TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 26552 DATE: 1/15 

ADDRESS: 2815 DECATUR ST 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: 2011^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d PRE AND POST VIDEO OF PORPERTY (DVD) 

d EXECUTIVE SUMMARY 

El EPA-PROVIDED PROPERTY SKETCH 

0 SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

n SIGNED ACCESS AGREEMENT{S) FOR ADJACENT PROPERTY 

0 RESTORATION AGREEMENT 

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

I3''^C0NFIRMATI0N DATA 

0 FPHOTOGRAPHS 

d I AS-BUILT SKETCH 

d SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

M PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

\ y UTILITY CLEARANCES 

d PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

SIGNATURE DATE 

30218429 

llillil 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2815 DECATUR 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: 

Bl = 277 PPM @ 2"; EA = 119 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 ofareas not meeting Interim ROD cleanup criteria. 

TEGHNOLOCIES. INC. 
Find Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 26552 ­ 2815 DECATUR ST 

Owner: User Provided Owner Information Resident: 

n Owner Ornipied 

Owner Name: Owner Name: Resident Name: 

JBUNDY CAROLE A 

Owner Addressl: 

1 

Owner Address2: 

|1722 N 28 ST 

City: 

lOMAHA 

Owner Phone 

1(402) 342-6604 

State: Zip Code: 

JNE |68111-

Alternate Phone: 

|(402) 455-2311 

1 

Owner Address: 

1 

City: 

1 

Owner Phone: 

1 

State: Zip Code: 

1 1 

Alternate Phone: 

1 

Property Address: 

|2815 DECATUR ST 

Zip Code: 

|68111-

Resident Phone 

I 

Contract: Assessment: 

Contractor: |PRUDENT2010_S Qualifying Group |400 

Contract Option {OPTION 2 Assessment Max XRF Value | 474.88 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: '2~'!o 5^2 _ Property Address: ^l" ? Pe^^rVoj,- <?-V. 

Date/Time: Owner's Name: Oj,,ro I BiJc<«a^A^ 

Quads Excavated: ^ f Contractor Group: Prudent Technologies, Inc. 

Excavation General 

Yes No 

1. If necessary, were tlie correct quadjrant(s) excavated and restored? / 

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

y 

Grading Sod and Vegetation Yes No 

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

/

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? 

/ 1 

5. Are the joints between the sod strips generally tiglit? (Only evaluate if inspected at a 30 day 

/

time period) 

6. Was the property graded sucii tliat water will not pool on the property'^ 

/ 

7. Was dainage to landscaping or plant materials avoided? 

/ 

1 

Gates, Fences and Retaining WalSs 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 sidmg or trim avoided? 

/ 

2. Was damage to tlie foundalion avoided? 

y 

3. Was damage to windows avoided? y 

4. Was damage to windows or door screens avoided? 

y 

5 Was damage to downspouts or downspout extensions avoided? 

y 

Sidewalks and Driveways (Concrete) Ves No 

1 Was damaj^e to diivewav surfaces avoided'? / 

2 Was damage to walkway surfaces avoided? 

/ 
Owners comments: 

Inspection notes: 

.y .y 

y* , 1 y 

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

EPA Representative Q<^ y*^ Date: i/i?/// 
>RUPEN1 

THNOLOGIES. INC 

AS - BUILT DRAWING 

OLS U 26552 

Date Excavated: 11/11/2010 OMAHA LEAD SUPERFUND SITE I'SEPA Signed-OfTDate: 

26552 

Owner Name: CAROLE A BUNDY 

Address: 2815 DECATUR ST 

Phone: H:

Sample Number 

RYASCPXA-26552 F1 

RYBSCPXA-26552 F2 

RYCSCPXA-26552 Bl 

RYDSCPXA-26552 B2 

RaZ€€PXA=2t5552 BZ 

RGZSCPXA-20552 GZ 

RP2SCP77rZ5552 PZ 

y:^-yyyi-yy-'-

Omah a Lea d Sit e 

Sit e Sketc h 

 W: 

Lead 

Concentration 

Sample 

Collected LAB 

1 n p^—•ppm D 

ppm D 

ppm D 

ppm D , ppm D D . ppm D D 

.ppm D D 

Number of Samples = U 

.tfWC 

^ 

Exterior Paint Nortti Arrow 

• Gcxjd 

• Poor 

Q Not paint 

Samples Collected 

Firm: PpC^ / F B iP» a 

Date: A/jQ/rf / 

Time: yV-' 3g 

Samples Analyzed 

XRF Unit: ^IX Book: ^ ^ - Date: _ ^\^^ ^ 

Time: 

•JVM 

Staff: r 

^ 

B1=277PPM®2 ' k^ %y ^ \\<\ HIS. 

^ 

^ 

/iJ^ • r " ' ^ d 

e 

moy 

r^; 

y2x^^ 

^r 

Mm. ntfpiViP. 

Omalia Lead Siic 46l3(t 

EA = 119 PPM ro SCRAPE (~l") 

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

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 future, excluding any 

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

Property ID: 

Property Address; ^S\ S 'I ^ (g^dpJKjLX­ ^^ V 

Q""^'-^ O a/^ A 

Phone: MfeSL­ ^MT^ ' S A 6^^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

^""•~"""TM 

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

/^-^1-^^^ " 

Owner's Signature ^ / Date 
Prudent lechnologies, inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up Icadconlaminate^ soijs at a number ot" properties located in Omaha, Nebraska, including tbe property located at 

^ 8 t o Dg0^tn^./y~ ^T ~ The EPA requests your permission to allow Prudent to pertbrm a soil cleanup at Ihis 

properly to remove lead-contaminated soil. By signing this form, the property owner grants permission to Pru-1enl to pertbrm 

activities related to the cleanup including soil sampling, removal of lead-contaminated soil, and restoration of :he leferenced pioperty. 

If you have any questions about the soil cleanup planned for your property, please contact Prudent . , • .-.•:-. M. ., Ibr the Omaha 

Lead Site cleaxiup, al (402) 733-1188; 733-1455. General questions about the Omaha Lead Site cleanup can b; directed to ihe EPA 

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

Property Access Granted By 

yM^-P-y^^^ 

Property Owner .Signature: 

' /Date) 

PROPERTY INFOFIMATION 

(T and/or propeity owner — please print) (Too bbee complete completedd bbyy residen resident

t and/a^ propeiiY owne 

RESIDENT NAME: (A^yr C6y<%A/ M - AS. /^Tl M y (Pwaei) Renter .^y^JyiJyA 

RESIDErrLADDRESS:: jIDErTLADDRESS , ^ r-/ I r>, ^ ^ . ^ I 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S IVIAILING ADDRESS; 

OWNER'S TELEPHONE NUIWBER - HOWIE: ( ) WORK: 

AGE OF HOME?: ^^ Q VEARS. HOW LONG HAVE YOU LIVED HERE? "•^' ^ YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978M\^\tL ? ^ / U - 'YES NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: V/f V NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

X ^ 

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 .indei this agreemert 

are pursuant to Section 104 ofCERCLA, 42 U S C. 9604. EPA's right ofaccess to the property is piovided fo- 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 of the title." 

3080 -.Va.-c ,-.?.'"< Ai.d-,, 

.Hiansas Ciry, •'WC ^^--i" 

s'lo.'VB. •.^••j^)" .7f 3•-•.•""' 
ENVfROiNMENTALA 

CONSTRLCTiON 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: ^<SIS D^CfM^rsV Date: t ( - o^-l7 ^ 

Phone; i(Ac^^ 3H0.-(d(DCLi BVID: 

^jPyyiiUy-t ^ Airc ^ f M 

Property Owner Prudent Empl^^yee 

Signature; y ^^[^d^iilisj^-^ 

8080 Watd Parkway. Suite 405 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-­ - /o-«e\ t o ty m c.. . t4rto\ yy.y ^OQ-> l-HM ET0.*e77 
26552 

Omaha Lead Site Exterior Paint North Arrow Owner Name: CAROLE A BUNDY 

Site SIcetcli • Good Address: 2815 DECATUR ST • Poor Phone: H: w. • Not paint 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Finn: rPft/ ^ 1 ^ 

RYASCPXA-26552 F1 D Date: ^//Q/Cf/ 

RYBSCPXA-26552 F2 AM 4 pp"^ D Time: 19' ^§ RYCSCPXA-26552 B1 vns > ppm D Samples Analyzed RYDSCPXA-26552 B2 V \ q oom Ef D 

RDZDOPXA 2BSSJ BZ ppm n D XRF Unit: .^11 Book: M. RGZQCPXA-iOa52 GZ ppm n D Date: _ 1\^^4 

RPZSCPX7r2B5S2 PZ ppm D • Time: _ 

Staff: Number of Samples = j t^ 

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AUG 1 b 2004 

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Omaha Lead Site 46130 
N LEGAL

: 60 X 127.5 

A Printed

: Nov 05, 2010 

vw.dcgis.org/dogis 
Page 1 of2 

"> 

Create AnotherTicket Back to Irth Internet Send Email 

• YOUR TICKET NUMBER IS 2635567. 

Original Call Date: 11/05/10 Time: 9:59 am Op: SIVA18967 


Work to Begin Date: 11/09/10 Time: 10:30 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2815 Street: DECATUR ST 


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


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: soil lead remediation propject 


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: 6FT Corner Lot: Y Front: Y Rear: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVEL3 COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl 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 

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Page 2 of2 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/5/2010 
ENVIRONME^r^AL 

ENGINEERING AND 

tBBHNOUWIBB , mc . CONSTRUCTION 

SOLUTIONS 

SITE SAltTY HAZARD ANALYSIS 

g)^-/ur s f i/-y^o Excavation Date: 

BackfiU Date: — 

Item Conditioii Hazards Corrective Action 

Overhead Lines QA 

Gras Line O 

Water Line n 

Sewer Line 

Septic/Leech 

Field nj± 

Propane^utane no 

Sidewalk A^ 

Foundation M. Retaining Walls nix 

Fences ao. Trees ^ki 

structures m. Driveway a 

Sprinkler System ^ D 

Other n^ 

Crew Foreman Site Safety Office 

Date: 

.Suito4(B 4242 Medical Drive, Suite 7250 iseoosiost 

lG«y,llO«4114 San Antonto, TX 78229 NilwMkaS8107 

Phone: (SIS) 3634703 Phone: (2t0) 8224588 (402)733-1188 

Fax: (81S) 3834707 Fax: (210) 6T9-«577 Tax: (402)73»'1883