SAID#: 28096

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

 DATE: 1/15 

ADDRESS: 2864 GRANT ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC. YEAR: 20l4 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d PRE AND POST VIDEO OF PORPERTY (DVD) 

0 EXECUTIVE SUMMARY 

m EPA-PROVIDED PROPERTY SKETCH 

Q SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

n SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

El RESTORATION AGREEMENT 

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

0 CONFIRMATION DATA 

\ i PHOTOGRAPHS 

Q 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 

m UTILITY CLEARANCES 

01 PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

n ^ ^ 

D 

D 

SIGNATURE DATE 

30217610 

IHIHI 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2864 GRANT 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 = 75 PPM @ 6"; B2 = 109 PPM @ 6"; NO EASEMENT 

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/or 

photographs 

iv) Signed form verifying satisfactory restoration 

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

TECHNOLOCIES. INC. 
Find Record 

Backfill: 

Sample Area: 28096 - 2864 GRANT ST 

Owner: 

D CXvner Occupied 

Owner Name: 

1 MORELLO BERNARD1 : 

Owner Addressl: 

1 

Owner Address2: 

111413 HICKORY RD 

City: 

jOMAHA 

State: 

|NE 

Zip Code: 

|68144-

Owner Phone 

1(402) 342-2820 1 

Alternate Phone: 

Contract: 

Contractor: |PRUDENT2010_S 

Contract Option |OPTION 1 

Renfiediation Query Lead Remaining Query I Property Damage Query 

User Provided Owner Information 

Owner Name: 

1 

Owner Address: 

1 

City: 

1 

State:

1

 Zip Code: 

1 

Owner Phone: 

1 

Altemate Phone: 

1 

Assessment: 

Qualifying Group |466 

Assessment Max XRF Value | " 514.61 

Resident: 

Resident Name: 

r 

Property Address: 

2864 GRANT ST 

Zip Code: 

|68111-

Resident Phone 
•-•-• ir^: ^ i*. 

TECHNOIXXJIES, INC. 

EPA Property Close Out 

Property #:'7^^^ ^ Property Address; ZS*^*^ <5)(nt>^*.'+' ^tDate/Time: Owner's Name: ^er^A>^ ^ flAd>ret/d 

Quads Excavated: (2,f ^ 6.Z Contractor Group: Prudent Technologie.*, Inc., 

Excavation General Yes No 

1, If necessarv. were the correct quadrant(s) excavated and restored? / 

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

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? / 

3, Does the 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. Arc tlie joints between the sod stnps generally tight? (Only evaluate if inspected at a 30 day y time period) 

6, Was the property graded such tliat water will not pool on tlie property? / 

7. Was damage to landscaping or plant materials avoided? 

y 

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 apphcable) 

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 tlie siduig or trim avoided? X 

2, Was damage to tlie fomidation avoided? 

y 

3. Was damage to windows avoided? 

y 

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

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

Sidewalks and Driveways (Concrete) 

Yes No 

 Was damage (o diivewav surfaces avoided? n 

2. Was damage to walkway surfaces avoided? 

I
Owners comments: 

Inspection notes: 

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

EPA Representative 9^ ^ ^Date: 'Z^'^^^" 
mm R'HNOLOUIES, INC, 

AS - BUILT DRAWING 

OLS # 28096 

Date Excavated: 10/04/2010 

USEPA Signed-Off Date: OMAHA LEAD SUPERFUND SITE 

28096 

Exterior Paint No*, h Arrow Owne Omaha Lead Site r Name: BERNARD J MORELLO 

Site Sketch • Good Address: 2864 GRANT ST • Poof Phone: H 402-342-2820 Vt 

[3''^Not paint 1

Sample Number Lead Sample 

Samples Collected LAB Concentration Collected Firm: Ctoft '.ftsVCxi 

RYASCPXA-28096 F1 ppm izr 

D Date: y^s - 2H-oi . 

RYBSCPXA-28096 F2 

ppm 0' D Time: IO : t S ^ r^ 

RYCSCPXA-28096 B1 ppm 0" D 

Samples Analyzed 

RYDSCPXA-28096 B2 ppmK 0 ' D 

RDZ8CPXA 28P96 Bir 

ppm D D XRF Unit: qOZ Book: lOCf 

ppm D D Date: ic-O^-ci^ 

ppm D D 

Time f M 

Numbe Staff: <1>5U r of Samples = J ^ 

Legend: F1 = Front Left. F2 = Front Right, B1 = Back Left, 82 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from th« street, facing property 

ENTERED 

'iMArprti. 

.\.y/s 

B2 = 109 PPM (o: 6' Bl = 75 PPM ffl) 6' 

8i t 

,6.i-. 

,2,$ fc.M, C»!ccx,n4 sr. 

r ~t- ­

4i 

I.. 

P' ' P 

IZ ,/,?..o 

C/^rar^* • '3.'-

NO EASEMENT 

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

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: ^ g £, M Q(t-«^ ^ Si -

Owner: 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

LiJ I agree restoration is completed. 

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

'X^ ^ fl 1^3/1 'IL 

ner's Signature Date 
• ; t 

Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up lead-. 

cqnlim^njrfed spils ait a numbelaer^f^propertie r ofpi s located in Omaha, Nebraska, including the property located at soils a' 

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

m/fe 1 property to remeje lead-contaminated soil. By signing this form, the property owner grants pemjission to Prudent to perfonn 

activities related to the cleanup including soil sampling, removal of lead-contaminated soil, and restoration of the referenced property, 

Ifyou have any questions about the soil cleanup planned for your property, please contact Prudent south office for the Omaha Lead 

Sile cleanup-at (402) 733-1188, General questions about the Omaha Lead Site cleanup can be directed to the EPA Public Information 

Centers al (402) 731-3045 (South Omalia office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By: i)Bfi^yi/iP /h6/e^^^Q

(Please Print Name) 

iJh f/2.4/^

Property Owner Signature: /^^ ^ J^.J\J^ ^ 

(Signature) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: </ ^C.A[^T [^Q ' f ' Owner Renter 

RESIDENT ADDRESS 

^g^ M <^rc<Lo^W S ^ DrAOLk A N^E - C1S> VI o 

IF RENTAL, PROPERTY OWMED BY: . . 

'BiOjrruiJlJ K M.0 rgAljP 

OWNER'S MAILING ADDRESS; 

^ -^^C^ ^VV^AJv-fl. jNL b f6^\^K^ 

OWNER'S TELEPHONE NUMBER - HOME: fj^ ^ 3 y Z ' ^ ^

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

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978?

 WORK: 

M/A- YEARS. 

_ 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: A ^ I ^ 

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

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 "detennining the need for response, or choosing or taking any response action 

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

8080 Ward 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 

Fax: (816) 363-3707 Fax: (402) 733-1883 Fax: (210) 579-6677 
ENVfRONMENT.ALA 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICE.S 

Property Status Form 

Address: J? $ 4 L( (^ran|- gV Date: ^/:^ W f 0 

Phone: BVID: 4^0^ ^ 3M2-- ;2.'22JC) 

rMrQ.ug- U h 

Property Owner Prudent Employee 

Signature: Signature: 

8080 Ward Parkway, Suf 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 
28096 

Exterior Paint North Arrow Owne Omaha Lead Site r Name: BERNARD J MORELLO 

Sit • Good Address e SIcetch : 2864 GRAf^n" ST • Poor Phone: H: 402-342-2820 W^ 

Q'^Not paint 1

Sample Number Lead 

Concentration 

Sample 

Collected LAB Samples Collected 

Firm: f:^ ^ \ft&^g M 

RYASCPXA-28096 F1 ppm ET D Date: e^K^ .2'^^ofc 

RYBSCPXA-28096 F2 ppm 0 ' D Time: to ; 1 ^ ^< w 

RYCSCPXA-28096

RYDSCPXA-28096

 Bl 

 B2 S/ S 

ppm 

ppmM 

ET D 

D Samples Analyzed 

RD2SCPXA 26006 92­ ppm D D XRF Unit: 90Z Book: A ^ 

ROgGCrXA-2000G

r^rZSCPXA-20006

 GiS-* 

 PZppm 

ppm 

D 

D 

D 

D 

Date 

Time 

(£>- O^'C^ 

£± L 

Number of Samples = : 4 . Staff: n'iu/ 

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

AH quadrants are as viewed from the street, feeing property 

ENTERED 

mm 

[ -^^4" 

81 .6.V 

s^r 

i 

r-- 2 i 

y 

... I 

p^ 

Ito. .y.2L.o. 

Cnr<»r, <^r » 

R«v4' 04«U) 0123 
286

4 Grant St 40 x 100 

A Printed

: Nov 30, 2010 

www.dcgis.org/dogis 
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU.. 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS  2605473. 

Original Call Date: 9/30/10 Time: 12:33 pm Op: SIVA18 967 


Work to Begin Date: 10/04/10 Time: 1:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2864 Street: GRANT ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-SE 


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 

lof 2 9/30/2010 12:33 PM 
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=%3CRESU.. 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

2 of 2 9/30/2010 12:33 PM 
ilNC. CONSTHUCnON 

SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address: --2L^.$^-^v:,^,£ir. Excavation Date: 

Crew: BackfiU Date: — 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition 

CPi ^ 

e^ 

h^' \V 

- — 

o/t. 

ar^ 

fpCC^ 

C5rt ^ 

t r ^ 

C7'— 

— — 

-

Hazards Corrective Action 

' ^-^-L J HdA-m^ M — 

Site Safety Office 

Date: 

n o Waiif ewtany. Sut e 405 SSOOSIOSt 4242 Modical Drhre, StiMe 7260 

BlmMB081O7 San Antonio, TX 78229 

nans: fSIt) 36>4703 Ptaone: {W2)733-11S8 Phone: (2t0)8224S88 

K^1« ) 363.3707 Fax: 4402)73».1«83 Fax; (210)«r»-«r7 
r*^ . •*•;.•:•-;i-i,ft^. 

VACAA;T- IJOT ' m 

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