(lic.s.s: /y^ ^ 5- // ^ 7y Ovvnc 

''• AAjbi7f-<. Ti/n/y^A 

Phone: " -7^^ v.?/? 

Restoration Items In Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

r l I iif;ne K'stomlion IN loinpk-U'tl, excepl ii.s iioletl 

I I I ill" nol am« - resloriilion i.s contpleled 

Owner's Signatur e 
PROPERTY CLEARANCE WORKSHEET 

Date Property ID SoL^l-K fl^l'/Ol' 

Property Project Omaha Lead -- Fixed Price Address liJN, S lis t 

Measurement XRF I D 0107-51 Count/Time J 

Field Shots 

Sample Area Shot # Reading Sample Area Shot # Reading 

. < ^ l^^r ^ py y^'" 

Sample Area Fl yit." 

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

^ • ^ ^ 

3 

2 

.5^'^ as^ 4 i9ic XRF Corrected Value --> 

5 (use calibration chart or add 

2 0 % to value) 

yf7 1 

Sample Area Pass/Fai l ? 

In Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical 

Reading Average (Dried & Spilt Sent (Bag) Number Results 1 (Bag) Sieved) ? 

2 

3 

4 

XRF Corrected Value —> 

5 (use calibration chart or add 

2 0 % to value) 

Sample Area Pass/Fai l ? 

I n Situ Composite Composite Analytical 

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

2 

3 

4 

XRF Corrected Value --> 

5 (use calibration chart or add 

2 0 % to value) 

Sample Area Pass/Fai l ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical Readinq Average (Dried & Spilt Sent 

1 (Bag) Number Results (Baq) Sieved) 

2 

3 

4 

XRF Corrected Value —> 

5 (use calibration chart or add 

2 0 % to value) 

Sample Area Pass/Fail ? 

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

2 

3 

4 

XRF Corrected Value —> 5 (use calibration chart or add 

2 0 % to value) 

(/.W Al)t)l I lONAt SHtff i l l 

XRF Technician's Signiture HffDH I /^y^s 
loucyl—l' ^ yiS) ^j ^ Total Quadrant Square Footage to be Excavated = 37 

Property Classification: 800 Tota^fco Zone Linear Footaae to be Excavated = 0 

•w 

SMM^ ^Qpepy y 

Legend 

•

ZZ 

o 

Concrete 

To Be Excavated 

Existing Structure 

Fence 

Permanent Landscaping 

Quadrant Boundary 

Street Boundary 

Tree/Shrub 

. v ^ -?"' 

5^> 

South 11 Street \ 

w 

North Arrow 

Scale 

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

Omaha Lead Site 

Omaha, Nebraska 

Property Number 

OLS-50648 

Property Address 

1406 S 11 ST 

Post Excavation Concentrations (ppm) 

Fl . B2 Play Area 

F2 DZ Easement 

81 Garden Other 

Desaiption of post excavation areas: F1. front yard left-hand quadrant; F2. front yard right-hand quadranl; Bl, bacl<yard left-hand quadrant; B2, backyard nght-hand quadrant; 

D2, drip zone (1 -3 foot area of soil around the foundation of the house). 
^vito sr<. 

COASTA L \ y 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 

Environnnental 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: ^'^i^^i ^ CAA/A^ ^ Daytime Phone: —7 "ZTP, cJ Q" t^-^k 

Address of Property 

covered by this \^t^(p s fls r 

Agreement: 

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 
\ ,,o*

 COASTAL 

r):a, eC^ ENVIRONMENTAL 'i t PR0l*-<^ 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 of the 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. 

ffigrI grant access to my properties

 Q I do not grant access to my properties 

yZ-^c^ ^ .^..-ilt^cn 

Signature Date Signature Date 

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

Page 2 of 2 
Restoration Agreement 

The purpose of this agreement is to provide a mutual agreeinent as to conditions ofthe propert>' prior to 

remediation 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). 

Property ID: (^0(^7 ^ 

Property Address: | C^Q ^ 5 [ \ ^ ^ 

Q»ner: A^tQbgjg^S a <CAVAt> A 

Phone: r55-qai3 

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 Owners responsibility. 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

iof^^u^^lZKS^ rU-^siT S 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of 
COASTA L 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

5<3b 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of 
COASTA L 

Landscape Inventory 

(Use additional sheets as necessary) 

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 relaii\e 

sizes and locations. 

Quantity 

?7fT" 

P! 

0 

y 

/ 

Unit 

Square feet 

Condition/Type/Specles 

Each 

i 

Each 

Each 

Each 

Square Feet i 

! 

Page 4 of 
Item 

Agreed upon value of 

plant materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

\oucher 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 comracioi'. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

ai-ea(s) to be replaced uith 

grass sod. 

.Area of City or County 

propert)' to be landscaped 

per their requirements. 

Include a sketch of tlic 

area (s) 

Easement .Area, to be 

excavated 

Quantity 

0^ 

^ 

2,1-rr 

^ 

^ 

Unit 

s 

Each 

SF 

SF 

SF 

Condition/Type/Specles 

Page 5 of 
COASTA L ENVIRONMENTA L 

CROUP . INC . 

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. 

0^1 agree n I do not agree 

y yS^^K^^-^ 77^^^ ^"^1 ^ - ye^y-7 

Owner's Signature Date Contractor's Signature Date ^ 

Page 6 of. 
n 

CONTACT FORM 

Property ID # 

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

yM/y 

Tkyyyy^ 

 Date: Time: Action: 

 Date: Time: Action: 

 Dale: Time: Action: 

 Transmit to EPA D Other Action: D 

JSSS'Iyy MiK it p hypt^t ^ 

/^?/..y-- l y s y y 

]jC/iy^ y^rm ^ <5b(e7y~ ­

3iymp^