TRANSMITTAL of OMAH A LEA D SIT E 

SOIL REMEDIATION FDLE FOLDE R 

SAID #: ^^^.^ ^ Date: 3JL ^ . 

Address: L^U^ ^ iOpra/uM .^TfRemediation Contractor: Ri • APJ" ^ ^r'J A 3s^r . . Year: ol<3 ( (p. 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d

B

d

d

D

d

 Video of property (DVD) 

 Executive Summary 

 EPA-provided property sketch 

 Signed Access Agreement for subject property 

 Signed Access Agreement(s) for adjai^«nt property 

 Restoration A^eement 

D

0

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

 Confirmation data 

d 

d 

d

tz

d

•

D 

 Photographs 

 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 

 Property information from Douglas County Assessor's OfiSce 

D 

D 

&^- % 8|t^^" 

Signature Date 

30260781 

Superfun( 
Find Recoixl Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 26428 - 4437 DECATUR ST 

Owner: Resident: Contract: 

n Owner Occupied Resident Name: Contractor: 

Owner Name: 

1 PAYNE TRACT M 

Owner Addressi: 

|C/0 OMAHA HABITAT FOR HUMANFTY 

Owner Address2: 

|2204 AMES AVE 

City: 

|OMAHA 

Owner Phone: 

1 

State: Zip Code: 

|NE |68110 

Alternate Phone: 

1 

PAYNE TRACT M 

Property Address: 

|4437 DECATUR ST 

Zip Code: 

|68111 

Resident Phone 

I 

|PRUDENT2009_S 

Contract Option 

|OPnON 2 

Assessment: 

Quaiifying Group 

poo 

Assessment Max XRF Value: 

r 451 
PROPERTY SUMMARY 

Datef;z>/15/2010 | Omaha Lead Site Reniedial Action Contract¥EP-R7-07-06 T0#1 | Month of: /J Q ^/ 

Property Address: 4437 DECATUR ST 

A EXECUTIVE SUMIVIARY 

A.l Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl = 85 PPM @ 3"; EA = 92 PPM @ SCRAPE (~1") 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant to contract specifications 

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

3) Pre-Excavation digital video clip/photographs 

4) Post-Excavation digital video clip/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Bui It sketch ­

i) Shall include final lead levels v) Legend 

il) 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 (ifany 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 ofareas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES, INC. 
TECHNOLOGIES, INC. 

Property #: 2<^*^'2. ^ 

Date/Time; 

Quads Excavated: p - \ 

EPA 

EPA Property Close Out 

Property Address: 44^ 7 Q e r^-V<^ir ^ 1 

Owner'sName: "Tr-^^j/^t ^<i.i^Y^-e. 

Contractor Group: Prudent Tccnnoiogies, Inc., 

Excavation General Yes No 

1. If iiecessar\'. were lhe correcl qiiadraiit(s) excavated and reslored? / 

2. If neeessaiy, were Ilie correct areas ofdrip zone excavated and reslored? . / 

Grading Sod and Vegetation 

Yes No 

1. Does Uie grading around tlie perimeter of the house in excavated areas generally slope away 

from the house':' A 

2. Has sod been laid in all areas lliat were excavated? A 

3. Does tlie sod appear to be generally healthy and growing? (Only evaluate if inspected al a ,"0 

day lime period) A 

4. Are sodded areas generally finn and evenly graded? d 

.>. Arc die joints belween the sod strips generally tight? (Only evaluate if inspected at a -30 day 

lime period) y 

6. Was the property graded such tliat water will nol pool on the property? / 

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

Gates, Fences and Retaining Walls Yes No 

1. Do gales open ;uid close freely? (If applicable) / 

2. Were all gales or fences taken down diuing restoration activities reinstalled? (Ifapplicable) y 

3. Was dmnage lo gales or fences avoided? (Ifapplicable) 

d 

4. Was danuige lo relaining walls avoided? (Ifapplicable) 

d 

Foundation. Siding and Gutters 

Yes No 

1. Was d;image lo the siding or trim avoided? d 

2. Was damage lo die foundation avoided? d 

3. Was diunage to windows avoided? d 

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

5. Was damage to downspouts or downspout extensions avoided? 

d 

Sidewalks and Driveways (Concrete) Yes No 

1. Was dam;ige lo dnveway surfaces avoided? / 

2. Was damage lo walkway surfaces avoided? y 
%^3" ^ O^cajun ^ t 

Owners comments: 

Inspection notes: 

BpRs close-oor' 

PuRW 7 

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

EPA Representative f^c^ / ^ Date: /^JlEJin 

y 
@0002/O003 J.*,. \*ij . t.wMO £.u.iJ M fA A 

••:;:.^i;i{(«.ai',>AtpV.-; 

Property Compietion Agreement 

Tins agroenicnl dociimevUf. tho con\pletioi"i of reinoval activities perionned on llic liciow [i^ied )iropcri\-. 

"I'lic pi'0|.%crb (ivvncr's s)L!,n,nl.'i.iro aidic-atcs tiial. the property owner is siili.sf'tccl w.it'i t.he rcinoration ol" inc. 

.subjoci propci'ty. ••md ;.iia! no ilcni.^ HVC in ql.lt-st:^?^i, no^v, ov at any vinic in the; i'tniirc, c.^cchidiiig :.inv 

ror.isining \\'nrr,n.ii.iy (30 da^'.s foitif) except tiio.w items listed below, if .luiy 

\^':T'-1!''' S-^.^ ..pi..S 

AAlffs !rft..c;i ti...:..fjj..^.r^ 

.R.esto;-£t:;ii[i l!;erns ft- G(.ri3s';;or;: 

3 Vi&ivi: 

i 

\ ;te:T;: 

,1 

ritSvi""' 

i (tem: 

S rve;T!; 

Item: 

Requii-erf conTicV;ions f;o compicfe t.'.^e property: 

i agree resforatioi": is Cionipieieci. 

i cio -not agree restoration 13 compteted at (noted deficiencies above) 

^ ^ () 3 ms. 

ysJ^.Pd-yA^y­
• • 

'::iW/ 

TECHNOLOGIES, IMC. 

l^rudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Proiection Agency (HPA) to cle.in up leadcoiUaniinatcd .soils at n numlier oi" properties located m Otnaha, Nebraska, including the property located at 

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

property lo remove lead-contammated soil. By signing this form, the property owner grams permission lo Prudeni lo perform 

aclmtie.s related to the cleanup including soil sampling, 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 "s . . for the 

Oiniiha Lead Sile cleanup, at (402) • • . General questions about the Omaha Lead Site cleanup can bc 

directed to the EPA Public InfomialionXenters at (402) 731 -3045 (Soath Omaha office) or (402) 991-9583 (North Oraaha office). 

Property Access Granted By; i(gto, yv\. y \ (Flease hTmt Name) 

Property Owner Signature 

(Date) 

PROPERTY INFORMATION 

-(To bc completed by resident and/or property owner — please print) 

RESIDENT NAME: 1 Owner Renter

^^r—N- A ^ 

RESIDEN ADORESS: tNTT AUDRbSS: n f 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

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

i\(?2^ .-^^o - M3ZZ ^ 

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

HAS THE EXTERIOR BEEN PAINTED OR COVERED WPfH 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: JI.E. DOGS, ENTRY GATES, ETC.) 

AUTHOKITY l-'OR ENVIRONMENIAL RESPONSE ACTIONS: The activities to be implemented by EPA under this agreement 

are puisuant lo Section 104 ofCERCLA, 42 U.S.C. 9604. EPA's righl of access to the pioperty is provided for in Section 104(c) of 

CERCLA, 42 U.S. C 9605(e), wliich provides entry for "determining the need for response, or choosing or taldng any response aclion 

under this lille, or otiierwise enforcing the provisions ofthe title." 

:;r;8C '•'••I-MI-. ^'i;:-^ ^ 

Knrv^iS City. WO 

:-'iK:);'.G: i&15) 2-r..-. 

iK:a; l.i:i'Jc. Siiii c 4/:t^'­

,;r. Ai;tO!i;o. TX 7S2:^i; 

;V;:H-; (310; !!Z2-9!?f;;; 

• -r: .'?io; r.^'? s?:^7 
i.'.-'-i':-'-,;!:-

Address: MM 3' ^ D ^

Property Status Form 

 CO-ft- ^ T Date: \P [ ^ 

item NO 

Om Map 

BVID: 

Piants & Permanent Landscaping To Remain In Place 

Description & Location 

0 pisyJrS 

Pre-Existing CoHidition of Structures 

Does your Basemenl: liave a iiistory of leaking? Ves No 

Item NO 

On Map 

Description & Lo-catioiiii 

Property Owiniet" Prudent Emplo'yee 

Sigraat wire:; SigBatntre; 
t 

KCHNOl.tJtUTS. INC. 

AS - BUILT DRAWING 

OI,Stt:2(i428 

Diilf lvviav:iti«l: 11/(14/20119 

tSKP.V Siuned-OtTDan: OIVIAHA LEAD SUPERFUND SITE 

26428 

Exterior Paint North /^row Owner Name: TRAGI M PAYNE Omah a Lea d Sit e 

[3^Good 

Address: 4437 DECATUR ST ^'*® Sketc h 

• Poor 

Phono: H: W: • Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: f c m ^ Rft \ 'CTCJ 

RYASCPXA-26428 Fl Date: O l . ^'i , - f^M 

~ ppm LJ D Time: 'S'. ^ s RYCSCPXA-26428 81 -2.0 ^ ppm n 

Samples Analyzed RYDSCPXA-26428 B2 '•2-^0 ppm \S/ n 

RDZSCPXA-26428 DZ 

10J> ppm D XRF Unit eiO Book: ^ S 

ppm D n Date: _ g/23/g / Lab RYASCPLA-26428 

ppm 

Result 451 ppm n Time: _ /^yA/ n Staff: A J ^ Number of Samples = 3 \ 

=¥^ fh- I V. . ><• >^^ 

BNTEHED 

^ny 

"^80 

jm -p 

2 0 Lj y<- ^ 7 ^ 

c p ^ 

103 

^ 

7 

p ^ ^ 

Fl =8.>PPMin 3" •d 

2^S: 

• S* ^ ci-e-M^eJUc^ 

^ t 

Omaha Lead Site 46130 

K.\ = 92 I'PM -III} SCR.APK (~1") 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENTTECHNOLOGIES, INC. 
• 

Omaha Load Site OwBter NnmiE: TR-^C! M HAVNt Site' Sketch Atldress: 'l^:*!'' nF-r.ATt.R ?i7 

Phone: H 

hiample Nunnber isac! 

Coni:c^rat/on 

Sanr-offi' LAB 

KyA3CPXA-2e425 F1 .. .:2-.afe ppnr r IT 

-FWEH5ePX/V?fi47B­ +-2 * — . PPfT- L. D 

RyDSCPXA-264?fl B? 

,_j . RYASCr^L.A-264?R 

'2.0^ 

...y^a.. !0?i 

_ ppn-i 

. :;:>:fri 

_ f.5 n 

_ pptn 

_ Ppi-i 

a­-

e' 

ET 

D 

D 

O 

n 

n 

n 

n 

Nunrsei' or Sanr.p,*s - ^ 

S=3«^ 

r;i%';?vT? •U-h: i^\ h'. H h\ I i 

:; 7 i m '. 

A^ 

Z i ; ^1 

T 

^ 

e­

-p 

.•s j.*^ " 

JS:V 

•?i'-r)t-: 

>•-, 

>:. 

< 

Z-g^^ 

•=S-Ii;.- '• di-^-...i^^.AQ 

Iiiiiiiiiii 26428 

E».le iof Paint NcJi't •%rTc>-w 

0^:.i-;r1 

r~ ?n:>.- I '"''^ t-:rMa \fe&-r.3'^-i i 

Dale- C l - ^-^^-CS.^:^ ­

"^i'T.o .:3ii,.;rs,-. 

Sfirrrpltjs flri-.i)./yiit\ 

KPFUnii ^'y^- ti-uuK 'S 3 

-Data. f/Z^/o!^ 

Tirr- _ _ /f>^, ! 

Si:;sll' Z ./^ ­

=?e= "••!W •% » - X ­

'<?-^.:r: 

J:^ ! 

: ^ 

r>**^ 

r 

^"•••-n 

P 

- A 

A r ^ J7 t- h (jfa-Lv*^ ^^:k

y-!tf,xh.\ I i'.ir.- Si:i! 
t 

• J ./ 77 4 '/yy 

v^. •Y. IV 

• • it:^ s'-hi ^ 

6' ' MP A' ' 

m1, J. • • » •' + •%.*•%%',' , 

» ••• f ,*:»*: • ..J - IIIIIIIII IJIIIIJI r.5slf 

4437 DECATUR 

ARCH 2005 « DOUGLAS COUNTY ASSESSO .:• ^ -:^r-^S^'^PyMl^-. i.^^/; >, JiS?^^ 
Print Preview Page 1 of2 fl 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

Owner 

City 

Owner 

State 

Owner 

I Zip 

2146440000 

PAYNE TRAGI 

M 

4437 

DECATUR ST 

OMAHA 

68111 

C/O OMAHA 

HABITAT FOR 

HUMANITY 

2204 AMES 

AVE 

OMAHA 

NE 

68110 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

SAUNDERS & HIMEBAUGHS ADD 

B 

10 

50X150 

0.17 

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

parc=2146440000 

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

accountno=R2146440000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/3/2009 

2 
9 

Pagel of2 

"> 

E SE 

YOUR TICKET NUMBER IS 2394433. 

Original Call Date: 10/27/09 Time: 9:28 am Op: SIVA18967 

Work to Begin Date: 10/29/09 Time: 10:00 am 

State: NE County: DOUGLAS Place: OMAHA 

Address: 4437 Street: DECATUR ST 

Twp: 15N Rng: 13E Sect-Qtr: 17-NW 

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 


: 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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS. INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 
% 

Page 2 of 2 

Day: 4067289343 

QLNNEIC QWEST LOCAL NETWORK NA 
 Alt: 4062071494 

Emerg: 8887289343 

5 

% 

^-^y^^^^l^p7f7'^AECHNGLOG\ES, INC. 

(L 

Adcires?;: 4^VJ7 L)c^^,4-ky^ d((^r 

^,. (iMof 

I'rew; 

^Stir; /<;? -^90 ^ 

5 Ol-"€-8"rici5rf .i.jrK^; -^^s^ ^ 

i GH< L3?5e 

; .Tiiyr'i ^ . /y-r S /g<^y ^ 

i Wii.ter I/ine A (­

J^evv^r Lii ilie ! Suni^ J /v&- ^ /Cr<L^4if/>Si 

\ Sepfic / Leech 

...sC.::^ 

Prouaoe/Byrasii? ^r/v^ 

1Sidewalk -p-s^J.^ i \^j<s . yl u C4ji=-i.y 

f-Olii'Khs iTiiOSl; -T~X..t* 

i Reta?ir5st]s« VValEs y y ^ 

Fences yn^ 

i rees^' Bysines j^PbyS . 

.yiyyS.^ 

\ Dsivena^ ^ sfhf/S... 

p^ritikler Svsaetri • y y y 

[Odie r 

Cre^ Foremiifi Ssfe Safefi' O'l'jlcer 
ffBW| 
\