TRANSMTTTAL of OMAHA LEAD STTE 

SOIL REMEDLATION FILE FOLDER 

SAID#: 2M^4 ^ Date: /jfT 

Address: ^Ci?> N . ^ ^ R-f 

Remediation Contractor: yvU^YVV fi.^^! \ ^ Year: cSc l D 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Q' Video of property (DVD) 

0^ Executive Summary 

a EPA-provided property sketch 

3 Signed Access Agreement fot subject property 

D Signed Access Agreement(s) for adja^«nt property 

3 Restoration Agreement 

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

a Confirmation data 

Photographs 

/ 

As-built sketch 

Satisfactory restoration signed by Property Owner 

sf Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

/ Utility clearances 

I

i Property information from Douglas County Assessor's OfBce 

D 

D 

D 

JSignattrre Date 

30260734 iiiliiliii 

Superfunci 
Find Record Remediation Query i Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 24543 ­ 803 N 35 ST 

Owner: Resident: Contract: 

• Owner Occupied Resident Name: Contractor: 

Owner Name: jZARDETTO-SMUH ANDREA M |PRUDENT2009_S 

)ZARDETTO-SMITH ANDREA M Property Address: Contract Option 

Owner Addressi: |803 N 35 ST [OPTION 1 

Zip Code: 

Owner Address2: [68131 Assessment: 

|803 N 35 ST Resident Phone 

City: State: Zip Code: I Qualifying Group 

[OMAHA |NE |68131 [400 

Owner Phone: Alternate Phone: Assessment Max XRF Value: 

j(402) 614-5765 )(402) 280-2596 I 531.6 
• • • • 

PROPERTY SUMMARY 

Date: /15/2010 [ Omaha Lead Site Remedial Action Contract # EP-R7-07-06 T0#1 | Month of: C /^ P 

Property Address: 803 N 35 ST 

A EXECUTIVE SUMMARY 

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: 

Bl = 171 PPM (g 13"; DZ = 528 PPM % 13"; EA = 157 PPM (g 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) Propertv- 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. 

T.EGHNOLOCIES, INC. 
'yy^^^y^''''' TECHNOLOGIIES, EvTC. 

Property*: /-•M''^? ' 

Date/Time: 

Quad.s Excavated: (6> I, PZ_ 

EPA Property Cflose Omt 

Property Address; ^' 0 3 /"V '5b $ ^ 

OwTicr's Name: ^iN^lr^i^.. '>"rn ' Vx, 

ConlD-acfor Groiup: Pnu'lcnl T?clinologi(CS, Int., 

Excavation General Yes No 

L. If neccssar\. were lhe correct qus,drant(s) excavated and restored? / 

2. If necessarv. were lhe correct areas ofdrip zone excavated and restored? y 

Grading Sod and Vegetatiom Yes No 

1 Does Llie grading around the perimeter of the house in excavated areas generally slope away / from Ihe house? 

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

3. Does lhe sod appear to be generally healtliy and growing? (Only evaluate if inspected at a 30 

day lime period) / 

4 Are sodded areas generallj' firm fnd evenly graded? y 

3. Are lhe joinls between the sod strips generally tight? (Only evaluate if inspected al a .30 daylime period) J 

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

7. Was damage lo landscaping or pUmt materials avoided? 7 

Gates, Fence*; and Retaimiing Walls Yes No 

1 Do gales open imd close freely? (If apphcable) 1 / 

2 Were all gates or fences taken dovvn during restoration activities reinstalled? (If applicable) / 

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

4. Was damage lo retaining walls avoided? (Ifapplicable) / 

Foundation, Siding atidi Gutters Yes No 

\. Was damage lo the siding or trim avoided? / 

2. Was damage lo lhe foundation avoided? / 

3. Was dnm;igc (o windows avoided'?" 7 

4. Was damage lo windows or door screens avoided? 7 

5. Was damage lo downspouts or downspout e.xtensions avoided? 

7 

Sidewaiki; anri Ri'ivt'ways (Coincrgtc) 

I. W;is diiiiiagc io drivcwHy siirfHces avoided'.' 

• • • 

Ye.s 

/ 

No 

2 Was damage lo walkway surfaces avoided? \j 
0,6 ^ N 36 Sl-

Owners comments: 

Inspection notes: 

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

EPA Representative •^c.^J^ Date: 12/17/0^ 
DRUD s;:^3s?i. 

15. 

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 fiiture, excluding any 

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

Property ID: 

Property Address: o ^ <-^ K) ?> ^ ^K 

0^°^'-= (\^Ar^ n cao^A V-'L 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

1 I agree restoration is completed. 

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

Date 

1 fy H 

I
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Enviromnental Protection Agency (EPA) to clean up leadcpntargjnated spilsatajjuraber of properties located in Omaha, Nebraska, including the property located at 

flO J / v J O .^j T ' . The EPA requests your permission to allow ftiident to perfonn a soil cleanup at this 

property to remove lead-contaminated soil. By signing this form, the property owner grants permission to Prudent to perfonn 

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

If you have any questions about the soil cleanup planned for your property, please contact Prudent's Adminislniiive Cleik for the 

Otnaha Lead Site cleanup. Ms. Si\a S. .l^imiianii-at (402) 733-1 ISS. General questions about the Oinaha Lead Site cleanup can be 

directed to the EPA Public Infonnation Centers at (402) 731-3045 (South Omaha office) or (402) 991-9583 (North Omaha office). 

Property Access Granted By: X //ndn/y TjQurlp-ri?^ -S/vw^j-Jx 

(Pleasee Prin Printt Name) 

Property Owner Signature: 

leask 1//V^y (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: /l/^clr€^ ^/^J/"^ 0 SfV\l-f'll ^OwneT) Renter 

RESIDENT ADDRESS f o J li/, 3 f Si 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

Sa/TTdy 

OWNER'S TELEPHONE NUMBER - HOME: Ho^S^\-iV53 WORK: cee//)

J 1 

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

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 19787 y YES NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD3:: O NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

a 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

COMMENTS ORSPECIAL 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 ofCERCLA, 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 pro\ides entr>' 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 

KansasCity, MO 64114 Omatia, 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 
(«(>iNmi«li;CjT?ION 

TECHNOLOGIES, INC. 

Property Status Form 

Address: ^"^ 3 /.^ J^ ' $</- D..e: 9'li-£>9 

Ph„e: '£>i-m'l'/^3 BVID: Sy^rV? 

^=^^^^^—^^^~—;^^^^—^^^^—»—^—^^—-—^— —... . Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

^ ^ rCl7AC>^^ lO^^ T 

¥^ Ou7fler / ^ /^ x r^/f7ii/L//^se/\/i^A^ gd/^>fe /^ / 

z//.^/f/J5^ re^A^^oe -f/^ m <^^''A ^^^'^ ' 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes No y 

Item NO Description & Location 

On Map 

0^3-/Ylu/h/l-^ t/ctcks jyj cJ/-ivei4/^y C^ur/ d 

f ) 

/^/ZB'- S^cJ,^ f>i£.c^ rn/s^i y C^a.^i-) 

Property Owner Prudent Employee 

Signature Signature A/' 

;aaSO-.»fertf Parkway ,5Siate:'4Q5 ;25Q5-N.'24*;StTBet,=SiittE;308 

I KansasTCity .i^WtO;S4t1'4 'Ornaha,'Nebraska'68i;iO 

f Ptione: (816):363^;n03 fPhone: (f402)-:5(J4^-t004 

.T=ax: (S16):363;J7D7 r'Fax; ;f402)f504-1005 
• • 

IMI 

UHTsTTCnniES, INC. 

AS - BUILT DRAWING 

OI.S#:24543 

Dat* K.\ia\;iti<l: 09/22/2009 OMAHA LEAD SUPERFUND SITE l>iJ':P.\ Signcd-OtTlXite: 

Name: ^Ai/>fi£/h i/^/ifiz/h smcr*^ Oniaha Lead Sits Date; '?/^'//^3 North Arrow AddressT~ I?/? 3 ^> ^-ir^*- Site Sketch Time: 

Phone: (Vq?) A/<^~<-H,STeam Mry.fiA£&/t}iiiS^y^<..f BVID# ^^•f'^' b XRFCode^ V'^^ M 

Sample Number Lead Concentration Confirmation Sample 

^ Yes n aSrfaii PP" No S 

f"-2Yes n No 0 

13/ Yes a No 13 j y j 11 <:cyx A,~y< rvi ^ ]<'i.±i ^ pp"^ ^Ye s n No S Sl^±'/ o ppm /a2Yes n No E: 

ppm Yes O No • 

ppm Yes • No • 

Omaha Lead Site 46130 

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

Name: PAi/>/l£/h ^Ano^Tte styicrf^ 

AddressT~j?<?3 A , •^^•^'^ 

Phone: (vto ; A/'^~<-?/. ^ 

Omaha Lead Site 

Site Sketch 

Date:

Time: 

 •^/?'//a 3 North Arrow —i 

Team r//r/c/l/f££,/ahi£j.>/fSi^ BVID # PV-TV? ) XRF Code^ V^^ M 

Sampie Number Lead Concentration 

Omaha Lead Site 46130 
SO? N ?5 ST "^ 

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 3* : :^ . 

ril 2004 • Doua as Countv Asaes&o 

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• • • • 

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Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

\Zip 

Owner 

Address 

Owner 

Address 

Owner 

City 

Owner 

State 

Owner 

1642740000 

ZARDETTOSMITH 

ANDREA M 

803 N 35 ST 

OMAHA 

68131 

803 N 35 ST 

OMAHA 

NE 

68131 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legai4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Unk 

LOWES 2ND ADD 

6 

3 

N 40 S 79 FTW 1/2 

40 X 96.96 

0.1 1 

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

parc=1642740000 

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

accountno=R1642740000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/15/2009 

2 
• • • • 

Page 1 of2 

"> 

[ Create Another Ticket ]| [ Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2364471. 

Original Call Date; 9/15/09 Time: 11:41 am Op: SIVA18967 


Work to Begin Date; 9/17/09 Time: 12:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 803 Street: N 35TH ST 


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


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 


: F/\X 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: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 

ALT87 2 ATTNEBRl CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 

QLNNEIC 

Service Area Contact Phone Number Utility Type 

Day: 4067289343 

ALT872 WrNDSTREAM COMMUNICATION NA Alt: 4062071494 

Emerg: 8887289343 

Day: 80024136249 

ATTNEBRl ATT/T Alt: 

Emerg: 80024136249 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 


Day: 8773668344 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/15/2009 
• • • • 

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Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFlC,SEWER RON

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK NA

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/15/2009 
• • 

ENVIRONMENTAL & 

CONSTRUCTION 

TECHMOLOGIES, INC, SOLUTIONS 

Site Safety Hazard Anaiysis 

CL> 

Address: 1^-3 xc^- 3-S Ex. 

Cre>v: Bf. 

Date: ^'/c&o ^ 

Corrective 

Item Condition Hazards Action 

Overhead Lines '5i'=<,cy? - /^4<///^/ e /g>v^A>7y^ C^/-«e „P'^'='/^ 

Gas Line Jityr. e d T^^y y-^c/i/KWater Line 4-

Sewer Line JOcrt . igW /uJ-Tr-/ /oc/^- g 

Septic / Leech 

field ;^V^V^ 

Propane/Butane , * ^ 

Sidewalk .-f^zi u-t g ^p/y^iz-ifit^ 

Foundation ^ . . 

Retaining Walts _rL^ 

Fences Pc^ ^ 

Trees ^ h ^ 

Structures .^y> 

Driveway j^"^ ^ LMtZ. jP^Y^rt/^l-P 

Sprinkler System 

Other 

Crew Foreman Site Safetj Officer 

Qcr y S-^^^ ^ 

8080 Ward Parkway, Suite 405 3505 W. 24"' Street. Suite 30S :42 Medical Dnve, Suite 7250 

Kansas City. MO 641 K Omaha, Nebraska 53110 San .Antonio, TX 7822S 

Phone: (816) 363-3703 Phone: (402) 504-1004 Phone: 1210) 822-9588 

Fax: (816\ 363-3707 Fax: Mn?\ ^r,/i.M^n~ 
^ ' fi ' ^'^ #•' ' t'"*^****''—,