TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 2J(^2ff Date: V///^7 

Address: ^3^3 MauboWJ S/ 

Remediation Contractor: Coastal Environmental Group_ Year: _2007_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

S^ Video of property (DVD) 

5/ Executive Sununary 

!F EPA-provided property sketch 

E« Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

w Restoration Agreement 

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

M Confirmation data 

/ Photographs 

As-built sketch 

^ Satisfactory restoration signed by Property Owner 

B Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

D Utility clearances 

D Property infonnation from Douglas County Assessor's Office 

D 

D , ^__ _ 

^ 

are 
t 

Property Access Checklist 

Property W: ^ \ ^ X ^ •^ WORK STARTED ON: £Hj2j_0 j 

Property Address; ^Q,2 3 rOSjbfr^ ^ D WORKCOMPELTED ON: / / 

Ownen ^e\^^ ^ Nfel^ M 

Address: q .^^. ^ W^^uberr M

Phone: ^o;i - 5^2. - ^ ^ 0 l^ 

Fax: 

Cell/Pager: 

r~l Notification Letter 

- ^ Access Agreement 

M Restoration Agreement 

Q Topsoil Sampling (if applicable) 

CH Disposal Sampling (if applicable) 

I I Garden Sampling (ifapplicable) 

Fl Utility Clearance 

Q v ideo/Photos (Before) 

D Video/Photos (During) 

^ Video/Photos (After) 

D Video/Photos (30-Day) 

W Property Completion Agreement 

I I Final Report 

Air Monitoring (as applicable) 

CD Community

Results;

n Community

Results: 

r~l Community

Results: 

 d ] Crew On:

 d Crew On:

 [U Crew On:

Renter: 

Phone: 5| ^ 

Fax: 

Cell/Pager: 

Additional Information: 

Sent: 

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Signed; ^ / (^ / 0 1 

Called: 6'/ gi / 0 ^ 

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Omaha Lead Site 
Total Qua^^BSquare Footage to be Excavated = 438 

^ Property Classification: EBL ^(S— . Total pWRn e Linear Footaqe to be Excavated = 0 

Description of post excavation areas: Fl, front yard left-hand quadrant; F2. front yard nght-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). 

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Print Preview Page ] of 1 

Douglas Count>'-Omaha, NE 

Parcel ID 1617610000 Owner 

Address 

Owner 

Name 

NEELEY 

JEFFREY L Addition LEAVENWORTH HEIGHTS 

Property 

Address 

4323 

MAYBERRY 

ST 

Block 0 

City OMAHA Lot 117 

Zip 68105 Legal 1 44X108 

Owner 

Address Legal 2 

Owner 

Address 2 

4323 

MAYBERRY 

ST 

Legal 3 

Owner City OMAHA Legal 4 

Owner 

State 

NE 

Old 

Assessor 

Site 

http://webarc CO douglas ne us/dcassessor/details asp? 

PARCELNB=1617610000 

Owner Zip 68105 

New 

Assessor 

Site 

http://w/ebarcco.douglas.ne.us:8080/RealWare1/detalls.do? 

id=R1617610000 

Sec-TwnRng 20-15-13 

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 = 273 feet appraisal, survey, or for zoning verification. 

http://vvwvv.dogis.org/dogis alias/dogis/printPrcvicvv.aspx?PrintOptData=Douglas County-... 5/8/2007 
Yahoo! Mail - trishkasl@yahoo.com Page 1 of2 

f MAIL Print - Close Window 

From: "NE-DIGGERS" <info@ne-diggers.com> 

To: trishkasl@yahoo.com 

Subject: Re: NE-Diggers.com - LOCATE Contractors Request Form 

Date: Tue, 8 May 2007 15:03:10-0500 

************************************************************** 

Ticket* 1782136 

Work to begin date: 05-10-07 @ 3pm 

The utilities we will notify are...city of omaha traffic and sewer, cox, mud, oppd, qwest local, mcleodusa and 

nebraska health system 

If there are any other utilities besides those mentioned above, you will need to notify them yourself and any 

privately owned lines will not be located. 

— Original Message — 

From: trishkasl @yaJioo.com 

To: info@ne-diggers.com 

Sent: Tuesday, May 08, 2007 1:37 PM 

Subject: NE-Diggers.com - LOCATE Contractors Request Form 

NE-Diggers.com - LOCATE Contractors Request Form 

Name: Trishka Simmons 

Alt. Name: 

Phone:402-504-2194 

Alt. Phone: 706-7322 

Email: trishkasl @yahoo.com 

Caller ID: 18790 

Company: Coastal Environmental 

Type of work: EXCAVATION 

For Whom: COASTAL ENVIRONMENTAL 

How Deep: 3ft. Oin. 

Explosives: No 

Corner Lot: No 

Front of Property: Yes 

Rear of Property: Yes 

Tunneling/Boring: Yes 

County: DOUGLAS 

City: OMAHA 

Address: 4323 MAYBERRY ST. 

http://us.f387.mail.yahoo.com/ym/ShowLetter?box=Inbox&MsgId=8786_2573367_292390... 5/9/2007 
Yahoo! Mail - trishkasl@yahoo.com Page 2 of2 

Directions: 

Where on Property: 

OVER ALL 

Township: 

Range: 

EorW: 

Section: 

1/4 Section: 

Township: 

Range: 

EorW: 

Section: 

1/4 Section: 

http://us.O87.mail.yahoo.coiTi/ym/ShowLetter?box=Inbox&MsgId=8786_2573367_292390... 5/9/2007 
CONTACT FORM 

Property ID # M^"^ 

PSA^ 

Property 

Address: ^i^UmWn^^^ 

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 ^^' ^o^i-v 

Comment (s): 

Site 

, 

Coordinator 

Comment (s): 
•" r.,r,i*-

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 following described 

premises: 

1 1 Owner's Name: j^ffN^^/^^ ' 

Daytime Phone: ^ 0 ^ ^^0 ^ 

Address: ^3^3/Uao]tQ^77q S t o\^^W\ \j^ tnoif 

Address: J ^ 1 

Addresses of 

Properties covered by Address: 

this Agreement: Address: 

Address: 

PURPOSE OF RESPONSE ACTIVITIES 

The EPA 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 removed and the excavated area(s) will be replaced with clean materials and 

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

remediation program. 

An EPA 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 fmished, 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 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: 

«Property_ID» Page 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 ofbuildings. 

AGREEMENT NOT TO IN TERFERE 

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 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 

M I grant access to my properties d j I do not grant access to my properties 

^^^-^ ^ 

Signature ^/ ^ Date Signature Date 

I 11 would like to be present during any sampling that is required. 

Page 2 of 2 

«Property_ID» 
------ -

'm 

Restoration Agreement 

The purpose of this agreement is to pro\ ide a mutual agreement as to conditions of propertv prior lo 

remediation activities. This will also serve as decontamination for the purpose of assuring that restoration 

activ ities are completed to the satisfaction of the property owner and the United Stales En\ ironmenlal 

Proleclion Agency (EPA). 

Propertv ID: ^ \ \^ 27 ) 

Propertv Address; H3Zl > ^ ) :>^^ U^ Tr M •S^ Dt^^iU IKHL ^S/ 0 ? 

*^""-- .Tnii^ k^fi-l^^ 

Phone: L^^_^ ^ ^^^. ^ ^ C; ^ ^^ | 

On the attached diagram(s) indicaie arca(s) to excavated and depict of e\ca\ation. locaiion of all known 

ulililies. subsurface features, surface sUTJClures and landscaping features, access location(s) to be used bv 

contractor, and the direction of North. Indicaie distances, depths, malerial tv pes. etc Indicate digital photos 

bv referencing the photo-log number wilh an arrow indicatmg direction of \ icw. 

Items To Be Removed By Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

Item: 

(^cxf, ^ro^U c^:^^ -^ e b rcL^s_<r/v^ 

Item: r>^<^ ciect c 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

^^^^^^^^—^^—-^-—^—^^ — Page 1 of ( o 

1 
iCffl^ 

Item s To Be Removed By Contracto r Durin g Remediation An d Replaced 

(Use additional sheets as necessary) 

t 

Item: 

v^L.^-3^-1 A pttA* ^ c^ y f^^ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of Q, 
Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: 

Item: 

f^^ ^ |>'if^ 

Item: 

Kem: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 2 of Q. 
m^ 

Item 

Pre-e.xisting property area 

that is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch of the 

sprinkler layout. 

Number of and size of 

each garden/ flower bed 

area. 

Attach a sketch of relative 

sizes and locations. 

Landscape Inventory 

(Use additional sheets as necessary) 

Quantity Unit Condition/Type/Species 

Square feet 1 ^3< i 

5 Each 

V Each 

1 

1 

! 

0 Each 

2. F'°"^ 

Each 

Square Feet 

Page 4 of fi 
Item 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Note this value will be 

used to issue a plant 

voucher to the property 

owner. 

Agreed upon list of plant 

materials that will be 

replaced by contractor. Be 

very specific and detailed. 

Include a sketch of were 

each plant will be placed 

by the contractor. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Include a sketch of the 

area(s) to be replaced with 

grass sod. 

Area of City or County 

property to be landscaped 

per their requirements. 

Include a sketch of the 

area (s) 

Quantity 

9 

1 <\p>j ^ 

^ o 

Unit Conditlonrrype/Specles 

s 

Each 

SF 

SF 

Page 5 of A 
Additional Comments / Instructions: 

• 1 'O- ^ 

• 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. 

/01a CH I do not agree M l agree CH I do not agree asree 

n 

VA D6 - O 'g- 6 1 i^Ar ^ 7 mer's 5^^7 Page 6 of. cVot^Sl: Date Signature Kfofj Signature 
A [XodoA-ai StMiA 

032. 3 fNAa^becrM S f 

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jiHoiA? 

^3'2. 3 Viavjijernj 

'\0\^\ ^Ytl.^OLXjeL.+€_iA 

1 ^ 

\=2 ­

1=^ 

M S>^M \oeorv . % ^ 
Cl-i;n€7: M-fh^^C) l^-^-O) ^09-^27f1 Totaf^M Square Footage to be Excavated = 438 

Property Classification: EBL ^ W TWBPII . one Unear Footaqe to be Excavated = 0 

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Mayberriy street 

Legend Nort:hA|rr h Arroo w Omaha Lead Site 

Omaha, Nebrasica j;^:i ^ Concrete 

1/^/ ^ Excavated Area Property Number N OLS-21629 r* ^ Existing Structure Scale Property Address ^ ^ Permanent Landscaping 1 Inch = 20 feet or 1 grid = 5 x 5 ft 4323 MAYBERRY ST 

•—•— • Fence 

^«^ . Post Excavation Concentrations (ppm) 

— — — Quadrant Boundary Fl . B2 PlayArea I A ; V HGL Street Boundary F2 DZ Easement 

^*»noy Bl Garden Other (Q) Tree/Shrub 

Description of post excavation areas: F1 , front yard left-tiand quadrant; F2. front yard right-hand quadrant; B1 , tiackyard tefl-tiand quadrant; B2. t>aclcyard rigtit-tiand quadrant: 

DZ. d'ip zone (1-3 foot area of soil around the foundation of the house). 
g^ 

PROPERTY CLEARANCE WORKSHEET 

Date 22-May-07 

Property ID 21629 

Property Project Omaha Lead — Fixed Price 

4323 mayberry Address 

Measuremen 

XRF ID 0107-51 t 

Count/Time 

Field Shots 

Shot # Reading Sample Area Shot # Reading Sample Area 

' 81 78 ea-n 

93 42 b l 

Sample Area ea-n Pass/Fail ? 

Aliquot 

1 

I n Situ 

Reading Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Analytic 

al Spilt 

Sent? 

Lab 

Numbe 

r 

Analytical 

Results 

2 60 ppm -H/- 4 ppm 

3 91 ppm -vl- 7 ppm 78 ppm 

4 82 ppm +/- 6 ppm 

5 94 ppm 1 

Sample Area b l Pass/Fail ? 

I n Situ Composite Composite Analytic Lab Aliquot Composite Readings 

Analytical Reading Average 

(Dried & al Spilt Numbe (Bag) 

Results 1 -31 (Bag) Sieved) Sent ? r 

2 86 36 ppm +/- 3 ppm 

3 24 37 ppm +/- 3 ppm 42 ppm 

4 57 53 ppm +/- 4 ppm 

XRF Corrected Value ~ > 

5 51 (use calibration chart or add 50 ppm 

2 0 % to value) 

Sample Area Pass/Fail ? 

I n Situ Composite Composite Analytic Lab Aliquot Composite Readings 

Anaiytical Reading Average 

(Dried & al Spilt Numbe (Bag) 

Results 

1 (Bag) Sieved) Sent? r 

2 -1-/- 0 ppm 

3 +/- 0 ppm 

4 +/- 0 ppm 

XRF Corrected Value ~ > 

5 (use calibration chart or add 

2 0 % to value) 

Confidential 5/22/2007 Page 1 of 2 
Sample Area Pass/Fail ? 

Aliquot 

1 

I n Situ 

Reading Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Analytic 

al Spilt 

Sent? 

Lab 

Numbe 

r 

Analytical 

Results 

2 -1-/- 0 ppm 

3 +/- 0 ppm 

4 +/- 0 ppm 

XRF Corrected Value --> 

5 (use calibration chart or add 

2 0 % to value) 

Pass/Fail ? 

Aliquot 

1 

I n Situ 

Reading Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Analytic 

al Spilt 

Sent? 

Lab 

Numbe 

r 

Analytical 

Results 

2 +/- 0 ppm 

3 +/- 0 ppm 

4 +/- 0 ppm 

XRF Corrected Value --> 

5 (use calibration chart or add 0 ppm 

2 0 % to value) 

XRF Technician's 

USE ADDITIONAL SHEETS IF 

NEEDED 

Signiture 

Confidential 5/22/2007 Page 2 of 2 
Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. ^ * www.coastalhazmat.com "iPBOlt^ COASTA L 

ENVIRONHENTAL 

C R O U r , INCEXECUTIVE SUMMARY: 

21629—4323 MAYBERRY ST 

No Issues or Concerns X Issues/Concerns 

Detail Explanation: 

Property Owner was issued a gift certificate # 2502 in the amount of $50.00 from Indian Creek 

Nursery as reimbursement for flower bed area removed during excavation. 
--

• • • 

As-Built Drawing 

COASTA L Omaha Lead Superfund Site 

Total Ouadrant Square Footage to t>e Excavated = 436 

Property Classification: EBL Tolal Dnp Zone Linear Footage to be Excavated = 0 

I 

1 

oral <»»» • 

1 

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1 ; 

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1 

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EA=78 PPM 

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k "* • ^>- : ! i * • . • 1 < , .•:ir-— y ". ,,:.. ' .<:.-. ^. ' , i '..:. 1 < •.«••• : 

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. "V.. 1 ! : F 

-layberry Stre r el 

Legend OLS#:21629 NorthAfTO W Omaha Lead Site 

Dateexca^ated:5/22/0 Omaha. Nebraska 7 

DJ Ite USE oASffgrtstfC )ff:6/29/07 N Propert y Numbe r 

OLS-2162 9 

1=) (isting Structure d Scale 

Propert y Addres s S p< .caping 3 •rmanent Lands 1 Incti = 20 teet or 1 gnd = 5 X 5 tt 432 3 MAYBERR Y S T 

Quadrant Boundary Pos t Excavatio n Concentration s (ppm ) 

F1 8 2 PlayArea - Street Boundary , ( , - , . • , -,. • •• • F 2 r^7 PacarMon t 

Tf ee/S Hrub Vi^ "-f ^ I ^^ ' Z ' ^ ••^- / 

\ 81 (3ar del T _ oth e r 1 

DMOipOon o'pDVt «xc«vanan «•• • Fl . front yard fmfi-hmrxS quadrant, F2. front yard tight-hand quadf ant, 61 . bacKyard ler^hand quadrant. B2. backyard nghl-tiand quadrani. 

OZ. dr9> zone < 1 3 foot area of SCHI around the founda1>on of ttie house). 

Legen d 

Area not Excavateid Dripzone Excavated Quadrants Excavated 

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

SEf^ 

Property Completion Agreement 

This agreement documents the completion of removal activities performed on the below listed property. 

The property owner's signature indicates that the property owner is satisfied with the restoration ofthe 

subject property, and that no items are in question, now, or at any time in the future, excluding any 

remaining sod warranty (30 days total) except those items listed below, if any. 

Property ID: c7lip'^ 

Property Address: ^3^ ^ hAaxjb-F. rriA s-h. Owner: U-f/f Ntc7tv\ J 

Phone: ^o^-^eo^'iJ 

Restoration Items in Question: 

Item: .- ^_^ ^,-^ 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

H^gre e restoration is completed, except as noted above. 

 I I do not agree restoration is completed 

A3-01 

Date 
^ 

Omah a Lead Superfund Site 

Miscellaneous Landscaping Replacement Certificate 

Property Owner ^'7 ^ Klt^l'Lv 

Property Address i!)2 2. (^^^XrJKL^^ K 

Property Identification Number 'S^ \ L? 'S "^ 

Material Removed Replaceinent Value 

Flower bed area *^o.' -

Trees 

Itemized 

shrubs/bushes 

Total '^ 5 b " ^ 

The acceptance of the replacement certificate and the signature below is full 

acknowledgement by the property owner that this is a fair and reasonable compensation 

for plant materials removed during remediation activities, but not planted or installed by 

the government or it's contractors. 

The total amount of $ ^o . 
^ has been received by the-^wngr in the form of a gift 

certificate, # ^S*^^ , to be utilized at ,_x,>aVA^ K 7_'ctJc_ (\X<^-vCq>'^-'^ 

Property Owner's Signatur^ Date ntractor's Signature Date 
SEPA^ 

EPA Property Close Out Form 

Property #: c9-l(^9'\ Property Address: ^^^ ^ '7^^ .•-. 

Date/Time: Owner's Name: ,J^lf Nt-^/-tAj 

Quads Excavated: Contractor Group - ^ 

Excavation General Yes 

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

2. If necessary, were the correct areas of drip zone excavated and restored? M ^ 

Gradine Sod and Vecetation Yes 

1. Does the grading around the perimeter ofthe house in excavated areas generally slope away A fix)m the house? 

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

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

day time period) A

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 y 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 

1. Do gates open and close freely? (Ifapplicable) to-J^ 

2. Were ail gates or fences taken down duringrestoration activities reinstalled? (Ifapplicable) i^ 

3. Was damage to gates or fences avoided? (Ifapplicable) AI A 

4. Was damage to retaining walls avoided? (Ifapplicable) y ^ 

Foundation, Sidinc and Gutters Yes 

1. Was daraage to the siding or trim avoided? y ^ 

2. Was damage to the foundation avoided? :7 

3. Was damage to windows avoided? y 

4. Was damage to windows or door screens avoided? i ^ 

5. Was damage to dovraspouts or downspout extensions avoided? y ' 

Sidewalks and Driveways (Concrete) Yes 

1. Was damage to driveway surfaces avoided? ^ 

2. Was damage to walkway surfaces avoided? i).A 

No 

No 

No 

No 

No 
Owners comments: 

Inspection notes: 

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

EPA Representari\^^/'^^z.^3z6L..^a.;^tH-'^ Date: ^72^ ^ / p 7