TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

^ SAID #: n. Date: / -

Address: 1^\< f^l^ ^ 

Remediation Contractor: _Coastal Environmental Group_ Year: 200i T 

( / 

Ef' 

43­

a/ 

D 

D 

D 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Stunmary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

Restoration Agreement 

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

Confirmation data 

Photographs ^«> Wn {o^ > b<6VMloi^ Y ih ' 6)cflVni\<yva 

As-built sketch 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property mfbrmatron from Douglas County Assessor's Office 

"Dafe 

Superfund 
« • 

Property Access Checklist 

Proptrr) ID: 32S 

n WORK ST/VRTED ON: / / 

Property Addrt»:^ip^\F=^PQy 4 3 ^ D WORK COMPELTED ON: /

Owner Ren.er V^,^^^-f. ^ "^j^fjfi ^ ^x^o^fi \ 

Addrtss: 

Phone: L^g y Q^2. S 

P,L\: 

Cell/Pager: 

&V>f^V».t<fe V)^V\ \ 

Additionul Inlnrmntion: 

Phone L\o^,c4S^-\v2 A 

F«x: 

Ccll/Pjger 

D Nutincalion Leitcr 

Scm: / / By: 

^ Access AgreemcBi Signed: ^

 1 ^ CP i B3=O0A-6L\|f o 

^3^ RertorniiOD Agreemem Sin»td:**j /.? lOO\ B>Y^n ^ 

D To|)»oil Sampling (if applicublt) 1 1 By: 

D DispoiRj Sarnpling (ft applicable) 1 1 J By: 

D Gnrdcn Snmpliog (if applicable) / / By: 

n Uiilily Clearance Called: / / , By: 

• Video/Photos (Before) On: / / By: 

• Video/Phoios (During) O B: / / By: 

D Video/Pholoi (After) On: / / By: 

D Video/Phoios (30-Djiy) On: / / By: 

^ Property Complelion Agreement Signed:/^//^/ ^ By: 

D Finn' Rcpon Issued: / / By: 

Air Monilorint; (ju iii>pticable ) 

D Community D Crew 1 Oo: / / By: 

RuuJls: 

D Community D Crcx On: / / By; 

Rc«ulls: 

1 D Communiri D Crv«- On: / / .... 

Results: 

Omaha Lead Srte 
Douglas Coimty Account Iij£|raiatio ^^^i < n Page 1 of2 

Douglas County, Nebraska Property Record - R l 144450000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 n west of 52nd St - Vie w OH Ma p Information is valid as of 2009-8-3 Treasurer's Tax Report 

New Feature H* ^ ^ Auto Sales Search 

Owner 

BRYANT ELLEN L 

ETAL 

3908 N 40 ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: 4445 0000 11 

Account Type: Residential 

Parcel Number: 1144450000 

Parcel Address: 2515 FORT ST 

OMAHA NE 68111-0000 

Legal Description: GLENGOE PLACE LOT 13 BLOCK 1 45 X 120 

Value Informatio n 

Land Improvement Total 

2009 $2,500.00 $40,300.00 $42,800.00 

2008 $2,500.00 $40,300.00 $42,800.00 

2007 $2,500.00 $40,300.00 $42,800.00 

2006 $2,500.00 $40,300.00 $42,800.00 

2005 $2,500.00 $14,600.00 $17,100.00 

2004 $2,500.00 $13,200.00 $15,700.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.12 5400.0 1.0 120.0 45.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 1... 8/11/2009 
Douglas County Account Ii^mnatio ^^i^ti ( n Page 2 of2 

569 0 sf 

ICC i 

First Pbof 

1070.0 « 

7ir 

iff; n»aw wrooii 

11/2 STORY HM 

CLICK TO ENLARGE IMAGE 

Square Footage: 1639.0 Percent Complete: f 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: End Condition: Fair 

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

HVAC: Forced Air Rooms: 6.0 

Exterior: Frame Vinyl Units: 2.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year 

year Built Physical Age Remodeled Remodeled Built 

1916 0% 1916 93 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 1070.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 216.0 

Porch Cvrd Wood Deck 50.0 

Porch Cvrd Wood Deck 192.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 1... 8/11 /2009 
Property ID #

Property 

Address: 

Initial Contact:

Second Contact:

Final Contact:

Final Action:

Comment: 

(!)wner 

Comment (s): 

Site 

Coordinator 

Comment (s): 

. 

CONTACT FORM 

 1{)Z 1 

7.515 FFyrfSt­

 Dale: Time: Action: 

 Date: Time: Action: 

 Date: Time: Action: 

 Transmit to EPA D Other Action: D 
Page 1 of2 

# • 

"> 

Create Another Ticket [: _ Ba^k to Irth^lntemet ] j[ Send Email 

• YOUR TICKET NUMBER IS 2360358. 

Original Call Date: 9/09/09 Time: 3:57 pm Op: ELIZABETH18790 

Work to Begin Date: 9/11/09 Time: 4:30 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 2515 Street: FORT ST 

Twp: 15N Rng: 13E Sect-Qtr: 04-NE 


Twp: 16N Rng: 13E Sect-Qtr: 33-SE 


Legal Given: C 


Type of Work: LEAD REMEDIATION 


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: COASTAL 


Depth of Excavation: 4 FT Comer Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MAGELLAN METRO MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

MAGELLAN MAGELLAN MIDSTREAM PARTNERS LP DEBORAH

Day: 9185747098 

 Alt: 

Emerg: 9185747098 

METRO METRO COMM. COLLEGE CHRIS 

Day: 4024572307 

Alt: 4026727033 

Emerg: 4024572313 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/9/2009 
Page 2 of2 

# • 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

QLNNEIC QWEST LOCAL NETWORK NA 

# • 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/9/2009 
627 

^ ^ As-Built Drawing ^ ^ 

COASTA L Omaha Lead Superfund Site 

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

Sit • Good e Sketch Address : 2515 FORT ST 

Phone: H: W: • Poor t

I I Not paint 

Sample Number Lead 

Concentration 

Sampie 

Collected LAB 

Firm: 

Samples Collected 

Sverdrup 

RYASCPXA-627 YA 176.2 ppm D Date: 

RYBSCPXA-627 YB 433.2 ppm a Time: 

RYCSCPXA-627

RYDSCPXA-627

 YC 

 YD 

319.4 

192.9 

ppm 

ppm 

D 

n Samples Analyzed 

RDZSCPXA-627 DZ 1800 ppm El El XRF Unit Book: 

RGZSCPXA-627 GZ ppm n D Date: 10/20/1999 

RPZSCPXA-627 PZ ppm D D Time; 12:16 

Staff: Number of Samples = 

Legend: YA = Yard (NE), YB = Yard (SE), YC = Yard (SW), YD = Yard (NW), DZ = Drip Zone, GZ = Garden. PZ = Play 

OLS#: 627 PC>f^T ^t -

Date Excavated :9/16/09 

Diite USEPA Signed Off: 10/23/09 

Area Sodden: 2358 sa ft 

Legend 

Concretie Drip Zone Excavated Quadrants Excavated 

Area replace d wilih Area replaced with 

Area left bare 
 Sod ' ' Rock/Mulch 


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

627 

Omaha Lead Site Owner Name: 

Site Sketch Address:_2515 FpRTST_ 

Phone: H: W: 

Sample Number Lead 

Concentration 

RYASCPXA-627 YA 176.2 

RYBSCPXA-627 YB U- 433.2 

RYCSCPXA-627 YC 319,4 

RYDSCPXA-627 YD 192.9 

RDZSCPXA-627 DZ a^ 1800 

RGZSCPXA-627 GZ 

RPZSCPXA-627 PZ 

Number of Samples 

Legend; YA = Yard (NE), YB = Yard (SE), YC = Y 

/Z6X/:J^^^ ; 

Rev 4 
627 

Omah Exterior Paint North Arrow a Lead Site Owner Name: 

Sit • Good 

Address : 2515 FORT ST e Sketch A • Poor 

Phone: H: W: Q Not paint 

Sample Lead Sample 

Samples Collected Number LAB Concentration Collected Firm: _ Sverdrup 

RYASCPXA-627 YA 176.2 ppm 121 • Date: _ 

RYBSCPXA-627 YB vO-^ 433.2 ppm D Time; _ 

RYCSCPXA-627 YC 319.4 ppm 

n Samples Analyzed 

RYDSCPXA-627 YD 192.9 ppm 

RDZSCPXA-627 DZ fiJL 1800 ppm IZI n XRF Uni t: Book: 

RGZSCPXA-627 GZ ppm 

a n Date: _ 10/20/1999 

RPZSCPXA-627 PZ ppm 

a a 

Time: _ 12;16 

Staff; Number of Samples = 5 1 

Legend; YA = Yard (NE), YB = Yard (SE), YC = Ya^ (SW), YD = YlFd (NW), DZ = Drip Zone, GZ = Garden, PZ = Play 2 

^a.^aois 

Rev 4 

0461410123 
627 

l^. 

% 

Owner Name: 

Address: 2515 FORT ST 

Phone: ^• W: 

Omaha Lead Site 

Site SItetch 

Sample Number 

RYASCPXA-627 YA 

RYBSCPXA-627 YB 

RYCSCPXA-627 YC 

RYDSCPX;V627 YD 

RDZSCPXA-627 DZ 

RGZSCPXA-627 GZ 

RPZSCPXA-627 PZ 

Lead Sampie LAB Concentration Collected 

176.2 ppm a 

433.2 ppm a 

319.4 ppm n 

192.9 ppm n 

1800 ppm 

ppm a D 

.ppm D a 

Number of Samples = 5 

Exterior Paint North Arrow 

• Good 

• Poor t 

[]] Notpaint 

Samples Collected 

Firni: 

Date: 

Time: 

SverdnjD 

Samples Analyzed 

XRF Unit: Book: 

Date: 10/20/1999 

Time: 12:16 

Staff: 

Legend: YA = Yard (NE). YB = Yard (SE), YC = Yard (SW). YD = Yard (NW). DZ = Drip Zone. GZ = Garden, PZ = Play 

V/////////A 

/ YA-I7U.'2. / 

/ 

V PZ. ^ 

VU 

\eoo 

4t 

J PZ. 

ZZZl 

|Rev4 AU-TY 046141.0123 
>*'2£S. 

COASTA L 

IN»l|OMHINia | 

ft•o w r. IHC 

Consent For Access To Property 

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: Daytirne Phone: 

Address of Property 

covered by this 

Aoreement: 

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 work 

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

work and confimn that it is complete and meets with the Grantor's approval. Upon 

completion, the Grantor will receive vy^itten 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 IMVUeHftrNTAl 

Clour , tk e 

• 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 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 v\^ich 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 (712) 352-0188 

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

I signature ^ate Signature

 Date 

Q I would like to be present during any sampling that is required. 
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 of the property owner and the United States Environmental 

Protection Agency (EPA). 

Properfy ID: (^ir? 

Property Address: -i ^ 'yL 

Owner: eu^ygM -h' c ^^^VvWy^ 

Phone; 4^ 7 ZjL.^^ ^^l l A 

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

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

Photographically and Videographi(^ly document the existing conditions ofthe property and the basement if 

necessary. 

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

rhe lenoval. storaqe, disposal, and/or return of these items is the Owners responeibility. 

ttem: 

ttem: /

ttem: 

Kem: 

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

Item: 

1/ U-^ C^L^ l 

item 

ttem: 

ttem: 

Pagel o-i 

 I 
COASTA L 

C k (• u ^ I •• t 

Items to Be Removed By Contractor During Remediation and Replaced 

ttem: 

Sv7iO ^ TSZ- ^ ^ ^ 

ttem: 

^ D Q - Ty-y^ , y iS 

Item: r 

[ 

I Item: 

\ 

Landscape Inventory 

(tern Quantity Unit Conditlon/Type/Species 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Quadrants 

Number of trees > 2 inch 

trunlc diameter 

Each 

Number of trees <= 2 inch 

trunk diameter 1 Each 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Miath ;i skfich ol ihtisri'i'l^l*.'' liivmi; 

^k Each 

Number of and size of 

each garden/ flower bed 

area. 

Alliith ;i skcirh 1)1 n-l.itivf 

M/os mid loc;iiiiMK 

I F4ich 

SquareFeet 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

N'CK' ll-.i­ \HIIIC «ill Ml 

USI'L' U) is'.ui .1 'IIBII; 

^o^ll.•!K'^ 1(1 ihe pr0))cil> 

DM ntr. 

S 

Easement Area, to be 

excavated ^^-L Each •L ^ ,^ ^ 

Page 2 of ^
# 

C O A S 1 A L 

C ^ O U ' • » N C 

! Addttlonal Comments / Instructions: 

MChChec t k 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/ i n I do not agree agree 

CRntfidn °l|-^|nQ Owner's Signature Date CoContractor' i s Signature Date 

Page 3 of. 3 
BVID# UX ^ 

XRF PROPERTY SAMPLE SHEET 


Date ^-/fe ' 0 9 Address 2-.S'l5 ^ P«rs ^ <Jr 

Project Omaha lead FP 2nd year option Sample time am/pm 

XRFID# sample length 30 sec izj^m 

Shot# Reading Sample area Shot# Reading Sample area 

B nfi ^/ v 2- 111 ^I H -3^. 5g ^/o b ^ 

99 iDepth Depth t II- '^ ^ J8/i-*-' ^ 

3 ^ /sz^ i. i.<r sHe~ ^ i^f:^ 43i 

Average /^ O " ^ t S ' Average 12-'^' ^ I f^ 

Shot# Reading Sample area Shot# Reading Sample area 

mk^M- 5V ^ / / ^tA M H Depth Depth s 

Average Z4 ^ ^ / g Average 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

RETEST AREAS 

Shot# Reading Sample area Shot# Reading Sample area 

Depth Depth 

Average Average 

lab sample # Lab result Sample area XRF Avg. 

Signature^ \&IIJl(lO 

Prints A^^iini;4t\Cam!k) 
# # 

.

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

 ^^^ ^ ° Coastal Environmental Group Inc. ^'^^g^ ^ 

V/^^lj ? www.coastalhazmat.com 

%pi.oi*' ^ COASTA L ENViaONNINTAl 

e II 0 U P. IN C 

EXECUTIVE SUMMARY: 

BVID # 627- (2515 FORT ST) 

~y| No Issues or Concerns []]

I 

 Issues/Concerns 

Detail Explanation: 
EPA Property Close Out Form 

Property tf: LnX ^ „ Property Addr«.-^^ \ ^ ^ ^ ^J -

Date/Time: OwTer? Name:./jTVDTm^ . ??.ti 

Quads Excavated: N ^ ^1 ^ Contractor Croup Or(VSsVd\ PjrvvTT^O 

Excavation General 

Yes No 

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

^ 

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

ty^ 

Gradin Yes No g Sod and Vegetation 

I. 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? 17' 

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

day time period) ___ ^ 

4. Are sodded areas generally fum and evenly graded? ^

5. Arc the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 17 _ _ 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, Fepccs and Retaining Walls 

Ves No 

1. Do gates open and clo.se freely? (Ifapplicable) tr 

Were all gates or fences taken down during restoralion activilies reinstalled? (Ifapplicable) ^ 

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

A. Was damage to retaining walls avoided? (Ifapplicable) 7' 

Foundation, Siding and Gmiers 

Yes .No 

1. Was damage to the siding or trim avoided? tX ' 

2. Was damage to the foundation avoided? 1 ^ 

Was damage lo windows avoided? 

4 Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspoul extensions avoided? 

Sidewalks and Driveways (Concrete) Yes No 

1 Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? P
Owners comments: 

Inspection notes: 

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

EPA Representative 
< > 

Property Completion Agreement 

This agreement documenls the completion of remedial acliviiies perloimed on my properly My signature 

will designate lhat I am satisfied with the restoration of my properly, and that no Hems are in questions, 

now. or at any lime in Ihe fiiture, except those ilems listed below, if any 

Property fD: [^^H 

Property Address: 2J^\f) P'cyV' S L 

Owner:-YTv^^^ ^ ?ir\l/lA V 

Phone: UM..m^\.\i^.< Hi ^ 

Restoration Items in Question: 

I Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: 

nyrcc i «torfllion is completed, except as noted 

[_J I do nol ^Krec rcstonttinn i» completed 

Owner's Signaturr Da^fc Contrarlor's Sicnaliirc 1 ^ Dale