TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 23506 DATE: 1/15 

ADDRESS: 309 N 35 ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC. YEAR: 201^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

a PRE AND POST VIDEO OF PORPERTY (DVD) 

Ef EXECUTIVE SUMMARY 

m EPA-PROVIDED PROPERTY SKETCH 

0 SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

a RESTORATION AGREEMENT 

D SETTLEMENT DOCUMENTS (I.E., FOR DAMAGE OR TO REPLACE PLANTS, ETC.) 

C / CONFIRMATION DATA 

Z / PHOTOGRAPHS 

Q AS-BUILT SKETCH 

B SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

0 PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

a DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

ef UTILITY CLEARANCES 

PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

a 

SIGNATURE DATE 

30217614 ill 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 309 N 35 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: 

B2 = 171 PPM @ 9"; DZ = 426 PPM @ 13"; EA = 42 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 sketch ­

i) 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/orphotographs 

iv) Signed form verifying satisfactory restoration 

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

TECHNOLOCIES, INC. 
Find Record 

Backfill: 

Sampie Area: 23506 - 309 N 35 ST 

Owner: 

n Owner Occupied 

Owner Name: 

jSTEPHENS WILLIAM 0 

Owner Addressl: 

1 

Owner AddressZ: 

|3515 LAFAYETTE AVE 

City: State: Zip Code: 

lOMAHA |NE |68131-

Owner Phone Alternate Phone: 

1(402) 280-2632 |(402) 981-1398 

Contract: 

contractor: )PRUDErn"_2010_S 

Contract Option [BASE 

Remediation Query I Lead Remaining Query I Property Damage Query 

User Provided Owner Information 

Owner Name: 

Owner Address: 

City: state:

'I— I 

 Zip Code: 

Owner Phone: 

r 

Alternate Phone: 

Assessment: 

Qualifying Group |400 

Assessment Max XRF Value j 492 

Resident: 

Resident Name: 

|Zach Fitzgerald 

Property Address: 

|309 N 35 ST 

Zip code: 

)68131-

Resident Phone 

1(402) 681-6458 
• ;

 '••• ti -TV: i-iMiiliiiiO TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: 2" ^ ^<^ ^ Property Address: 3>< ^ ^ ^' ^ ^^ ' 

Date/Time: Owner's Name: c£)".lf(>w^ 9^<^(3l^€Vv.> 

Quads Excavated: D^ . 'g>'Z__ Contractor Group: Prudent Technologies, Inc.. 

Excavation General Yes No 

1 If necessary. were the correcl quadrant{s) excavated and restored? J 

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

Grading Sod and Vegetation Yes No 

1. Does the grading aromid the perimeter of the house in excavated areas generally slope away 

from lhe house? y 

2. Has sod been laid ni all areas that were excavated? y 3.

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

day lime period) y 

4. Are sodded areas generally firm and evenly graded? y 

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

lime penod) y 

6. Was the property graded such tliat water will not pool on tlie property? y 

7. Was diiinage lo landscaping or plant inaterials avoided? y 

Gates, Fences and Retaining Walls Yes No 

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

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

3. Was damage lo gates or fences avoided? (If applicable) y 

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

Foundation, Siding and Gutters Yes No 

1 Was damage to the siding or trim avoided? y 

2. Was damage lo the foundation avoided? y 

3. Was damage (o windows avoided? y 

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

5. Was damage lo downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) Yes No 

! Was damage to driveway surfaces avoided? yA 

Wa ^ s damage lo walkway surfaces avoided? 
Owners comments: 

Inspection not^: 

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

EPA Representative Bc^'A^ Date: izlioho 
HNOLUGIES, INC. 

AS - BUILT DRAWING 

OLS tt 23506 

Date Excavated: 08/30/2010 

USEPA Signed-Ofr Date: OMAHA LEAD SUPERFUND SITE 

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CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
il 

Property Completion Agreement 

This agreement documents the completion of removal activities performed on the below listed property. 

The property owner's signature indicates that the property owner is satisfied with the restoration of the 

subject property, and that no items are in question, now, or at any time in the fiiture, excluding any 

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

Property ID: 

PropertyAddress;3(r)<^^3ll |^^ 3 ^ A ^-^V^ ^ O/vUAiv^NCB 4>^ i ^ T 

Owner; Qam^-flUy^ S^-f^Ke>l S 

Phone: ( I^Q2. 1 :?W-3'i&3 ^ 

Restoration Items in Question: 

»»m: ^,, K c^ae r ^ ^ ^"^t^i^'l- ^ 'JlT^'^r^^ ^cov*<^. 

Item: Sod oJ.oirv^ n&rif^ <x)La.e oS bYv^*>^^ tK)Hj^e*\ -cf-hvt&i^ IAJ^UI OJ^ dtiCfLf/- cuv/ 

fervc^ y^<W r\o+ h(xyt4 4t:^W^n—jy-Km-gr-ttss ra«w la>-»- !b€:/H:> 

Item: 

Item: 

Item: 

Item: 

L J I agree restoration is completed. 

13^ I do n ^ agree restoration is completed at (noted deficiencies above) 

2. l^ecen^L^.^ 2X)10 

Owner's Signature H Date 
"L-JtVnE^X'JF^tV; 

Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up lead4 A 4Vl <l^5JpP''t^'"'"*'^<' ^°''^ *' ^ number of properties located in Omaha, Nebraska, including the property located at 

3 ^ T TM **^ ^yy3iCI G L^W#*fgffpg- JW^ « The EPA requests yqur permission to allow Prudent to perform a soil cleanup at this 

property 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 sampling, removal of lead-contaminated soil, and restoration of the referenced property. 

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

Lead Site cleanup, at (402) 733-1188; 733-1455. General questions aiiout tlie Omaha Lead Site cleanup can be directed to the EPA 

Public Information Centers al (402) 731-3045 (South Omaha office). 

Property Access Granted By: 

(Please Prjn\Name) 

Property Owner Signamre: 

(Sigijature) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: \ e.^riv\\- ^ Owner 

RESIDENT ADDRESS: 

fO -^^ ^ 21 - rorv^T^Lo. UE: ^" ^ i^ I 

IF RENTAL, PROPERTY OWNED BY: / ^ . 

OWNER'S MAILING ADDRESS; 

3 S^ 5 LCU^CIJUP, A v ^ Om>>ivcL iOF c^\ ^ + ^ 

OWNER'S TELEPHONE NUMBER - HOME: J L WORK: 

OWVAeJL 

AGE OF HOME?: YEARS. HOW LONG HAVE YOU HsIVES HERE? v ^ YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? * ^ 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: M.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(c) of 

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

under this title, or otherwise enforcing the provisions of the title." 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^o^^ - ^ M M *2>sV^ ^ ^H Date: "71"2^ ( 2-C>I C> 

Phone: BVID: 3MM - 0,^3 ^ 

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Property Owner ^ Prudent Employee 

Signature: ^ ^Mytc^A/<X Signature: 
Omaha Lead Stte Date: 3 Nortti Anow 

Address: Jo l yV 3 5 g.T Site Sketch Tfm«: 

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Sampie Number Lead Concentrafion Confitination Sagnpte 

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http://douglasne.mapping-online.eom/assessdoc/Photos/l 1/Rl 3044600000001 .jpg 8/19/2010 
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Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

\Zip 

Owner 

Address 

Owner 

Address 

2 

Owner 

City 

Owner 

State 

Owner 

Zip 

Sec-TwnRng 

1304460000 

STEPHENS

WILLIAM 0

309 N 35 ST 

OMAHA 

68131 

3515 

LAFAYETTE 

AVE 

OMAHA 

NE 

68131 

16-15-13 

Addition 

' , 

 "'°^' ^ 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Unk 

Assessor 

Website 

Unk 

HAWTHORNE ADD 

3 

17 

50X136 

0.16320775 

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

parc=1304460000 

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

accountno=R1304460000 

httt)://www.doeis.orB/do2is alias/doeis/nrintPreview.a.sr)x?PrintODtData=Douelas Countv-... 8/19/2010 
8/17/2010 ittp://www.dhon.org/irthinternet/DHO... 

Create Another Ticket Back to Irth Intemet Send Email 

YOUR TICKET NUMBER IS  2569692. 

Original Call Date: 

Work to Begin Date: 

8/17/10 

8/19/10 

Time: 10:22 am 

Time: 10:45 am 

Op: SIVA18967 

State: NE 

Address: 309 

County: 

Street: 

DOUGLAS 

N 35TH ST 

Place: OMAHA 

Twp: 15N Rng: 13E Sect-Qtr: 16-SW,21-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: Lead Soil Remediation Project 


Location of Work: LOCATE ENTIRE REAR OF 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

Involves Tunneling or Horizontal Boring : N

 Front: Y

 Explosives: N 

 Rear; 

CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber 

Utility 

Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day:

Alt:

 4029340469 

 4029340469 

Emerg: 4029329757 

LEVEL3 LEVELS COMMUNICATIONS, 

LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

Day: 4024447197 


CITYOFOMAHA- OMAHACOF RICH/TRAFFIC AH: 4024445161 TRAFFIC,SEWER 

Emerg: 4024445160 

dhon.org/irthinternet/.../MessageText.as.. 1/2 
8/17/2010 ^yittp://www.dhon.org/irthinternet/DHO... 

OPPDGPR5 OMAHA PUBLIC POWER ELM

^Day : 4067289343 

 4062071494 

OPPDOPR5 DisT^cT LOCATING ^ ­ ^062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK

FTM 

 LOCATING

Day:

 ^ "

 4067289343 

 ^062071494 

Emerg: 8887289343 

dhon.org/irthinternet/.../MessageText.as... 2/2 
ENVIRONMENTAL & 

CONSTRUaiON 

TECHNOLOGIES, INC. SOLUTIONS 

Site Safety Hazard Analysis 

Address: 30" ^ Mo . S S S- h Ex.. 

Crew: ](.ey\r\Kj DWCfgl M Bf. 

Date: ^^JSO / fO 

Corrective 

Item Condition Hazards Action 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic / Leech 

fiel

Propane/Butan

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e 

mSidewalk &by^rl 

Foundation GnOC^ 

Retaining Walls U^ 

Fences to 

Trees/ Bushes GO O (\ 

Structures 

Driveway Ay»*'^g/'^<1 f/yc^A^J 

Sprinkler System %t 

Other 

Crew Foreman Site Safety Officer 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 7250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Ptione: (402) 504-1004 Ptione: (210)822-9588 

ax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
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