TRANSMirrAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#:y52.3?.___ Date: l-\!b-|2-

Address: /\o.7Z!D^CjOHt:\.^i)c\LQ.\)^^ .— 

Remediation Contractor: Coastal Environmental Group^ YearcSlOl ^ 

SOIL REMEDIATION 

PROPERTY FILE POLDER DOCUMENTS 

A/ikx Video of properly (DVD) 

« Executive Summary 

LVT: EPA-provided property sketch 

. .-rvii^^==Signed Access -Agreement for subject property 

- ISj]^- wSigned .Access Agreemeni(s) for adjacent property 

y Restoration Agreement 

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

^ Confinnation data 

fi/ Photographs ^^fpKC(x\xiAdl5:Xccx\tx{)0[\, ^ ^ 

sy As-built sketch 

[%/ SatiBfactory restoration signed by Property Owner 

^ Property close-out check list signed by EPA 

lijA Description of areas not meeting ROD cleanup criteria 

Ai^ Utility clearances 

\ / Property information from Douglas Couniy Assessor's Office 

^ ^ ^ 

13ite 

Superfund 
^\ 

Property Access Checklist 

Property ID: L)fi2^ 3,; ^ 

PropertyAddress: ^^;^<^ /V.^Vv>Il All 

D

D

 WORK STARTED

 WORKCOMPELTED

 ON:

 ON:

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 /

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/ 

^""^••^ffl5(xrVfUa[ob(is

Address: 

•\. VI 

Phone: 

Fax: 

eo70 ?jf)i-Mnvi 

Cell/Pager: 

 Al-Himirriif^ Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

n

^

1^

D

D

i~1

D

D

n

n

n

Q

D

 Notification Letter 

 Access Agreement 

 Restoration Agreement 

 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: / / 

Signed: ^/2a/Zl _ 

Signed: J2_/23/I L 

/ / 

/ / 

/ / 

Called: / / 

On: / / 

On: / / 

On: / / 

On: / / 

Siened: / / 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

Air Monitoring (as applicable) 

r~l Community ED Crew 

Results: 

On: / / By: 1 

n Community

Results: 

Q Crew On: / / 1 

r~1 Community

Results: 

 EH Crew On: / / By: 

Omaha Lead Site 
Douglas County Account Information 

Page 1 of4 

Douglas County, Nebraska Property Record ­ R2340200000 

Print Report 

Information is valid as of 2011-3-8 View Interactive GIS Mao 

Treasurer's Tax Report 

New Feature ->-»- » Subdivision Sales Search 

Owner 

VILLALOBOS-ALTAMIRAN ETA CESAR 

6225 CAMPBELL AVE 

OMAHA NE 68107-0000 

Property Informatio n 

Key Number: 4020 OOOO 23 

Account Type: Residential 

Parcel Number- 2340200000 

Parcel Address: 6225 CAMPBELL AV 

OMAHA NE 68107-0000 

Legal Description: UPLAND HOMES ADD LOT 9 BLOCK 0 IRREG 40 X 126.2 

Value Informatio n 

Land ; improvement Totai L_.-^. . -.^. . -•.^ a .^^. . __ 

$74,900.00 

$80,000.00 

$88.100.00 

$88,100.00 

$88,100.00 

$78,^00.00 

$78,600.00 

Sales Informatio n 

Sales Date: 2010-02-24 ! View Pocument 

Deed Type: \ WD Book: 2010 T' Page: > o 16967 

Price: j $80,000.00 

Grantor: | SOUTH O JOE LLC 

Grantee: \ VILLALOBOS-ALTAMIRANO CESAR ETAL 

Valid/Invalid: \ valid 

Exclusion Reason: • 

Sales Date: : 2010-01-29 View Pocument 

Deed Type: \ WD Book: 2010 Page: ! 012611 

Price: ; $38,000.00 

Grantor: \ sZARKE MILDRED M 

httn://doiipla.sne.manning-online.com/DouelasCoNe/static/accountinfo.isD?accountno=R23... 3/18/2011 
Douglas County Account Infomiation 

Page 2 of4 

Grantee: SOUTH 0 JOE LLC 

Valid/Invalid: Valid 

1 

Exclusion Reason: 

Land Informatio n 

Acres SF

0.15 i 6930.0

 Units 

~: 1.0 

1 

1 Depth 

'• 126.0 

Width 

55.0 

Vacant 

No 

Improvemen t Information 

Building 1 

RarcT 6225 Caripbdl Ave 

e .6 . 11 I 1.. 11 

.•< ' 'i» - r . • - ll . 

„ift»ii.u.»jiH;«ii.iiMi.i.«4iiiii.*i.-m!om 

CLICK CLICK TO ENLARGE IMAGE TO ENLARGE IMAGE 

Square Footage: 764.0 Percent Complete: 100.0% 

Perimeter 0^0 Quality: Fair 

Unit Type: Condition: | Average 

Built As: Ranch Condo Square Footage: ! 0.0 

HVAC: Central Air to Air Rooms: ! 4.0 

Exterior: Frame Vinyl Units: i 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.0 

Floorcover: Allowance Foundation: Block 

I Sprinkler Square Footage: 0.0 

r Year Percent Adjusted Year I Year Built 

Physical A^e Remodeled Remodeled Built \ . 

i 1941 0 _ 1941 69 

 0%_ 

Oeta/7 Type Detai Units l Description 

r Add On Fence Chain Link 1.0 

[ Appliance Allowance 1.0 

; Basement Bsmnt Block 8 ft 696.0 

r 

Basement Minimal Finish 200.0 

Fixture Base Fixtures 1.0 

httn//flniialasne manninp-nnline r.nm/DoiiplasCnNe/.sfatic/accoiinttnfn isn?accountno=R23... 3/18/^01 
Douglas County Account Infonriation Page 3 of4 

Fixture Bath Full 1.0 

Garage Detached 800.0 

Porch Slab w/Steps 56.0 

httn7/Hniipla.<5ne.manninn-nnline.r.nm/noiipla.<?CnNe/.static/accountinfo.isn?accountno=R23... 3/18/201 1 
As-Built Drawing 

OLS: 45232 ^ . COASTAL DATE EXCAVATED: 8/16/2011 EnvironmentarGroup, DATE USEPA SIGNED OFF: 8/25/2011 

Inc. Omaha Lead Superfuncl Site AREA SODDED: 220 

45232 

Omah a Lead Site 4613 0 

CONCRETE DRIP ZONE EXCAVATED QUADRANTS EXCAVATED 

AREA AREA REPLACED WITH AREA LEFT BARE REPLACED WITH SOD ROCK/MULCH 

CONTRACT #: EP-R7-09-06 COASTAL ENVIRONMENTAL GROUP, INC. 
yyzyzi M y ^ ^ 45232 0 

Exterior Paint North Arrow Owner Name: ANTONE J SZARKE Omaha Lead Site 

Sit • Good e Sketch Address: 6225 CAMPBELL AV • Poor 

Phone W: : ^• I 

[ J Not paint 

Omaha Lead Site 461.10 
lilli Iilllilll 45232 

Omaha Lead Site 46130 
45232 

Exterior Paint North Arrow Owne Omaha Lead Site r Name: ANTjONE J SZARKE^ 

Site • Good Sketch Address: 6225 CAMPBELL AV • Poor 

Phone: H: W: I [3^ Not paint 

Sample Number 

RYASCPXA-45232

RYBSCPXA-45232

RYCSCPXA-45232

RYDSCPXA-45232

RDZSCPXA^5232

KbZSCP> 

^A=452: 

 Fl 

 F2 

 81 

 B2 

 DZ 

Lead Sample 

Concentration Collected 

2ol'c> ppm 

LP n ppm 

R . ppm . ppm 

.'ZyiW.n ppm 

.ppm 

.ppm 

Number of Samples = '

^rl/0-l££ 

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<o c.c 

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Samples Collected LAB 

Firm: 

D Date: //y/^yc '

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D Time: ly/ O 

n Samples Analyzed n 

D XRF Unit: % \ \ Book: in ^

Date: a Time: 

Staff: 

ENTERED - NOV 1 7 20U4 .By 

t c »«• r 

J>Z.~39LLC 

C/J,yi/>sy/c yf ^ 

Omaha Lead Site 46130 
tlltllONnlNUc yy c I 0 u r I It c u\s^^^ 

C^oiisic^iii for At:c:(iSi'- 'lo ['ropcit^' 

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: 

r"' 

Owner's Name: jf^V \-C}/^{<'OC i Dvv'time Phone: 

Si.(c:.:>_a..^...,...._ 

Address of Property 

covered by this (^ZZ^ Cd^W<&U Av;^ Agreement: 

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 

work 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 wori( 

before it begins. Once the work is finished, the Grantor will be asked to review the work 

and confirm that rt is compiete 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 ACTIOIMS 

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 
'•/iiL ^ v^SI=^ 

CO ASI AL 

C « 0 U . 1 11 c 

« Remove obstructions including boats, Uailers. vehicles, playscape iiems, 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 leplacement 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 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 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 

ly^.iL 

Signature Dat Signature Date e 

Q ! would lika to be present during any ssmpling that b required. 

Page 2 of 2 
COASTA L 

C k O u V , I •• C 

Restoration Agreement 

The purpose of this agreemeni is to provide a mutual agreement as to condilions of ihe properly prior lo 

remediation activities. This will aiso serve as documentation for the purpose of assuring that restoration 

activities are completed to ihe satisfaction ofthe property owner and the United Stales Environmental 

Prolection Agency (EPA). 

Property ID: ^C, ^ij/ l 

Property Address: \fi1yV^ CO^^\M.\ ^ hMU 

Owner: 

O&ft-r \li\\fl,loV)*vS • AWANv-.r *v.A 

Phone: i o i •^\--\n( ^ 

On the attached diagram(s) indicale area(s) to excavate, surface structures and landscaping feahjres and 

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

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

necessary. 

Items t o be Removed by the Owne r before Start of Remediation: 

The removal, storage, disposal, and/or retum of these items is the Owner's responsibility. 

Item: 

^MAL U PZ.AAJK 

Item: 

lA/^o^ur^ LtGHr^^" ^ 

Item: 

Item: 

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

Page 1 of. 
Items to Be Removed By Contractor During Remediation and Replaced 

Item: 

^^^fS^ Z 

Item: 

Item: 

Item: 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

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

is covered wiih grass. f\ 

Number of trees > 2 inch Each 

/ trunk diameter 

Number of trees <= 2 inch Each 

trunk diameter 

^ 

Number of SprinkJer 

Zones, Control Valves, 

Each Timers, Heads, elc. 

Attach a sketch of the / 

sprinlder layout. 

Number of and size of 

each garden/ flower bed Each 

area. Square Feel 

Attach a sketch of relalive 

sizes and locations. 

Agreed upon value of planl 

maierials not to be 

replaced bv contractor. 

Note thif value will be 

used (0 issue a plant 

voucher to the prop9rt>' 

owner. 

Easemeni Area. lo be Each 

excavated AJ 0 

Page 2 of 
Additional Comments / Instructions: 

The city of Omaha ordinances may prohibit you from using dirt or gravel areas on your property 

as driveways or vehicle parking areas. The Environmental Protection Agency (EPA) may be 

removing and replacing soil underlying a gravel or dirt area on your property that you may be 

using as a driveway or vehicle parking area. If this is the case, you should understand that this 

removing and replacing of soil does not mean that any illegal driveway or parking area on your 

property is made legal. To the contrary, you may be cited by the city if you use a gravel or dirt area 

as a driveway or parking area, not withstanding any removal or replacement of soil by the EPA. 

If you have any question about legality of a certain driveway or parking area, you may contaci 

the city of Omaha's Planning Pepartment at (402) 444-5150. 

[ 0 Please check this box if you understand the information outlined above. 

ED Check the box if Owner does nol 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 foundafion cracks or fissures. 

[ 0 I agree ED J do not agree 

er's Signature Datle r^ntrasior' (^ntra^^or's Signature^ Signature^^ OatDle/

Page 3 of 
BVID ^JySfZjffL 

XRF PROPERTY SAMPLE SHEET 


Date 

Project, 

9-^^y/ 

Omaha Lead ARRA 

Address 

Sample time 

XRF ID# 3^;2. ^ sample length 

Shot# Reading Sample area Shot# 

s­ ^i± /I n 

c^ 37 i IZi Depth 

7 s-o-ta uAverage ^ ri /a 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 

Signature., a. ^/v^ 

Print l^a^'.fl f t I-L ua.^i_ 

^Z 2 5- Oki^fihetf yJVf 

am/pm 

30 sec 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 

Reading Sample area 

Depth 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

Certificate of Verification 

XL3t-39022 

Reading No 8 

Mode Soil 

Time 2011-08-16 16:33 

Duration 90.21 

Units ppm 

Sigma Value 2 

Sequence Final 

Flags 

AVERAGE Avg of 5-7 

ADDRESS 6225 Campbell av 

QUADRANT Fl 

DEPHT 6" 

XRF TECH KING 

MISC confirmation 

NOTE confirmation 

Error 

Pb 45.846 12.822 

Supervised By: 

ppm 

r(2j2^ ^y\r ^ 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 49.951 

Supervised By: 

5 

Soil 

2011-08­

30.05 

ppm 

2 

Final 

45232 

Certificate of Verification 

16 16:32 

6225 Campbell av 

Fl 

6" 

KING 

confirmation 

confirmation 

± Error 

± 13.232 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 49.951 

Supervised By: 

Certificate of Verification 

5 

Soil 

2011-08-16 16:32 

30.05 

ppm 

2 

Final 

45232 

6225 Campbell av 

Fl 

6" 

KING 

confirmation 

confirmation 

± Error 

± 13.232 
Thermo 

SCIENTIFI C 

Thermo Fisher Scientific 

900 Middlesex Turnpike 

Billerica, MA 01821 

XL3t-39022 

Reading No 

Mode 

Time 

Duration 

Units 

Sigma Value 

Sequence 

Flags 

BVID 

ADDRESS 

QUADRANT 

DEPHT 

XRF TECH 

MISC 

NOTE 

ppm 

Pb 50.201 

Supervised By: 

Certificate of Verification 

7 

Soil 

2011-08-16 16:33 

30.10 

ppm 

2 

Final 

45232 

6225 Campbell av 

Fl 

6" 

KING 

confirmation 

confirmation 

± Error 

± 13.111 
ili^ 

ii^^ \ Omaha Lead Site—Fixed Price EP-R7-09-06 

§ J^^^ ^ ° Coastal Environmental Group Inc. 

\y^j? www.coa8talhazmat.com 

'*tp„ott.'>" COASTA L • H«l>OIIIIINT«l s • o u r. INC. 

EXECUTIVE SUMMARY: 

BVID #45232- (6225 CAMPBELL AVE) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: 
^ 

Property Completion Agreement 

I Int iififecmtrw rlucuineni.". lhe LOinpIci lOn ol icmedi?.! aciivmes peiibimcfl nn m)- properly My .>;igii?iuic 

ivili rle.sijjnaie ihai I air saii.^fied with ilie rc.";io/alion of my pioperiy. and ihai nn iieins aie m rjue.'iiions 

now. oi ai any nme m ihe fulurr. excepi ihose iiems lisied below, ifany 

Properly ID: L i C O T o 

Property Addrc^.: (g2^ r QJUmpV ^ \ i Av I 

Phone:4QX- 'bo\- ^n ^ 

Restoration Ilems in Question. 

Item: 

(lem; 

Item: 

Item; 

Addilional Comments: 

TyJ I fii;'rr i rMoi ?lion ii cnmplrltd , ne t pl m nnlcri 

I J I r|o nm S|!iri irMOralinn i.v coiniilclrrl 

S-2V' ll yy/yy^) g-w-u 

ipnaliii p Dair ("iml i Riio i ' j Sif naliii <• Oair 
EPA Property Close Out Form 

Property H: _ ^7.?- ^ 

Property Addresr. _ V '-f^f S——- ^ 

Datc/Tlnie: 75-2^-1 1 IOI T OwVer'. Name: ...J f H^l'^h.? S ^y^H-^r'' ^ ^ 

Quads Excavated: Contractor Croup Cx^'ji^ ^ - £ l 

excavation Yes No General 

1. If necessaiy, were the conrct quadrant(s) excavated and restored? 

2. If necessary, were the correct areas ofdrip zone excavaied Rod restored? y 

Grading Sod and Vegeiation 

Yes No 

I. Does Ihe grading around the perimeter orihe house in excavated areas generally slope away 

fromibe houie? 

2. Has sod been laid m all areas thai were excavated? 

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

day time period) 

4. Arc sodded areas generally firm and evenly graded? 

5. Are thejoints between the sod sirips generally tight? (Only evaluate if inspecled at a 3D day y i_ time period) 

6. Was the property graded such that waier will not pool on ihr property'' 

I 7. Was damige lo landscaping or plant maierials avoided? 

Gates. Fences aad Reuining Walll \ n .Nil 

r 

!. Do gates open and close Ireely? (If applicable) y

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

i. Was damage lo gates or fences avoided? (Ifapplicable) 

4. Was damage 10 retaining walls avoided? (Ifapplicable) r 

Foundation, SiJiagand Cullers Yes .No 

y

I. Was damage to the siding or trim avoided? 

2. Was damage to Ihe foundation avoided? y —

 • 

Was damage lo Mrindows avoided? 

I y 1 

4 Was damage to windows or door screeni avoided? y 

Was damage lo downspouts or downspoui exlensions avoided? / 

Sidewalks and Driveways (Concrete) Ycs No 

I. Was damage lo driveway surfaces avoided? y 

2. Was damage lo walkway surfaces avoided? y 
•A. 

OM'ncrs comments: 

fn.spection notes: 

Reniova) and restoralion activates complele including lhe 3U-day .sod warranry: 

L^PA Representaiive 9^ ^ Da,e: •[ ..