TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: loiVb Dare: I ^ / '' ^ 

Address: 

Remediation Contractor: Coastal Environmentai Group_ Year: _200g} 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video ofproperty (DVD) 

t/ Executive Summary 

EPA-provided property sketch 

d Signed Access Agreement for subject property 

-B ' Signed Access Agreement(s) for adjacent property 

W Restoration Agreement 

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

-B Confirmation data 

[3/ Photographs % '^ 9 V feCQWi^lWt K \\iy{!pO(mi<^ 

5/ As-built sketch 

M Satisfactory restoration signed by Property Owner 

^ Property close-out check list signed by EPA 

—& Description of areas not meeting ROD cleanup criteria 

Iw Utility clearances 

d/ Property injormation from Douglas Coimty Assessor's Office 

D 

D 

D 

^ \ \ 0 

Signature I ­ ^^ ­ ­ ­ 'Date 

30054462 

Superfund 
• # • • 

Property Access Checklist 

Property ID: ZOfhl' ^ 

Property Address: 32. 1 ?.Popd(»to n AVrt 

n

D

 WORK STARTED 

 WORKCOMPELTED 

ON:

ON:

 /

 /

 / 

/ 

o^^r- (iV\/xrlnW9i ?^\pjtis 

Address: 

321 ^ PoppWcPA AVG 

Phone; 

Fax: • (}oi)?^\i-\fi?M 

Celi/Pagen 

Renter 

Phone: 

Fax: 

Cell/Pftgen 

Additional Infonnation: 

D Notification Letter 

• Access Agreement 

D Restomtion Agreement 

D Topsoil Sampling (if applicable) 

D Disposal Samplhig (if applicable) 

D Garden Sampling (if applicable) 

D Utility Clearance 

Q^ideo/Photos (Before) 

D Video/niotos (During) 

D Video^hotos (After) 

D^ Video/Photos (30-Day) 

13 ^ Property Completion Agreemmt 

t l Final Report 

Sent: / / 

Siened: / / 

Signed: / / 

/ / 

/ / 

/ / 

Called: / / 

On:j2_//7 / 0^ 

On: / / 

On: / / 

On: / / 

Signed: /^/. 

Issued: / / 

^ 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

^r-OOw/zj //^£r//H^ 

By: 

By: 

By: 

By: 

By: 

Air Monitoring (as applicable) 

D Commnnity D Crcn 

Results: 

On: / / By: 

n Conunnnity

Resuhs: 

• Crew On: / / By: 

• Commnnlty

Results: 

 QCrew On: / / By: 

Omaha Lead Site 
Douglas Cotmty Accotmt I ijlJbnM^on Page 1 of2 

Douglas County, Nebrasica Property Record - R1236330000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vie w OH Ma p Information is valid as of 2009-8-3 Treasurer's Tax Report 

New Feature -•->- » Auto Sales Search 

Owner 

SHIELDS CHARLOTTE 

3212 POPPLETON AVE 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 3633 0000 12 

Account Type: Residential 

Parcel Number: 1236330000 

Parcel Address: 3212 POPPLETON AV 

OMAHA NE 68105-0000 

Legal Description: HANSCOM PLACE LOT 14 BLOCK 7 W 11 FT LTS 11 & 12 & E 29 FT LTS 13 & 40 

X100 

Vaiue Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$5,200.00 

$5,200.00 

$5,200.00 

$5,200.00 

$5,200.00 

$5,200.00 

Improvement 

$88,600.00 

$72,000.00 

$72,000.00 

$74,800.00 

$74,800.00 

$74,800.00 

Total 

$93,800.00 

$77,200.00 

$77,200.00 

$80,000.00 

$80,000.00 

$80,000.00 

Saies Informatio n 

Sales Date: 2008-06-09 

Deed Type: 

Price: 

QC 

$0.00 

BooJir: 2008 Page: 056415 

Grantor: VOLVOLKA ALAN 

Grantee: SHIELDS CHARLOTTE 

Valid/Invalid: 

Exclusion Reason: 

Invalid 

Family Sale 

Land Informatio n 

Acres 

0.09 

SF 

4000.0 

Units 

1.0 

Depth 

100.0 

Width 

40.0 

Vacant 

No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=R12... 8/22/2009 
• • 

Douglas County Account I: i^^o n Page 2 of2 

Building 1 

TWO STORY ":^OY.I : 

1?l30sqY 

Tsir 

flnunl-n « fW* *^ -Ida Lwn^ Araa ' ^ 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 2068.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Good 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 6.0 

Exterior: Frame Vinyl Units: 2.0 

Interior: Drywall Baths: 2.0 

Roof Cover: ! Composition Shingle Bedrooms: 4.0 

Roof Type: Gambrel Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1890 2007 0% 1913 96 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 1172.0 

Basement Fair Finish 720.0 

Fixture Additional Fixtures 1.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Porch Slab Roof Ceil 72.0 

Porch Slab Roof Ceil 178.0 

User 2 apt conv 1.0 

User codei 25tomodel 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12... 8/22/2009 
• • • • 

CONTACT FORM 

Property ID # 20^\ ^ 

Property 

Address: 22jrL pQpp\e.'k3n /^ve 

Initial Contact: Date: Time: Action: 

Second Contact: Date: Time: Action: 

Final Contact: Date: Time: Action: 

Final Action: Transmit to EPA D Other Action: D 

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 
"> 

• • • • 

Page 1 of2 

Create Another Ticlcet ] Bacl< to Irth Internet | ' [ Send Email | 

• YOUR TICKET NUMBER IS 2362525. 

Original Call Date: 9/12/09 Time: 6:27 pm Op: ELIZABETH18790 


Work to Begin Date; 9/16/09 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3212 Street: POPPLETON AVE 


Twp: 15N Rng: 13E Sect-Qtr: 28-NW 


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 OF CORNER LOT 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: coastal 


Depth of Excavation: 4ft ront: Y Rear: 


Involves Tunneling or Horizont; ves: N 


CXCATV LEVELS MUD02 QLNNEIF 


Service Area mber UtiUty Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVELS LEVELS COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUD02 METROPOLITAN UnLITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://virww.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/12/2009 
Page 2 of2 

• • • • 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/12/2009 
20513 

OLS#: 20513 As-Built Drawing ^ Date Excavated:9/26/09 

Date USEPA Signed Off: 10/23/09 

C OASTA L Omaha Lead Superfund Site Area Sodden: 1062 soft 

Owner Name: ALAN A VOVOLKA 

Address : 3212 POPPLETON AV 

Phone: H: W: 

Sample Number 

RYASCPXA-20513 

RYBSCPXA-20513 

RYCSCPXA-20513 

RYDSCPXA-20513 

RDZSCPXA-20513 

RGZ3CPXA-20513 

Omaha Lead Site 

Concrete KZ/jJ

Area replaced with


Sod ' '


Contract #: EP-R7-07-05


Exterior Paint North Arrow 

Site Sketch 

Omaha Lead Site 

Q-'SSod 

• Poor 

[~1 Not paint t 

Firm:

Date:

Time:

Samples Collected 

 T'B . P^'T^ (A^S> 0 

 ^V- \J> M 

 VCa '. ^A3 ' ^r- ^ 

Samples Analyzed 

XRF Unit: O 1 \ Book n ^ 

Retaining Wall 

F2 = 270 PPM @ 9" 

461.W 


Legend 


 Drip Zone Excavated OOOI Quadrants Excavated 


 Area replaced with 


Area left bare 
 Rock/Mulch 


 Coastal Environmental Group Inc. 

• • 

20513 

Omaha Lead Site fOLi 46130 
Z,^1d r^ 0%r\ aV 

. 20513 

Omah Exterior Paint North Arrow a Lead Site Owner Name: ALAN A VOVOLKA 

Site Q--Sood Sketch Address: 3212 POPPLETON AV / \ • Poor 

Phone: H: W: Q Not paint 

Sample Number 

RYASCPXA-20513 

RYBSCPXA-20513 

RYCSCPXA-20513 

RYDSCPXA-20513 

RDZSCPXA-20513 

ROZ3CPXA-20513 

nPZOCPXA-20513 

Fl 

F2 

Bl 

B2 

DZ 

-6Z 

Sample 

Collected 

Sannples Collected 

l 6 '• M ^ ^r ^ 

"6x5^40- A 

/;i)c//-^J>> 

/O^b f 

Oinaha Lead Site fOLb 461.-?0 
20513 

Omaha Lead Site Exterior Paint North Arrow Owner Name: ALAN A VOVOLKA 

Sit Q-Sood e Sicetcii Address: 3212 POPPLETON AV • Poor 

Phone: H: W: • Notpaint T 

Sample Number 

RYASCPXA-20513 

RYBSCPXA-20513 

RYCSCPXA-20513 

RYDSCPXA-20513 

RDZSCPXA-20513 

ReZSCPXA-20018 

RPZOGP)(A«20013 

-.icSample 

Collected 

Fl 

F2 

B1 

82 

DZ 

-62 

-pzNumber of Samples = . S 

I 

fo-l 

fc-^ 3^ 

JSlAo 

3^0 ^ Pojjiehvo 

O-ZzJ^in 

I SS 

\ ^ ^ 

T M ^ 

{opii|£T^ 

LAB 

D 

D 

D 

n 

D 

D 

D 

KyJ 

Au 

Samples Collected 

Firm: pB . r^^fA^^V J 

Date: Cy. \3-(4 

Time: \.C> '• >-V5~ A.KV 

Samples Analyzed 

XRF Unit: g> I \ Booltrv 4 

m 

staff: ss QL 

< 

fe.-.?: 314 

>r • Y 

iAtP 

hi^ 

^-P 

£A\^ 

ENTEBilD 

S^P 2 0 !Z004 

Om^ha Lead Site 46130 
z.^** 

^ 

.•^^IT"** 

COASTA l fHiriltONKIHTAl ^ t PBO"^^ c R 0 u r. > N C 

Consent for Access To Prop6Fty 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States 

Environmental Protection Agency (EPA) or its authorized representath/es, collectively 

the Grantee, to enter and perform certain environmental response activities upon the 

following described premises: 

Owner's Name: Daytime Phone: 

-^xl- Gl'b ^ ^^KcvrloH? ^ \ 

Addrass of Property 

covered by this 

Agreement: 3212 

PURPOSE OF RESPONSE AcTivrriES 

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 vt/ill be asked to review the work 

and confirm that it is complete and meets with the Grantor's approval. Upon 

completion, the Grantor vinii 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 
f 

V"^^'M*3=^ ' COASTA L •>

 ^ IKVmOhHIKTAt 

^ i PRO"^ C II O U r I R C 

« Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

c 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 proF>erty 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 ariy questions about this program, please contact Coastal 

Environmental Group, at (402) 991-1199 

Ofggran r t access to my properties D I do not grant access to my properties

Sianatur Signaturee Dat Datee Signature

 Date 

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

Page 2 of 2 
-il^ '4. COASTA L 

Restorataon Agreement 

The purpose of this agreement is to provide a mutual agreement as to conditions ofthe property 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: ^pg , ^ 

Property AddrcM: ^„u^, u 4^ o 4 WUc ­

O^gf' <CUr\oHe ^h'.^\A< 

Phone: '^yl-^TS ^ 

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

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

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

necessary. 

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

Item: 

^U\ rlcuJ-s 

ttem: 

ttem: 

/ 

ttem: 

/ 

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

ttem: 

JL^w^m^^ SSA/LJL 

ttem: ^ 

Kem: 

ttem: 

Page 1of 2_ 
'((T^ 

COASTA L 

Items to Be Removed By Contractor Durinfl Remediation and Replaced 

ttem: 

^ ^

ttem: 

^^-A - Item: 

ttem: 

Item 

Pre-existing propeny area, 

that will be excavated, that 

is covered whh grass. 

Number of trees > 2 inch 

tnuik diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Aiiath a skeiclr ol ilitr 

•.rr'Pkici l;>v'.)ui 

Number of and size of 

each garden/ flower Ijed 

area. 

Alliith .1 skcich ol rcUitivf 

M/fS niid loc;iiii'ti> 

Agreed upon value of plant 

materials nat to be 

replaced bv contractor. 

Vole Ihi' \HI(IC will tii 

i:si'L' 10 \i:.\n il filHii! 

voiifln-T !(/ the |;ro|)cii> 

IM< ner. 

Easement Area, to be 

excavated 

 <>^^\

 D Z 

Quantity 

n/i 

2 

^ 

f 

^ 

^t^ 

 mo(ok " F). F 2 

Landscape Inventory 

Unit 

Quadrants 

Each 

Each 

Fach 

Eacfa 

Square Feet 

S 

Fjich 

Condition/Type/Species 

\e.\^sKC. XK^i^ ^ 

Page 2 . . ^ 
XL. COASTA L 

* Additional Comments / Instructions: 

I w ^r&A-\- <:^ Wo^^c— Hvx F\ cLvvcS} F2"' 

<>^e^Hfif f^'S ^"^ -F^^ ^ ^^^^^ ^H ^ Kill ' 

Le^ . ^ , ^,, V S^o ^ cre. t <^,^ ^ 1 , • 

^i^ot^f- Tet^ia ^ 

TWVW 

Q Check the box if Owner does not want CEG to document interior foundation walls and possible 

pre-existing damage. By checking this box CEG ts not responsible for any damage done to the 

interior of house, Including foundation cracks or fissures. 

BZi* agree Q I do not agree 

Owner's Signatnre Date ' / Cmtractor's Signature *" Date 

Page 3 of. 
BVID# '2 , 6^* 3 

XRF PROPERTY SAMPLE SHEET 

Date Address ^2-/7 - Po p p/-c-H.v^ Aoi^ 

Project Omaha leadF! P 2nd year opilon Sample time am/pm 

XRFID# h7<<'fi'^ sample length 30 sec 

Shot# Reading Sample area _Shot # Reading Sample area bampiear 7a sz^ J 2 ^ f^/ 

m Depth eg 4 Depth 

-fm. / 3 ^ La dO 

Average /y-^/^Z ^ Average ^ ^ <i^lQ _ 

Shot# Reading Sample area Shot# Reading Sample area 

25 

^ ^ ^ ^ IS '5 J=^^ iLgl 

/ Depth 'tifT-i^/ ^ Depth 

3 ^ ^ V/?% i>tS^ 

Average '^J^j ^ " ^ ^ ^ Average /^jh/ ^ 

Shot# Reading Sample area Shot* Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot* Reading Sample area 

Depth Depth 

Average Average 

lab sample # Lab result Sample area XRF AvQ. 

Signature. ^caam. Print f^ Uoji M a Cocef(fs 
• • • • 

/ v^ ^ \^ Omaha Lea I . d Site—Fixe .. d Price EP-R7-07-0 . . . ._5

Coastal Environmental Group Inc. M 

V*^^ ^ vinvw.coastalhazmat.com ^ ^ 

XpROrt ^ COASTAL MVIIOMNEIITAL 

CIOUP , IN C 

EXECUTIVE SUMMARY: 

BVID #20513-(3212 POPPLETON AVE) 

No Issues or Concerns | ^ Issues/Concerns 

Detail Explanation: 

-COASTAL TO DROP OFF ADDITIONAL BAGS OF MULCH TO PO.(COMPLETED ON 

10/21/09) 
4

^%EPA 

EPA Property Close Out Form 

Property #: "ZPS B . . DfltcHlme: — : Owi«r'iNanie:..£h.nrl0ttf _f)hl'<'^\G\^ , 

Quad rnn^mctnr Croup C*r^r^fa/>^^ KfW l^yPnTU'/Vm » s Eicavated; )F\, f 2 , D 7 

Excavatio Yes No n General 

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

2. If necessary, were the correct areas ofdrip zone excavated and restored? y ' 

Grading Yes ,No Sod and Vegctatton 

1. IX>es the grading around the perimcier ofthe house in excavated areas generally slope away T7f 

from the house? 

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

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 y day time period) 

^ 4.

 Are sodded areas generally firm and evenly graded? 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day C / 

time period) ___^_ _ 

6, Was the property graded such that waler will not pool on the propert}**] IP' 

7. Was danuge to landscaping or planl materials avoided? IP^ 

Gates, Fences and Rctaialng Walls 

Ves No 

I. Do gates open and close freely? (Ifapplicable) 

2. Were all gates or fences taken down during restoralion activities reinstalled? (Ifapplicable) 

3. Was damage to gates or fences avoided? (Ifapplicable) 17^ 

" ^ ^ 4.

 Was damage to retaining walls avoided? (Ifapplicable) 

Foundation, Siding and Gntlers Yes No 

I. Was damage to the siding or trim avoided? 

2. Was damage to Ihe foundation avoided? K ^ 

3. Was damage to windows avoided? 

 Was damage to windows or door screens avoided? 

5. Was damage lo downspouts or downspoul extensions avoided? iy ' 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage to driveway surfaces avoided? c x " 

2. Was damage to walkway surfaces avoided? 

-Z^'^ 
Owners comments: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod warranty: 

EPA Representative Uov t \Sa££ . Date: /o/xi/oj 
L 

• 

Property Completion Agreement 

This agrcemeni documents the completion of remedial acliviiies pcrloiincd on my pioperty My signalure 

will designate that f am satisfied wilh Ihe restoralion of my properly, and Ihal no items are in queslions. 

now, or al any lime in the future, except those items lisled below, ifany 

Property ID: 2(05lg > 

Property Address: -^^^i . Pr)pp\P.Vy n /W P

^'"""'^"""'"' :>7..\L yg^SA 

Owner: CYV^r\oVV ^ rSVlAtcL S 

Phone: g^^ ^ Q^^y^, ^^^< ^ 

Restoration Items in Question: 

"•-^ fflulr.K 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

D^e=^f^-\ c.9r \0 ^^<^ ^ )MOIOU^ t^<9 ^jc^lci \\^ ^ |0 

I VTl agree • Mtoralion » completed, except as nolcii 

[_| I do nnt «Krec retloration is completed 

Owner's Sipnahir gnahirrr Dutc* D«tc •' ^ ^ Connirlor' s Signalnrc Dale