TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: /y^^7 7 Date: 

Address: //¥ / S 3 3 S f 

Remediation Contractor: _Coastal Environmental Group_ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

A 

Video of property (DVD) 

Executive Sutnmary 

EPA-provided property sketch 

D 

Z 

D 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Confirmation data 

A Photographs 

As-built sketch 

Satisfactory restoration signed by Property Owner 

A Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

u 

u 

Utility clearances 

Property information from Douglas County Assessor's Office 

u 

D 

D , 

D 

mp7 

Date 

40317890 

III 

Superfund 
Property Access Checklist 

PropertylD: Q-Q^'j ^ 

Property Address: ///-/ / 3P^'^^P f 

n

D

 WORK STARTED

 WORKCOMPELTED

 ON:

 ON:

 /

 /

 / 

/ 

Owner:

Address:

 // ^ (/// l

 ^ ^ ^ /

 Sn^'HlZZ l 

^ 3'3^/j ^ 

Renter: 

Phone: 

Fax: 

Cell/Paser: 

Additional Information: 

fax: 

Ccll/Pager: 

D Notification Letter Sent: / / By: 

r ^

L J

r~l

 Acccs,s Agrccnicnt 

Restoration Agreement 

Topsoil Sampling (ifapplicable) 

Siuned: ^n

Signed: ' P

/

 l9Z)lC p 

I^l0 l 

/ 

By: 

By: 

By: 

/liarcz^ 

/liArczp> 

n Di,sposal Sampling (if applicahlc) / / By: 

n

^ i

" ^

n

 Garden Sampling (ifapplicable) 

Utility Clearance 

Video/Photos (Before) 

Vidco/Photos (During) 

/ / 

Called: ^/^/^/ 7 

oiv.'Xti 5"/^)^ 

On: / / 

By: 

Byr 

By: 

^z/sUiUi 

fijcM 

By: 

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

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

[H Properly Completion Agreement 

1 1 Final Report 

Sijincd:

Issued:

 /

 /

 / 

/ 

By: 

By: 1 

Air IVIonitoring (as applicahlc] 

UJ Community CH Crew 

Results: 

On: / / 1 

II 

CH Community

Results: 

CH Crew On: _ / / 1 

CH Community

Results: 

CH Crew On: _ / / By: 

Omaha Lead Site 
Total (^Wcant Square Footage to be Excavated = 450 

Property Classification: 800 Tolal ^^ppn e Unear Footage to be Excavated = 124 

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

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

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

Sec-TwnRng 

1236370000 

SNETHEN 

KEVIN R 

1141 S33ST 

OMAHA 

68105 

1141 S33ST 

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 

HANSCOM PLACE 

7 

15 

W 168,8 FT 

50 X 168,8 

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

PARCELNB=1236370000 

http://webarc,co,douglas,ne,us:8080/REALWARE/details,do? 

id=R1236370000 

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 = 317 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 5/29/2007 
Property ID #

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action: 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 .?65"7-7 

^U, iJMI S.3 ^ 

 Date: Z\f2Joy Time:i'-()b^ Action: L^cj. becoW.-; 

 Date: "^74.^ Time: H-t?*^ (>h Action: \MoO^ (/\^ po<9fL 

 Date: Time: Action; 

Transmit to EPA D Other Action: D 

^ V^ IVt:^^ i^fKV^^ 
i ^ 

Restoration Agreement 

The purpose of this agreement is to pro\ide a mutual agreement as to condiiions of property prior to 

reinediation aclivilies. This will also serve as decontamination for the purpose of assuring tiiat 

restoration activities are completed to the satisfaction of tiie property ouner and the United States 

Environmental Protection Acencv (EPA), 

Property ID: ^.^^m 

Property Address: 1^1^.^ /^ '\Pp{*' 'n\' 

OOnner V4 n p r • ' y.- M . _ / ^ . il / ., I I y . - : '^\\z\ ^'\Ai'\W(y\ 

Phone: V o^

 Iv^ z<^^ 

On the artaclied diagram(s) indicate area(s) to excavated and depth of excavation, locaiion of all known 

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

contractor, and the direction of North. Indicate distances, depths, material txpes. etc. hidicate digital pliot.^s 

hv referencing the photo-log number with an arrow indicaiing direction ofv iew. 

Items To Be Ramoved By Owner Before Start Of Remediaticr.: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return cf these items is the Owrer's rsspcr.sibillty. 

Item: i- y hit 

^ 

Item: y ^ 

Item: / ^ 

Item: 

^ 

Item: y ^ 

Item: y ^ 

Item: ^ y 

Item: / Z 

Paqe 1 of (/' 

T 
Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Page 2 of 0 
Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

fI^H- ij\ \)f(h/? 

Item: 

Item: 

Paqe 3 of U 
V^sS 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-existing property area 

that is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trecb • = 2 inch 

trunk diameter 

Number of Sprinkler 

Zones. Control Valves, 

Tiniers. Heads, etc. 

Attach a sketch of the 

sprinkler lavout. 

Number of and size of 

each garden' flovser bed 

area. 

Anach a sketch of relative 

sizes and locations. 

Quantity Unit Condition/Type/Specles 

Square feet 

w 

\ 

Each 1(7 

y y Each 

y Each 

y r Each 

Square Feet 

Page 4 of M* 
Item Quantity Unit Conditlon/Type/Species 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Note this value

used to issue

voucher to the

owner. 

 will be 

a plant 

 property 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. Each 

Include a sketch of were 

each plant will be placed 

bv the contractor. 

,'\greed upon area of 

properrv to be replaced 

with grass sod. 

Include a sketch of tlie 

area(s) to be replaced with 

sirass sod. 

y U SF 

Area of Citv or County 

propenv to be landscaped 

per their requirements. SF tfe f bv>^ (^ ^ A 

Include

area (s) 

a sketch of the 

Page 5 of l i 
Additional Comments / Instructions: 

- Wl/|« iiei^Hb(?ft 

- \\y i tlohfy^i^Oi f \ 

• Check the box if Owner does not want CEG to docutnent 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. 

^ I asrce I I I do not agree n«<^ asrec I I I do not agree 

Owner s Signature Date Page 6 of _ U ictor's Signature Date 
r 

.i* — Sf 

# 

-«C PKOt*-^ 

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 follovsing described 

premises: 

Owner's Name: 

«Owner_NaLme» \^) M ^ viefHt^ Davtime Phone: 4^ ^ ^ 

«Second Owner Nanie» 

Address: «Property_Address» 

Address: | | ^^ ^ ^ ^^1 ^ ^ ^ 

Addresses of 

Propertie Address: s covered by* 

this Agreement: Address: 

Address: 

PL RPOSE OF RESPONSE ACTIMTIES 

The EP.A 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 renio\ed and the e.xcavated area(s) will be replaced with clean materials and 

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

remediation program. 

An EP.A 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 Grantor 

will be asked to re\iew the work and confirm that il 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. 

ENVIRONMENT.AL 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: 

«Frcperf/ Paae 1 of 2 
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 of buildings. 

.AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper vvith any ofthe activities or work done, or 

the equipment used to perfomi the activities, or to undertake any actions regarding the 

use of said property which would lend to endanger the health or welfare ofthe Grantees 

or the env ironment. or to allow others to use the property in such a manner. 

Should you have any questions about this program, please contact ????? ???';' at ???-??'?­ 009 9 

1 grant access to my properties I I I do not grant access to my properties 

^ 

2SIfiAiHil yAj^iuizi^x._ J^^A^^ 

>ignature Date ^Signature D4*e 

I I 1 v^ould like to be present during any sampling that is required. 

Page 2 of 2 

(P-.-ro-r, . TTv 
PROPERTY CLEARANCE WORKSHEET 

Date 

Property ID (V4)?)^^ 

7_OS-in 

Property Project Omaha Lead — Fixed Price Address iiM\Srs -y^'^-^ 

t>1easurement XRF ID 

0107-51 Count/Time 

Field SInots 

Shot # Reading Sample Area Shot # Reading Sample Area 

7.Z \ie . hA- u.) 

Lxa y(-C\ 

^PZ. \7 -'M 

^ 7 _ \<?/„ l^t r,-t--

Sample Area f;n-u^ 

I n Situ Composite Composite Analytical Aliquot Composite Readings 

Lab Analytical Reading 

Average (Dried & Spilt Sent (Bag) 

Number Results 1 

(Baq) Sieved) 7 

2 

ZIL. 3 

\loC> 4 

Q O 125 

XRF Corrected Value - > 

5 (use calibration chart or add 

20% to value) i5G 

Sample Area .>7 p-iS'- Pass/Fai l ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings Lab Analytical Reading 

Average (Dried & Spilt Sent (Bag) 

Number Results 1 

(Bag) Sieved) 7 

2 i^?^ 3 

Z Z \CP\ 4 i^: ^ 

XRF Corrected Value - > 

5 (use calibration chart or add 

\3G. 20»/o to value) 

Sample Area 

Pass/Fai l ? r\ ^-^ 

I n Situ 

Composite Composite Analytical Aliquot Composite Readings 

Lab Analytical Readinq 

Average (Dried & Spilt Sent (Bag) 

7 Number Results 1 l-a-^ (Bag) Sieved) 

2 i<^^ i'V^ 

3 1Z\C^ -2JCXJ 

l?6. 4 

\-l<^ •Zil ^ 

7JS3 XRF Corrected Value

- >

5 (use calibration chart or add 

20% to value) c533 

Sample Area Pass/Fai l ? 

I n Situ Composite Composite Analytical 

Aliquot Composite Readings 

Lab Analytical Readinq 

Average (Dried & Spilt Sent (Bag) 

7 Number Results 1 

(Bag) Sieved) 

2 

3 

4 

XRF Corrected Value - > 

5 (use calibration chart or add 

20% 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 

20% to value) 

USE ADOIIWHAI SHEETS I F 

XRF HEEDED Teclinician's Signiture 
/ZOL\

S ^^^ ^ I

V/^^TP *

%«a^ ^

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

 Coastal Environmental Group Inc. 

 www.coastalhazmat.com 

 COASTA L ENVIRONMENTAL 

G H O u P . INC . 

EXECUTIVE SUMMARY: 

20577—1141 S. 33'''ST 

X No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation 
As-Built Drawing 

COASTA L Dmaha Lead Superfund Site 

Total Quadrant Square Footage to be Excavated = 450 

Property Classification: 800 Total Drip Zone Linear Footage to be Excavated » 124 

Property extends an oth$r 22 feet 

O 

Q 

O 

EA=125 PPM 

. !^. j,-i.,-A-r--'-'.4.,---!.-A>>0' 

mm^ 

South 33 Street 

Legend pLS#:20577 North Arrow Omaha Lead Site 

Oinaha, Nebraska [^fe ^cavated: 

Property Number te USEPA feigned Off:6/29/07 

OLS- 20577 Scale 

-* F«rKe Property Address 1 Inch = 20 feet or 1 grid » 5 x 5 ft 

Permanent Landscaping 

1141 S 33 ST 

— — — Quadrant Boundary Post Excavation Concentrations (ppm) 

Street Boundary J F1 . B2 Play Area t /• HGI . F2 DZ Easement \ y TrG«.'Shnjb l^V l- X Ji •=• HyHr,,.,.,,! ,„;„ IIK Bl ' Garden Other ^^PTM- ^ Description ot post evcavation araas Ft. front yard l»ft-t^and quadrant: F2. from yard n^jtil-tiand quadrant: B1 backyard lett-hand quadrant B2. backyard nght-hand quadrani 

OZ, d(T>2an«|t-3 tootaieei at soil ground tha toundvlion of lli« house) 

Legen d 

Area not Excavated Dripzone Excavateci Quatdrants 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 perfonned on my property. My 

signature will dcsignalc that I am salisficd with the restoration of my property, and that no items arc in 

questions, now. or at any lime in the future, cxccpl those items listed below, ifany. 

Property ID: ^^^57-7 

Property Address: j / J_J/ ^ ^ 33 ^ SA 

ovvner: Z^i'in Sz^tAuPi 

Phone: 7^97- ^oAA 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

L^ I iigroo restonition is coinplete<l, except HS noted 

 I I do not aprcc restoration is coniptrtcd 

AI1XJ 7 

OWncr's Signatu Date 

I
SEPA 

% A Property Close Out Fo t 

Property #: ^^7- 1 Property Address: / /^ / S . 33'^S'i r 

Date/Time: Owner'i Name: Z J ZZ ^ PneZH i n 

Quads Excavated: Contractor Group 

Excavation Gcnenl 

Yes No 

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

2. If ncccssa^, were the correct areas ofdrip zone excavated and restored? l y 

Gradln£ Sod and Vesctatioa Yes No 

1. Ooes the grading around the perimeter ofthe house in excavated areas generally slope away 

t ^ from the botue? 

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

i ^ 

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

y day time period) 

4. Are sodded areas gcnerallv firm and evenly graded? 

L ^ 

5. Are the joints twtween the sod strips generally tight? (Only e% aloate if inspected at z ?0 day *X time period) 

6. Was the property graded such that water w ill not pool or the propet)"]

 j *^ 

7. Was damage to landscaping or plant materials avoided? 4^ 

Galcv FCDCCS aad Rcuinint '^aiis Yes .No 

'.. Do gates open and close freely? ifapplicable) ^ 

1 

2, Were all gates or fences laken dov^Ti during restoration acti'i ities reir>.s'ji!!ed? ifapplicable) j »^ 1 

3. Was damage to gates or fences avoided? (If applicable) • 

4. Was damage tc retaining »• alls avoided? (.Ifapplicable) u ^ , 

Foundation, SidiBf and Gutters Yes S'o 

1, Was damage tc the siding or trim avoided? y 

2. Was damagfe to the foundation avoided? 

t ^ 

3, Was damage to windows avoided? ^ 

4. Was damage to windows or door screens avoided? 

«*- ' 

5, Was damage tc downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) \ es No 

1, Was damage to driveway surfaces avoided? jjj ^ 

2, Was daraage to walkway surfaces avoided? t y 

1 
Inspection nctes: 

laf d ' '^ '^ — ^KA-^-a- ­

Remc\'al and restcration acihaies con".p!ete including ihe 30-day sod '^^arrant}': 

EP.'\ Representative^ >Jc^jt ^/^f/zzy