TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: ^MH ^ 

Date: 

I k 

Address: li n f]^u ^f 

Remediation Contractor: Coastal Environmental Group_ Year: 2001 

SOIL REMEDIATION 

PROPERTY nL E FOLDER DOCUMENTS 

5 / 

Video of property (DVD) 

Executive Summary 

ei 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adjacent property 

t/ 

Restoration Agreement 

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

Confirmation data 

Photographs %o ^^ ^ h ^ ^ \H jS^^irjL ^ 

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 

PropertyjafSfmaiion from Douglas County Assessor's Office 

" ^ < ( . 

me 
Property Access Checklisi 

Property ID: O • ILA O 

Properly Address: ^^\'J _ "Pv^TC e ^ 

D

D

 WORK STARTED

 WORK COMPELTED

 ON: 

 ON: 

_/ /_ 

Owner: 1Sro&e -\Vv>Y\p<=;en Rcnie r 

Address 

Pho 

"" 'l-\4-\f?<^'^ 

F«x: 

Ccll/Pager. 

D NotiHc^jfion Letter 

J ^ Acceu Agrcemeni 

j ^ Restoration Agreemem 

D Topsoil Sampling (if applicubic) 

D Disposal Simpling (K applicable) 

D Ciirdcn Sampliog (if applicable) 

JS ' Uiilitv Clearance 

^ ^ Video/Photos (Before) 

• Video/Photos (During) 

D Video/Pholos (After) 

D Video/PholM (30-Day) 

D Pro|»crt.v Complelion Agreement 

D Final Rcpon 

Air Monitoring (as applicable) 

D Community D Crew Oo:

Rc5ulls: 

D Comrounir>' O Crew On:

Results: 

D Communis D Crv>v On: 

ResulU: 

Phone: 

FH.V: 

Cell/Pager: 

Additionul IntorwAtiw. 

Sent: / / 

Sipicd; ^ / I /C ^ 

Signed: 3./J_/Cl ^ 

/ / 

/ / 

/ / 

Called: ^/J^/ ^ 

0f^:3.'Jl'C>^ 

On: / / 

On: / / 

Oo: / / 

Siened: / / 

Issued: / / 

/ / By: 

/ / Bv: 

Bv: 

Omaha Lead Srte 

By: 

ByOC-^vIO 

8y:rv>-!tt>\/\0 

By: 

By: 

By: 

BjC^/^/O ^ 

By noAav/tO 

Bv: 

By: 

By: 

By: 

By: 
• • 

• • 

CONTACT FORM 

Property ID # ^\\4 X 

Property 

Address: ^X\X Vx<yZ€ h\ 

Initial Contact: Date: Time: Action: 

Second Contact: Date: Time: Action: 

Final Contact: Date: Time: Action: 

Final Action: 

Transmit to EPA D Other Action: D 

Comment: 

Owner 

Comment (s); 

Site 

Coordinator 

Comment (s): 
• • 

Douglas County Account I [i|£^i||^ion Page 1 of2 

Douglas County, Nebraska Property Record - R2216500000 

Print Report 

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

New Feature ->->• • Auto Sales Search 

Owner 

THOMPSEN BRUCE A 

ETAL 

3511 WOOLWORTH AVE 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 1650 0000 22 

Account Type: Residential 

Parcel Number: 2216500000 

Parcel Address: 

Legal Description: 

2212 PIERCE ST 

OMAHA NE 68108-0000 

SHULLS ADD LOT 3 BLOCK 2 E 1/2 S 1/2 30 X 91.5 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$3,300.00 

$3,300.00 

$3,300.00 

$3,300.00 

$3,300.00 

$3,300.00 

Improvement 

$24,100.00 

$24,100.00 

$24,100.00 

$33,100.00 

$33,100.00 

$33,100.00 

Total 

$27,400.00 

$27,400.00 

$27,400.00 

$36,400.00 

$36,400.00 

$36,400.00 

Land Informatio n 

Acres 

0.06 

SF 

2730.0 

Units 

1.0 

Depth 

91.0 

Width 

30.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.coin/DouglasCoNe/static/accountinfo.jsp?accoimtno=R22... 8/22/2009 
Douglas County Account I t^^||H^ion Page 2 of2 

• • 

*•• • » _ 

RANCH 

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a>iia»j,iiH.i.iiMa.Mw.iii.%t».fc»j.'am 'sr.irt^ifSimtm 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 602.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: Ranch Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: i 3.0 

Roof Type: Gable Stories: 1.0 

Floorcover: i Allowance Foundation: I Block 

Sprinlder Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1886 0% 1886 123 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 532.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch Slab Roof Ceil 84.0 

Porch Wood Deck 16.0 

Storage Wood 60.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22... 8/22/2009 
Page 1 of2 

"> 

Create Another Tici<et ] Bacl< to Irth Internet ] : [ Send Email ) 

• YOUR TICKET NUMBER IS 2356579. 

Original Call Date: 9/03/09 Time: 1:05 pm Op: ELIZABETH18790 


Work to Begin Date: 9/08/09 Time: 1:30 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2212 Street: PIERCE ST 


Twp: 15N Rng: 13E Sect-Qtr: 27-NW,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: 4ft Comer Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 METHODIS MUD02 OMAHACOF 0PPDGPR6 PAETEC 

QLNNEIF 

Utility Service Area Contact Phone Number Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, ^^^,1 

Alt: 4029340469 

INC 

Emerg: 4029329757 

Day: 8773668344 


LEVEL3 LEVELS COMMUNICATIONS, ^ ^ Alt: 


Emerg: 8773668344 

Day: 8888474757 


METHODIST HEALTH METHODIS Alt: SYSTEMS 

Emerg: 8888474757 

Day: 4025047823 

METROPOLITAN UTILITIES MUD02 SANDY Alt: DISTRICT 

Emerg: 4025047970 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/3/2009 
Page 2 of2 

Day: 4024447197 

OMAHACOF J^FIC^EWER ^° ^ ^^^ Alt:' 402444516 4024445161 1

Emerg: 4024445160 

Day: 4067289343 

0PPDGPR6 g;^^^^^^^°^ ^ NA Alt:: 406207149 40620714944 

Emerg: 8887289343 

Day: 8002891901 

PAETEC PAETEC COMMUNICATIONS EM^GeTCY^"^^ ^^^ ^'Alt*: 

Emerg: 8002891901 

Day: 4067289343 

QLNNEIF QWEST LOCAL NETWORK NA Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/3/2009 
C-S#: 21142 

Date Excavated:9/15/09 

Date USEPA Slatted Off: 9/24/09 

As-Built Drawing 

COASTA L Omaha Lead Superfund Site Area Sodden: 1785 sof t 

Name :_rXHC E e itfOi Omaha Lead Site Date Nortii Arrow 

Address r Sf\ Site Sketch Time 

Phone 4 

Team ^l^^i/l^. •{inti,r\^ fr)£s BVID# ^//V 2 XRF Code . ^ 

Sample Number Lead Concentration Confirmation Sample 

F, Yes a 

S^7^3 / PP'" 

Oinaha Lead Site 46130 

Quadrants Excavate d 

Are a replace d wit h Are a replace d wit h \M^ 

Are a lef t bar e Sod ' ' Rock/Mulch 

Contrac t #: EP-R7-07-05 Coastal Environmental Group Inc . 
^^V 

C 7 ^ ere 

Name: lYjf^ c Tl^Oin^Ser ^ Omaha Lead Site Date: 7//g/i;'^ North Arrow 

Site Sketch Time: •f.V^ 

:& „ , 

Address: p J /A P.^^^^ S-f, 

Phone: 4

ms 

Team BVID# XRF Code S : fr/^o*^ 

Sampie Number Lead Concentration 

U^^z-y IZ /r/> ^ ^•/^^r/f -;;>// ^ 

5)o 

>- 5i'(t»~».//t' - ­ gfc.-^t^.'t.. .^ ^^"FV 

Omah erce a Lead Site 46130 
Omaha Lead Site Date: T/Zf/l'^ 

: ^33 i:^ XiPi/t, St , 

Omaha Lead Site 46130 
Name:: (W f IjJOinf^en Omaha Lead Site Date: zWi . North AiTOW 

Address: Site Siwtch Time: 'ff/ ^ 

Phoness: : p j tx y.jrr^T: f 

Team SM^A BVID« ^//^; ^ XRF Code ^5:^ / 

Sample Number Lead Concentration Confirmation Sample 

F". Yes a No — 

P« Yes a No 13— 

«» Yes a No cr " 

P.. Yes ° No C^ -

No CB" 

ppm No I=i 

ppm No • 

^h^^J k "*-*«•"«-* • 

Omaha Lead Site ?'erce 3^. 46130 
^€X> BUf, 

COASTA L INVIKONniRTA I 

C ft O 11 f . IN C 

Consent for Access To Properti' 

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: 

^"^'*^7H-J5*^3 

Owner's Name: Daytime Phone: 

brooeTVxoM^ev^ 

Address of Property 

covered by this 

Agreement: ^2} 7 PkJ-<.^^i- 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 wotk 

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 vmtk. This access shall 

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

agrees to: 

Page 1 of 2 
^^V ) «r4,, 

v ^ ^ 

COASTA L tftVtRONHFKTA l \:,oy C R O U » IN C 

t 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. 

6 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 

Signature Date 

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

Page 2 of 2 
• • 

COASTA L INVmONnrNrA L 

C n O U r . IN C 

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 Environmenta] 

Protection Agency (EPA). \ 

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

access Iocatioti(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 removal, storage, disposal, and/or return of these items is the Owner's responsibility. 

Item: 

^t^c . \\ ?wJb 

Kem: 

/ 

Item: / 

ttem: 

, ,, ... 

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

ttem: 

^rw, < •?\^.w 

ttem: r 

Item: / 

ttem: J f 

Pagel of ^ 
• • « « 

COASTA L rNVlMONH f NTAI . 

c • o i> r . IN C 

'Items to Be Removed By Contractor During Remediation and Replaced 

ttem: <^^1 

Item 

Pre-existing property area, 

that will be excavated, that 

is covered with grass. 

Number of trees > 2 inch 

trunk diameter 

Number of trees <= 2 inch 

trunk diameter 

Number of Sprinkler 

Zones, Control Valves, 

Timers, Heads, etc. 

Attach a sketch ol' the 

sprinkler liivoui. 

Number of and size of 

each garden/ flower bed 

area. 

Atuich il sketch of relative 

sizes nnd loc;lti(ln.^. 

Agreed upon value of plant 

materials not to be 

replaced bv contractor. 

Note this \aliie will he 

used lo issue H plant 

voiielier to the property 

0^\ner. 

Fnsement Area, to be 

excavated 

Quantity 

/ 

Landscape Inventory 

Unit 

Quadrants 

Each 

Each 

Each 

Each 

SquareFeet 

$ 

Each 

Condition/Type/Species 

Page 2 Of ^ 
I

^ 

COASTA L HVIIIOMnl.«4TA t 

O It O U P . IN C 

Addttlonal Comments / Instructions: 

k Check the box if Owner does not want CEG to document interior foundation walls and possible 

}re-existing damage. By checking this txix CEG is not responsible for any damage done to the 

interior of house, including foundation cracks or fissures. 

Q I do not agree 

'Owner's Signatu Contractor' ontractor'ss Signatur Signaturee ' Date

Page 3 o.O' 
BVID#_7.;m-X_ 

XRF PROPERTY SAMPLE SHEET 


Date 

Project 

XRFID# 

Shot# 

M 

mE 

M l 

! # fe

Average 

Shot# 

^ 

Average

Shot# 

l a Ut 

x ^ 

Average

Shot# 

Average 

lab sample # 

/ / 

^f/</ ^ 

Omaha leacf FP 2nd year option 

:^l-e>8 ^ 

Reading 

C?fe ^i H 

l^2^j>/1( 

Keaoing 

i^:i^ ^ie 

m ^ IT.. m^ /r 

 )H.^J^l ^ 

Reading ^^f^ t ^>0 

g/ y ,^(^ ^r?-:<>/,;r 

 'pJaZrt : Z O 

Reading 

Lab result 

Sample area 

£^ 

Depth 

Sample area 

D2^ 

Depth 

Sample area 

SbZ- Depth 

I S^ 

Address -

Sample time 

sample length 

Shot# 

Average

Shot# 

m

m^ 

Average

Shot# 

Average 

RETEST AREAS 

Sample area Shot# 

Depth 

Average 

Sample area XRF Avg. 

Signature, 

?_il ­ Vis^r-C ^ < f 

am/pm 

30 sec 

Reading 

1^9-^ lie 

<:b i>L<=: 

Z*^t^ J^/ C 

 iSOj^j ^ 

Reading 

1 ^H:^ 

> ^ :<.:^ f 

>:^t; j^t< r 

 fPileJ^] ^ 

Reading 

Reading 

La££2m. 

Sample area 

^ 

Depth 

Sample area 

u 

Depth 

Sample area 

Depth 

Sample area 

Depth 

printa'\3abo4^ OACPte 
¥ 

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

Coastal Environmentai Group inc. ^ ^ www.coastalhazmat.com 

COASTAL 

INVItOIIHINTAL 

s ao u r, IN C 

EXECUTIVE SUMMARY: 

BVID #21142-(2212 PIERCE ST) 

No Issues or Concerns Issues/Concerns 

Detail Explanation: 
^ ifco^B^ 

EPA Property Close Out Form 

Property #: 

Date/Time: 

Quads Excavated; ^ 1 .T Vyl J^ V/l ^ \^. Contractor Group CJPT^7Tn^ 

Yes No Excavatioii General 

1. If necessny, were the correct quadrant(s) excavated and restored? (X- ' 

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

cX' 

Gmdlo Yes No g Sod and Vcgctatioii 

1. 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? 

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

day time period) 

4. Are sodded areas generally firm and evenly graded? 

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day ~7 

time period) 

6. Was the property graded such that water will not pool on the property? v / 

7. Was danuge to landscaping or plant materials avoided? ^ ' 

Gates, Fences and RctainiBg Walb 

Ves No 

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

U -' 

2. Were all gates or fences taken down during restoralion activities reinstalled? (irapplicable) l y 

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

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

FouDdation, Siding and Gntters 

Yes No 

I. Was damage to the siding or trim avoided? y^ 

2. Was damage to the foundation avoided? 

c / 

3. Was damage to windows avoided? 

IP' 

4. Was damage to windows or door screens avoided? 

-y' 

5. Was damage lo downspouts or downspout extensions avoided? 

T?" 

Sidewalks and Driveways (Concrete) 

Yes No 

1. Was damage lo driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 3^ 
Owners comments: 

Inspection notes: 

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

EPA Represenlalive l)(^ IVJ/ ^ Dale: .^/^ f 
Property Completion Agreenrient 

Ihis agreemem documenls Ihe complclion of remedial acliviiies perCoiinedon my properly My signature 

will designate ihai I am satisfied wilh the resloralton of my properly, and lhat no items are in questions, 

now, or at any lime in the future, except Ihose Hems listed below, ifany 

Property ID: ^)|*-; ^ 

Property AddrcM: 

Owner: 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Additional Comments: