TRANSMITTAL of OMAH A LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 25n3 n Date: 

Address: 1^0% <vN«^>g. ^^-

Remediation Contractor: Environmental Restoration, LLC_ Year: _2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

A f Video of property (DVD) .^efor e DAfter D Basement G 

JS Executive Summary (Final Report) 

yZT EPA-provided property sketch 

J a Signed Access Agreement for subject property 

• Signed Access Agreement(s) for adjacent property 

^ A Restoration Agreement 

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

JZ ' Confirmation data 

j A Photographs ^^Before DCrevv Photos piDuring Excavation D Sod 

^30-day Sod •_ _ 

As-built sketch 

A^ Completion Agreement signed by Property Owner 

yZf Property close-out check list signed by EPA 

D Description ofareas not meeting ROD cleanup criteria 

y Z Utility clearances 

JzA Property information from Douglas County-Assessor's OfBce 

J Z

A_y

 Property access checklist 

 30261916 

J Z Contact Log 

Superfund 

Environme ntal Restoration Signature Date 

A COR sienature / Date 
EPA 

EPA Property Close Out Form 

Omaha Lead Site 

Property #: Z^iy \ PropertyAddress: 1>\0'^ nrvcxfi\e. Srt-. 

Date/Time; Owner's Name: Ttrvx i-OooA, 

Quads Excavated: t>2. Contractor Group : Environmental Restoration (ER) 

Excavation General Yes No 

I. Ifnecessary, were the correct quadrant(s) excavated and restored? A 

2. Ifnecessary, were the correct areas ofdrip zone excavated and restored? UA 

Grading Sod and Vegetation Ves No 

house? 

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

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at 30-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 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 Walis Yes No 

1. Do gates open and close freely? (ifapplicable) 

2. Were all gates or fences taken down during restoration activities re-installed? (ifapplicable) 

Was damage to gates or fences avoided? (ifapplicable) 

4. Was damage to retaining walls avoided? (ifapplicable) 

Foundation, Siding and Gutters Yes No 

1. Was damage to siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? \JOL(Uit\\r toi^ m 

4. Was damage to window screens or door screens avoided? 

5. Was damage to downspouts or downspout e.Ktensions avoided? 

Sidewalks and Driveways (Coacrete) Ye Yess No

I. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? i ^ 

Inspection notes: 

Remedial and restoration activities complete including 30-day sod warranty: 

EPA Representative Date: <^/^/ ^

yb/-/ 
J Omaha Lead Site—EP-R7-09-05 ' --,,„-" - * Environmental Restoration. LLC 

% , ^ www.crilc.com -I . MO^**^ 

EXECUTIVE SUMMARY: 

29737 3108 MAPLE ST 

No Issues or Concerns Q] Issues/Concerns 

Detail Fxninnntion­
Page 1 of 1 

"> 

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

YOUR TICKET NUMBER IS 2684477. 

Original Call Date 3/15/11 Time: 8:08 am Op: ADAM24186 


Work to Begin Date: 3/17/111 Time: 8:45 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3108 Street: MAPLE ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-NW-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead soil removal 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)451-1069 


: 29737 


Company ENVIRONMENTAL RESTORATION 


Contact Name ADAM Phone: (402)451-1314 


Alt. Contact Phone: (636)288-9616 


Work Being Done For: epa 


Depth of Excavation: 24in Corner Lot: N Front: N Rear: N 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMLINICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY MUD 

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! C QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 3/15/2011 
-^^i^^-'iS^^" 

Contact Information Log 

SAID#o?77J7 

owner's Name:-77^ ^ ,^^ ^ Daytime Phone: ^bZ'/^j,/^-/^7 ^ 

PropertyAddress: 3/0 ^ Al^fi/ c • 

Attempt to contact Date/time Name 

•(\CC<^S.i -{VAM Mv(rof ("Si/-ff i^o 

l-p<^-ll [lO't^i^) (3 

f ! 0 - ^'i(c>^// t?/ttA^ Pn^ii [\'25pro] •— N

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2-2F'// Cf'^f^ ) (p» 

... . ..._ - • • • - • - • - • - ­

 1 
Property Access Checklist 

SAID: ^77J 7 n WORK STARTED ON: / / 

PropertyAddress: "^(o ? /n«<f/< 5^^ D WORK COMPELTED ON: / / 

Owner: -JT^ ^ y^^^J , Renter: 

Address: ^^^7 7 3 ^^:^ ^ J^ii. Phone: 

Fax: 

Cell/Pager: 

Phone: C^OZ'(p(e, 0 ­ iZl ^ Additional Information: 

Fax: 

Cell/Pager: 

B^cces s Agreement Signed: 3 / / l^ f By: ACj) 

H^Restoration Agreement Signed: 3 / / / / / By: ( 0 

B'vide o Property Before On :'2i_ll_ l ' / By= M v 

O^gita l Photos Before On •.'h 1 I 1 I t By: ( ^ 

0 Video Property After On : / / By: 

D Digital Photos After On : / / By: 

K[ Property Completion Agreement Signed: V 1 t^fl / ( By:^0 

D FinalReport Signed: / / By: 

Additional Video or Digital Photo's Taken: 

D Video n Digital Photo On : / / By: 1 

Reason: 

n Video n Digital Photo On : / / By: 

Reason: 

D Video n Digital Photo On : / / By: 

Reason: 

n Video n Digital Photo On : / / By: 

Reason: | 

Omaha Lead Project Work Plan Pagel of 19 i 
Mar. 01.2011 10:52 AM Stah^tidge Winery 91896821^	 PAGE. 3/ 5 


Consent for Access to Property SAID# Dl7 3 7 

RiciH r OH EN^i'itY 'IO PREMISES 

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

Protection Agency (USFPA) or its autliorized representatives, collectively the Grantee to enter 

and perform certain environmental response activities upon the following described premises: 

I Owner'sName: TTn. ^ U«-^Og^ | Daytime Phone; */02-'(eO>0 " (ffZZ ^ \ 

Add revs: J'o:y Ai^pltL. iY. Address: 

Addresiiies uf Pnipcrtics 

Address: covered by this 

Agreement: 

Address: 

Addres.s: 

PURPOSE OF INVHSIICA IION 

Tlic purpose of the remedial activities is to remove all soils at the property which are 

contaminated with hazardous substances, in particular lead at concentrations greater than or equal 

to 400 parts permiliion (ppm). 

REMEDIAL ACTIONS 

The environmcntai response actions to he performed on said property may include tlie following 

activities: 

a. iakiiig photographs and/or video of the property before, during, and after remedial 

activities; 

b. Locating equipment and machinery on-site in preparation for and in the course ofthe 

environmental respon.se; 

c. Planning and implementing the removal action on or near Grantor's property. 

d. Obtaining samples from Grantor's property; 

AGREEMENT NO T T O INTERFRRR 

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 iictions regarding the use of said 

propeity 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 

5t^ I grant access Xn my properties CH I do not grant access (o my properties 

.ii<lr*.t%. .^r v

 ^~t'- t i 

Signature Date Si{;natiire Date 
Owner's Jsignatu re Contractor's Signature 
Mar.01.2011 10:53 AM St: idge Winery 9189682: PAGE. 4/ 


Restoration Agreement 

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

contractor 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 (HPA). 

SAID: P17J7 

PropertyAddress: J/^ P //\<^plc s ^ 

Owner: TifMK. \^^ooiA 

Phone: VO2.'/^/^0- /oZi s 

On tiie attaclied diagram(s) indicate area(s) to l« excavated and depth of excavaiion, location of all known 

utilities, subsurface features, suiface structures and landscaping features, access locatJon(s) to be used by 

contractor, and the direction of North. Indicate distances, depths, niaterial types, etc. Indicate digital photos 

by referencing the photo-log number with an ai-row indicating direction of view. 

Items to be removed by Contractor and not replaced: 

Item: 

^•^.fNo'CL. TVI .^X^^Ho^cr-ec^ <^/'<.'\ r t-^f/ n A"<7cJ 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Page 1 of 2 
Mar.01.2011 10:53 AM St idge Winery 9189682] PAGE. 5/ 5 


Additional Comments / Instructions: 

[0Ta| C3 1 do not agree I.y I T agree M' agree n I do not agree 

..?! rt-trrA, ?^'t-|< •«. «»• 

OwnurVs Signature Date Contractor's Signature Date 

Attachment 

Page 2 of 2 
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 

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

SAID: .prz-? 7 

Property Address: 3/of r^<K?[<. Xf 

Owner: "TT^Aev L^Or^C^ 

Phone: 

4^^-'Uo • /.z^zsRestoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

fj ^ i agree restoration is completed, except as noted Jpyl I agree restoration is completed, except as noted 

I I 1 do not agree restoration is completed I I I do not agree restoration is completed 

<7i m faiOwner's Signature Date Contractor'^ Signature Date 
Douglas County Account Infoimation Page 1 of2 nnat 

Douglas County, Nebraska Property Record

Information is valid as of 2010-12-1 

Owner 

WOOD TINA C 

840473 S 3530 RD 

STROUD OK 74079-0000 

Property Informatio n 

­ R1917100000 

Print Reoort 

View Interactive GIS Mao 

Treasurer's Tax Report 

New Feature ->-•- > Subdivision Sales Search 

Key Number 

Account Type: 

Parcel Number: 

Parcel Address: 

Legal Description: 

Value Informatio n 

1710 0000 19 

Residential 

1917100000 

3108 MAPLE ST 

OMAHA NE 68111-OOOO 

OMAHA VIEW LOT 2 BLOCK 11 50 X 78.99 

Land Improvement Total 

2010 $400.00 $0.00 $400.00 

2009 $400.00 $0.00 $400.00 

2008 $400.00 $0.00 $400.00 

2007 $400.00 $0.00 $400.00 

2006 $400.00 $0.00 $400.00 

2005 $400.00 $0.00 $400.00 

Land Informatio n 

>*cres SF Units Depth Width Vacant 

0.09 3950.0 0.0 79.0 50.0 Yes 

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Douglas County Account Information 

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Map data ©C^iiilGoogle 

The above map is powered by Google, and is intended to provide a general idea of a property's location. If 

you require a more exact property location, you may use the Interactive GIS Maps that are maintained by our 

office. 

httn7/flnnpla';ne mannincr-online cnm/noii£'lasCoNe/.static/accountinfo.isD?accountno=Rl... 12/17/2010 
ENVIRONMENTAL AS-BUILT DRAWING 

OMAHA LEAD SUPERFUND Sl^ 

RESTORATION 

Illlllllllli llllill 29737 

Exterior Paint North Arrow Owner Name: riNA STRONG WOOD Omaha Lead Site • Good Address: 3108 MAPLE ST S**® Sketch k • Poor Phone: H W: [3^o t paint 

Sampl Sample Samples Collected e Number Lead LAB Concentration Collected Firm ft W K(V< 

RYASCPXA-29737 Fl Z-S H ppm n Date ?-n-cv RYBSCPXA-29737 F2 35 1 ppm a Time ^:\'b . RYCSCPXA-29737 Bl 30 1 ppm D Samples Analyzed RYDSCPXA-29737 82 S8 6 ppm 

RDZOCPXA-29737 B? ppm D n XRF Unit: lOCT l Book; j icF\ 

HGZ3CPXA-29737 S2 ppm D D Date: P-.-PH-nC o 

RrZOCrXA-29737 PZ ppm D D Time: LQ=L. 

n Staff: M^U r Number of Samples = H 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

SAID # 29737 ENTERED DATE EXCAVATED 3-17-11 

DATE EPA SIGNED OFF 4-28-11 

AREA SODDED 1000 SQ FT 

04614101}' 

Quadrant aiccavated Drio Zona Excavatftd ContarninaMon Laft Bahind 

/«»»«^^»« u. CO OT no ne Cv«l*li»^^MM,% AM*^ l 0^.^t^.....^l^..m ^ 11 ^ 
IIIIIIIIIIIIII 29737 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: TINA STRONG WOOD 

Site Sketch Address: 3108 MAPLE ST 

Phone: H: 

Sannple Number 

RYASCPXA-29737

RYBSCPXA-29737

RYCSCPXA-29737

RYDSCPXA-29737

RDZOCPXA-23737

RGZ3CPXA-29737 

RrZOCPX/r20737 

W: 

Lead 

Concentration 

Sample 

Collected LAB 

 Fl Z 5 H ppm D 

 F2 35 1 ppm D 

 Bl 3c n ppm D 

 B2 

 B2 

-GZ 

-PZ 

.58 5 ppm 

ppm 

ppm 

ppm 

D 

D 

D 

n 

D 

D 

D 

Number of Samples = '-\ 

• Good 

• Poor 

Q^o t paint f 

Samples Collected 

Firm: 

Date: 

t-n-oo 

Time: 3 ' >5 ^iy\ 

Samples Analyzed 

XRF Unit: lOO l Book: fio'^ 

Date: R-?H-r)( o 

Time: Ar- ^ 

Staff: nsv.r 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

ENTERED 

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29737 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: TINA STRONG WOOD 

Site • Good Sketch Address: 3108 MAPLJST • Poor Phone: H: W; 

[34jot paint f 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm: 

RYASCPXA-29737 Fl ppm D Date: t-Jl-Ck? 

RYBSCPXA-29737 F2 35/ ppm D Time: 3'> 5 

RYCSCPXA-29737 B1 

.3o l ppm D pm 

Samples Analyzed RYDSCPXA-29737 B2 -5R5 ppm D

RDZGCrXA-29737 BZ ppm D D XRF Unit: lOO l Book: \i/ ^ 

RGZSCPXA-29737 GZ ppm D D Date: f^-?'i-nC o 

RrZOCP)(A-20737 PZ ppm D D Time: Arv-, 

Staff: H.-.Uf Numberof Samples = '-j 

Legend: Fl = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

ENTERED 

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Rev 4 
NVIRONMENTAL XRF DATA ENTRY LOG G 

RESTORATBOM 

SAID #Z ^ "7 ST DATE 3 \\ T \v \ 

PROPERTYADDRESS TliWE 

"S^oS mac>v«_ S.T 

XRF S/N ^n?^o 

QUADRENT OR SAMPLE AREA 

DEPTH AVERAGE OF RESULTS SHOT#s 

redig 

n p^ 

n F2 

n Bl 

• 82 4 ns i z.'z. ms-'-^J^f 

• DZ 

n EZl -Wo€=fc 

D EZ2 

n OTHER 

SAMPLER NAME O •l>a.ro\ev5s 
Thermo Fisher Scientiflc TheiTBTio 900 Middlesex Tumpike 

Billerica, MA 01821 

SCIENTIFI C 

liule.v I'inie AVi:u.\(;i'. ADDUKS. S .SAMI - l.KAKI ' A OI'I-RAIO K l)i:i' l I I NOIK S \VU\\iS SAI D |-| > 

1 2011-03-17 11:22 Avg of 478-480 3108 maple st B2 JIMMY 4 final clearance 175.05 ± 21.60 

2 2011-03-17 11:22 3108 maple Sl B2 JIMMY 4 final clearance 29737 177.02 ± 21.81 

3 2011-03-17 11:21 3108 maple SI B2 JIMMY 4 final clearance 29737 183.97 ± 21.81 

4 2011-03-17 11:21 3108 maple st 82 JIMMY 4 final clearance 29737 164.15 ± 21.17 

Page 1 of 1 03/22/11 10:46:32 
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