0 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID 

*: 1^ 0 ^ Date: t q 

Address: H^^^ V\MU ^f 

Remediation Contractor: Coastal Environmental Group_ Year: 200 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

i Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

4 

Restoration Agreement 

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

Confinnation data 

Photographs 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Prcpmy infjetrmation from Douglas County Assessors Office 

a W(. 

Date 

30054859 

Superfund 
•I 

Property Access Checklist 

Property ID:2^qQ7 ^ n WORK STARTED ON: 

Property Address: i^-a^mp) ^qpV e 6 \ D WORK COMPELTED ON: 

Owner: 

Renter "^ar^ Vo'S.oJf^ 

Address: 

Phone: 

Fa,\: 

Cell/Pagen 

Phone: "J 

w Additional Information: X^ZVi? 

Fax: 

Cell/Pager: 

D Notification Letter 

Sent: / / By: 

H^ Access Agreement 

Signed: _g./4i!t/-03 

By:£. C 

H^ Restoration Agreement Signed: A / \^ ' 0 ^ By: £. r 

• Topsoil Sampling (if applicable) 1 1 By: 

D Disposal Samplmg (if applicable) 1 1 By: 

n Garden Sampling (if applicable) 1 1 By: 

J3^ Utility Clearance Called: y_/i^/D 9 By:^/lW(9 ^ 

^ Video/Photos (Before) On:±,lL!.IJ^ By: 

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

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

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

""^J Property Completion Agreement 

Signed: _/D/i£?/ ^ By: 

' r t l Final Report 

By: Issued: / / 

Air Monitoring (as applicable 

• Community • Crew On: / / By: 

Results: 

D Community D Crew On: / / B,= 

Results: 

D Community Q Crew On: / / By: 

Results: 

Omaha Lead Site 

1 
Property ID #

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

CONTACT FORM 

 ?A'AO Z 

^mn ^a^^ is\: 

 Date: Time; Action: 

 Date: Time: Action: 

 Dale: Time: Action: 

 Transmit to EPA D Other Action: D 
Douglas County Account Infona^ion Page 1 of2 

Dougla s County , Nebrask a Propert y Recor d - R090897000 0 

Print Report 

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

New Feature ->-•- > Auto Sales Search 

Owne r 

PUSCH JAN E 

P O BOX 540432 

OMAHA NE 68154-0000 

Propert y Informatio n 

Key Number: 0897 OOOO 09 

Account Type: Residential 

Parcel Number: 0908970000 

Parcel Address: 4340 MAPLE ST 

OMAHA NE 68111-0000 

Legal Description: CREIGHTON HEIGHTS LOT 22 BLOCK 9 S 11 FT LT 22 BLK 1 COVELLS ADD & 

50 X 90.4 

Valu e Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$5,400.00 

$5,400.00 

$5,400.00 

$5,400.00 

$5,400.00 

$5,400.00 

Improvement 

$44,400.00 

$44,400.00 

$44,400.00 

$44,400.00 

$12,400.00 

$11,300.00 

Total 

$49,800.00 

$49,800.00 

$49,800.00 

$49,800.00 

$17,800.00 

$16,700.00 

Lan d Informatio n 

Acres 

0.1 

SF 

4500.0 

Units 

1.0 

Depth 

90.0 

Width 

50.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R09... 8/11/2009 
Douglas County Account InforiM^on Pagel ofl rn^ c 

<S«>M«P1LEST 

Sacond Fteor p-—' 

»«r » p 

Br*» Floor I*" Lssi 

860.0 W|.4t, " ' 

<ir 

nv I un' 1 1.C STORY FTN 

f«4W=IJ.<.M.W.t.llMH.-W.III.«i.'gna5mm 

CLICKXO EN LARGE JMAeE CLICK TO ENLARGE IMAGE ] 

Square Footage: 1444.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: I Fair 

Unit Type: Condition: I Fair 

Built As: 1 1/2 Story Fin Condo Square Footage: I 0.0 

HVAC: Central Air to Air Rooms: i 8.0 

Exterior: Frame Siding Units: \ 1.0 

Interior: Drywall Baths: | 1.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1900 0 0% 1900 109 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 680.0 

Carport Detached 360.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch Slab Roof Ceil 226.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R09... 8/11/2009 
Page 1 of 1 

"> 

Create Another Ticket Back to Irth Internet j Send Email 

• YOUR TICKET NUMBER IS 2374307. 

Original Call Date: 9/28/09 Time: 2:26 pm Op: ELIZABETH18790 


Work to Begin Date: 9/30/09 Time: 3:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4340 Street: MAPLE ST 


Twp: 15N Rng: 13E Sect-Qtr: 08-NW-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 OF CORNER LOT 


: RESENT DUE TO WORK EXTENDING. PLEASE REFRESH PAINT AND FLAGS 


Company : COASTAL ENVIRONMENTAL SERVICE 


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


Work Being Done For: coastal 


Depth of Excavation: 4ft 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 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 


Emerg: 4029329757 


Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt 4024445161 

Emerg: 4024445160 

Day: 4067289343 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK NA Alt: 4062071494 

Emerg: 8887289343 

http://v^ww.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/28/2009 
As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

lllllll 29402 

Omah Exterjpr Paint North Arro w Owne a Lea d Site r Name: JAN ERIC PUSCH 

Sit ig^oo d e Sketc h Address : 4340 H/IAPLE ST • Poor Phone : H: f r r Not paint 

Sample Number 

RYASCPXA-29402

RYBSCPXA-29402

RYCSCPXA-29402

nYDOOPXA 20402

RDZSCPXA-29402

r^OgOGPXA-20402

nrgoonxA-20402 

 F l 

 F2 

 B1 

BS-

 DZ 

 GZ­

-PZ 

: OLS#: 29402 ; 

Date Excavated: 10/7/09 

Date US£PASitineidt>fft?t 

\rea Sodden: 1926 sa ft 

Lead 

Concentration 

Sample 

Collected LAB 

_y£4f__ppm 13" D 

n 

^5^ 1 ppm cr n 

/00C^ 

ppm 

ppm D 

D 

n 

ppm n 

ppm n n 

Number of Samples = 

Samples Collected 

Firm: m^^'^riiJOA . 

Date: \l/S/0 ^ 

Time: II'- 3" ^ 

Samples Analyzed 

XRF Unit: ^ I'Z- Book: ^ 

Date: //-J&-'^'f ~ 

/ V ^ 

Omaha Lead Site 46130 

Legend 

Concrete Drip Zone Excavated Quadrants Excavated 

Area replaced with Area replaced with 

Area lef t bar e Sod ' ' Rock/Mulch 

Contrac t #: EP-R7-07-05 Coastal Environmental Group Inc . 
29402 

L Vr¥e 

^^^•^M> 1/5^ ^^70 

r(\a^.le.'SV 

Omaha Lead Site 46130 
i^^ll ^ il l 29402 

Exterjpr Paint Nortti Arrow 

Owne Omaha Lead Site r Name: JAN ERIC PUSCH [g^ood Site Sketch Address: 4340 MAPLE ST • Poor 

Phone: H: W: f

[]] Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB Samples Collected 

Firm: /Y\FS.'/\.f(./OJ . 

RYASCPXA-29402 Fl ppm D Date: It/fi/o S 

RYBSCPXA-29402 

RYCSCPXA-29402 

^YDOCPX;^ 20402 

F2 

Bl 

-BSr 

5^g 

^^ 7

ppm 

 ppm 

^PP m 

cr 

n 

D 

D 

D 

Time: // '• 3 ^ 

Samples Analyzed 

RDZSCPXA-29402 DZ /0^ ^ ppm D XRF Unit: ^/ ^ Book: ^^ 3 

ROZOCPXA-20402 GZ­ ppm n D Date: //'/g~^^ ^ 

RnZOCrXA-20402 P2 ppm D Time: /V ^ 

Number of Samples = ' ^ Staff: C7<r ^ 

%^\^.%\ . 

Omaha Lead Site 46130 
^rW ^ 

29402 

Omah Exterjpr Paint North Arrow Owne a Lead Site r Name: JAN ERIC PUSCH 

Site [g^ood Sketch Address: 4340 MAPLE ST [ • Poor 

Phone: H W: f

Q Not paint 

Sample Number 

RYASCPXA-29402

RYBSCPXA-29402

RYCSCPXA-29402

nYDSOPXA-20402 

RDZSCPXA-29402

nOZOGPXA-20402

nPZOCPXA-20402 

 F1 

 F2 

 81 

-B2­

 DZ 

 G2­

-P2 

Lead Sample 

Concentration Collected 

ppm 

^9e ppm cr 

ppm ir 

^PP m D 

/&0Cf i ppm [T 

ppm D 

ppm n 

Number of Samples = '-I 

LAB 

D 

D 

D 

D 

D 

D 

D 

0 

Samples Collected 

Firm: yUFS-Zl./y./A/l. 

Date: W/^JJOH 

Time: //" 3 ^ 

Samples Analyzed 

XRF Unit: ^/ ^ Book: ^^ 3 

Date: //-/g-^ ^ 

Time: f ^ 

Staff: OKT^V 

raAfc..<;4. . Omatia Lead Site 46130 
,v^to sr4 . 

COASTA l 

ENVtKONM f XTAI 

''^< Pno't"^ C H 0 U r . IN C 

Coinsent fcf Access To FrQ'pert^/ 

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 

following described premises: 

Owner's Name: Daytime Phone: 

Jot <> . V^^^ ^ -7^g- • 'Vi?^^ 

Address of Property 

covered by this ^^ ^ /U/vf It^ 

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 w/ritten 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 perfomning the work. This access shall 

remain in effect until the work has been satisfactorily completed. The Grantor also 

agrees to: 

Page 1 of 2 
.^-'^If'^v, 

. ^ 

"*! PflO^ 

COASTA L 

IPtVIKONKFKTA I 

C II D U * IK C 

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

piles, dog houses, etc; 

od 

e Remove flower bulbs or plants that the Grantor or the Grantor's tenant may w

to save; 

ish 

c Water and maintain replacement vegetation, including fertilizer application,

necessary' subsequent to an initial watering period by EPA; 

 as 

c Abide by health and safety guidance provided by EPA; 

f If the property is rented, assist EPA in obtaining tenant approval for access

the properti' to perform the work. 

to 

c 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 (402) 991-1199 

.^1 grant access to my properties D I do not grant access to my properties 

Sianature 'HJ^ f\ u Date Signature Date ^ W 

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

Page 2 of 2 
COASTA L 

RestorataoiT Agreement 

The purpose ofthis 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 ofthe property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: Qj^^lf- Q ^ 

Property Address: 6^'^ Q J^A^Ui "^ V 

; Owner: 1<y^ 'C yus ^ 

• ^ . 

Phone: 75 ^ T^I( , 

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

access iocation(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 Renriediation: 

The lemoval, storage, disposal, and/or return of these Hems is the Owner's responsibility. 

ttem: 

W-w/ ^ -^v// PLd^^r^Jc 

ttem: 

Kem: 

Item; 

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

Item: 

CL . S^lj ?^|,( bJk ^^^x.A 

Item: •f 

Item: 

Item: 

a 

Page 1 of 
COASTA L 

Items to Be Removed By Contractor During Remediation and Regiace^ 

Item: 

Kem: 

SoO ^

Kem: 

Item: 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

tmnk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

All.ith a skeicli ol the 

"•rrii'kloi l;!\'.uii 

Number of and size of 

each garden/ flower bed 

area. 

All;\cll ;i skL-lcli ol ri-!;HiVL' 

M/fS niid loc;lIi(^^^ 

Agreed upon value of plant 

materials not to be 

replaced by contractor. 

Voir llii' ^Hlllc will hi 

lisrt. Ill I;; 111 .; iilKni 

»oiiC)UT Ul ilie |:riipcii> 

u^^ ner. 

 Tl ^r-z- jSi ^ p= 

Landscape Inventory 

Quantity Unit Condition/Type/Species 

fi;fa 

Quadrants 

I Each 

Each 

(^ Each 

/ ^ 

Each 

Square Feet 

( ' 

S 

/ 

Easement Area, to be Each 

excavated 

Page 2 of / 
# 

COASTA L 

* Additional Comments / Instructions: 

L. 

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 is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

^ I agree n I do not agree 

/ Owner's Signature jO ^ nato r'nn«..o/.tnri Contractor'c ciimot.,..,, r r«««. s Signature '-^Z)-y 

Page 3 of (_ 
BVID#c2g^^^ 

XRF PROPERTY SAMPLE SHEET 


Date )OIQ^O^ Address i/^t/Q moAitr SE Project Omaha lead FP 2nd year opilon Sample time am/pm 

XRFID# sample length 30 sec 

Shot# Reading Saniple area Shot# Reading Sample area 

i f^ rk/(^ / ^ ^Ij 

i>r?. i^( ^ Nl -^/r P^ 

Depth Depth im. 2^.?Y f^ ^ 

/^^2 ^ m -^(^ 

Average f/^.^ J^ l (^ Average ///g?-J^ / / ^ 

Shot# Reaeadin d ing i Sample area Shot# Reading Sample area Ym 

W^T- % ^ M ,m. ^-( 3 Depth m ?^(^ £ ^ Depth 

\\ 3:^ 3S: w^Y ^^ ^ l^-*-

Average l^^j - // T Average '2..ii> :3^ ^ 

Shot# Reading Sample area Shot# Reading Sample area 

£1 i

£ 

7^2 - ^ /I Depth Depth 

?^^C ll^?"^/?- .IZX 

Average \ ^ / JI I | (_^ Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

Signatun ££Mm^ 

Print iy\oaY£)}f\ Coc.a^ 

o 
?^JOL \ Omaha Lead Site—Fixed Price EP-R7-07-05 

^J^^v ' I

% ' ­p* %Pnott^'^

 Coastal Environmental Group Inc.

 www.coastalhazmat.com 

VI 

^? ' 

COASTA L ENVmONHENTAL 

CROUP , IHC . 

EXECUTIVE SUMMARY: 

BVID # 29402-(4340 MAPLE ST) 

^ No Issues or Concerns Q] Issues/Concerns 

Detail Explanation: 
4

f •I 

^£•• 1 Bf t 

EPA Property Close Out Form 

Property #: "2.^4^7- . 

Date/Time: Owner's Name:. ,^.X\,Y^^±(0 -

Quads Excavated: p ] f-'-^. fi\ DiL Contractor Group QC^KI^iOJ CJjTMiogi^P ( -

Excavatio Yes No n General 

1. If necessaiy, were the correct quadrant(s) excavated and restored? t / 

2, If necessary, were the correct areas ofdrip zone excavated and restored? iy^ 

Yes No 

1, Does the grading around the perimeter ofthe house in excavated areas generally slope away 

from the house? ty 

2, Has sod been laid in all areas that were excavated? l y ' 

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

Grading Sod and Vegetation 

y day time period) _^__ 

4. Are sodded areas generally firm and evenly graded? \y 

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

6. Was the property graded such that water will nol pool on the property? y 

7. Was damage to landscaping or plant materials avoided? \ / 

Gates, Fences and Retaining Walls Yes No 

I, Do gates open and close freely? (If applicable) 1 / 

Were all gates or fences taken down during restoration activities reinstalled? (Ifapplicablc) \ y ' 

3, Was damage to gates or fences avoided? (If applicable) 1/' 

4, Was damage to retaining walls avoided? (If applicable) 

Foundation, Sidinnand Gutters Yes No 

1. Was damage to the siding or trim avoided? ( / ' 

2. Was damage to the foundation avoided? T ^ ^ 

3. Was damage lo windows avoided? 

 Was damage to windows or door screens avoided? 

5, Was damage to downspouts or downspoul extensions avoided? ^7-

Sidewalks and Driveways (Concrete) Yes No 

1, Was damage lo driveway surfaces avoided? 

2, Was damage to walkway surfaces avoided? IP' 
Ov^ners comments: 

Inspection notes: 

Removal and restoration activates complete mcluding the 30-day sod warranry: 

EPA Representative jJo H nO^J^ y Date: /Of^^/0 9 
Frora:COASTAL ENVIRONHENTAL 877 662 4211 to/2 9 10:56 #451 P, 002/003 

< # 

Property Conripletion Agreement 

llitb agreement dwuineni* lhe completion ot remedial acliviiies perfoiircd on my properly My signaiuic 

will desi^naiE iliai I am satisfiisd with the rcsicialion of my properly, and Ihal no ncms arc in qiitstions 

now. or ai any innr iii lhe future, excepi ihose iiems listed tielciw, if any 

Property m : ^QLT).; ^ 

f>riytrcy Addrc..«: { j "3, L/f ^ M apl ^ S V 

I 

Phone: p^^ ; -15ft - 2 a 7 A 

Restaration Hems in Question: 

Iterr: 

Item: 

Jtem: 

Item: 

Item: 

Jtem: 1 

1 

Additional Comments; 

QS\} *trc r 1 nrnrntion il complcird, cxccpl at nolril 

I I I rto nni »i;rpc rcsiorxtian is (smplclcd 

OwhHi'sSJtnanir e ' Owe Conliiirlfn' J SiEnaliirt Oaic 

JO B6Bd H SQI e^ouiBH a