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TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 50038 DATE: 1/15 

ADDRESS: 3613 SEWARD ST 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: 20l() 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

[^ PRE AND POST VIDEO OF PORPERTY (DVD) 30237544 

H EXECUTIVE SUMMARY 

/ Superfund 

Gl EPA-PROVIDED PROPERTY SKETCH 

H SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT{S) FOR ADJACENT PROPERTY 

 RESTORATION AGREEMENT 

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

fli CONFIRMATION DATA 

• PHOTOGRAPHS 

of AS-BUILT SKETCH 

m SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

A PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

A UTILITY CLEARANCES 

d PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

8^U fA 

SIGNATURE DATE 
PROPERTY SUMMARY 

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

Property Address: 3613 SEWARD ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Infonnation: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

F2 = 137 PPM (@ 3"; EA = 104 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 (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 of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOCIES, INC. 
Find Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 50038 - 3613 SEWARD ST 

Owner: User Provided Owner Information 

1 

n Owner Occupied 

Owner Name: Owner Name: 

ICTTY OF OMAHA 

1 

Owner Addressl: Owner Address: 

|C/0 OTY nNANCE 1 

Owner Address2: 

|1819 FARNAM ST 

City: State: ZipCode: City: State: Zip Code: 

lOMAHA | NE |68183- 1 1 1 

Owner Phone Alternate Phone: Owner Phone: Alternate Phone: 

1(402) 441-5150 |(402) 444-5180 1 1 

Resident: 

Resident Name: 

I 

Property Address: 

|3613 SEWARD ST 

Zip Code: 

|68111-

Resident Phone 

Contract: Assessment: 

Contractor: |PRUDENT2010_S Qualifying Group |466 

Contract Option lOPTION 2 Assessment Max XRF Value j " 470.98 
TECHNOLOGIES, INC. 

Property #: yOOlAb 

Date/Time: ^ 

Quads Excavated: p n 

EPA Property Close Out 

Property Address: ~^Q['b ^ujofA. 

Owner's Name: Cy ^ o^ Qirr^ad/KCK 

Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

I. If necessary, were the correct quadrant(s) excavated and restored? •r 

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

Grading Sod and Vegetation Yes No 

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

from the house? 

2. Has sod been laid in all areas that were excavated? J 

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

day / lime period) 

4 Are sodded areas generally finn and evenly graded? y 

5. Are Ihe joints between die sod strips generally tight? (Only evaluate if inspected at a 30 day y (ime period) 

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

7. Was damage to landscapmg or plant materials avoided? y 

Gates, Fences and Retaining Walls Yes No 

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

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

3. Was damage to 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? / 

2. Was damage lo the foundation avoided? y 

3. Was damage to windows avoided? 

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

-"i. Was damage to downspouts or downspout extensions avoided? r 

Sidewalks and Driveways (Concrete) Yes ye» . No 

 Was damage to diiveway surfaces avoided'^ 

y Was damage to walkway surfaces avoided? 

I
Owners comments: 

Inspection notes: 

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

EPA Representative ^^ ^ Date: iz)^}'^ 
rFTNDDCSClE.S, INC 

AS - BUILT DRAWING 

OL.S # .MM)38 

Date Excavated: 11/04/2010 OMAHA LEAD SUPERFUND SITE ISEPA .Signed-Ofr Date: 

^ 0 0 2>? 

Omaha Lead Site CXMTtei Hame: y,l^^ i Qi^-i^'iy-*^ Site Sketch Address: "iyi l •^^-.y l 

Phone: H W 

Lead Sample , . „ Sample Number Concentrstion Collected 

RYASCPXA- F1 i^(^ ppm B' ' n 

RYBSCPXA- F2 ^ 7 / ppm 0 " [-] 

RYCSCPXA- Bl ^ ^ ^ pp"i Ei : D 

RYDSCPXA- B2 /^ ? ppm ET n 

-HGZSe P-XA- ——BZ - ppm D D 

-l«<SZ-SGPXA- -Gi - ppm D D 

•RPZ5CPXA -PZ- ppm D Ll 

Number of Samples = "^ • 

Nortfi Arrow 

I 

Samples Cotlected 

Firm: MB.') 

Date: ^5^ 

3'-/ 

Time: i'.'/iSamples Analyzed 

XRF Unit: ^( D Book: ..^3 _ 

Oate ^g/zV^.V 

Time r/^ 

Staff: FAJ 

Otnaha Lead Site 46IM 

CONTRACTS: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
OfcHrV 

Property Completion Agreement 

This agreement documents the completion of removal activities perfomied 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 future, excluding any 

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

Properly ID: Sfi<?Sg' 

Properly Address: . 1 ' • 

Owner: < I ••U-•. A 

M

Phone: y - y y/'ftj" 

Restoration Items in Question: 

Item: 

item: 

Item: 

Item: 

item: 

item: 

L^. I agree restoration is completed. 

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

-y / / •", (,'• >i I • / c y ' • .'V — y • 

Owner' Date s Signature ,, 
Prudent Technologies, Inc. (Prudenl) is under contracl vvith the U. S. Enviionmcntal Proteclion Agency (KPA) to clean up leadcontaminated soils at a number ofproperties located in Omaha, Nebraska, including the property located al 

3c-/v S.^'V«' S-yry r . The EPA requests )-our permission lo allow Prudent lo perform a soil cleanup at Ihis 

propert)' lu remove lead-contaminaled soil. By signing this form, tiie propert) owner grants permission lo Prudent to perform 

activities related lo the cleanup including soil sampling, removal of lead-contaminated soil, and rcsloratiun ofthereferenced property. 

If you have any questions about the soil cleanup planned for )'uur propert)'. please contact Prudent south onice .for the Omaha Uad 

Site cleanup-at (402) 733-1188. General questions about Ihe Omaha Lead Site cleanup con be directed lo Ihe EPA Public Informalion 

Centers at (402) 731-304S (South Omaha olTice) or (402) 991 -9583 (North Omaha ofl'ice). 

Properly Access Granted By: //.//,,'/•'t / .-^-.n v. }r\ 

(Please Print Name) 

Properly Ovmer Signature: /V^V y/yy" > 2 I yy.^A i u^j-Cif-.^o/o 

(Signature) (Date) 

PROPERTY INFORMATION 

(To be completed by resident and/or properly owner - please print) 

RESIDENT NAME: Ovmer Renter 

RESIDENT ADDRESS: ^ 

(ymSi^WjK Mg " Q g ll (o 

IF RENTAL, PROPERTY OWNED BY: 

^ /!-'•/ (bvx^ e (TI • f 

OWNER'S MAILING ADDRESS; 

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

J 1 

AGE OF HOME?: YEARS. HOW LONG HAVE YOU LIVED HERE? 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 6 HOURS OR MORE PER WEEK: 


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


AUTHORI TY l-OR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented by EPA under this agreement 

are pursuant to Section 104 ofCERCLA. 42 U.S.C. 9604. EPA's right of access to Ihc properly is provided for in Section 104(e) of 

CERCLA. 42 U S. C 960S(e). whicii provides entr)' for "detennining the need for response, or choosing or taking any response action 

under Ihis litle. or otherwise enforcing Ihc provisions ofthe tille." 

8080 Ward Parkway, Suite 405 5600 S los t 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68107 San Antonio, TX 76229 

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

Fax: (816) 363-3707 Fax: (402)733-1883 Fax: (210) 679-6677 
EN VlROP^fVlEri'TAL.it 

Ct>f^STRUrTIO>i 

TECHNOLOGIES, IINC. 

Property Status Form 

Address: 3 e.l' b Sp,.^nrd t ^ Date:V0(2_^ f^ 

Phone: BVID: 

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1 

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: 

1: 

1 

; 

i 

_^f ^ o/^L_. Hr ^ . Property Owner Prudent Emjiioj^e ' ... ^y ^ 

{ Signature: Sjgnature: /t^A/rA ) Ay-^-Cyl 

3080 Weird ParHway. Suitp 40,S 5GC() y -flJ Sl. •;^.:;?. Merncs! Otivo. Oimo4250 

fvansas City, iVlO B-tH-'J Oriwrii"), I'Jebrasti.a i'l'B lO" Gwii Anioriic, TX '/'JS:;!! 

Pt\one: (S'ie) 365-i70.-? f^hone: <i:iO) rJZii-MSOfl /.*vi'^ ^ 7^'-r •.;<SO*J JV - *'J-»rt\ CT Q tcT- r 
S0O2>>< 

Oinab.a Lead Sii.t 
"H 

50 X 130 

A Printed

: Nov 22. 2010 www dcgis.org/dogis 
Page 1 of2 

" > 

Create Another Ticket Back to Irth Intemet Send Email 

• YOUR TICKET NUMBER IS 2629435. 

Original Call Date: 10/29/10 Time: 8:58 am Op: SIVA18967 

Work to Begin Date: 11/02/10 Time: 9:30 am 

State: NE County: DOUGLAS Place: OMAHA 

Address: 3613 Street: SEWARD ST 

Twp: 15N Rng: 13E Sect-Qtr: 16-NW,17-NE 

Twp: Rng: Sect-Qtr: 

Legal Given: C 


Type of Work: lead soil remediation project 


Location of Work: LOCATE ENTIRE PROPERTY 


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


Company : PRUDENT TECHNOLOGIES 


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


Work Being Done For: EPA 


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


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVEL3 LEVELS COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 


Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RICH/TRAFFIC Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 


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Page 2 of2 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT Alt: 4062071494 ELM LOCATING 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK

Day: 4067289343 

 ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthimemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 10/29/2010 
TECHNQLOSSS, INC. 

ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION 

SOLUTIONS 

SITE SAITfcTY HAZARD ANALYSIS 

Address: : 2L£i:L.-5£i^i:i-_^i Excavation Date: J-tAlZJ ^ 

Crew: —-Jfcl^iS^-^ Backfill Date: —iL-tl^y^L-^ 

Item Condition Hazards Corrective Action 

Overhead Lines it/A 

Gas Line h^ir\Q^ n Q 

Water Line 4- \r Sewer Line 

Septic/Leech 

Field MIA. Propane/Butane n4 

Sidewalk 6<»^j/f^ a - y e<i ?\ ^ \yi}aA ^ Foundation } ^ y^i ^ 

Retaining Walls lUA 

Fences 

Trees V \ Q 

Structures fZ/A 

Driveway A//\^ 

Sprinkler System UlA^ 

Other 3^m ^ V y t«A 

Crew Foreman Site Safety Office 

Date: 

8080 WanllSartaany, Sut e 40S SSOOSIOSt 4242 Medical Drive, Suite 7250 

Kansas GMy, MO 04114 ebnsia 68107 San Antonio, TX 78229 

Phone: 1810) 363^703 Phone: (402)733-1188 Phone: (210)822^9588 

Fax: (816) 363-3707 Fax: (402)733^1883 Fax: (210)679-6577 
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