TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: Qiyf^ i Date: ^^-UW 

Address: 99^ ^ M- P/" ^ /4u^ 

Remediation Contractor: Envrionmental Restoration, LLC_ Year: _2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) JZfeefore DAfter D Basement D 

^ Executive Summary (Final Report) 

X EPA-provided property sketch 

^ 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.) 

/Q Confirmation data 

^ Photographs JZ^efore DCrew Photos JZT)uring Excavation D Sod 

^30-day Sod D 

^ As-built sketch 

/S Completion Agreement signed by Property Owner 

y0 Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas Coimty Assessor's OfFice 

Property access checklist ^f^iAd^l hi^oA ) 

30261860 

Contact Log / 

J ^ yoLca^-h /o~^ Superfund 

""Envirotimental Restoration Signature Date 

Date 
EPA 

EPA Property Close Out Form 

Omaha Lead Site 0U#2 

Property #: ^171 3 Property Address: d?;iS- N- ^pth /fu< 

Date/Time: Owner's Name: _£j7-y *•( 0/^ , / . 

Quads Excavated: "Bl Contractor nvironmental Restoration (ER) Group : Envir 

Excavation General Yes No 

1. Ifnecessary, were the correct quadrant(s) excavated and restored? y 

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

Grading Sod and Vegetation Yes No 

i y 

house? 

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

3. Does the sod appear to be generally healthy and growing? (Only evaluate ifinspected 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 ifinspected at 30-day time period). 

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

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

Gates, Fences and Retaining Walls Yes No 

I. Do gates.open and closefreely? (if applicable) hk 

2. Were all gates or fences taken down during restoration activities re-installed? (ifapplicable) A/i^ 

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

4. Was damage to retaining walls avoided? (ifapplicable) t^k 

Foundation, Siding and Gutters Yes No 

1. Was damage to sidins or trim avoided? 

2. Was damage to the foundation avoided? \[aM^ U 

3. Was damage to windows avoided? # •

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

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) Ye No s 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Inspection notes: 

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

EPA Representative;^-^;^y>^y$y£A yy^^^tyUJ^JL^^ ^ ' Date: 9/ / /^/ 7 
^y'^*' ^ 

i ^J ^ \ Omaha Lead Site—EP-R7-09-05 

\;^»S!^ ' Environmental Restoration, LLC 

EXECUTIVE SUIVIMARY: 

29793 2825 N 28 AV 

No Issues or Concerns Q Issues/Concerns 

Detail Fxnlanntinr^­
a g e 1 «ji 1 

[ Create Another Ticket ] [ Back to Irth Internet ] [ Send Email ] 

• YOUR TICKET NUMBER IS 2671009. 

Original Call Date:

Work to Begin Date:

 2/14/11

 2/16/11

 Time:

 Time:

 8:48 am 

 9:15 am 

Op: ADAM24186 

State: NE 

Address: 2825 

County: DOUGLAS 

Street: N 28TH AVE 

Place: OMAHA 

Twp: 15N Rng: 13E

Twp: Rng:

Legal Given: C 

 Sect-Qtr: 09-NE-SE 

 Sect-Qtr: 

Type of Work: lead soil removal 

Location of Work: LOCATE ENTIRE PROPERTY 

Remarks: FAX ALL CLEARS TO: (402)451-1069 

: 2 97 93 

Company : ENVIRONMENTAL RESTORATION 

Contact Name: ADAM 

Alt. Contact: 

Phone:

Phone:

 (402)451-1314 

 (636)288-9616 

Work Being Done For: epa 

Depth of Excavation: 24in Corner Lot: N Front: N

Involves Tunneling or Horizontal Boring : N Explosives: N 

CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 

 Rear: N 

Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY MUD

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TR/y='FIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNE 1C QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 2/14/2011 
Contact Information Log 

SAID# 2^7^3 

Owner's Name: _Ci ^ r ^ /yma.h^ 

PropertyAddress: 2Q2 S NJ 

Attempt to contact Date/time Name 

^\OLne.J access fi/zV'o J5 •• 

f)4ar0 t-M^nSo l^• t<,K> r/3­
Property Final Report 

SAID: 2g|7f3 

Property Address: ?,tzS jy. 7^y ^ 

n

D

 WORK STARTED

 WORK COIVIPELTED

 ON:

 ON:

 /

 /

 / 

 /" 

Owner:

Address:

 ^ ^

 U 

^ 0.^k ^ Renter: 

Phone: 

Fax: 

P''°"'==

Fax: 

O^oSryjK.^S CaS'\85 

 /^02,^ ^W-^-JW ^ 

Cell/Pager: 

Additional Information: 

Cell/Pager: 

fyi Access Agreement 

[^ Restoration Agreement 

0 Video Property Before 

0 Digital Photos Before 

UD Video Property After 

n Digital Photos After 

JB'^ropert y Completion Agreement 

Signed: ^ / _2>^/ j<o 

Signed: ^ / ^ / / o 

On : (Z /IO /3 6 

On : It / iQ / lo 

On / / 

On / / 

Signed:3" l3f I I f 

»y­ J (5 

By­ Qg 

By­ j:^ . 

By= 3-. ft^. 

By: N/A 

By: 

^T^ O 

n FinalReport Signed: / /. By: 

EXECUTIVE SUMMARY 

Omaha Lead Project Work Plan Page 1 of 19 
% 

% 

Consent for Access to Property SMD#2?r?3 

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 certaia environmental response activities upon the following described premises: 

Address: Z0Z5 // Z 8 Ave. Address: 

Addresses of Properties 

covered by this Address: 

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 envirormiental response actions to be performed on said property may include the following 

activities: 

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

activities; 

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

enviroimiental response; 

c. 

Planning and implementing the removal action on or near Grantor's property. 

Obtaining samples from Grantor's property; d. 

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 imdertake 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 

0 1 grant access to my properties 

n I do not grant access to my properties 

Datc^ Signature 

Date 
'•JW^^ i " 

Additional Comments / Instructions: 

[3sCheck 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. 

' ^ > I agree n I do not agree J^r^g ree CH I do not agree 

/ /^y-XJyfC^^^d 'T^'t^^^ ^ QeA.^y^ '3'-3r f/ 

Owner's Signature te Contractor's Signature Date 
Restoration Agreement 

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

contractor 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). 

SAID: ^cin^ 2 

PropertyAddress: ^.f^ZS M 2^ ^ 

^r:^!!:: r^n ^-f .^^Wu^ 

Phone: rf 

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: 

iyty)lcu'^. ^ v«5s^v/A.-/v J a^^e^cL<: cury k Aot i 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of 2 
SSfe^ »^SMSZ2 T ^ % % 

I agree n I do not agree ^J!2^'agree n I do not agree 

^^y^^~^7 \ yl¥'4^'^yy) T^t^ ^ CUL^C^ ^-J/-/ / 

vifer's Si&n^re Date Contractor's Signature Date 

Attachment 

Page 2 of 2 
''s/'Mar. 31. 2011-'7:27A[r OMAHA PLANNING DEPT, 402-444-6' Jo, 4814 P. 2'°°''" " 

Property Completion Agreement 

This agreemem documeats die completioa of remediaJ activities perfonned on my property. My 

signatine wlU designate that I am satisfied with * a icstotatlon of my propeity, and that no Items are ia 

qu^tion, now, or at any time in thefiiture, except those itans listed below, ifany. 

SAID: ?J11^3 

Property AddreHs: ,^ ^ ^ . ^ ^ ^ 

Owner: 

Ffconet ?% ^

tM^' ^U^^fi 

 t\rvytU''t^ 

Rotttoratlon (tsma in Question: 

ttam: 

ttem: 

item: 

ttam: 

itam: 

item: 

Additional CommontB: 

P^l I agree restomUoii M coinFictsd, osapt ai noted .i^^ere e restoration is ooinpleted« except a< not«d 

Q I do DAt agr«e rextoratloa i5 cvmpleted CJ I do not Agree reitoratioo l« completed 

J/'/yf!in^- ;v/ / 

Owner' Date O>ntractor*9 SIgniitnre Date 
Douglas County NE GIs Map 

Disclaimer: This map is not guaranteed 

10 be accurate, correct, current, or 

complete and conclusions drawn 

are the responsibility of Ihe user. 
Douglas County Account Infaspation lagpi Page 1 of 2 

Douglas County, Nebraska Property Record ­ R0755040000 

Information is valid as of 2010-8-16 

New Feature ­ • •• ^

Print Report 

View Interactive GIS Map 

Treasurer's Tax Report 

 Subdivision Sales Search 

Owner 

CITY OF OMAHA 

C/O PLANNING DEPARTMENT 

1819 FARNAM ST #1111 

OMAHA NE 68183-0000 

Property Informatio n 

Key Number: 5504 OOOO 07 

Account Type: Ex Govemment 

Parcel Number: 0755040000 

Parcel Address: 

Legal Description: 

2825 N 28 AV 

OMAHA NE 68111-0000 

CATALPA 2ND ADD LOT 1 BLOCK 0 46 X 128 

Value Informatio n 

2010 

2009 

2008 

2007 

2006 

2005 

Land 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Improvement 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Total 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

Show Ail Transactions 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.13 5888.0 0.0 128.0 46.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07... 8/21/2010 
Douglas County Account InfaM?ation Page 2 of 2 

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Oftpojt OtMoSt 1 1 / 

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3­ zr 1 IB' 

Otilo St 

TOWERED BV 

Cocgic' ^^k^sf" Lake St 

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Lake St 

Map data €C01 Q Google 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R07... 8/21/2010 
ENVIRONMENTAL AS-BUILT DRAWING ^ 

OMAHA LEAD SUPERFUND SIT ^ 

RESTORATION 

llllllllllllilllllllilillll 29793 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: CITY OF OMAHA 

Site Sketch 

• Good Add ress: 2825 N 28 AV • Poor Phone: H W: 

O^o t paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm; m£, S g^^ , KfV\ 

RYASCPXA-29793 Fl I CQ((; ppm D Date: I'T-QU ? 

RYBSCPXA-29793 F2 Z"Z-H ppm D Time: '~^ •3-5>I>YV\ 

RYCSCPXA-29793 B1 (aC)^ ppm sr D Samples Analyzed RYDSCPXA-29793 B2 37- 0 ppm 

nDgOCrXA-20790 B2 ppm n D XRF Unit: lOQ-i Book; l5 ^ 

RQZ3CPXA-29790 Q? ppm D D Date: ~i -i"i - 0 ( ^ 

RPZOCrXA-g9790 P2 ppm D D Time: A/^ D Staff: AISVA / Number of Samples • 

Legend: F1 = Front Left, F2 = Front Right, B l = Back Left, B2 = Back Right DZ = Drip Zone, GZ • Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

LEfiENQ 

Quadrant flxcavatad t)flo Zone Excavated Contamination Left Behind

r>/i>»«.•'..^« M. C D D-7 n n n c Cai^vxia^'^v^vwv. M »*4«« t ^)«^^4 ^ ^««4* ^ ^ t I ^ 
29793 

Owner Name: CITY OF OMAHA 

Address: 2825 N 28 AV 

Phone: H; 

Sample Numtjer 

RYASCPXA-29793

RYBSCPXA-29793

RYCSCPXA-29793

RYDSCPXA-29793

RDgGGrXA-29793

RQZOCPXA-29793

RrZOCr)(A-29793

 Fl 

 F2 

 Bl 

 B2 

 BZ 

 Q? 

 Pg 

W: 

Lead 

Concentration 

Ms^ 

Z-^'i 

^r>, ^ 

3ZO 

Omaha Lead Site 

Site Sketch 

Sample LAB Collected 

ppm D 

ppm D 

ppm sr D 

ppm n 

ppm D D 

ppm D D 

ppm D D 

Number of Samples • 

Legend: Fl = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

-^e- MT—- ^ 

61 

(oC)5 

^ f

^8^5|^^. 

r 

Fi 

iU^ 

Exterior Paint North Arrow 

• Good 

• Poor 

IVf Noi paint 

Samples Collected 

Firm: m£ S ^^ \ K M 

Date: "l-l-Qi ^ 

Time: V^S Oyn\ 

Samples Analyzed 

XRF Unit: too l Book: 159 

Date ~1 -n - OG> 

Time Ai± 

Staff: /V|£VA/ 

ENTERED 

JUL 1 :O20 np-: 

b% 

:^lO 

^m 

F^ 

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^ 

5> X 

WAUH N 

Rev 4 .^^ol8.^ve. 0461410123 
29793 

Omaha Exterior Paint North Arrow Owne Lead Site r Name: CITY OF OMAHA 

Sit • Good e Sketch Address: 2825 N 28 AV • Poor 

Phone: ^ W: IVf Not paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm: m^ S ^^ ^ K M 

RYASCPXA-29793 Fl ifiU- _pp m D Date; 1 - 1 -Du> 

RYBSCPXA-29793 F2 I'^'i _pp m D Time: "^'^SQAV A 

RYCSCPXA-29793 Bl ^r)3 _pp m D 

Samples Analyzed RYDSCPXA-29793 B2 32. 0 ppm D 

RDgGCrXA-2Q703 BZ ppm D D XRF Unit: IOOI Book; JM . RQZOCPXA-29790 ©? ppm D D Date: 1 - il - OCg 

RrZOCP)(A-20703 PZ ppm D D Time: Ai ^ 

Staff: rV1S\A/ Number of Samples = i UJ 

Legend: Fl = Front Left, F2 Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

-^e - Xl—- ^ 

ENTERED 

JUL 1 0 20ns; 

61 6 ^ 

(oC>3 •ZIO 

^m 

@ - - r 

Fl F9L 

KA- -1? ^ 

^ 

5> I 

W^UV<s 

Rev 4 .iy.oig.A.yg. 046141.0123 
ENVIRONMENTAL XRF DATA ENTRY LOG 

c 

RESTORATION 

SAID* ?0(^^ ^ 

PROPERTYADDRESS 

QUADRENT OR SAMPLE AREA 

DEPTH 

redig 

D 

n F2 

• 31 ^ 

n B2 

• PZ 

^ T 

n EZ2 

n OTHER 

SAMPLER NAME ^ - &aco-\ OJ^ 

DATE 

TIME 

XRF S/N 

AVERAGE OF RESULTS 

\n^^-\ ^ 

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2. WS. \ VV 

SHOT#s 

IHl'l^^ i 

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Thermo Fislier Scientific Thermo 900 Middlesex Tumpike 

Billerica, MA 01821 

SCIENTIFI C 

Lvvi'.K.vGr. M)i)Ri:ss •VKK/V ()IM;UA tOR NOir.s s,vii) I'll 

\ 2011-02-15 15-.16 Avg of 751-753 2825n28av EZ jimmy surface final clearance 44.46 ± 12.96 

2 2011-02-15 I5;16 2825 n 28 av EZ jiinmy surface fmal clearance 29793 43.49 ± 12.77 

3 2011-02-15 15:15 2825 n 28 av EZ jimmy surface final clearance 29793 49.64 ± 13.60 

4 2011-02-15 15:14 2825 n 28 av EZ jimmy surface final clearance 29793 40.25 ± 12.50 

5 2011-02-15 15:12 Avg of 747-749 2825 n 28 av Bl jiinmy 8 final clearance 104.29 ± 18.21 

6 2011-02-15 15:12 2825n28av , B l jiinmy 8 final clearance 29793 105.29 ± 18.29 

7 2011-02-15 15:12 2825n28av Bl jimmy 8 final clearance 29793 111.02 ± 18.61 

8 2011-02-15 15:11 2825 n 28 av Bl jiinmy 8 final clearance 29793 96.57 ± 17.73 

02/15/11 14:33:22 Page 1 of 1 
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