TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 0,55//?( ^ Date: |/2/ | | 

Address: fSr)M"7 S^UTglTt^ S-\-

Remediation Contractor: Coastal Environmental Group_

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

^y 

xy 

ly 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

 Year: _2010ARRA 

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

Confirmation data 

t y Photographs 

As-built sketch 

Satisfactory restoration signed by Property Owner 

g / Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Office 

D 

D 

D 

^ ^ 

30218237 

Superfund 
# 

vv 

Property Access Checklist 

PropertylD: [^f;^i^l o 

Property Address: ^,-^g-| ^ex^r A 'b^. 

n

n

 WORK STARTED

 WORKCOMPELTED

 ON:

 ON:

 /

 /

 / 

/ 

Owner: ft^ iViA )<A\[ A 

Address: ' 

^^--^'•eDs)'iou yA9>Qu 

Fax: " 

Cell/Pager: 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

D

n?

sn

D

Q

D

S

D

n

n

D

Q

D

 Notification Letter 

 Access Agreenient 

 Restoration Agreenient 

 Topsoil Sampling (if applicable) 

 Disposal Sampling (if applicable) 

 Garden Sampling (if applicable) 

 Utility Clearance 

 Video/Photos (Before) 

 Video/Photos (During) 

 Video/Photos (After) 

 Video/Photos (30-Day) 

 Property Completion Agreement 

 Final Report 

Sent: / / 

Siened: 72 / / IO<i 

Signed: iL l 1_'CH 

I I 

1 1 

1 1 

CaUed:IZ 1 2. ICC\ 

On: / / 

On: / / 

On: / / 

On: / / 

Siened: / / 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

By=

By: 

By: 

By: 

By: 

By: 

By: 

 n_)a A Q 

Air Monitoring (as appUcable) 

• Community Q Crew 

Results: 

On: / / By: 1 

• Community

Results: 

 O Crew On: / / By: 

• Community

Results: 

 O Crew On: / / By: 

Omaha Lead Site 
Douglas County Account In|^aation Page 1 of3 

Douglas County, Nebraska Property Record - R0909940000 

Print Report 

NEW Faature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - VIe W O n Ma p Information is valid as of 2009-10-15 Treasurer's Tax Report 

New Feature -* ^ ^ Auto Sales Search 

Owner 

KELLY BRIAN M 

ETAL 

5047 SEWARD ST 

OMAHA NE 68104-0000 

Property Informatio n 

Key Number: 0994 OOOO 09 

Account Type: Residential 

Parcel Number: 0909940000 

Parcel Address: 5047 SEWARD ST 

OMAHA NE 68104-0000 

Legal Description: CREIGHTON PARK LOT 12 BLOCK 4 W 27 FT LT 11 & E 26 FT 53 X 150 

Value Informatio n 

Land Improvement Total 

2009 $7,000.00 $144,200.00 $151,200.00 

2008 $7,000.00 $144,200.00 $151,200.00 

2007 $7,000.00 $144,200.00 $151,200.00 

2006 $7,000.00 $144,200.00 $151,200.00 

2005 $7,000.00 $144,200.00 $151,200.00 

2004 $7,000.00 $105,400.00 $112,400.00 

Sales Informatio n 

Sales Dato: 2008-02-28 

Deed Type: WD Book: 2008 Page: 021441 

Price: $153,300.00 

Grantor: DRAKE COURTLAND ETAL 

Grantee: KELLY BRIAN M ETAL 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Dato: 1999-08-19 

Deed Type: Book: 2130 Page: 572 

Price: $111,000.00 

Grantor: 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accoimtno=RO... 10/23/2009 
Douglas County Account In|^nation Page 2 of 3 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Lan d Informatio n 

Acres SF Units Depth Width Vacant 

0.18 7950.0 1.0 150.0 53.0 No 

Improvemen t Informatio n 

Building 1 

1.5 Story Unfin 

5047 Sewai^ St *00 Ifl t n* tfi turn 

Bi*"'<8«c»9nt:«9 0?fl n 

4 r * ^ „ „ 1 ' ' ^'^ 1 

»•& «r 

-«*-l * frtfl'lMr 

(Mr ? i * 

H I T 

MH CV^'O 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1053.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Good 

Unit Type: Condition: Average 

Built As: 1 1/2 Story Unfin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 5.0 

Exterior: Masonry Common Brick Units: 1.0 

Interior: Drywall Baths: 2.5 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: ! 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1940 0% 1940 69 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Appliance Security System 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo .jsp?accountno=RO... 10/23/2009 
Douglas Coimty Account It^^atio t^^ a n Page 3 of3 

Basement 

Basement 

Fixture 

Fixture 

Fixture 

Garage 

Porch 

Porch 

User 

Bsmnt Block 8 ft 

Finished 

Base Fixtures 

Bath Full 

Bath Half 

Basement Single 

Open Slab 

Open Slab 

SEE NOTES 

1263.0 

400.0 

1.0 

1.0 

1.0 

1.0 

100.0 

210.0 

1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=RO... 10/23/2009 
Page 1 of 1 

\ Create Another Ticket ^ [, Back to Irth Intemet ^| j|i^ Send Email ;) 

• YOUR TICKET NUMBER IS 2415903. 

Original Call Date: 12/02/09

Work to Begin Date: 12/04/09

 Time: 9:53 am 

 Time: 10:30 am Op: ELIZABETH18790 

State: NE 

Address: 5047 

County: DOUGLAS 

Street: SEWARD ST 

Place: OMAHA 

Twp: 15N Rng: 13E

Twp: Rng:

Legal Given: C 

 Sect-Qtr: 18-NE 

 Sect-Qtr: 

Type of Work: LEAD REMEDITION 

Location of Work: INCLUDE ALL EASEMENTS LOCATE ENTIRE PROPERTY 

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: 4 FT 

Depth of Excavation: COASTAL Corner Lot: N 

Involves Tunneling or Horizontal Boring : N 

Front: Y

Explosives: N 

CXCATV MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 

 Rear: 

Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITYOFOMAHA-TRAFFICSEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 12/2/2009 
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f^ As-Built Drawing 

C OASTA L Omaha Lead Superfund Site ENVIItONHENTAL C It O U r .

 INC . 

OLS#: 65566

Date Excavated: 12/7/2009

Date USEPA Signed Off: 5/6/2010 

Area Sodden: 488 sa ft 

Omaha Lead Site 

Site Sketch 

Sampling Address: 5047 SEWARD ST 

Sample Number 

RYASCPXA-65566 F1 

RYBSCPXA-65S66 F2 

RYCSCPXA-65566 81 

RYDSCPXA-65566 B2 

RDZSCPXA-65566 DZ 

nozocrxA-ossoo—e« 

RrgOCPXA-ri.nr,r,r, oa. 

Lab RYDSCPLA-65566 

^ Result 320 ppm 

_„aw.~. • I - nuii i Len, \-i . -

Lead Sample LAB Concentration Collected 

Cell ppm 

3 1 7 ppm 

2r« I ppm 

ppm 

ppm 

ppm 

ppm 

Number of Samples = | ^

 Front Right, Bl = Back Left, B2 All quadrant! areas Viewed 1 

i l * 1 

D 

D 

D 

n 

D 

D 

| | )

 f 

' 

65566 

Exterior Paint 

• Good 

•

[ 2

Flmi:

Date:

Time: 

 Poor 

 t^ot paint 

Samples Collected 

 FT^I Pg-4J" 

 lO'L-C^ 

iZ-t p pm 

Samples Analyzed 

XRF Unit: 6>5iQ Book: 2^2 . Date: _ U oS 00 

Time; 

Staff: [ 

= Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla' 

ix 

•7\ 

1 

H OVO 3 2066 s r } 

'zu.\.. J5T.... ) 

ZH. 

1 1 

1 

> 1 'k 

'''* kift 

- t 

; Ozt 192. 

^a^ ^ 

f\- W/ "

^yy F1 = 67 PPM @ 6" yA •riV< 

^ n "^ 1 

^N^p^ -^ 

SBNftfiS> s t • Rfiv i» «

 rrejifti ;7-.\i^J« 

Legen d 

Concre'te Dri p Zone Excava'ted Quadran'ts Kxcavate d 

Area replaced wi'th 

Sod 

Area replace d wi'th 

Rock/Mulch Area lef t bar e 

Contrac t #: EP-R7-07-05 Coasta l Environmenta l Group Inc . 
I'iO-l 

ovv^ 65566 

Omaha Eirterior Paint Lead Site 

Site Q Good Sketch 

Q Poor 

Sampling Address: 5047 SEWARD ST 

[2 Mot paint 

Sample Lead Sample Samples Collected Number 

i 

LAB Concenlration Collected Firm: m PP-A7 

RYAScpxA-essee F1 ppm D Date: 

ID'2.-M 

RYBSCPXA-65566 F2 

3 1 7 ppm D Time: it-ti?arr y 

RYCSCPXA-65566 81 

Samples Analyzed 

RYDSCPXA-65566 B2 

ppm 

ppm n

ROZSCPXA-65566 DZ lf^2 ppm D XRF Ui;ll : 6i5^0 Book: 2ZO 

nGgDCPXA-65500 B? ppm D Date: i/o s oe 

ppm D Time: Orr, RYDSCPLA-65566 .Lab ns\^ Staff: ? Reault 320 ppm Number of Samples • K • riom Len. r-2 = Front Right, B1 = Back Left, B2 = Back Right DZ Garden. PZ -

Rtv 2'*i* ("rciioii- ;7-,\itB-n(i 
\Zy•

-

 0^] 

Omaha Lead Site 

Site SIcetch 

Samolina Address: 5047 SEWARD ST 

Sample Number 

RYAscPXA-essee F I 

RYBSCPXA-65566 F2 

RYCSCPXA-65566 Bl 

RYOSCPXA-65566 B2 

RDZSCPXA-65566 DZ 

nGZCCPXA-65500—eg 

RrgocPXA.nrir;nn » • 

Lab RYDSCPLA-65566 

r Result 320 ppm 

--S.-"" ' I - '-"J"! Len, t-2 =

Lead Sample 

Concenlration Collected 

ppm 

•377 ppm 

_iiT _ ppm 

ppm I

iPiL 

ppm 

ppm D 

ppm D 

Number of Samples = 

LAB 

D 

D 

n 

Exterior Paint 

• Good 

•

0

Firm:

Date:

Time:

 Poor 

 Nol paint 

65566 

North Arrow 

\ 

Samples Collected 

^ P^'AJ 

 ID'Z'i)P, 

 If- 2.0 ffn 

Samples Analyzed 

D XRF Unit: {D6H 0 Book: 22 ° 

n Date: 1(0 $ 0 6 

D Time: .Ben. Staff: 

 Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla All quadrar^ts are as viewed fn the slreat, facing property 

y P 

fJ:OV 0 3 2008 

ZU.l .33.1 r 

;^- -_,«ii>W C ' _ 

]ZZZr - ' — . < •

D-2.- 10^ . a 

C;t>'\r SofAM.5i 

StwARp Sf. 'IM ('rciiM :7-.\iip-'iR 
^ivh 

65566 

Omaha Lead Site Exterior Paint 

Site Sketch • Good 

• Poor 

Sampling Address: 5047 SEWARD ST 0 Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB Firm:

Samples Collected 

 fJ ^ PB'A^ 

RYASCPXA-65566

RYBSCPXA-65566

 F1 

 F2 

¥^6>ll 

317 

ppm 

ppm d n 

n 

Date:

Time:

 IQ-l-CA 

 \2--- ^ f>m 

RYCSCPXA-65566

RYDSCPXA-65566

 Bl 

 B2 

2.1^" I ppm 

ppm 

n 

0' Samples Analyzed 

RDZSCPXA-65566 DZ 

RGZocrxA-ossoo—es 

ppm 

ppm 

n 

D 

XRF Unit: 

Date: _ 

6/5iO Book: 22£. 

RrZOCPXA-fi.''T'ififi IM -

.Lab 

i Resutt 

RYDSCPLA-65566 

320 ppm 

ppm 

Number of Samples = | 5 

n Time: _ 

Staff: 

n-os

ns\^ 

 oe 

1 - noi n Len, t-2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Pla; 

All quadrants are aa viewed fri the street, facing property 

Tk wN;0V 0 3 2086 

ZU.\. W .33.-) 

:tenc 

a 

?yy->Hy 

'¥)Z 

>stw*«;P.'fSt .uod- ^T-Aug-'lt OJJTOI.rilH 
65566 

Omah Exterior Paint Nortti Arrow a Lead Site 

Sit • Good e Si(etch • Poor 

Samolinq Address: 5047 SEWARD ST ( ^ Not paint \ 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Fimi: m PB'A7 RYASCPXA-65566 F1 Coll ppm D Date: 

RYBSCPXA-65566 F2 3 7 7 ppm D Time: 

RYCSCPXA-65566 Bl *JaJ_ ppm n Samples Analyzed RYDSCPXA-d5566 B2 ^ 3 1 ppm 0' ROZSCPXA-65S66 DZ y fl Z r)Dm D XRF Unit: Book: 22 0 

nozoopxA-ossoo—aa ppm D Date: _ oe 

RPgOOPXA-e.WW B»a. ppm D Time: _ .^d . Lab RYDSCPLA-65566 Staff: JC2£U L 2 ResuK 320 ppm Number of Samples = j_£ j | | | 

taV^WIIVI. I I n o m Len, t-2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone. GZ = Garden, PZ = Pla; 

AH quadrants are as viewed Ii'i ¥• 

the street, facing property, • • • • » 

I NiOV G 3 2008 

.33.1 

1 

^ 

1 

u - ^ ^ 

t 

. f l 

SE»/M!fi S t R«3J08 Crejled :7-,\ug.08 U4470I III 23 
COASTA L INVIItOHniNTAI •^1 pno'*r CROUP . I ft C 

Consen t for Acces s To Propeft y 

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: 

^n/^^ K^ui^^ ^jloH Me^M 

Address of Property 

covered by this 

Agreement: S^Hf 5tivJ/^^D ^ t 

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 

wori< 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 worit 

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: 

Page 1 of 2 
..*^"'">, 

COASTA L IHVIROHHIKTAL '*\yy C I O U > IH 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; 

c Water and maintain replacement vegetation, including fertilizer application, as 

necessary subsequent to an initial watering period by EPA; 

c 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. 

ft Allow videotaping and/or photographing of the property. 

AGREEMENT NOT TO INTERFERE 

The Grantor agrees not to interfere or tamper with any of the wort< 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 

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

rKM/^ 

signature Date Signature Date 

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

Page 2 of 2 
« 

»*^'*!r'v. 

COASTA I tHVUtONH f KTA l 

CROUP . IN C 

Consen t for Acces s To Propert y 

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: 

Address of Property 

covered by this 

Agreement: 5/^W I '^^OAMirrJi sfPURPOSE 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 

wori( 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 perfonned, the Grantor will have an 

opportunity to review and approve the planned soil removal, and restoration wori( 

before it begins. Once the wori( is finished, the Grantor will be asked to review the wori< 

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 woric. This access shall 

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

agrees to: 

Page 1 of 2 
y 

COASTA L . , _ .

 tfrvtftONHIKTAl 

« 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; 

c 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 perfonn the work. 

e 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 wort< 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 

\2l I grant access to my properties D i do not grant access to my properties 1\. 

x ^ ^ yj^y^^yiy /zy^yy^ f . "signature/ """ " Dat^ / Signature

 Date 

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

Page 2 of2 
iZU^ 

COASTA L 

Restoratson 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: ^55^ ^ 

Property Address: c^^g^y f •^t^'I'l^r ? 

Owner: ^^^^ ^ ^^^^ y 

Phone:• (&^]lo^-H6'^H 

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

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

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

necessary. 

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

The lemoval. storaqe, disposal, and/or return of these itoms is the Owner's respons bilily. 

Item: 

^f^4LL- yZiOi 6 

item: 

/ 

Item: 

/ 

item: 

' 

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

Item: 

(^y^Ul^lO/f ^z^4L.L rLy4JZ< 

Item: 

item: 

Item: 

Page l of. 
1 

COASTA L 

Items to Be Removed By Contractor Durinp Remediation and Replacecf 

Item: 

^cPD - r l 

Item: 

<70'll . ' n 

item: 

Item: 

Ljindscape Inventory 

item Quantity Unit Condition/Type/Species 

Pre-existing property area, Quadrants that will be excavated, that 

is covered with grass. f l 

Number of trees > 2 inch Each 

trunk diameter y 

Number of trees <= 2 inch z Each 

trunk diameter 

Number of Sprinkler 

Zones. Control Valves, Each Timers

Aiiath a

, Heads

 sketcl

, etc

i u

. 

l (lit- y

Number of and size of 

each garden/ flower bed Each 

area. Square Feet 

Aiuith .1 skcicli ol rc!;iiiv(.' 

<izi'S niid loc;lIi(l|l^ 

Agreed upon value ofplant 

materials not to be 

replaced bv contractor. S 

VCU' ll'ii- ^MlllC Null ni 

USl'O' 10 li-.Ul .1 pittlli / 

> oiii.-;\f; !(/ illf |;rii)icrl\ 

iiMiier. 

Easement Area, to be Rach 

excavated ^fi > 

Page 2 of. 
C O A S 1 A L IMVtnOMn i HTA t 

D » O U » , IN C 

! Additional Comments / Instructions: 

L. 

^ ^ Check the t»x if Owner does not want CEG to document interior foundation walls and possible 

pre-existing damage. By checking this t>ox CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

Q I do not agree 

0^ 7^}<\ 9j,0r\C[\QOS\ \?lilcPi 

Owner*s Signature | Datee tt Qmtractor' Contractor'ss Signatur Signatu e Date 

Page 3 of. 
BVID#_4SSi A 

XRF PROPERTY SAMPLE SHEET 

Date i Z- ^^O ^ Address 

Project Omaha Lead ARRA Sample time 

XRF iD# <^^i?a: sample length 

a 

Shot# Reading Sample area Shot# 

^ ^ 5i,.p^//.s:f- P/ •V3 %.Sfoil2.?.3 Depth 

Hi ^5^>5fe ^ l^.^ l / f " 

Average U^.f/ j J /gt? 3 Average 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# 

Depth 

Average Average 

?j^QMmh 

>f jQl>ti l CAI7K)I}QJ\ 

c:oH9' ^euy^AAi <.*­ am/pm 

30 sec 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 
9 • 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 45 

Mode SOIL 

Time 2009-12-07 16:53 

Duration 91.00 

Sequence Final 

Flags 

AVERAGE rAyg-of-42-44—-n 

ADDRESS ^5047_seward-st^ 

QUADRANT Fl 

DEPHT 6" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm ± Error 

Pb 12i?;33^ 

Supen,ised By: qXlMMI S 
t • 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 56.771 

Supervised By: 

Certificate of Verification 

42 

SOIL 

2009-12-07 16:52 

30.38 

Final 

65566 

5047 seward st 

Fl 

6" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 11.565 
• • • • 

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 43 

Mode SOIL 

Time 2009-12-07 16:52 

Duration 30.50 

Sequence Final 

Flags 

BVID 65566 

ADDRESS 5047 seward st 

QUADRANT Fl 

DEPHT 6" 

XRF TECH R. VENTRY 

MISC clearence 

NOTE ngnc 

ppm Error 

Pb 76.555 ± 12.729 

Supervised By: 
# • m •

Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 67.955 

Supiervised By: 

Certificate of Verification 

44 

SOIL 

2009-12-07 16:53 

30.12 

Final 

65566 

5047 seward st 

Fl 

6" 

R. VENTRY 

clearence 

ngnc 

± Error 

± 13.905 
i 

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

Coastal Environmental Group Inc. 

www.coastaihazmat.com ^ : ^ 

COASTAL 

(ll«l>ONNINTAL 

6 I O U P. IH C 

EXECUTIVE SUMMARY: 

BVID #65566-(5047 SEWARD ST) 

No Issues or Concerns |~~| Issues/Concerns 

Detail Explanation: 

-COASTAL TO REVISIT THE SOD IN THE SPRING OF 2010. ALSO TO REPLACE A 

CONCRETE SPLASHBLOCK. (COMPLETED 4/28/10) 

- DAN GARVEY WALKED THE PROPERTY ON 5/6/10 
A 

EPA Property Close Out Form 

P-P^rt,n : /^S?4> > PropertyAddr^.- ^^^^"^^"^ ^ 

DateHlme: Owner's Nime:..^./gO^T!! & 

Qusdi Excavaied: Contractor Group CZy^S ] 

Excavation Yes No Ccnenl 

1. I r necessaiy, were the conect qiudnuit(s) excavated and restored? y 

2. If necessary, were the contct areas of drip zone excavaied aod restored? y 

GradlDE Sod and VcKetation 

Yes No 

I. 

IDoes the grading around the perimeter ofthe house in excavialed areas generally slope away 

from 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) y 

4. 

Arc sodded areas generally firm and evenly graded? y 5. 

Are the joints twtween the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) y 

6. 

Was the property graded such that water will nol pool on the property^ y 

7. 

Was damage to landscaping or plant maierials avoided? y 

Gates, Fences and Rctatoing Walb 

Yes No 

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

Were all gates or fences talcen down during restoration activities reinsulled? (Ifapplicable) / 

3. Was damige to gates or fences avoided? (Ifapplicable) / 

A. Was damage to retaining walls avoided? (ifapplicable) / 

Foundation, SidiBK and Goiters 

Yes Nc 

1. Was danuge to the siding or trim avoided? / 

2. Was damage to the foundation avoided? / 

3. Was damage to windows avoided? / 

A Was damage to windows or door screens avoided? / 

5. Was damage to downspouts or downspoul extensions avoided? 

^ 

Sidewallts and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? / 

2. Was damage to walkway surfaces avoided? T 
I 

^ 

Owners comments: 

jinspection notes: 

Removal and resloration activates complele including the 30-day sod warranry: 

EPA Representative 9^^^ ^ Dale; 5!^^ ^'^ 
Property Completion Agreement 

rins agreemeni documenls Ihe complclion ol remedial acliviiies perloimed on my pioperly My signature 

will designate thai i am satisfied with Ihe restoralion of my properly, and thai no items are in questions, 

now, or al any lime in the future, except those ilems listed below, ifany 

Property ID: (^^^^j ^ 

Property Address:^^^^- ^ ^^^Qa f r\ ^ 

Owner:-^y^^ ^ Vf>\ \ 

onoun vn\a Phone: 

Restpration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

P\\ I ayrcc I'cstoralion » completed, except as noleri 

i Z I rianni «i>rec cesiorfltion is completed 

^^mHr^ o ^CAMJOC^ ?2 2y{]\d 

Owncr'.« Sicnariirr \ Dat ta*<e. '7F1_>. ...<«..' . c:>~-I. Gontrarlor's Signiiliir ' c ' Dale rv_.­
DECEIVED 

^r'H 0 ^ 20111 

rropettYOv/nerSeVisfECiion Survey Q j JDCO n nm ^ 

Omaha Lead Superfund Sit ^^^^^WND DlVlSm 

2008 

Remediation Contractor: Coastal Environmental Group 

Property Identifier Number: (.^^OQjf p 

Property Address: g^rNU I ?.e\lOnrr l g A 

Property Owner's Name: "^r'lOy ^ Vl^^^^ U 

(above information to be filled out bv rem^djjbtion contractor pnorto delivery of form lo Property Owner) 

Instructions to Property Owner: 

This form is provided to you as a means of trying to capture your level of satisfaction with the 

work of the above-identified remediation contractor, as applicable to the soil cleanup action at your 

property. The U.S. Environmental Protection Agency (EPA) is very interested in your opinion regarding 

the w^ork performed by its contractors. This form is intended to provide an easy means for you to 

express your opinion about the work performed on your property. 

Please indicate your level of satisfaction with the contractor's work by selecting a numerical 

rating (ranging from 1 to 10) using the following rating scale, then please sign and date the form and 

return it to the USEPA in the attached self-addressed & stamped envelope, (additional comments may 

also be provided in the space below, at the option of the property owner.) 

9-10 "excellent" 

7-8 "very good" 

5-6 "acceptable" 

3-4 "poor" 

1-2 "very poor" 

Propertv Owrner's Satisfaction Rating Regarding Contractor's Worit 

10 5 

9 A 

CD 3 

7 2 

6 1 

Additional Comments from Property Owner (optional: continu >ntinufctobac>< e to bac><<of paee if needed! 

I'^^^^PO^ 

Property Owner's Signature: V j^wTL A ^ Date: ^ <\/\ftfl*^ ^L > 
Water Bill Settlement 

Property ID 65566 

Property Address 5047 Seward St 

Tenant Mr. Brian KeUy 

I have received from the contractor. Coastal Environmental Group Inc. (Coastal), the sum of $ 13.87 for 

water usage required to maintain the sod. 

Check Number 1927 

Value of Check $13.87 

Made Out To Brian Kelly 

Description of Settlement 

To reimburse tenant for estimated water charges on their MUD monthly invoices. 

My signature below is acknowiedgement of the receipt of the sum listed above, which I further 

acknowledge to be fair compensation and full payment for the above, and release Coastal 

Environmental Group Inc. from further obligations or liability. 

^iQ[\n^(yi ^/i3|io 

Contractor's Signature Date 

y 

1927 COASTAL ENVIRONMENTAL GROUP INC. 27-6/1040 003 2411 MARTHA STREET 6247372904 

OMAHA, NE 68105 

•O\\2^l0 DATE 

PAY 7U THE J $/3 ^ 

ORDEii or 

Faaian 

: DOLLAfVS P*i*>l> 

MUhFvgKBlnk.NA.