TRANSMITTA L of OMAH A LEAD SITE 

SOIL REMEDIATIO N FILE FOLDER 

SAID#: Vy^U o 

Date: Z-Z^-W 

Address: iSfW KJ . 2^ ^ ^ T 

Remediation Contractor: Envrionmental Restoration, LLC_ Year: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

y Video of property (DVD) J36efore J3^fter D Basement D _ 

y 

Executive Summary (Final Report) 

EPA-provided property sketch. 

Signed Access Agreement for subject property 

D 

Signed Access Agreement(s) for adjacent property 

X Restoration Agreement 

D 

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

y Confinriation data 

y Photographs Zl Before DCrev/PhotosJZ'During Excavation D 

^30-day Sod D 

X As-built sketch 

Completion A.greement signed by Property Ovv'ner 

y Property close-out check list signed by EPA 

D 

Description of areas not meeting ROD cleanup criteria 

y Utility clearances 

y 

Property information from. Douglas County Assessor's Offic 

Property access checklist 

30261886 Contact Log 

y 

WcLCCrA Lof Superfund 

-ZS- U 

Environmerk al Restoration Signature ^ Date" 

70-/k-/ / 

HPA COR signat gnaturi e Date 
EPA 

EPA Property Close Out Form 

Omaha Lead Site 

Property #: "Zfa^ZG? PropertyAddress: \??U (\ K 2SS T 

Date/Time: Owner'sName: pAVti o-^ OwiaV^GL 

Quads Excavated: ^3. Contractor Group : Environmenta : & l Restoration (ER) 

Excavation General Yes No 

]. Ifnecessary, were the correct quadrant(s) excavated and restored? y y 

2. Ifnecessary, were the correct areas ofdrip zone excavated and restored? \/li/Uiti T irn" a 

Grading Sod and Vegetation Yes No 

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

house? y

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 30-day time 

period). 

4. Are sodded areas generaUy 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? 1^-1 

7. Was damage to landscaping or plant materials avoided? ^ ^ 

Gates, Fences and Retaining Walls Ves No 

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

Were all gates or fences taken down during restoration activities re-installed? (ifapplicable) TJA 3. Was damage to gates or fences avoided? (ifapplicable) 

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

Foundation, Siding and Gutters Yes No 

1. Was damage to siding or trim avoided? 

2. Was damage to the foundation avoided? ^jo^^^Ei^ 

3. Was damage to windows avoided? ^ 

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

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? / JA 

2. Was damage to walkway surfaces avoided? y 

fnspection notes: 

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

EPA Representative; M^=- . L M^J^u ^ Date: 4XJL 
,"" l O "x, Omaha Lead Site—EP-R7-09-05 ^ 3j^v ^ ^ Environmental Restoration, LLC 

'-tpwi*" 

EXECUTIVE SUMMARY: 

26826-1811 N25ST 

No Issues or Concerns Q] Issues/Concerns 

Detai l F.xnlanatinn­
"> 

[ Create Another Ticket ^ [ Back to Irth Internet ] Send Ennail 

• YOUR TICKET NUMBER IS 2664766. 

Original Call Date: 1/17/11 Time: 7:53 am Op: ADAM2418 6 


Work to Begin Date: 1/20/11 Time: 7:15 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1811 Street: N 25TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 16-NE 


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 


: 26826 


Company ENVIRONMENTAL RESTORATION 


Contact Name ADAM Phone: (402)451-1314 


Alt. Contact Phone: (636)288-9616 


Work Being Done For: epa 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVELS MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY MUD 

Day:

Alt: 

 4025047823 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFlC,SEWER RICH/TRAFFIC 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 1/17/2011 
rage z oi z 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day:

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 1/17/2011 
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Contact Information Log 

SAID#/68^G 

Owner'sName: Q ^ ^ y ^^^/ ^ | Daytime Phone: if ^ - ^y V - ^74^ ^ 

I PropertyAddress: \^\ \ fj . Z^ ^ 57 ^ 

Attempt to contact Date/time Name 

CAu ^ u/«» fl-«t»oe^ il-iolO %X»fi^ TT/J. 

^^fcte' ^ f>e(Jii^ fry cuun 

l l '3 - IO J > 

LSPr ssf- u>''^ cjjT'^ (Li-J-'O :rA 

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/<j-'?••/' ? T:/?. 

C-^Arf^c^^c' -^ r KJCC'KU*-'^^"^ /•n-K 

-^D 

/eo F'\yecfi Co/Mplt+.'(»/> 

^•f- n 
Property Final Report 

s^°>=26B^6 

PropertyAddress: /g/ / yy,. t<r^ S H 

n

D

 WORK STARTED 

 WORK COMPELTED 

ON: 

ON:. 

/

/

 / 

/ 

Owner: CJTTV O F 0^*U< . 

Address: 

16^1 f/htWKrt^ 'ST' 

Renter: 

Phone: 

Fax: 

1 

Phone: t/b2,-WHtj . q^t/ g 

Fax: ^^/Sl-q^^'ClHO 

Cell/Pager: 

Cell/Pager: 

Additional Information: 

PrAccess Agreement 

•Pl Restoration Agreement 

jy ] Video Property Before 

Jx T Digital Photos Before 

n Video Property After 

Sisned: J^ l /Sl/*> 

Sianed:/^ 1 LT i / o 

On -.f^llSi/r^ 

On y^liS'/K ^ 

On •._l_l _ 

By- -ri^ 

^T-TPBycr^ 

By=rr-z? 

By: N/A 

n Digital Photos After 

.•PT^Propertv Completion Agreement 

On : / / 

Siened:-i? l7( ^ i /C 

By: 

By:^. ^ 

• Final Report Sisoed: / / By: 

EXECUTIVE SUMMARY 

Omaha Lead Project Work Plan Page 1 of 19 
^^Dec. 15. 2010 1:24PM^ ^ Om^f \ PLANNING DEPT. 402-444-614 0 

1300 P. 2'^'^'^^'''''^ ^ 

/ • ^ 

Consent for Access to Property SAiD# 2C(>S>2C> 

RIOHT OP gi^TRYTO PREMISES 

Grantor (the property ovvner), consents to and authorizes ^ e United States Envirotunentol 

Protection Agency (USEPA) or its authorized representatives, coUeotively the Grantee to enter 

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

Owaer-sWamt: CTT Q AfT C\»A^W^ Daytime Phone; 4tw,»f/tjV-t/Z*/6 

""''"^ (^11 H. 1/f ^ . Addren; 

Afidresms of Propertlei 

covered by this Address: 

Agreemeiit: Address: 

Address: 

PURPOSE OF INVESTIGATION 

The 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 per million (ppm). 

REMEDIAL ACTIONS 

The environmental response actions to be peifoimed on said property may include the following 

activities: 

a. 

Taking photographs and/or video of the propeity before, during, and after remedial 

activities; 

Locating equipment and machineiy on-site in preparation for and in the course ofthe 

environmental response; 

c. 

Planning and Implementing lhe removal action on or near Grantor's property. 

d Obtaining samplesfirom Gnmtor's property; . 

AOREEMENT NOTT O fNTRRFqpn 

The Grantor agrees not to inteifixe or tamper with any of the activities or woilc done, or the 

equipment used to perfonn the activities, or to undertake any actions regarding the use of said 

property which would tend to endanger the health or welfare ofthe Grantees or the environment, 

or to allow others to use the property in such 

^ grant access to my properties 

Q I do not grant access to my properties 

/yi)o-c)o^^ 

Date Signature 

Date 
iZ Dec. 15. 2010 1:24PM^'^ QU.m PLANNING DEPT. 402-444-6' Jo. 1300 P. 3t^«93/««5 

f f 

AddWonai Comments / iQLatructions: 

x)or fir ^TiUKJue^ o ) n^ € fif^P>^TV 

Tcheck this box if owner does not want E.R. to enter the residents to document interior 

foundation walla and possible preexisting damage. By cheddng thia box E.R. Is not responsible 

for any damage done to the Interior of house, induding foundation cracks or fissures. 

H^hi 

TS J agree • I do not agree £fl Agree m I do not agree 

Owner' Contractor's Signature s SiebaMre Date 
Jo, 1300 P. 42l«o'»/J05 •^Dec. 15. 201 :24PM'"" OM^ANA PLANNING DEPT, 402-444-61 


Rsstoration Agraement 

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 puqjose of assuring that restoration 

activities are completed to the satisfaction of the property owner aod the United States Environmenta! 

Protection Agency (EPA). 

SAID: ^2L^2L 

PropertyAddress: /^/ / ^ ^C^^ST " 

—P^»^''^C ^ n r ciM^A. Vi^T ar—ofl E 

On the attached dlag)Fam(s) indicale area(s) to be excavated and depth of excavationi location of al) kno>vn 

utilities, subsurface features, surfiioe structures and landscaping features, access locadon(s) to be used by 

contractor, and die direction of North. Indicate distances, d^iths, material types, etc. Indicate digital photos 

by referencing the photo-iog number with an arrow indicating direction of view. 

Itsms to be removed by Contractor and not reptaeed: 

ttem: 

Item; 

Itam: 

ttam: 

Item: 

Kem: 

Kem: 

Paga Iot a 
i2n ec. 15. 2010 1:24PM**'' OMiHA PLANNING DEPT. 402-444-6140 300 P. 5'^"'"5''''°^ 

f< 

AddKional Comments / Inabuctlons: 

1% ! agree O I ^o BOt agree yi agr«e O I do not agree 

/CiP^i'-yo7^ |,^ ^ S^^-*^^*:^^ S-v-W 

Owner' Date Contiractor's Signature Date 

Attachment 

Page 2 of 2 
>J4. J.U J.J. j.j.iut j rnuij~jjuui>j.ijy 'iiac~'i'fi-ocao 1 njonj 1 ujiuiuo/tJKjj.u r-t l f IU 

ST> v^K o l P<v<^or 

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 ntstoradon of my property, and that no items are in 

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

SAIP; 20etCp 

Property Address: ;^/ / ^ , ^ ^ j ^ 

<>^*" a ^ af^ rtMA^A 

Phoi.e;^.q^q.tj2l/ 5 

Restoration Kama tn Queation: 

Rem: 

item: 

Hem: 

Item: 

ttam: 

Item; 

Addittonat Commenls: ~1 

k} 11 agree reitoradon b campleted, «xc«pt n notul ypH"agr«e restoration is eompleted, e^iGept ns noted 

i^i^ a atli agree remranon ia compieted i i I Ud Qot a^ee resvartifon i) completed 

/7r/ZL-Pb/l 

Date Contractor's Signature Date 
l^UUK'O ^ *^*-^ iiiiu i lllCLliyjLL ± <A.p.\. 1 yj± £- J^B uiiij' .rv^v^v^uiii

Douglas County, Nebraska Property Record - R1945510000 

Print Report 

View Interactive GIS IVIaD Information is valid as of 2010-8-16 Treasurer's Tax Report 

New Feature -^ -> '-> Subdivision Sales Searcii 

Owner 

CLEAVE TEMPLE CME CHURCH 

2431 DECATUR ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 4551 0000 19 

Account Type: Ex Religious 

Parcel Number: 1945510000 

Parcel Address: 1811 N25ST 

OMAHA NE 68111-0000 

Legal Description: PARKERS ADD LOT 8 BLOCK 7 N 33 FT LT 7 & N 33 W 16 FT 33 X 76 

Value Informatio n 

Land Improvement Total 

2010 $0.00 $0.00 $0.00 

2009 $0.00 $0.00 $0.00 

2008 $0.00 $0.00 $0.00 

2007 $0.00 $0.00 $0.00 

2006 $0.00 $0.00 $0.00 

2005 $0.00 $0.00 $0.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.05 2508.0 0.0 76.0 33.0 Yes 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo,isp?accountno=Rl9... 8/20/2010 
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ENVIRONMENTAL AS-BUILT DRAWING 

OMAHA LEAD SUPERFUND SITE 

RESTORATION 

26826 

Omahi Exterior Paint Owne a Lead Site r Name: CLEAVE TEMPLE CME CHUR • Good Site Sl<etcii Address : 1811 N 25 ST • Poor Phone: H 402-572-0360 W 402-342-0919 

p f Not paint 

Sample Number Lead Sampte SampMes Collected LAB Concentration Collected Firm: yt:> A ^ft.s-^ C M 

RYASCPXA-26826 Fl ^ 7 1 ppm D Date: Q •g-^t , - o '^^ 

RYBSCPXA-26826 F2 ?<^q ppm I3-" 

Time: £^ . i c p (w 

RYCSCPXA-26826 Bl J^L>i n

ppm Q ^ 

D Samples Analyzed 

RYDSCPXA-26826 82 6,05 ppm ET 

D

_aOZSCRXA~26836 QZ­ ppm D XRF Unit: QQ 2 Book: IOL> 

-RGZSCP>;A-2«82« - GZ. ppm D D Date: LP0 5 

ppm D D Time: AM D Staff: MSU / Numtjer of Samples = A ' 

Legend: F l = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ= Play 

Ail qua<lrants are as viewed from the street, facing property 

MNTEUBB 

HAv 3 0 zm 

SAID # 26826 

DATE EXCAVATED 1-19-11 

DATE EPA SIGNED OFF 3-1-11 

AREA SODDED 600 SQ FT 

...?iv . [ £>^ 

.\.%\) .NitX ^ sr 

- ^ - ­ L

{ 

I 

F i ­

3 2 J I 29H 

K><»'.V:­

>J, . /2-S-. S.-^ 046141.0123 

~n 

Quadrant oxcavated DrlDZot^eEKcavatpd CowtaminaBon Left 8c*ilnd 
iiiiiiiiiiiiiiiiin 26826 

Exterior Paint North Arrow Owne Omaha Lead Site r Name:.CLJAVE TEMPLE CME CHUR • Good Site Sketch Add ress: M l N25ST 

Phone: H: 402-572-0360 W: 402-342-0919 

[vj Not paint 

Sample Number Lead 

Concentration 

Sampte 

Collected lAB Samples Collected 

Firm: Ft> A \a.i. \ C«S 

RYASCPXA-26826 Fl •=^71 ppm D Date; G cj-.DC. - o fe 

RYBSCPXA-26826 F2 .23S. ppm D Time: a \ i<,nr ^ 

RYCSCPXA-26B26

RYDSCPXA-26826

 Bl 

 82 

3^/ 

(p05 

ppm 

ppm 

D 

D Samples Analyzed 

_EOZSCeXA»26826 BZ­ ppm 

ppm 

D 

D 

D 

D 

XRF Unit: 9D ^ 

Date: ( ^ 0 5 

Book: i^ 

RR2 ppm D D Time: /\ M 

Number of Samples = ^ Staff: M3\A / 

Legend: Fl = Front Left, F2 = Front Right, 81 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

M.TEEB 

MY 3 0 m 5o,:/ --e ­

o-h={l tJ( - (cOO 

•f/-. ^ 

%\.. \ £>.%. 

3id (y>5 

.If V^..N4i% € sr 

4­

4 ^ 

...F":...[ It. 2-. 

32.7 i Z'^H 

V4atlc. 

046141,0123 .w. .Z.S. :s.t 
26826 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: CLEAVE TEMPLE CME CHUR • Good Site Sketch Address: 1811 N25ST Q Poor 

Phone: H: 402-572-0360 W: 402-342-0919 [Vj Not paint 

Sannple Number 

RYASCPXA-26826 Fl 

Lead 

Concentration 

M l ppm 

Sample 

Collected 

&r 

LAB 

D 

Samples Collected 

Firm: Ft>f i ]a.s.\ CN.\ 

Date: Qg-^G - P fe 

RYBSCPXA-26826 F2 ?f\H ppm D Time: ^ ­. \ <. p JA 

RYCSCPXA-26826

RYDSCPXA-26826

 B1 

 B2 

36.1 

<!g05

ppm 

 ppm 

D 

D Samples Analyzed 

_fiDZSCeXA»2©826 B2- ppm D D XRF Unit: Q0 2 Book: lb( ^ 

.RGZSCPXA-2682-6 GZ ppm D D Date: U • 0,-S ­ 06 -

ppm D Time: M j 

Numberof Samples = i Ac 

Staff: MS-^ / 

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 

m n a o im% 

.^i... i 5.Z. 

3(o1 6o5 

I 

sr 

...; I 

..I.. 

F.^. 

32.7 a^H 

V>Sta\ic, 

kcv ^ W.: .2.S. S-V. 04614I.0123 

\ 
c ENVIRONMENTAL XRF DATA ENTRY LOG 

RESTORATION 

SAID#_7/<»^2.C., DATE \ \iq \ \ \ 

PROPERTY ADDRESS TIME 

l^\l K] 2. ^ sr 

XRF S/N y.^^-^ O 

QUADRENT OR SAMPLE AREA 

DEPTH AVERAGE OF RESULTS SHOTss 

redig 

D Fl 

n F2 

n 81 

n

• 

82 

DZ 

l,-^ ^^t?, \ ^s^ - zjsn 

n PZ 

n GZ 

n EZl M n E-?i 

n F7? 

n OTHER 

SAMPLER NAME ~S-^r-cH^'\ 
Thermo Fisher Scientific Thermo 900 Middlese.x Tumpike 

Billerica, M A 01821 

SCIENTIFI C 

Indc.v I'lnic |AVi.;i<..\f;K AI)I)I<K.SS .S,VMI',I,KAI{I': A OI'KUA'I'OK .DKITI 11 NOIKS LSAli) I'h 

1 2011-01-19 17:39 AvB or254-256 181 I n 25 s( B2 jimmy 13 final clearance 353.79 ± 30.89 

2 2011-01-19 17:39 1811 n25st B2 jimmy 13 final clearance 26826 363.66 ± 31.07 

3 2011-01-19 17:38 181 I n 23 st B2 jiminy 13 final clearance 26826 343.83 ± 30.65 

4 2011-01-19 17:38 l811n2Sst B2 jimmy 13 final clearance 26826 353.88 ± 30.96 

Pa^je 1 o f I 01/20/1109:30:42