TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

l^^K. ^. llt^h o SA1D#: I \/l ^ Date: 

Address: W' j HjCft^H ^ f 

Remediation Contractor: _CoflStal Environmental Group_ Year: _2O0A_ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

1/ Video of property (DVD) 

H Executive Summaiy 

EPA-provided property sketch 

^ Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

0 Restoration Agreement 

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

/ Confinnation data 

1/ Photographs ^Cfi^fijIiO^ X XVc (/^^yKlf/iA 

1/ As-built sketch 

Satisfactory restoration signed by Property Owner 

, / Property close-out check list signed by EPA 

-Q­ Description of areas not meeting ROD cleanup criteria 

M Utility clearances 

Property information from Douglas County Assessor's Office 

t( vA^ 

T5ate" 

30054786 

Mi 

Superfund 
• • 

^ 

Property Access Checklist 

Property ID: 

Property Address: 

n^LUL 

2f^l^ n\c,l^ryj^ ^ , 

D

D

 WORK STARTED

 WORK COMPELTED

 ON: __/__/_ 

 ON; / / 

O^ner: p^^^ ^ ^urr{t2]/ \ 

Address: 

Z5/q Uici^nj s f 

Phone: q<Da . fSqft . \OlZ.lP 

Fax: 

Cell/Pager: 

Renter: 

Phone: 

Fax: 

Cell/Pager: 

Additional Information: 

'

D Notification Letter 

D ^ Access Agreement 

 J ^ Restoration Agreement 

D Topsoil Sampling (if applicable) 

D Disposal Sampling (if applicable) 

D Garden Sampling (if applicable) 

n Utility Clearance 

Cg^ideo/Photos (Before) 

n Video/Photos (During) 

n Video/Photos (After) 

D Video/Photos (30-Day) 

n Property Completion Agreement 

D Final Report 

Sent: / / 

Signed: ** 1 i ^ 1 Cf^ 

Signed: ^/^/C2 3 

/ / 

/ / 

/ / 

CaUed: / / 

On: °} 1 li?l O"! 

On: / / 

On: / / 

On: / / 

Signed: / / 

Issued: / / 

By: 

By: 

By: 

By: 

By: 

By: 

By: 

By:

By: 

By: 

By: 

By: 

By: 

 OC7ft,x/iz> - (^fOsJr^n. 

Air Monitoring (as applicable) 

O Community [U Crew 

Results: 

On: / / By: 1 

O Community

Results: 

• Crew On: / / By: 1 

• Conunimity

Results: 

d Crew On: / / By: 1 

Omaha Lead Site 
^ouglas Cotmty Account Iafor|^tio b^r|^t i n Page 1 of2 

Douglas County, Nebraska Property Record - R2221640000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vlev y O n Ma p Information is valid as of 2009-9-15 Treasurer's Tax Report 

New Feature ••••• • Auto Sales Search 

Owner 

FOUNTAIN PETER T 

2519 HICKORY ST 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 2164 0000 22 

Account Type: Residential 

Parcel Number: 2221640000 

Parcel Address: 2519 HICKORY ST 

OMAHA NE 68105-0000 

Legal Description: SHULLS 4TH ADD LOT 16 BLOCK 0 W 5 FT LT 15 & ALL 35 X 120 

Value Informatio n 

Land Improvement Total 

2009 $4,000.00 $73,100.00 $77,100.00 

2008 $4,000.00 $73,900.00 $77,900.00 

2007 $4,000.00 $73,900.00 $77,900.00 

2006 $4,000.00 $63,100.00 $67,100.00 

2005 $4,000.00 $63,100.00 $67,100.00 

2004 $4,000.00 $63,100.00 $67,100.00 

Sales Informatio n 

Sales Date: 1999-09-02 

Deed Type: Book: 2132 Page: 087 

Price: $60,000.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.09 4200.0 1.0 120.0 35.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22... 9/17/2009 
J)ouglas County Account Jj^riMation Page 2 of2 

Building 1 

1 1/2 STORY FINISHED 

S«< n i -OCT %ii 330 J 51 1 f 

Si i 

Bsmrt eiock 8 fl 

8640SF 

iaM!m.HM.i.iiMi.m.iiuu».Mai;aa3 

XICK TO ENLARGE IMAgE CLICK TO ENLARGE IMAGE 

Square Footage: 1216.0 Percent Complete: 100.0% 

Perimeter ! 0.0 Quality: ; Average 

Unit Type: Condition: : Good 

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

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: i 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1912 0% 1912 97 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 864.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch End Screen 160.0 

Porch Wood Deck 77.0 

Storage Wood 96.0 

User Shed not finished 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22... 9/17/2009 
Page 1 of2 

Create Another Ticket Back to Irth Internet [ Send Email | ][ 

• YOUR TICKET NUMBER IS 2381461. 

Original Call Date: 10/07/09 Time: 9:53 am Op: ELIZABETH18790 


Work to Begin Date: 10/09/09 Time: 10:30 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2519 Street: HICKORY ST 


Twp: 15N Rng: 13E Sect-Qtr: 28-NE 


Twp: Rng: Sect-Qtr: 


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: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number UtiUty Type 

Day: 4029340469 


CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 


Day: 8773668344 


LEVEL3 LEVELS COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUD02 METROPOLITAN UTILrnES DISTRICT SANDY Alt: 

Emerg: 4025047970 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/7/2009 
Page 2 of2 

0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA

Day:

 Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/7/2009 
OLS#: 19316 

Date Excavated: 10/13/09 

Date USEPA Signed Off: 12/2/09 

As-Built Drawing 

C OAST A L CNVIRONHENTAL Omaha Lead Superfund Site Area Sodden: 1071 sof t CROUP . INC . 

19316 

Omaha Exterior Paint Norfri Arrow Lead Site Owner Name: PETER T FOUNTAIN 

Site Sketch Address: 2519 HICKORY ST • Poor Phone: H: 402-342-3738 W • Not paint \ ; 

Sample Number Sample 

Collected LAB Samples Collected 

Finm: FDO> \ (Z.^ \T o 

RYASCPXA-19316 D Date: f^ c ­ 2. ' - P "< 

RYBSCPXA-19316 D Time: \ \'. S o p rv. 

RYCSCPXA-19316 

RYDSCPXA-19316 

RDZSCPXA-19316 

nGZGCPXA-19310- D 

n 

n 

n 

n 

Samples Analyzed 

3Ji XRF Unit: ^ \ \ Book; 

Date: 1 .Q % D L^ 

m 

RPZOCPXA-igSIO 

Number of Samples =

D 

9 

D Time: 

Staff: 

.PK fw 

Omaha Lead Site 46130 

Legend 

Concrete Dri p Zone Excavate d Quadrants Excavate d 

Area replaced with 

Sod 

Area replace d wit h 

Rock/Mulch Are a lef t bar e 

Contrac t #: EP-R7-07-05 Coastal Environmental Group Inc . 
t r 9-S R 19316 

Omaha Exterior Paint North Arrow Lead Site rl Owner Nanne: PETER T FOUNTAIN 

Site Sketch E3^ood Address: 2519 HICKORY ST • Poor 

Phone: H: 402-342-3738 W: Q Not paint xy 

Sample Number Sample 

Collected LAB 

Firm:

Samples Collected 

p D O \ <2..S \7c u 

RYASCPXA-19316 Fl or D Date: f:>c. - 2.'-e>- ^ 

RYBSCPXA-19316 F2 D Time: \ ^ '. 5 g> p rw 

RYCSCPXA-19316

RYDSCPXA-19316

 B1 

 B2 

D Samples Analyzed 

RDZSCPXA-19316 DZ 

nczGcrxA-iQoio—ez 

RPZGCPXA-193t€ PZ 

D 

D 

n 

D 

D 

D 

XRF Unit: 

Date: 

Time: 

JX 

3 M Book: JJL I 

Number of Samples = <^ Staff: ^ ^ 

Omaha Lead Site 461.10 
• • 19316 

r Owner Name: PETER T FOUNTAIN Omaha Lead Site 

Site Sltetch 

Exterior Paint 

Q^oo d 

Nortti Anrow 

• Poor 

Q Not paint 

Omaha Lead Site 46130 
19316 

Omaha Lead Site Exterior Paint NorthArrow Ownsr Name: PETER T FOUNTAIN 

Site Sketch D'^o d Address: 2519 HICKORY ST • Poor Phone: H: 402-342-3738 W £} Not paint J

Nd; 

Sample Lead Sample Samples Collected Number LAB Com Collected Fimi: gDft \ g>& \TC J 

RYASCPXA-19316 Fl 

D Date: CiC - 2.t-t>' < 

RYBSCPXA-19316 F2 D Time: > t'. S o p r^ 

RYCSCPXA-19316 Bl 

D Samples Analyzed RYDSCPXA-19316 B2 

RDZSCPXA-19316 DZ a ET XRF Unit: ^ \ \ Book: 

nCZOGPXA-19910 D \A D Date:_rUaX_DJ 4 

RPZ3CPXA-19010 PZ D Time:_ '^ ^ * n 

Numt)er of Samples = | ^ n Statf: ^5E 

F\U<>j C»U-<-*3 P > ^ i 

ENTERED { ^ 

JUN 2 8 ^ii ^ 

:<->- ^ 

CA^ e^ S> 

A 

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ov 

: V 

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Omaha Lead Site 46130 
..MO tr „ 

COASTA l 

iNvtROHni mx t 

c t o u r INC 

Consent for Accciss To Pfopfcfly 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United Slates 

Environmental Protection Agency (EPA) or its authorized representatives, collectively 

the Grantee, to enter and perform certain environmentai response activities upon the 

following described premises: 

Daytime Phone: 3^^y^/^ ^ 

Address of Property 

covered by this 

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 perfomied, 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 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 
s 

COASTA L 

tNVtNONKrKTA t 

« » O U > IM C 

Remove obstructions including boats, trailers, vehicles, playscape items, wood 

piles, dog houses, etc; 

f Remove flower bulbs or plants that the Grantor or the Grantor's tenant may w

to save; 

ish 

i 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. 

t 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 

0 T gra I granr t access to my properties G I do not grant access to my properties 

Signature Date 

G I wouid iike to be present during any sampling that is required. 

Page 2 of 2 
# 

(CQ 

COASTA L 

RestoratsoFi Agireemsnt 

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: /^^/ ^ 

Property Addr^:^57 ^ ^}^j^y^y / ^ T 

Owner: 

^2IJ,J^Z^ ^ 

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

access iocation(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 renoval. storage, di&posal, and/or return of these itoms Is the Owner's responsibility. 

ttem: 

:^ytfy^/ /^A^ry 

Item: /^/></ s^*^ 

Item: 

Item: 

Items to be Removed by the Contractor During Remediation and Wot Repiaced 

ttem: 

^ f /?/y^r:^ 

ttem: 

Item: 

ttem: 

Pagel of. i. 
- : ^ 

COASTA L 

Items to Be Removed By Contractor During Remediation andRepiaced 

t ttem:I . 

ttem: 

w^ 

ttem: 

ttem: 

L ^ 

Landscape Inventory 

Item Quantity Unit Condition/Type/Species 

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

is covered with grass. 

Number of trees > 2 inch Each 

trunk diameter y 

Number of trees <= 2 inch Each 

trunk diameter ^ 

Number of Sprinkler 

Zones, Control Valves, Each Timers, Heads, etc. 

Aiiath il sketch ol tliir ^ 

'•rr'nkk'i li>\'.)iii. 

Number of and size of 

each garden/ flower bed FxrM 

area. Square Feet 

Aiiach il skcicli ol rcNiiivf ^ 

iizi-s nnd lnc;iiiiitis 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. S 

\cU ' ll'ii' NHIUC will rii. / USI'L' 10 Miw. .1 riian; 

>nin.ln.'.- 1(1 llie (}ro))ciI> 

in' ner. 

Easement Area, to be ^ ^ e?A^6d!^-^yC/ 

excavated ( / Each 

Page 2 „'> 
C O A S 1 A L I >« VIMOMM I HTA » 

e ll a u r . • N c 

\ Additional Comments / Instructions: 

I -^ /^/yi'ue ^>^/^ ^ Arztj>6^ / ^ ^=7e^>Air^z^ 

I 

L. 

Q Check 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. 

agree Q I do not agree 

I Date ' JContractor's Sienaturr Date 

Page 3 of. 
BVID # l^3/(. XRF PROPERTY SAMPLE SHEET 

Date IO-l2> -O ^ Address ^Sl ^ ^ \ cJk^Hjt s: 

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

XRFID# sample length 30 sec 

Shot# 

WES- ^ThU ^ 

Reading Sample area 

D ^ ^ 

^ 

Shot# 

^ 

Reading Sample area 

b ^ 

d^Tin 

^0-^1 

^<?/) i ^ [f^ 

I^L±Jk 

Depth 

jSr 

9^ % 

g^ ^ 

Depth 

J2LL. 

Average ^/£ ) ^ \S ' Average pL^^i JZ } ^ 

Shot# Reading Sample area Shot# Reading Sample area 

^^ » 

^^^2 > 

^22L 

^^^?r 

^=^/ ^ I

^zz ^ 

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Depth 

S 

Depth 

Average ^ J ^ l ^ 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. 

Signatun ^2cmMprint£tiygW=mn Cac^fe^ 
Jl ^ 

# • 

<r — ** 

/^A. \

I ^^^ ^ o

\~^y^ ^"tpRO ^

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

 Coastal Environmentai Group inc.

 wvin*.coa8taihazmat.com

 vj 

— COASTA L 

Clour . IN C 

EXECUTIVE SUMMARY: 

BVID #19316-(2519 HICKORY ST) 

No Issues or Concerns [^ Issues/Concerns 

Detail Explanation: ' 
m

^ EPA 

EPA Property Close Out Form 

Property#: \^^i] ^ , , Property Addrcaa-^7\>\^j0 ^^'\ jOiM— 

Date/Time: Owner's Name:. .C^ f J^ sf^- >0r 

Quads Excavated: 1^1 J^ 7 . f) ? Contractor Group CCYif^ n \ 

Yes No Excavation General 

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

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

u^ 

Grading Yes Nl Sod and Vcgetatton 

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

ftx)m the house? . 

2. Has sod been laid in all areas that were excavated? t/' 

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected ai a 30 \ y day time period) 

4. Are sodded areas generally Rrm and evenly graded? 

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

time period) 

6. Was the property graded such that water will not pool on lhe propert>'' ^ ^ 

7. Was danuge to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls 

Yes 1^0 

I. Do gates open and close freely? (Ifappiicable) 

Were all gates or fences taken down during restoration activities reinstalled? (Ifappiicable) 17" 

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

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

Foundation, Siding and Gutters 

Yes No 

1. Was damage lo the siding or trim avoided? 1/' 

2. Was damage to the foundation avoided? ly" 

3. Was damage to windows avoided? IZ 

4 Was damage to windows or door screens avoided? 

\ y 

5. Was damage to downspouts or downspout extensions avoided? 

y 

Sidewalks and Driveways (Concrete) 

Yes /Jo 

I. Was damage to driveway surfaces avoided? 

^ ^ 

2. Was damage to walkway surfaces avoided? 

w / 
, Owners comments: 

Inspection notes: 

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

EPA Representative kJo h lj)riJly^Jf>^ Date:/^/^^V ^ 7 
# 

Property Completion Agreement 

This agreement documenis lhe completion ol remedial acliviiies perioimed on my property My signature 

will designate ihai I am satisfied with the rcstoralion of my propeity, and that no items are in questions, 

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

Property ID: \()^y ^ 

Property Addr».: 25 1 q ( ^ fc^l^OnJ . ^ 

Owner: p^p_ ^ ^xjrH^Tl^ A 

Phone: qo^,,^q^,^|2.^ ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Addttional Comments: 

I c^torfliion it compleled, except as noteri 

[ I I Ho not aKrec rcsromtion ii completed 

: /V>y^,f 9.cr,cof?0f^ \Olz?.lcfl 

Owner's Sigtifltirif Date Contrarloi 's Signaiure Dale