TRANSMTTTAL of OMAHA LEAD SH E 

SOIL REMEDLVTION FILE FOLDER 

SAID #: 60) Date: loll<^n ^ 

Address: 9-1C7)/ S I ^ X h 

Remediation Contractor: /^3^ . ^ 0^,/ > T^c , Year: -2^0^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ Video of property (DVD) ____^_ _ 

izf Executive Svunixiary 

Ef EPA-provided property sketch 

0 Signed Access Agreement for subject property 

D Signed Access .^reement(s) for adjacent property 

Ef Restoration Agreement 

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

0 Confirmation data 

ef Photographs 

eT As-b\jilt sketch 

Sl Satisfectory restoration signed by Property Owner 

^ Property close-ont check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

a Utility clearances 

E Property information from Douglas County Assessor's Office 

D 

D 

D 

Signature Date 

30054278 inimiii 

Superfund 
Rnd Record 

Backfill: 

Sample Area: 601 - 2501S 12 ST 

Owner: 

D Owner Ocaipied 

Owner Name: 

[SMITH 3AS0N A 

Owner Addressl: 

Owner Address2: 

|2501 S 12 ST 

City: State: Zip Code: 

(OMAHA |NE |68108 

Owner Phone: Alternate Phone: 

1 1 

Remediation Query I Lead Remaining Query I

Resident: 

Resident Name: 

r 

Property Address: 

)2501 S 12 ST 

Zip Code: 

|68108 

Resident Phone 

I 

 Property Damage Query I 

Contract: 

Contractor: 

|PRUDEI^r2009_S 

contract Option 

[OPTION 1 

Assessment: 

Qualifying Group 

400/CHILD 

Assessment Max XRF Value: 

I 549.2 
mmaxmswmBUBiiMs^ 

Date: 10/15/2009 | Omaha Lead Site Remedial Actioii Contract # EP-R7-07-06 TO#l | Month of: September 

Property Address: 2501 S 12 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl = 74 PPM @ 10"; DZ = 695 PPM @ 13"; EA = 132 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-Buih 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. 

THEHNOIQCKS.IINC. 
TECHNOLCX;iES.INC. SEPA 

EPA Property Close Out 

Property #: 6o ^ Property Address: 2S0 | S )2. firf 

Date/Time:^- Z^~^ ^ Owner's Name: "^e^-^ov^ ^n^^^ ^ 

Quads Excavated: ypfVZ- Contractor Group Prudent Technologies 

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? ^/ 

Grading Sod and Vegetation 

Yes No 

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

from the house? y 

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? v/ 

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 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) / 

Foundation, Siding and Gutters Yes No 

1. Was damage to the siding or trim avoided? V 

2. Was damage to the foundation avoided? / 

^ 3.

 Was damage to wandows avoided? 

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

5. Was damage to downspouts or downspout extensions avoided? J 

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 warranty: 

EPA Representative B ^ ^ Date: ^h*t/o^ 
^•^^^^^• ^

''14. • 

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 arc in question, now, or at any time in the future, excluding any 

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

Property ID: 

Property Address: ol^C^ J 5" /A >/- -

Owner: )j^^ ^ <JM7TH- ' 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

agree restoration is completed. 

 I I do not agree restoration is completed at (noted deficiencies above) 

1- /V- ^ 

Date 

I
Prudent Technologies, Inc. (Prudent) is under coatract with the U. S. Envirwiniental Protection Agency (EPA) to clean up leadcontaminated soils at a number ofproperties located in Omaha, Nebraska, including the property located at 

. The EPA requests your permissian to allow Prudent to perform a soil cleanup at this 

property to remove lead-cantaminated 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-cantaminated soil, and restoration ofthe referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact Prudenfs AJinnii^h mi, c I.JLI ^._ for the 

Omaha Lead Site cleanup, JVls^'ii u> J>...'."IiJl2i!Ui! -at (402) 711_:11 sx. General questions about the Omaha Lead Site cleanup can be 

directed to the EPA Pubhc Information Centers at (4Q2) 731-3045 (South Omaha office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By: W<^^I^ii ^ 

Property Owner Signature; -f'-il' ^ 

(Signature) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: /OflL^Py N Ss7'^/>>^ ^ C Owner ^ Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

^33 -

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

. ' \ • ^

AOE OF HOME?: ( /f p YEARS. HOW LONO HAVE YOU LIVED HERE? ^s YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? \^.i(t S NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: '~\ NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

_s 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR S 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 "determining 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 2505 N. 24"^ Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

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

Fax: f8161 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
ENVTROlVfMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Date: ^/3 I t<*«t 

Phone; Q("? - 5 H H BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

?z 

SVe^i'^^^ ^ ^ SvvAoJlil -Uetf . KX^ee ^ k> buL ^oju.eJ [ 

p3 

Pre-Existing Condition of Structures 

DoesyourBasement have a history of leaking? Yes No 

Item NO Description & Location 

On Map 

Property Owne; Prudent Employee ^'•"'''^ ~~^ 

Signature: Signature: Xs0c^--^ 

8080 Ward ParkwMr. Siiitp 40S '><;n<; M Oii'^ <itr<»o» c..ifr« tn o .•T Jrt H JI 1;. 
601 

FCTTKnrnniF.s. i\c 

AS - BUBLT DRAWING 

Or,S#:601 

Date F.via>utwl: (lS/21/2UIJ9 OMAHA LEAD SUPERFUND SITE I SKP.\ SIsncd-Off Date: 

Omah Extenor Paint North Arrow a Lead Site Owner Name: Site • Good Sketch Address: 2501 S12 ST A • Poor Phone: H: W: • Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm: _ 

Samples Collected 

Sverdrup 

RYASCPXA-601 YA 356.6 ppm D Date: _ 

RYBSCPXA-601 YB 334 ppm n Time;. 

RYCSCPXA-601 

RYDSCPXA-601 

YC 

YD 

337.2 

549.2 

ppm 

.ppm 

1^ 

121 

n 

a Samples Analyzed 

RDZSCPXA-601 DZ 3507.2 ppm a XRF Uni l: Book 

RGZSCPXA-601 GZ 224.8 .ppm B D Date:. 10/10/1999 

RPZSCPXA-601 PZ 382 6 .ppm 

Number of Samples = 7 

a Time:. 

Staff: 

10:44 

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

EA = 132 PPM a 

Sf.RAPF. (~1") 

Pi^V&WAf 

LOCATIOKS HCn NCTEP 

CONTRAa #: EP - R7-07-06 T0#1 PRUDENT TECHNOLOGIES, INC. 
• • 601 

Omah Exterior Paint North Arrow a Lead Site Owner Name: • Good Site Sketch Address: 2501 s 12 ST 

W: D P°°'^ Phone: H: [ • Not paint t 

Sample Number 

RYASCPXA-601 YA 

Lead 

Concentration 

356.8 ppm 

Sample 

Collected 

El 

LAB 

a 

Firm:

Date: 

Samples Coliected 

 Sverdrup 

RYBSCPXA-601 YB 334 ppm a Time: 

RYCSCPXA-601

RYDSCPXA601

 YC 

 YD 

337.2

549.2

 pom 

 ppm 

a 

a Samples Analyzed 

RD2SCPXA-601 DZ 3507.2 ppm a XRF Unit Book: 

RGZSCPXA-601 GZ 224.8 ppm D Date: 10/10/1999 

RPZSCPXA601 PZ 392.6 ppm 0 D Time: 10:44 

Staff: Number of Samples = I 7 

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

PZ= 550X2. Pi^jv^WAY 

LOCATIONS HOT HOTBQ 

[tav4 046141.0IZ3 
• • • • 
• • • • 

Print Preview Page 1 of2 

Douglas County-Omaha, 

Parcel ID

Owner

Name

 0704230000

 SMITH

 JASON A

 Addition :l 

: „ , .

 ^'°' ^

 BOWERY HILL 

„ 

^ \ 

Property 

Address 

2501 S12 

ST Lot 7 

City 

Zip 

OMAHA 

68108 

Legall 

Legal 2 

LTS 6 & 7 

132X138 

Owner 

Address 

• 

Legal 3 

Owne r

Address

2

 ocn n o n n 

 ^="1 ^ ^^

 ^ ' 

 Legal4 

jcX'^'^ i OMAHA Acres 0.41 

Owner

\ State

 ^.p

 ,

 w^^i^' ^

 iS k

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

 i Parc=0704230000 

1 

^

uwner

^

 gg.,Qg

 Assessor 

 Website 

 iLink 

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

accountno-R0704230000 

Sec-Twn- Rng 27.15.13 

 ^^liJi- i . 
"> 

Create Another Ticket Bad( to Irth Intemet Send Email 

YOUR TICKET NUMBER IS 2342576. 

Original Call Date: 8/17/09 Time: 12:08 pm Op: SIVA18967 


Work to Begin Date: 8/19/09 Time: 12:45 pm 


State: NE County: DOUGLAS Place: OMAHA 

Address; 2501 Street: S 12TH ST 

Twp: 15N Rng: 13E Sect-Qtr: 27-SE,34-NE 

Twp: Rng: 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 


: 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 


ATTNEBRl CXCATV LEVEL3 MCINEB MUD02 
OMAHACOF 0PPDGPR6 


PAETEC QLNNEIF 


Service Area Contact Phone Number Utility 

Type 

ATTNEBRl ATT/T 

Day: 

Alt: 

Emerg 

80024136249 

80024136249 

CXCATV COX COMMUNICATIONS. 

INC HEIDI 

Day: 

Alt: 

Emerg: 

4029340469 

4029340469 

4029329757 

LEVELS LEVELS COMMUNICATIONS, 

LLC NA 

Day: 

Alt: 

Emerg: 

8773668344 

8773668344 

MCINEB MCI NO CALL PER MEMO 

Day: 

Alt: 

8002893427 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessaeeText.a.sti?ret=<RF.ST n TS 8/17/9nno 
M-e^ ^ vx ^ 

MUD02 

OMAHACOF 

0PPDGPR6 

PAETEC

QLNNEIF

METROPOLITAN UTILniES 

DISTRICT 

CITY OF OMAHATRAFFIC.SEWER 

OMAHA PUBLIC POWER 

DISTRICT 

 PAETEC COMMUNICATIONS 

 QWEST LOCAL NETWORK

SANDY 

RON 

NA 

NO NEED TO CALL OUT 

EMERGENCY 

 NA 

Emerg: 8002893427 

Day: 4025047823 


Alt: 


Emerg: 4025047970 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


Day: 8002891901 


Alt: 


Emerg: 8002891901 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

httn://www.dhon.orc/irthintemet/DTTONNoticeCreation/MessageText a<5n7re1=<RF,ST TT ,TS 8/17/7009 
AGREEMENT AND RELEASE FOR RESTORATION OF REAL PROPERTY 

This Agreement and Release (hereinafter Agreement) is entered into by and between, 

Jason Smith (hereinafter Property Owner) and the United States Environmental Protection 

Agency (hereinafter EPA). 

WHEREAS, the property located at 2501 S 12* Street (hereinafter the Property), more 

specifically described below, is owned by Jason Smith 

WHEREAS, EPA through sampling and analysis has discovered the Property was 

contaminated with lead; 

WHEREAS, the EPA performed a remedial action and removed the contaminated soils 

from the property and backfilled the formerly contaminated areas with clean fill then sodded 

and/or seeded the described, effected property; 

WHEREAS, the Property currently requires a limited amount of restoration work to 

return the Property to its original condition prior to initiation of EPA's remedial activities, or as 

nearly as possible to its original condition; 

NOW THEREFORE, in consideration ofthe mutual covenants, promises and conditions 

and terms to be kept and performed as recited herein, the parties hereto agree as follows: 

1. The real Property which is the subject of this agreement is owned by Jason Smith 

and is more specifically described as follows: 

BOWERY HILL LOT 7 BLOCK 8 LTS 6 & 7 132 X 138 

2. The EPA will complete the following restoration items: 

A small section ofthe back yard (angled portion) that the property owner previously did not 

want sodded, now, will be sodded. 

3. The Property Owner acknowledges that EPA shall have no responsibility for fiuther 

restoration woric at the Property beyond the 90 day warranty period. 

4. The Property Owner releases the United States and the EPAfix>m any and all claims 

arising out of or connected with, directly or indirectly, their ability to inhabit, occupy, use, transfer, 

or sell the real or personal property at 2501 South 12* Street and the reimbursements, compensation, 

payments, costs, expenses, and any inconveniences or damages relating to the foregoing and the 
cleanup, decontamination, disposal and restoration ofthe Property, including any claims under the 

Uniform Relocation Assistance and Real Property Acquisition Policies Act, 42 U.S.C, Section 4601 

et. seq. 

5. The Property Owner affirms that she is the legal owner ofthe Property at 2501 South 12* 

Street 

This agreement is entered into and made effective the i8 day of Stpjcmbca 2009. 

FORTHEBROPERTY 

7- (^^ df 

Date 

' F0R THE UNITED STATES ENVIRONMENTAL PROTECTION AGENCY 

9h/o'i cfcunAt2 

Date 

U.S. EPA, Region VH 

nay8 2o«t» 2 
•-?**' ' • 1