TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#^: I'll V^ Date: 

^ 11 

Addres.s: felV M'^ 1 "^ T 

Remediaiion Contractor: Coastal Environmental Group Year: _20]0ARRA 

/ 

/ 

y 

A 

A 

A 

"kr 

A 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

EPA-provided properly sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

Settlement documenls (i.e., for damage or lo replace plants, etc.) 

Confirmation data 

Photographs 1 ft p p C/^iXXU;^ y OpZ/)(i/rac^ ^ i<c^^ 

As-buill skelch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Office 

0^ jT' ^ lj Date 

30218821 Hi 

Superfund 
Property Access Checklist 

Property ID: 2'\\'yn D WORK STARTED ON: / /_ 

Properly Address D WORKCOMPELTED ON: / / 

Owner _C.»V>^ fi£ OAt.«LV«. 

Address: 

Cell/Pager: 

Phone: Additional Inlormation: HcfV.HH«A. Ha.M»> 

Fax: 

Ccll/Pager: 

• Notification Letter Sent; / / Bv: 

B Access Agreement Siened: \p / tM / u> By: 

¥*wy 

^ Restoration Agreement Signed: ua /v»\ Ao By: 

to Vet 

O Topsoil Sampling (if applicable) / • / By: 

Q Disposal Sampling (if applicable) By: 

/ / 1 

Q Garden Sampling (if applicable) / / By: 

SI Utility Clearance Called:,« / v«. / v» By: 

QD Video/Photos (Before) On: io / \v\ / lo By: 

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

D Video/Photos (After) On: / / Bj : 

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

O Property Completion Agreement Siened: / / By: 

1 • FinaJ Report {.•isued: / / By: 

Air Monitoring (as applicable) 

D Community • Crew On: / /z:i By: 

Results: 

D Community' D Crew | On: / / | By: 

Results: 

Omaha Lead Site 

1 
Douglas County Account In ^^B^ion Page 1 of2 

Douglas County, Nebraska Property Record

Information is valid as of 2010-8-30 

Owner 

CITY OF OMAHA 

C/0 PLANNING DEPARTMENT 

1819 FARNAM ST 

OMAHA NE 68183-0000 

Property Informatio n 

­ R0920330000 

Print Report, 

View Interactive GIS Map 

Treasurer's Tax Report, 

New Feature -^ ."^ -^ Subdivision Sales Search 

Key Number: 

Account Type: 

Parcel Number: 

Parcel Address: 

Legal Description: 

Value Informatio n 

2033 OOOO 09 

Ex Government 

0920330000 

2213 MIAMI ST 

OMAHA NE 68110-0000 

DENISES ADD LOT 5 BLOCK 1 50 X 122 

Land Improvement Total 

2010 $0.00 $0.00 $0.00 

2009 $0.00 $0.00 $0.00 

2008 $0.00 $0.00 $0.00 

2007 $500.00 $0.00 $500.00 

2006 $500.00 $0.00 $500.00 

2005 $500.00 $0.00 $500.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.14 6100.0 0.0 122.0 50.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R092... 9/3/2010 
Douglas County Account In^Bation Page 2 of2 % ' 

w _Binnt!v St Binney Si Btnney St 

Locust St Locust St 

a 

Maple St 

Corby St 

CA 

Wiorni 51 teCO 

Uapte St 

Miami S( 

o 

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01 

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¥ 

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- lulaple Sl

Corby Sl 

fk^iami St 

a 

S2 M I Qf»»ost --

Ohio Sl 5 PMoSI z 

9 

<o 2 CA 

CM to 

Lake St a. LakeSt LakeSt 

._ J £rsluneS( _

St John 

 Ame Chijrcin 

WlilisAve • WlilisAve wrdtsAve 1 f 

POWtRED BV 

Go'jgle Grant St 

Map data GC010 Googl^ 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R092... 9/3/2010 
Page 1 of 1 

% 

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

• YOUR TICKET NUMBER IS 2627871. 

Original Call Date: 10/27/10 Time: 2:28 pm Op: ELIZABETH18790 


Work to Begin Date: 10/29/10 Time: 3:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2213 Street: MIAMI ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-SE,10-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


Location of Work: LOCATE ENTIRE PROPERTY, ALL EASEMENTS AND TO THE PEDESTAL 


Remarks: FAX ALL CLEARS TO: (877)662-4211 


: UNSURE IF CORNER LOT. 


Company : COASTAL ENVIRONMENTAL SERVICE 


Contact Name: ELIZABETH Phone: (877)662-4210 


Work Being Done For: COASTAL 


Depth of Excavation: 4 FT Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 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=<RESULT... 10/27/2010 
^ As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

OLS#: 29120 

Date Excavated: 11/1/2010 

Date USEPA Signed Off: 12/2/2010 

Area Sodden: 1370 sa ft 

29120 

Omaha Lead Sile 

Legen d 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced

Sod 

 with Area replaced with 

Rock/Mulch Area lef t bare 

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

46130 
% 

29120 

\ o /:i ^ 

46130 
% 29120 

Omaha Exterior Paint North Arrow Lead Site Owner Name: WILLIAM PHILMON 

Site • Good Sketch Address: 2213 MIAMI ST • Poor 

Phone: H: • Not paint 

Omaha Lead Site 46130 
29120 

Omaha Lead Site 46130 
t c; ; s "I A I I ^ M ^ 0 h K I . W. I 

('A)\\i::i\\\ 1r;f /y(.:('.v.ir 'l C !"U)|K-liy 

RIGHT OF ENTRY TO PREMISES 

Gtgnlot (the pfopert^' ownei) consei'ilh to srid aulhoiizes the l'nited Slates 

Fnvironmental Protection Agency (F-PA) oi its authorized representatives, collectively 

the Grantee, to enter snd perform certain envitonmenta! lesponse activities upon the 

following described premises: 

Owners kame: ^; A arf 0,rn^ i/X- Da^flime Phone: i-^L^L/- c/i \^ y 

Address of Property 

covered by this <^^/3 rfltfi^r^'i S^<-^Z 

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 removai, 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 ACTIOWS 

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, tor 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 ? 
C C A S "1 / I 

'. * V U 0 »• ••• f • U I 

C fl C I' '

( Remove obstructions incluriing boats, tiaileis. ve.hiciGs, i';lay&.cai)C- iK-'Tir, WCKJO 

piles, doo tiouses, etc; 

I [Remove fiovi'ei bulbs oi pients that the Grantoi ot the Giaritoi's tc-iicnt may w

to save; 

ish 

Water and maintain leplacernent vegetation, includino iertili/er application, as 

necessary' subsequent to an initial watering period by EPA; 

< Abide by health and safety guidance provided by EPA; 

<. If the properly is rented, assist EPA in obtaining tenant api:)iov8! foi

the property to perform the work. 

 access to 

I Allow videotaping and/or photographing ol the property. 

AGREEMENT HO I TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the work activities, oi with any 

of the work done, or with the equipment used on his properly, 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 (402) 991-1199 

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

.£^^ytyj z /Y-^y-z'^yo 

Signature^ Date Signature Date 

G I >vo;Jio' [fkti to be nfeseni ciu.tirijj any sannpljrtc thai is lepniieo. 

 • •• c 

Paoe 2 of 2 
C O A S T A L 

C M O U P . t N C 

Restoration Agreement 

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

remediation activities. This will also serve as documentation for the purpose of assuring that restoralion 

activities are completed to the satisfaction of the property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: QS{l2i> 

Property Address: ^^, 3 ^,^^ ; ^^^ ^ 

Owner: Z2/-K c^t- ZZm^y^l^ 

Phone: 

H'JH-^i^'-iZ 

On the attached diagram(s) indicate area(s) to excavate, surface stmctures and landscaping features and 

access location(s) to be used by the contractors. Indicate distances, depths, material types, etc. 

Photographically and Videographically document the existing conditions ofthe property and the basement if 

necessary. 

Items to be Removed by the Owner before Start of Remediation: 

The removal, storage, disposal, and/or return of these items is the Owner's responsibility 

Items to be Removed by the Contractor During Remediation and Not Replaced 

Item: 

Item: 

Item: 

Item: 

Page 1 of 2 
COASTA L tNVIRONMrNTA L CROUP , ) N C 

Items to Be Removed By Contractor During Remediation and Replaced 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

Pre-existing property area, Quadrants that will be excavated, that N 

is covered with grass. 

Number of trees > 2 inch J i~ Each 

trunk diameter 

Number of trees <= 2 inch M-y Each 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, Each Timers, Heads, etc. 

Attach a sketch of the 

.sprinkler layout. 

Number of and size of 

each garden/ flower bed Each 

area. Square Feet 

Alt;icl\ a sketch of reiiiti\e 

-.izes and locaticm.s. 

Agreed upon value of plant 

materials not to be 

replaced by contractor. 

\()tc this Miliif will he 

'isfd io issiit- i\ pliiiil 

(URIUT HI till' proptri) 

l)>\ !UT . 

Easement Area, to be Each 

excavated 

Page 2 of S 
C O A S T y* L 

CROUP . 

Additional Comments / Instructions: 

The city of Omaha ordinances may prohibit you from using dirt or gravel areas on your property 

as driveways or vehicle parking areas. The Environmental Protection Agency (EPA) may be 

removing and replacing soil underlying a gravel or dirt area on your property that you may be 

using as a driveway or vehicle parking area. If this is the case, you should understand that this 

removing and replacing of soil does not mean that any illegal driveway or parking area on your 

property is made legal. To the contrary, you may be cited by the city if you use a gravel or dirt area 

as a driveway or parking area, not withstanding any removal or replacement of soil by the EPA. 

If you have any question about legality of a certain driveway or parking area, you may contact 

the city of Omaha's Planning Department at (402) 444-5150. 

l ^ Please check this box if you understand the information outlined above. 

J . 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. 

Oil agree Q I do not agree 

y^c)^Z'^dJo '^CtlftAUi^ 

Date Contractor's Signature Date 

Page 3 of jS . 
B\l\D#Z3JZO 

XRF PROPERTY SAMPLE SHEET 

Oate /- n - ZO(( Address ZU 3 MlAm S r 

Project Omaha Lead ARRA Sample time am/pm 

XRF ID# ^'=\0?AL sample length 30 sec 

Shot# 

6^^ 

^ 

=^1 

Reading 

Z3(^ t n 

^^ / i Z3 

Z^0^~­ ZO 

Sample area 

£A 

Depth 

/ " 

Shot# Reading Sample area 

Depth 

Average Z.4Z: u y Average 

Shot# 

GS 

(oio 

G^ 

Average 

Reading 

ZJX> i 1 ^ 

T^ i t ZO 

iee> t 13 

ZZP6 i n 

Sample area 

Fi 

Depth 

r 

z 

Shot# 

Average 

Reading Sample area 

Depth 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

Shot# Reading 

RETEST AREAS 

Sample area Shot# Reading Sample area 

Average 

/

x ^ 

/ 

Depth 

Average 

Depth 

Signature_ 

Print l^a M/htt/k 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 72 

Mode SOIL 

Time 2011-01-19 11:34 

Duration 91.55 

Sequence Final 

Flags 

AVERAGE Avg of 69-71 

ADDRESS 2213 MIAMI ST 

QUADRANT EA 

DEPHT 1" 

XRF TECH C.PADILLA 

MISC CONFIRMATION 

NOTE CLEAR 

ppm 

Pb 242, 

Supervised By: 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 236.024 

Supervised By: 

Certificate of Verification 

69 

SOIL 

2011-01-19 11:33 

30.65 

Final 

29120 

2213 MIAMI ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 19.911 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 251.037 

Supervised By: 

Certificate of Verification 

70 

SOIL 

2011-01-19 11:34 

30.31 

Final 

29120 

2213 MIAMI ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

23.642 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 240.485 

Supervised By: 

Certificate of Verification 

71 

SOIL 

2011-01-19 11:34 

30.59 

Final 

29120 

2213 MIAMI ST 

EA 

1" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 20.587 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

AVERAGE 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

Pb 

Supervised By: 

Certificate of Verification 

68 

SOIL 

2011-01-19 11:32 

92.38 

Final 

Avg of 65-67 

2213 MIAMI ST 

Fl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 200.833 

Supervised By: 

Certificate of Verification 

65 

SOIL 

2011-01-19 11:30 

30.91 

Final 

29120 

2213 MIAMI ST 

Fl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

± 19.074 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 231.286 

Supervised By: 

Certificate of Verification 

66 

SOIL 

2011-01-19 11:31 

30.56 

Final 

29120 

2213 MIAMI ST 

Fl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

± Error 

20.688 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 188.784 

Supervised By: 

Certificate of Verification 

67 

SOIL 

2011-01-19 11:32 

30.91 

Final 

29120 

2213 MIAMI ST 

Fl 

4" 

C.PADILLA 

CONFIRMATION 

CLEAR 

Error 

18.834 
/ jOk \ Omah aa Lea I, . d Site—Fixe .. d Price EP-R7-07-0 . , . —5 

Coastal Environmental Group Inc. M 

. j ^ www.coastalhazmat.com ^sg^ 

'^tPROit^ COASTA L INVIIONNENTAL 

GROUP , IN C 

EXECUTIVE SUMMARY: 

BVID #29120-(2213 MIAMI ST) 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 

-DAN GARVEY WALKED THE PROPERTY ON 12/2/2010 
i^ 

EPA Propcrt>' Close Out Form 

Proptrty Addrwr. - >**'*' *^^«"^^ "^^ 

Dste/Tlrne: Owner's Nenit /: & ^ gt Oi>ry>,V.v--= 

Quads F.xravHi^d: Y \ Contratlor Croup _ (bA^1>t\ y 

Property *(; aiS\>.D^. 

E;icava(|on Grntni l 

1 If neccssar)', were thc correct quadrant(j) excavated and restored'' 

2 If neccssar)', were (he correct areas of dnp /one excavated and restored'' 

C radJDg Sod and VrncUliop Ves t^ii 

1 Does the grading around the perimeter ofthe house in excavairri area? generally ^ki|K awa\ 

from the house? 

2

i Doc

 Ha

day

s

 tim

 so

s Ih

d

t

e

 bee

 ptriod

 sod

n

 appea

 lai

) _

d in

r t

 al

o b

l area

e generall

s that wer

y health

e excavated

y and growling

? 

? (Only

 .

 ev?tluai

 . 

e if inspertrd at a 30 z

A Z\ 4 /\re sodded areas generally firm and evenly graded'' 

'' Are the joints between the sod strips generally fighf (Only evaluate if inspccicd at a I'D day ^ / / lime period) _ ^ 

r 6 Was the property graded such thai water will rioi pool nn iht proptnv'^ 

1 Was damage to landscaping or plant materials avoided'' ; / 

Gates. Ftnccs apd Rcuiolng Walls 

Do gates open and close freely^ fif appli( able) 

• / : , 

Were all gates oi fences taken down during restoration acliviiies reinstalled'' (II apolicahlf' 

^ Was damage to gates or fences avoided? (Ifappiicablcj 

J yi . 

1 Was damage to retaining walls avoided? (Ifapplicable) \.^y r oundatioQ, Sidint and Cutlers _ _ _ _ Vc>_ Nc 

I Was damage lo the siding or trim avoided^ 

? W'as damage tn the foundation avoided'' 

Was damage tc windows avoided'' 

^ Was dannage to windows or door Kreens avoided'' 

y y ^ 

i • -( 

.' Wa.< damage to downspouts or downspout txien.sionj aMiidcd' / I 

Sidewalks and Driveways (Concrete) > fS M ­

1 Was damage to driveway surfaces avoided' 

2. Was daniBge to walkway surfaces avoided'' 1 y " 
v>M'rpr< rommen 

In.vp^ctior? rjofev: 

KeniONa) ajitj rt.Mojalion in livdlt:^ ccinplfie including the .MJ-day .sod wanaiU) 

l.-P.A Hff)resc'nuiivf * ^ Dale: izU w 
Property Completion Agreemenl 

Mns H^iectntn\ (kiiutrieitis the loitiplchon ol icinedial acliviiies pci loi med on my pioperiy My xigiiitiuii' 

will desigttDlc iliai I am satisfied wtlh ihe restoralion of my properly ^ndlhai no items are m quesiions 

now, or al any ume m ihe fulure.. exccpl those items listed below, if any 

PI npcrcy II): 

.-iMAtt-- -

Propcrfy Address-

AiVV-JAUitn'L.J4 

Owner: _^i^_»V. .0»*V,K — 

Phone: • J^*ft>..>^>\a,>QaSt.. 

Restoration Items in Queslion: 

r r 

Item: 

llem: 

Item: 

Item: 

Item: 

item: 

Additional Commenls: n 

iN7| i a|ircr ir^loration n complrltd, rtccpl i i nnlrrl 

|_J I ric nol «i;i»t rr»if>i'«linn it lofflpleirri 

yy4^jb-y<i 

wiifr's signalinr Dale Ctinli at toi 's Sigpmiii'i D»lf 

1