TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 22-3>77 Date: i Jn^J^ol ^ 

Address: li f 5 2.^ /Ixy 

Remediation Contractor: nr^e.yr Ttu7..^yL fi^.^7^1nt. Year: p/^oTI 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

0' Video ofproperty (DVD) 

y Executive Summary 

y EPA-provided property sketch 

y Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

y Restoration Agreement 

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

W Confiimation data 

y Photographs 

y As-built sketch 

y Satisfectory restoration signed by Property Ovvner 

y Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

0' Utility clearances 

y Property information from Douglas County Assessor's Office 

D 

D 

D 

J^^^t ^ 3/ltl£r'i 

Signatmy*­ ' Date 

40311304 

liiinniiini 

Superfund 
 I 

PROPERTY SUMMARY 

1 Date: 01/23/2009 | Omaha Lead Site Remedial Action Contract # EP-R7-07-06/0004 Mondi of: Dec/Jan | 

1 Property Address: 721S25AV

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Oflier Relevant Information: AREA NOT EXCAVATED BRICKS 6'X2', 6'X2' @ 317 PPM 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl = 237 PPM @ 6"; F2 = 219 PPM @ 6"; DZ = 460 PPM @ 13"; B2 = 137 PPM @ 6"; Bl = 287 PPM 

(@ 6"; EA = 224 PPM @ SCRAPE 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant to contract specifications 

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

3) Pre-Excavation digital video clip/photographs 

4) Post-Excavation digital video clip/photographs 

5) Documentation - Comfdeted Close-out Checklist 

6) As-Built sketch ­

i) Shall includefinal 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 

Backnil: 

Sample Area: 22377 - 721 S 25 AV 

Owner: 

n Owner Occupied 

Owner Name: 

JGODBERSON MARTIN 

Owner Addressl: 

r 

Owner Address2: 

(8106 CEDAR ISLAND ROAD 

City: State: Zip Code: 

[OMAHA [N E [68147 

Owner Phone: Alternate Phone: 

r r 

Qean Up Query lead Remaining Query I Praperty Damage Query 

Resident: 

Resident Name: 

[ALLEN BENNETT 

Property Address: 

j721 S 25 AV 

Zip Code: 

[68105 

Resident Phone 

I " 

Contract: 

Contractor: 

PRUDEI^T2008_S 

Group: 

Assessment: 

Qualifying Group 

Isoo 

/Assessment XRF Date: 

/Assessment Max XRF Value: 

1032 
w SEm 

EPA Property Close Out Form 

Property #: ^^31 1 Property Address: ~lo?) -^ o?5«Q'V 

Date/Time: Owner's Name: ^ /;' 

Quads Excavated: Contractor Group 'j^iPgr^-f T<"(i|-l»Nififft <:j>i-S? 

Excavation General 

Yes No 

1. Ifnecessary, were the correct quadraQt(s) excavated and restored? 

2. Ifnecessary, weretiie correct areas ofdrip zane excavated and restored? 

Grading Sod and Vegetation 

Yes No 

1. Doe

fit)m

s th

 th

e

e

 gradin

 house

g

? 

 around the perimeter of the house in excavated areas generally slope away y

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

3. Doe

day tun

s th

e

e

 period

 sod appea

) 

r to be generally healthy and growing? (Only evaluate if inspected at a 30 7^ 

4. Are sodded areas generally firm and evenly graded? y 

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

time period) y 

6. Was the property graded such that water will not pool onfee property? 

7 ^

' .

 Was damage to landscapmg or plant materials avoided? 

Gates, Fences and Retaining Walb 

Yes No 

1. Do gates open and close fieely? 0f applicable) 

2. Were all gates or fences taken down during restoration activities reinstalled? (If applicable) 7^ 

7zL 

3. Was damage to gates or fences avoided? (If applicable) 1

4. Was damage to retaining walls avoided? (IfappUcable) 

Foundation, Siding and Gutters 

Yes No 

1. Was damage to the isiding or trim avoided? 

y ' 

2. Was damage to tfae foundation avoided? 

7^ 

3. Was damage to windows avoided? 

I/ ' 

4. Was damage to windows or door screens avoided? 

7^ 

5. Was damage to downspouts or downspout extensions avoided? 

7' 

Sidewalks and Driveways (Concrete) Yes ^No 

1. Was damage to driveway surfeces avoided? 

y y 

2. Was damage to walkway surfeces avoided? 

\y 
Owners comments: 

Inspection notes: 

Removal and restoratioiLactivates complate including the 30-day sod warranty: 

EPA Representative N>X^ Z^<^CA ^ Date: /j J ff '^^'(^^ 
i. 9» 

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 ofthe 

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: / ^ ^ (• 

^ p<;hV Sl Ly iT-

^ Owner: 

Phone: 

I 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

10 ] agree restoration is completed, except as noted above. 

LJ I do not agree restoration is completed 

/j^7-^ y 

Date 
Prudent Technologies, Inc (Prudent) is under contract with the U S Environmental Protection Agency (EPA) to clean up leadcontammated soils at a number ofproperties located in Omaha, Nebraska, including the property located at 

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

property to remove lead-contammated soil By signing this form, the property ovmer grants permission to Prudent to perform 

activities related to the cleanup mcluding soil samplmg, removal oflead-contaminated soil, and restoration ofthe referenced property 

If you have any questions about the soil cleanup planned for your property, please contact Prudent Administrative Clerk for the 

Omaha Lead Site cleanup. Ms. Deborali Johnson -at (402) 733-1188 General questions about the Omaha Lead Site cleanup can be 

directed to the EPA Public Information Centers at (402) 731 -3jHiiSouth Omaha^ffice^or (402) 99,1 -9583 (North Omaha office) 

Property Access Granted By. [/I P J ^ K f^r&'^. rt^ytjll fC^ 

-'[^Please Print Name) 

Property Owner Signature 

PROPERTY INFORMATION 

I / (To be completedjw resident and/or property owner ~ please print) 

RESIDENT NAME: i^U.^ ^7Z7 7e,JL Renter 

RESIDENT ADDRESS: « 

(3<V>^^AAA. IjLjg, fegjo ^^ 1Z\ 5 2^-^"- l\ vsL. 

IF RENTAL, PROPERTY OWNED BY: 

>pd.AiUiL^. 

OWNER'S MAILING ADDRESS; 

[U ^tA^jJL ^ fo ^ Cg? ( o -^ 

OWNER'S TELEPHONE NUMBER - HOME: ( ^fl ) 1 Hi,-CiO l WORK: 

J 1 

AGE OF HOME?: : /:? 3 YEARS. HOW LONG HAVE YOU LIVED HERE?? o , 6 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 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 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 

Kansas city, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

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

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
pllp^i* ^ 

OLS#: 22377 

Date Eicavated: 11/25/2008 

USEPA SIpwd-OfTDate: 

22377 

Omaha Laad Site Exterior Paint Noith Arrow 

Site Sketch • Good 

B'Poor 

Sampling AddraM : 721S2SAV Q Notpalnt 

Sample Number Lead 

Concentratton 

Sample

Collected

 ^^ . 

 ^ ^ Fimi:

Samples Collected 

fatw, p B 11) 

RYASCPXA-22377

RYBSCPXA-22377

 Fl 

 F2 

<i31

CiH

 ppm

 ppm

 EJ'

 Q^

 D 

n 

Date: £l£ic/£ifL 

Time: .aifidMi. RYCSCPX/^22377

RYDSCPXAr22377

 Bl 

 B2 

__fi2i/L.PPm

_Lfl32^ppm

 o r

 s y

 D 

D Samples Analyzed 

RD2SCPXA-22377 DZ 382 a ppno ET D XRF Unit: CBH O Book: 2( ? 

ROZSOPXA-ifflOT? 6Z ppm D D Date: fi-Zgr-CS 

nPgOOP}(A-Bg077 PZ ppm n D Time: _ftca_ 

Number of Samples = [^5 ! | ^ [ Staff: rn5u;> 

Legend: F1 = Front Left, F2 « Front Right, 81 = Back Left, B2 - Back Right OZ = Drip Zone, GZ = Garden. PZ = Play 

Ml quadrinti are at rfawad from ttw sirsst, Mn g pnipoty .-JJll 

81 = 287 PPM® 6" W RDLK : ,on US i;2 

:B. \ 

:---,,d .C«. 

82=137 PPM® 6" 

iz 

fiiMLA&E 

D2» 3«ia 

DZ = 460PPM@13'< 

CONTRACT #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
INC. 

Property Status Form 

Add«ss: 7^f S. Z5^ ^ ^^^ 0M7^H(^ \]£ a/OS ^^^^,

Phone: BVID: 

ILNV IRONMENTAL & 

CONSTRUCTION 

SERVICES 

 f/^/^-or 

Item NO Plants & Pennanent Landscaping To Remain In Place 

OnNfap Description & Location 

0 Y\(^yJh] 

Pre-F.YJstjng Condition of Structures 

Does your Basement have a history of leaking? Yes No 

Item NO Description & Location 

On Map 

Property Owner Prudent Employe 

' Signature: V 

^'—M 

\ j 

8080 Ward Parkway, Suite 405 2505 N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio. TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210) 822-9568 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
22377 

Omaha Lead Site Exterior Paint North Anrow 

Site Sketch q|Good 

OlPoor 

Sampling Addres! c 721 S 25 AV •igNot paint 

Lead Sample Sample Numqer bkB Concentration Collected 

RYASCPXA-22i77 F1 ppm m 

RYBSCPXA-22;;77 F2 jSt2J ppm [] 

RYCSCPXA-22a77 B1 Ji2jL ppm [] 

RYDSCPXA-22;(77 B2 [] 

RDZSCPXA-22;i77 DZ ^saia ppm %y [] 

RO200PXA-22|)77 GZ ppm U [] 

RrzocpxA-22:ffy—PE ppm D [] 

Number c f Samples = | g " | ( \ 

Legend: F1 = Fron^ Left, F2 = Front Right, Bl = Back Left, B2 = Back 

All quadranti are as viewed from the street, 

i | Samples Collected i | . oaiiipie 

FirmlfB:^ 

Daty^i^LjM 

Timyi:(X)Ay\ 

1 51^ Samples /analyzed 

XRFQ|iit: GSit O Book: 2t 3 

DateE fi •/S' " be 

J^C5_ 

fOSLJ) 

: DZ = Drip |one, GZ = Gtarden, PZ = Play 

I property j r--iy'^'-•...'^ v*i-<--, , 
R14268900000001.jpg (JPEG Image, 640x480 pixels) http://doviglasne.imppmg-online.coiii/assessdoc/Photos/16/Rl 42689.. iUpix 

Amil 2002 — Doiiuhis C'(iun1\ Assessor 

7 ^ j S ^5" AV 

lofl 11/5/2008 9:36 AM 
Print Preview ht^://www.dogis.org/dogis_alias/dogis/priiJiPreview.aspx?PrintOpL. 

Douglas County-Omaha, NE 

Parcel ID 1426890000 Sec-Twn-Rng 

Owner 

Name 

PERALTA 

VICTOR P Addition 

Property 

Address 

721 S 25 AV Block 

\city OMAHA Lot 

Zip 68105 Legal 1 

Owner 

\ Address Legal 2 

Owner 

\ Address 2 71 S 25 AVE Legal 3 

1 Owner City OMAHA Legal 4 

Owner 

\state 

NE Treasurer 

Website Link 

Owner Zip 68105 

Assessor 

Website Link 

21-15-13 1 

JOHNSON ADD REPLAT 

0 

9 

8 5 FT SUB LT 2 & ALL 

SUB LT 3 OF 

33.13X132 

http://webapps.dotcomm.org:8080/TreasTax/faces/pages 

/taxinfo. jsp?parc= 1426890000 

http://douglasne.mapping-online.com/DouglasCoNe/static 

/accountinfo.jsp?accountno=R1426890000 

Disclaimer Map and parcel data are believed to be accurate, but accuracy is not

guaranteed. This is not a legal document and should not be substituted for a title search, . , X • - r ,.• appraisal, survey, or for zoning verification. 

M 9 i 

 ,, .—^ tf t i. 

' "icn - 27 feet 

lofl 11/5/2008 9:36 AlV 



^ • ll . 
Page 1 of2 ^ I ­

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2179296. 

Original Call Date: 11/20/08 Time: 10:50 am Op: MADHURIMA18967 


Work to Begin Date: 11/24/08 Time: 11:15 am 


State : NE County: DOUGLAS Place: OMAHA 

Adciress: 721 Street: S 25TH AVE 

Twp: 15N Rng: 13E Sect-Qtr: 21-SE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation work for soil 


Location of Work: LOCATE ENTIRE PROPERTY 


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


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: MADHURIMA Phone: (402)733-1188 


Alt. Contact: Phone: (618)401-2223 


Work Being Done For: epa 


Depth of Excavation: 6 ft Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MCLEODNE MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Utility Service Area Contact Plione Number Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, ^^^^^ 

Alt: 4029340469 INC 

Emerg: 4029329757 

Day: 8773668344 


LEVELS LEVELS COMMUNICATIONS, ^ ^ Alt: 


Emerg: 8773668344 

Day: 8002891901 

NO NEED TO CALL OUT MCLEODNE MCLEODUSA Alt: EMERGENCY 

Emerg: 8002891901 

Day: 4025047823 


METROPOLITAN UTILITIES MUDOl SANDY Alt: DISTRICT 

Emerg: 4025047970 

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Page 2 of2 

CITY OF OMAHA- OMAHACOF RON TRAFFIC,SEWER 

0PPDGPR5 SJ^^SCT''^'^*'^"'''^^' ' NA 

QLNNEIC QWEST LOCAL NETWORK NA 

Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Alt: 


Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT... 11/20/2008