"•np«*y,?:"r-'i^'»^- • • •, ' ''• .:"->r^j"'5rW"»=f' 

TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: SS'34 Date: A//^^/:2^^ 5 

Address 

Remediation Contractor: Coastal Environmenta l Group _ Year: 2007 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

B^ Video of property (DVD) \>£^pn ^ 

0^ Executive Summary 

[J/ EPA-provided property sketch 

0^ Signed Access Agreement for subject property 

n Signed Access Agreement(s) for adjacent property 

[F Restoration Agreement 

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

ffl^ Confirmation data 

i / Photographs [>f.-(-0<le, 3^20 '. 

^ As-built sketch , 

0^ Satisfactory restoration signed by Property Ovraer 

E Property close-out check list signed by EPA IJ^IShl£>0~J 

D Description ofareas not meeting ROD cleanup criteria 

D Utility clearances 

u Property information fi'om Douglas County Assessor's Office 

D 

ignature < DatT 

40312874 liliiiii 

Superfund 
Final Report Property Check List (piease place with each nie) 

Har d Cop y Informatio n 

Property Check List 

Site Working Drawing Map 

EPA originals Map 

Douglas County Assessor's Map 

Property Contact Sheet 

Agreement 

i s 1. Access Agreement 

"S "• Restoration Agreement 

IMiscellaneous Documents 

/^l . Final Map from the Field 

n 2. Change Orders ^Vfy 

^3 . XRF Data . 

I~( 4. Any emails or PO correspondences ^ r^ 

Property Completion 

; ^ 1. Executive Summary 

SI 2. AS BUILT 

3. Property Completion Agreement 

\. Any buyout info or reimbursement into 

Qs ^ Check or money order copies 

"^ISK 6. EPA Property Close Out Form 

lH 7. Attached Begin Video 

Electroni c Documentatio n 

Drawings 

K i I- EPA original 

^^2 . Working Drawing 

3. AS Built.vso 

4. AS Built.jpg 

Photos 

1 Begin Photos 

2 During/Excavation Photos 

^ Sod Photos ji 

4 30-Day Sod Photos 

Scanned Documents 

Final Documents 

Executive Summary 

> 

Videos 

' Begin Video 

••^ My Movie 
Property Access Checklist 

PropcMty lb: ^^^3" ^ 

n WORK STARTED ON: _/ /_ 

D WORKCOMPELTED ON: / / Pr»,>c.-rV Address: 'JYOS^'^JM^^S ^ 1 ^ ^ 

Renter: ^'UiO:iLr^ \Xo\ ^ 

Address: 

Phone: 

Fax: 

Cell/Pager: 

Phonor^a:) cg^-67<^^7 

Additional I ni'onnation: 

Fax: 

|j ^ NotiCieation Letter Smt'._^l£_l^- ^ Bv: ^c^ S 

c E Aeeess A<;reement Signed: ^/_^422 L 

^y- ^A^, ^ 

p s Restoration Ajjreenient Signed:/0/X-/dS­ B.v- ^A^f ^ 

1 1 Top.soil Sam|)lin<4 (if applieahle) / / By: 

1 1 Disposal Samplin<; (iC a|)plieal)le) / / By: 

1 1 Garden Sainplin<> (if applieable) / / By: 

^ Utility Clearance Called: fi_ 1 ^ l/lp- „ ^ lo/9^€-hisd 

J^ Video/Photos (Before) On: M^/a^J-Oj 

n Video/Photos (Durinj;) On: / / By: 

^ Vidco/Pliotos (Aftci) On: IL/A.^ 67 By: Ui ch^ 

n Video/Photos (3()-Dav) On: / / By: 

^ Property Completion Ajircement Signed: i ^ 5/0 7 ^y- (k^cs. 1' ^ Final Report Issued:

 / / ^y- Pi-hA 

Air IVIoiiitoiinu (as a|)plieal>le) 

• Coniniunity • Crew On: / / 

Results: 

n Community O Crew On: / / B,: 

Results: . • il ­

1 1 Community CH Crew On: / / By: 

Results: 

Omaha Lead Site 

ffS.>iJiM::Mik. ^.•...-...i..^!V..,V _i_.. . 

1 
© 

}^ - \<^l^'^ l 

jV^e opi% 

Name Omaha Lead Site 

Address: )Qr\'^ f'(T^ y Site Sketch 

Dhnno' ' i' Phone 2/tSi/ 4^ce$j 

Date O / XRF Code y//^^-> ;a^ ^^-.fe^^f/4\pnK^r°*«^y 

Sample Number 

Lead Concentration Confimiation Sample 

<^i ^ ppm Yes • NO^,ZJ 

2 ^^^m-^<.^ L 

Yes • No^ja ^ 

Yes Z2X^Mozf\ ^ 

Yes j2^;^|^No^zr ^ 

Yes«n r '^No • 

^^^^^^^c^mA 

Omaha Lead Site 

46904.783-01 
Douglas County Account Information Page 1 of 1 

Douglas County, Nebraska Property Record - R1040380000 

Print Report Information is valid as of 2007-8-24 Vjewpn jyiap Values not finalized until after Board of Equalization i Treasurer's Tax Report 

Owner 

MOISE WILLIE L 

PO BOX 34746 

OMAHA NE 68134-0000 

Property Information 

Key Number: 4038 0000 10 

Account Type: Residential 

Parcel Number: 1040380000 

Parcel Address: 1805 CORBY ST 

OMAHA NE 68110-0000 

Legal Description: FLACKS SUB DIV-MILLARD & LOT 3 BLOCK 0 30 X 78 5/8 

Value Information 

Land Improvement Total 

2007 $200.00 $0.00 $200.00 

2006 $200.00 $0.00 $200.00 

2005 $200.00 $0.00 $200.00 

2004 $0.00 $0.00 $0.00 

2003 $200.00 $0.00 $200.00 

2002 $0.00 $0.00 $0.00 

Sales Information 

Land Informatio n 

Acres SF FF Units Depth Width Vacant 

0.05 2370.0 30.0 0.0 79.0 30.0 Yes 

Land Attributes 

Attribute Attribute Description 

Improvemen t Information 

http://douglasne.mapping-onHne.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 0... 10/5/2007 
Dougla

s County NE GIS Map 

LEGEND 

Minor Straets 

X out 

Major street* 

X tuto

r SAitta 

InterstAtes 

X 

IntMiUtM 

Parcels • 

parcelZ 

Hydro H 

Drh/Bfiby We^GUIDEl 

Disclaimer: This map is not guaranteed 

to be accurate, correct, current, or 

complete and conclusions drawn 

are the responsibility of the user. 

CONTACT FORM 

Property ID # 

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

Owner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

^^s' ^ 

 Date: Time: Action: 

 Date: Time: Action: 

 Date: Time: Action: 

 Transmit to EPA D Other Action: D 
X 

i % 

Omaha Lead Site—Fixed Price EP-R7-07-05 

Coastal Environmental Group Inc. ^ < # www.coastalhazinat.com 

COASTA L ENVIRONMENTA L 

CROUP . INC . 

EXECUTIVE SUMMARY: 

05534—1805 CORBY ST 

No Issues or Concerns I I Issues/Concerns 

Detail Explanation: 
Property Completion Agreement 

This agreement documents the completion of remedial activities performed on my property. My signature 

will designate that I am satisfied with the restoration of my property, and that no items are in questions, 

now, or at any time in the future, except those items listed below, if any. 

Property ID: ^52, 

ProptrlyAddr...: /^ ^ ^At^^.J/ -

Owner: £1 lir.^SJ? 

Phone: Od:) ic ^ - U^ie^] 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

\ 

j 

[y r agree restoration is completed, except as noted 

 I I do not agree restoration is completed 

Owner's Signature Date Contractor's Signature 

I
As-Built Drawing^ 

COASTA L "Omaha Lead Superfund Site 

Name: Omaha Lead Site 

Address: )'^n,"? (\'Xk>V Site Sketch 

Phnnp - ' i' 

XRF Code °-' '^Mr^^ •'-%^.^jkr.>^r'"«^ :7a4L 

Sample Number Lead Concentration Confirmation Sample 

M .52, (Sn^d:^ ^ ppm Yes • No FD S: ^ ppm Yes • No^0 ^ 3 iyffi'CPXR-^^^^, 5^S ppm Yes • No JZ!f\^ 

A is'y^>^.PXT^^T^ '—" ^ J ppm Yes • No /Q""' ^ 

Yes • No • 

Omaha Lead Site 46904.783-01 

Legend 

Area not Excavated Dripzone Excavated Quadrants Excavated 


Contract #: EP-R7-07-05 Coastal Environmental Group Inc. 

i

S*?L EPA 

EPA Property Close Out Form 

Property #: ''yS^^H' . , Propert y^u jL ^ Property Address: Address:- J-MD -

Date/Time: Owner's Name:. // l jr Uj/^.^ 

Quads Excavated: Contractor Croup 

Excavation General 

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

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

Grading Sod and Vegetation 

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

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 

day time period) 

4. Are sodded areas generally firm and evenly graded? 

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

time period) 

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

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls 

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

2. Were all gates or fences taken down during restoration activities reinstalled? (If applicable) 

3. Was damage to gates or fences avoided? (If applicable) 

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

Foundation, Siding and Gutters 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

^i^ 

Yes No 

^ 

Ves No 

i x ^ 

1 ^ 

t ^ 

1 ^ 

i X 

Yes Nu 

x/UA/'L 

A'^ 

iJ^ 

Yes No 

/(M 

/^A 

/yi 

N I 

Ph 

Yes No 

/^A 

pl^ 
Owners comments: 

Inspection notes: 

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

EPA Representativ^,^^;^^;^!^;^^ \A^7 ^ Date: 
......:% 

•J'-": •'i- r.»'<*'

4i PROPERTY CLEARANCE WORKSHEET 

"^ 

Date Property ID 11-09'Ol E^^'i 

Property Project Omaha Lead -- Fixed Price Address /8o5 C^r^^ sr 

Measurement 

XRF ID 0107-51 Count/Time 

Field Shots 

Shot # Reading Sample Area Shot # Reading Sample Area 

/fco Z5^ e A ' N 

/6S ns R2. tJ-C 

Sample Area <^A-Ki 

Aliguot 

1 

I n Situ 

Reading Composite Readings 

(Bag) 

Composite 

Average 

(Bag) 

Composite 

(Dried & 

Sieved) 

Analytical 

Spilt Sent 

7 

Lab 

Number 

Analytical 

Results 

2 

3 

4 

iV/ 

Zot 

ZS1 Z3V XRF Corrected Value - > 

5 (use calibration chart or add 

2 0 % to value) 2'15 

Sample Area ^•2- »f-L» Pass/Fail ? 

I n Situ Composite Composite Analytical Aliguot Composite Readings Lab Analytical 

Reading Average (Dried & Spilt Sent 

(Bag) Number Results 1 180 (Bag) Sieved) ? 

2 i n I9S 

3 i k l 120 /^y 4 lib n f XRF Corrected Value - > 

5 19^ (use calibration chart or add J.OS 2 0 % to value) 

Sample Area Pass/Fai l ? 

I n Situ Composite Composite Analytical Aliguot Composite Readings Lab Analytical Reading Average (Dried & Spilt Sent (Bag) Number Results 1 (Bag) Sieved) 7 

2 

3 

4 

XRF Corrected Value —> 

5 (use calibration chart or add 

2 0 % to value) 

Sample Area Pass/Fai l ? 

I n Situ Composite Composite Analytical Aliguot Composite Readings L a b Analytica l Reading Average (Dried & Spilt Sent (Bag) Numbe r Result s 1 (Bag) Sieved) •> 

2 

3 

4 

XRF Corrected Value --> 

5 (use calibration chart or add 

2 0 % to value) 

Sample Area Pass/Fai l ? 

Aliquot I n Situ Composite Composite Analytical 

Readin Composite Readings Lab Analytical g Average (Dried & Spilt Sent (Bag) (Bag) Sieved) 7 

2 

1 Number Results 

3 r 

4 

XRF Corrected Value —> 5 (use calibration chart or add 

2 0 % to value) 

l/W AUBIIIONA l SMtfl' i I f 

XRF Tech nician's Siqniture Q\j \ J^JLASLSU ^ hX)jM\CM ^ NffDi n 

• jtfSuLt ^'7£»K..i^ 
^ 'dlds-^l fl^ o ^^9/<=)6S ^ . 

S [P^he ^/# t 

Name Omaha Lead Site 

Ad(jress: )Qr). < COTH. / Site Sketch 

Phnno- ' \ Phone f/fsy 4^ce$j 

Date O . '. T M ^ BV1D# 

XRF Code 'llhk^^'^^'X 

<-?^-

y^ , ^2=? ^ 

Sample Number Lead Concentration Confirmation Sample 

1 ^yA-srf>)(n-.^-7 

(Sfyj-t-Sf ppm Yes • No^_ 2 j<.Vt<.-brPyQ-c^^^^ > 

]46^. ^ ppm Yes • No^^.0^ 

ppm Yes • x ^ No J^f\ , 

ppm 

Yes jzr 1,'r^No^j^r 

Yes« n 'N o • 

4 ppm 

rb 3 

f)2iiO£^ 

:;i^ 

^3X3 ^ =^f t 

iiad^i 

J35;fei 

i£ts&5s!: 

--)— • 

^S 

* t 

f^^^M^ 

Omaha Lead Site 

46904.783-01 

r^ 
• 

COASTA L 

L * C \J 9 IN C 

Consent For Acces s To Propert y 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to an(j 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: ^ 7 ^ (^^^ ^ 

Address of Property /S^^^^/^y 5"/^ 

covered by this 

Agreement: 

-URPCSE OF RESPCMSE N . iES 

The EPA 's -equesting access :o collect soil sar ies and :-er,:\e :-cr,ta:ns 

elevated concentrations of lead and ~ay ccse a health hazard. The area(s} will be 

excavated to remove contaminated soil. The rencved contaminated soil will be 

'epia'ced with ctean materials and the a'ea will be restored to its original condition. Tf-.^s 

A --epreseptative cf Coastal Environmental G-oup, contracted by USEPA. will contact 

:ne Grantor in-person to discuss the \vo'k tc be cerfcrmed. the Grantor .vil! have an 

opportunity to review and approve the planned soil 'emcval. and restoration wcrx befcre 

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 i-ece've written documentation *rom EPA that the property has been 

'em.ediated. 

EK'VIRCNIMENT.AL RESPONSE ACTIONS 

3y 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: 

Paae 1 of 2 
COASTA L 

'*i PRO"'*' C P C I, P N C 

• 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; - : * ­

• 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 ofthe property , , *'.-, 

AGREEMENT NOT TO INTERFERE - .. ,-„^. :.' , "'; 

The Grantor agrees net tc interfere cr tamper with any of the work activities, or with any 

of the work done, or with the eqjipm:.ent ^.sed on his property, cr to 'jnderfiake any 

actions i^egarding the Lise of said property which would tend to endanger the health or 

A'el'^a''e of the G'a'^'^ees ' " *'"e —~\,''C^'^e''* c "" s'lcw cthe''S tc use the orcpertv' '^ 

Should you have any questions about tnis p:-0Gram, please contact Ccasta' 

Envi^onrriental Group, at-S??) 234-e2:"0. • " 

I grant sccess tc .TV properties

 1 do not grant access to my properties 

Sionature ^ Date / ' Sionature Date 

I would like to be present during any sam.pling that is required. 

Paae 2 of 2 
COASTA L 

Restoration 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 ofthe property owner and the United States Environmental 

Protection Agency (EPA). 

Property ID: ^^^ V 

Property Address: /^^ ^ ^>g ^ S 7 

Q""^'-= Ur/// ^ /Pf^/$£^ 

Phone: ^7 ^ . (^Z^ ^ 

On the attached diagram(s) indicate area(s) to 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 Owner Before Start Of Remediation: 

(Use additional sheets as necessary) 

The removal, storage, disposal, and/or return of these items is the Owners responsibility. 

Item: 

aOAJC 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of. 
COASTA L 

Items To Be Removed By Contractor During Remediation And Not Replaced 

(Use additional sheets as necessary) 

Item: i 

^m^/ / ^^^ii^'^ ^ ^o:y^S

Item: 

' 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

! 

Item: 

Page 2 of. 
COASTA L 

C N O W r . I W e 

Items To Be Removed By Contractor During Remediation And Replaced 

(Use additional sheets as necessary) 

Item: 

^ol > 

Item: 5< ^!/6^ 

Kern: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 3 of. 
COASTA L 

Landscape Inventory 

(Use additional sheets as necessary) 

Item 

Pre-existing property area, 

that will be excavated, 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. 

.Auach a iketcl". of ihe 

iprinkle:- la.\ out. 

Number of and size of 

each garden/ flower bed 

area. 

.-"'.uaci'i ;•; :>keic!i oi'i-cla;i\c 

'•izes and locations. 

Quantity Unit Condition/Type/Species 

Square feet 

-lot Each 

• 

A/l Each 

Each 

/ 

Each 

^ Square Feet 

Page 4 of. 
COASTA L 

Item Quantity Unit Condition/Type/Species 

Agreed upon value of 

Diant materials not to be 

reolaced 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 vsere 

each plant will be placed 

b\ the contracK>r. 

Agreed upon area of 

property to be replaced 

with grass sod. 

Iriclude a sketch of ihc 

area(s) lo be replaced N'vith 

grass sod. 

.Area of City or County 

property to be landscaped 

per their requirements. 

Include a -kekTi i.;' ;|-.carea is! 

Easement .Area, to be 

excavated 

1 

1 

<^ j $ 

< / Each 

! 

SF 

D^t^tHlAJ^h 

SF 

SF 

Page 5 of. 
COASTA L • NVinONHEMTA L C n O U P . INC . 

Additional Comments / Instructions: 

n 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. 

Q^agre e C] I do not agree 

Owner's Signature Date Contractor's Signature 

Page 6 of.