TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: f3^S ¥ Date: lO/\tl^^\^ 

Address: ;?g^6:S> ^ • 3' ^ ^ ^ 

Remediation Contractor: fig^, nPr^'J T^r-\i Nfy-oc, ]9- <^^ Ir^d'i Year: "i^iO^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

0^ Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjaijent property 

Restoration Agreement 

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

Confirmation data 

Photographs 

As-built sketch 

Satisfectory restoration signed by Property Owner 

Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property infonnation from Douglas County Assessor's Office 

D 

D 

D 

30237435 

iniMi 

Superfund 

Sipuature ^ 

DSe 
PROPERTY SUMMARY 

Date: 10/15/2010 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: October 

Property Address; 2802 S 33 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

F2 = 60 PPM @ 6"; Bl = 55 PPM @ 4"; DZ = 173 PPM @ 8"; EA = 67 PPM @ SCRAPE (~1") 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant to contract specifications 

2) Signed Access Agreement including access agreements required for crossing other properties 

3) Pre-Excavation digital video clip/photographs 

4) Post-Excavation digital video clip/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Built sketchi) Shall include final lead levels v) Legend 

ii) Contamination left behind areas vi) Contractor identification 

iii) Property address vii) Date 

iv) BVID number 

7) Other items to be included in the individual property file, if available, or obtained include: 

i) Pre-excavation agreement details (if any are made with the property owner) 

ii) Property Status Form signed by property owner 

iii) Excavation digital video in MPEG, WMV (Windows Media Video) or SWF (Flash Player) format and/or 

photographs 

iv) Signed form verifying satisfactory restoration 

v) Description of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES, INC. 
Find Record 

Backfill: 

Sample Area: 15484 - 2802 S 33 ST 

Owner: 

n Owner Occupied 

Owner Name: 

IVIECELJ CAROL S 

Owner Addressi: 

1 

Owner Address2: 

|2802 S 33 ST 

City: State: Zip Code: 

jOMAHA |NE |68105-

Owner Phone Alternate Phone: 

1 r 

Contract: 

contractor: )PRUDEI\n"_2010_S 

Contract Option |BASE 

Remediation Query I Lead Remaining Query I Property Damage Query 

User Provided Owner Information 

Owner Name: 

1 

Owner Address: 

1 

City: 

1 

State:

1

 Zip Code: 

1 

Owner Phone: Alternate Phone: 

1 " 1 

Assessment: 

Qualifying Group |400/CHILD 

/^sessment Max XRF Value j 518.27 

Resident: 

Resident Name: 

ISEFFRON KENNETH A & CAROL 

Property Address: 

)2802 S 33 ST 

Zip Code: 

|68105-

Resident Phone 
TECHNOLOGIBS. INC. 

EPA Property Close Out 

Property #: I'^iJt^U Property Address: 2^07 . ^ S ^ S b 

Date/Time: ^A:r]/'i©N? Owner's Name: lt£xfl/\cX o /V SdfA' o <r) 

Quads Excavated: Contractor Group: Prudent Technologies, IncJ ' 

Excavation General Yes No 

1. If necessaiy, were tlie correct quadrant(s) excavated and restored? / 

2 If necessary, were the correct areas of drip zone excavated and restored? / 

Grading Sod and Vegetation Yes No 

1. Does the grading around the penmeter of the house in excavated areas generally slope away X 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 / time penod) 

6. Was the property graded such tliat water will not pool on the property*^ / 

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

Gates, Fences and Retaining Walls Yes No 

1 Do gates open and close freely? (If applicable) / 

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

3 Was damage to gates or fences avoided"^ (If applicable) ^ 

4. Was damage to retaining walls avoided? (If applicable) X 

Foundation, Siding and Gutters Yes No 

1 Was damage to the siding or tnm avoided? / 

2. Was damage to the foimdation avoided? / ^ 

3 Was damage to windows avoided'^ X 

4. Was damage to windows or door screens avoided'? y 

5 Was damage to downspouts or downspout extensions avoided? ^ 

Sidewalks and Driveways (Concrete) Yes No 

/ ^ 1. Was damage to driveway surfaces avoided*? 

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

Inspection notes: 

Removal and restoration activates complete including the 30-day sod wa^anty: 

i 

EPA Representative Qcu^^A^ ^Date:___9/29^___ 
i:CHNOI,()GIHS, l> 

AS - BUILT DRAWING 

OL,S#35368 

Date Excavated: 10/13/2010 

llSKP.'\Sigiicd-OITl)ate: OMAHA LEAD SUPERFUND SITiy| 

15484 

Omaha Exterior Painl Lead Site North Mow Owner Name: KENNETH A SE^FRON 

Site Sketch [3'-t3ood A ddress: 2B02 3 33 ST • Poor Phone: H W; Q Nol paint 

Sample Number Lead 

Concentration 

Sample 

Collected Firm 

Samples Collected 

RYASCPXA-15484 Fl ppm D Date o«r-l I'-ijoC 

RYBSCPXA-15484

RYCSCPXA-15484

RYDSCPXA-15484

RDHSCPXA-15484

R6ZSGPXA-V&464

 F2 

 Bl 

 B2 

 DZ 

 62­

j±n 

SI& 

All . 

.,12 V 

, ppm 

.ppm 

. ppm 

. ppm 

ppm D 

a 

D 

D 

D 

D 

Time •S'$b f^ 

Samples Analyzed 

XRF Unit: tot Book;

Date •i-lH 0\t 

 /r o 

«FESePXA-15484-—P2- .ppm D Time KM n Staff: Number of Samples = S laiwl 

ly- -V • A' -W 

1)/,= II3 1'l'Mf« S" 

(ONTAMIN.VnON LKi-1 BiClllNl) 

I>1;R I'.O KKQIKST: l)Z/LS (2"X10') 

2.S52 I'l'M (rt SCRAI'i: 

i'2 = f.0 I'l'M « t)" 

i;,V = 67 1»l'M rt SCKAl'i; 

'^:): ^'5 t>fc 

Oinahfl Lead Site 461.10 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGfES, INC. 
Pr©p©r%' C@mpi©tiosi Agreemeeit 

This agreeniciTi uocuineiits tlie coirtplctiOi'i of removal activifies perlonued oii tJie below listed piOperty 

The propem owner's signature tndicates that the propertj- OM/ner is satisfied with the restoration oi the 

subject piopert)-, and that no items are in question, now, or at any time in the future, excluding any 

remaining warranty (30 days total) except those items listed below, ifany. 

Property 

Propert iertyX3t y 

a ^s*'^ sr 

Owner ^f/:^^OA} 

Phonet l/(n^.9SO- /dU 6 

RestoraSBomi Items irs QtaestioBi!: 

Reqyired cosrectaoims to compilete tlh© propeBUy,' 

agree restoration is completed, except as noted above. 

 I I do not agree restoration is completed 

W 5 JW^ 

Owneir't SigiDaiiiure Daie 

I
Pmdent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadconlammated soils at a number ofOToperties located in Omaha, Nebraska, mduding the property located at 

l^ft^, ^ 3> ^ /v T ' The EPA requests your permission to allow Prudent to perform a soil cleanup at this 

propert Ifopertyj to remove lead-contaminated soil By signing this form, the property owner grants permission to Prudent to perform 

activities related to the cleanup including soil samphng, removal of lead-contaminated soil, and restoration ofthe referenced property 

If you have any questions about the soil cleanup planned for your property, please contact Prudent south office _for the Omaha Lead 

Site cleanup-at (402) 733-1188. General questions about the Omaha Lead Site cleanup can be directed to the EPA Public Information 

Centers at (402) 731-3045 (South Om^ofRce ) or (402)291-9583 (North Omaha office) 

Property Access Granted By i^^Ro/ Se/P/^dJ 

^— ^ ^_ ^ (Please Print Name) 

Propert <9'n<yLo/d y Owner Signature: 

(Sig (Date) 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner ~ please print) 

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: S ^Sf7< ^1 ^ ^^^^^jL. t^ e <b?10JIF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: t WO2 L <3Hf>«~Q^A ^ WORK: 

AGE OF HOME?: YEARS. HOW LONG HAVE YOU LIVED HERE? YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 197B? YES NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 


NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 


COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) 


AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS^ The activities to be implemented by EPA under this agreement 

are pursuant to Section 104 of CERCLA, 42 U S.C. 9604 EPA's right of access to the property is provided for in Section 104(e) of 

CERCLA, 42 U S. C 9605(e), which provides entry for "determinmg the need for response, or choosing or taking any response action 

under this title, or otherwise enforcing the provisions ofthe title " 

8080 Ward Parkway, Suite 405 5600 S 10 st ' 4242 Medical Drive, Suite 4250 

Kansas City. MO 64114 Oniaha. Nebraska 68107 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402) 733-1188 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)733-1883 Fax: (210) 579-6677 
ENVCROMVIEIVTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: C^<^C5 2 - S ^^r ^ ^ ^ '^***-

Phone: BVID: 

^C&.NJ ^ IDVAA^V^ \^^( U tx^t Ks)CjaJ-9-A 

(a> PA Sod. 

_^^ij_=_o^ 

= Vb^r^). fro<.)/v i l l "V-r€-g- . ^pg'^ ^ 

txe^^3- ^ ^ (?^oXcM^ />>t/^ ^ ^ Or\.> ^ ^ ^ 

£l a i^»^i \ V j- p g)^^r(l p^ ­

a. M.uJLc(L . 

t>'Z-> - 9o^^J ^ <W3o b-vJ^< ^ 

« e-jrvMs^^-<^ g jQ gHfvJU^:ro 6^ji ^ 

Property "Sva Prudent Employee 

^<a j Signature: Signature: 

8080 Ward Parkway, Suite 40S 5600 S 10 St 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68107 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)733-1188 Phone: (210)822-9588 

C...... IOAe\ ^Ct 4TAT lAn'ix T4V 4eo i 
15484 

Omah Exterior Paint North Arrow Owne a Lead Site r Name: KENNETH A SEFFRON {3''l5ood Site Sketch Address: 2802 S 33 ST • Poor Jtak. 

Phone: H: W. • Not paint 

Ssmple Number Lead 

Concentration 

Sample 

Collected LAB 

Firm: 

Samples Collected 

RYASCPXA-15484 F1 3Q^ ppm a Date: 0(^ | t^|0 ^ 

RYBSCPXA-15484 F2 JUL ppm n Time: 'i'<, ^ f. ^ 

RYCSCPXA-15484

RYDSCPXA-15484

 B1 

 B2 

5/ft 

ilL 

ppm 

ppm 

D 

D Samples Analyzed 

RDZSCPXA-15484 DZ Jiiit . ppm 

ppm 

ppm 

D 

D 

n 

D 

D 

XRF Unit: to^

Date: S-IW 

Time: \ M 

Book:

Jlk. 

 /ro 

Staff: K<N^ Number of Samptes = S 

.•\''.^r -t 

^ 5 3 -,te 

Omaha Lead Site 46 LlO 
Page 1 of 1 

,. VT, .. .-«AT,' •'V 

y^-ih ^ 

March 2007 DOUGLAS COUNTY ASSESSO 

^ISdCi S 3 3 S:;. 

http://douglasne.mapping-online.com/assessdoc/Photos/21/R14097100000001.jpg 6/15/2010 
Print Preview Page 1 of 2 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

Owner 

City 

Owner 

State 

Owner 

Zip 

Sec-TwnRng 

1409710000 

VIECELI 

CAROL S 

2802 8 33 

ST 

OMAHA 

68105 

2802 S 33 

ST 

OMAHA 

NE 

68105 

33-15-13 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

ILERADD 

4 

1 

50X13 0 

0.16 

http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp? 

parc=1409710000 

http://douglasne.mappingonline.com/DouglasCoNe/static/accountinfo.jsp? 

accountno=R1409710000 

http://w'ww.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 6/17/2010 

2 
"> 

Page 1 of2 

Create Another Ticket Back to Irth Intemet Send Email. •t^ ..-^r^.-t.A 

• YOUR TICKET NUMBER IS 2580168. 

Original Call Date: 8/30/10 

Work to Begin Date: 9/01/10 

Time:

Time:

 2:36 pm 

 3:00 pm 

Op: SIVA18967 

State: NE 

Acddress: 2802 

County: DOUGLAS 

Street: S 33RD ST 

Place: OMAHA 

Twp: 15N

Twp:

 Rng: 13E 

 Rng: 

Sect-Qtr: 28-SW,33-NW 

Sect-Qtr: 

Legal Given: c 


Type of Work: SOIL LEAD REMEDIATION PROJECT 


Location of Work: LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)733-1883 


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: SIVA JAMPAMA Phone: (402)733-1188 


Work Being Done For: EPA 


Depth of Excavation: 6 FT Corner Lot: N Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Nunlber Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVELS COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

http://vmw.dhon.org/irthinteniet/DHONNoticeCreatioii/MessageText.asp?ret=<RESULTS... 8/30/2010 
Page 2 of2 

OPPDGPR6 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/30/2010 
ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION 'BBBMNOUUSS, HO:. SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

^"^oT- 5' 33> 

^ ?'/• /6 Address: Excavation Date: 

Crew: Backfill Date: — 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition 

^^^i . 

6>^^9^ 

\ 

V>wt *c ^ 

/ V ^ 

yy> 

f>ei>^ 

i?^^A 

/L. . 

^ . ^ 

- ^ 

fl.. ^ 

Hazards Corrective Action 

-/-^ly O i x j e /'/' r Cty-C' ^ 

u% <. fiU/ *t/*>»-^ 

/ ' 

Site Safety Office 

Date: 

'7'^ ' /o 

8080 WMcHtetany. Suite 405 

Kansas.C^;MD:«4114 

fiSOOSIOSt 

Omata, Nebotfa 68107 

4242 Medical Orrve, JSt^ 7250 

San Antonio, TX 78229 

VtaMie: 1816)^363^3103 

Fax:|816)363«3707 mmw : '.(402) 733-1188 

Tiajc (402) 733*1883 

Phone: (2t0):822i;9688 

Fax: t210)-«7»«8T7 

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