TRANSMITTAL of OMAHA LEAD SITE 

SOIL MIMEDIATION FILE FOLDER 

SAID#: lU^r ^ Date: g / 16^ 

Address: ^o^? l C -z 7 .^ h 

RfimediadonConttactor: f>fnAe>r& '^tc h Qr^C Year: ^O l n 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

B Video of property (DVD) 

3 Executive Sunomary 

J EPA-provided property sketch d Signed Access Agreementfor subject property 

D Signed Access Agreenient(s) for adjacent property 

d Restoration Agreement 

D Settlement documents Q.e., for damage or to replace plants, etc.) 

0 Confiimation data 

d Photogr^jhs 

As-bidlt sjcetch 

Satisfiactory restoration signed by Property Owner 

d Property close-out check list agned by EPA 

D Description of areas not meeting ROD cleamq> criteria 

Utilily clearances 

d Property infonnation fiom Douglas County Assessor's Office 

D 

Q 

D 

Signature DS " 

30217974 

HHI 

Superfund 
• 

« 

Find Record I 

Badcflil: 

Sample Araa: 14659 - 3022 S 33 ST 

Owner: 

D Owner Occupied 

Owner Name: 

JHEMSLEY DONALD L 

Owner Addressl: 

1 

Owner AddressZ: 

|3022S33ST 

aty: State: Zip Code: 

|OMAHA |NE [68105 

Owner Phone: Altemate Phone: 

|(402) 341-9515 1 

Remediation Query I Lead Remaining Query I

Resident: 

Resident Name: 

JHEMSLEY DONALD L 

Property Address: 

|3022S33ST 

Zip Code: 

|68105 

Resident Phone 

1 

 Property Damage Query 

Contract: 

Contractor: 

|PRUDEWT2009_S 

Contract Option 

lOPnON 1 

Assessment: 

Qualifying Group 

|400/CHILD 

Assessment Max XRF Value: 

1 648.8 
PROPERTY SUMMARY 

Date;.S./15/2010 | Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l | Month of: fl (^/ /^ 

Property Address: 3022 S 33 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: AREA NOT EXCAVATED PER P.O. REQUEST; Bl/LS (20'X10') = 107 

PPM @ SCRAPE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 155 PPM @ 6"; DZ = 290 PPM @ 13"; EA = 158 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 (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. 

i.y\0Jj7.'^ . \L . 
TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: f^^^^ Property Address: SD^-- ^ ^ f^ ^*~ 

Date/Time: Owner's Name: fArcl^U<€, \K^y^^K ^ 

Quads Excavated: 6 L P 2- Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

I. If necessary, were Ihe correct quadrant(s) excavated and restored? / 

2. If necessary, were the correct areas of drip zone e.xcavated and restored? / 

Grading Sod and Vegetation

I. Does the grading around tlie perimeter of the house in excavated areas generally slope away 

from the house? 

 Yes

7 

 No 

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

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

day time period) 

4. Are sodded areas generally fimi and evenly graded? 

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

time period) 

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

y 

7 

7 

7 

7 

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

Gates, Fences and Retaining Walls

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

 Yes

7 

 No 

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 dmnage to retaining walls avoided? (If applicable) 

y 

7 

7 

Foundation, Siding and Gutters

1. Was damage to tlie siding or trim avoided? 

 Yes

7 

 No 

2. Was damage to tlie foundation avoided? 7 

3. Was damage to windows avoided? 7 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

7 

7 

Sidewalks and Driveways (Concrete)

1. Was damage lo driveway surfaces avoided? 

 Yes

7 

 No 

2. Was damage to walkway surfaces avoided? 7 
3^17^ S 33 S\r 

Owners comments: 

Inspection notes: 

Removal and restoration activates complete including the 30-day sod wa^anty: 

EPA Representative Am )SLy Date: t/s//fa 
yifss^ssi gip 

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: l/^ti^ 

Property Address: 2«2_'2- S I^SrT- Owner: 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

11^ 

JcdU

f ^

 L 

k 9\J^ ^i 4^f^—gypi^ ,—,n\.Sff^S 

-fi^if, ^ { yn.^A tt7 ^et ^ 

Item: 

E:i,9fV­ cIlTU Jt ^s„^ L . £ ^ 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

L J I agree restoration is completed, except as noted above. 

L J I do not agree restoration is completed 

^^lef) Owner's Signature Date 
t* • • 

ENVIRONMENTAL & 

CONSTRUCTION 

TECHNGLGGEBS SERVICES 

PROPERTY CONTACT ATTEMPTS 

Property ID: /^6^ ^ 

Property Address: 102.2^ ^3 3 Q ^ 

Owner Name; ^/&vi. lAJLt t>^^JlJ 7. 

Owner Phone: 

Below please find a listing of unsuccessful attempts to reach the above 

property owner. 

Date Time Initials Result 

l^H/o1 2 A e ^ 

P^M' "Zyttfow yygwy^ M IrJ r fcnK fc»«r ^fnLj^U T i ^^(a^%^^'> . ^h/Tc^ 

A4^ ^ ^v/ f U »V^J)» t^/ly/^^ 

Signature Date 

Prudent Technologies, Inc., 

B^^f^em /«/4f/>y 

Acknowledgment signature Date 

EPA 

8080 Ward Parkway, Suite 405 2505 N. 24*^ street. Suits 308 4242 IWedical Drive, Suite 7250 

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

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 
TECHNOLOGIES, INC. 

Prudent Technologies, Inc. (Pmdent) is under caabact 'with the U. S. Environmental Protection Agency (EPA) to clean up leadcqpteminate^oilg at anumtei;^f properties located in Omaha, Nel)raska, including the property located at 

'^ 0 9"l~. ^ ZTQ ST T The EPA requests your permission to allow Prudent to perform a soil cleaniq) at this 

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

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

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

Omaha Lead Site cleanup. N4s. Siva S. Jampana-at (402) 733-1188. General questions about the Omaha Lead Site cleanup can be 

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

Property Access Granted By: /Vl ,(»A fif-C^ ^4 ^ <W<.Cl. ^ 

(Please Print Name) T^ 

Property Owner Signature: y[i,<iM, tvAk-y <i.-n 0°) 

(SigifctSre) T y ' (Date) 

PROPERTTINFORIMATION 

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

RESIDE!^ NAME: • _ Renter 

RESIDENT ADDRESS; 3^^a ^. ^^ si-' 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

Sr/y\er 

OWNER'S : ,^^ 3^/- 'is'/r TELEPHONE NUMBER • HOME: WORK: 

J 1 

AOE OF HOME?: W YEARS. HOW LONG HAVE YOU LIVED HERE? Jk YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? SC 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'sright 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 5600 S 10*^ Street 4242 Medical Drive, Suite 4250 

KansasCity, MO64114 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) 579-6577 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: 'do'^'^f . Cj^ ^ ' Date: 7-/T'Of 

Phone: 7^^ - 3>^>' ' 9^/ ^ BVID: /V^r ? 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

f^ - Boe,f^c€^ Tree ^roJe u/)^e/r>«« .M> 

Pre-Existing Condition of Structures 

Doesyour Basement have a history of leaking? Yes No y

Item NO Description & Location 

On Map I lA p7^|aAc yJcti ^ 

r 

Property Owner Prudent Employee 

Signature: Signature: 

8080 Ward Parkway, Suite 405 5600 S 10*^ street 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) S79-6577 
KHKOrOGfES, INC. 

AS - BUILT DRAWING 

0!.SB: 14659 

Date K\cavattd: 08/17/2tW9 

t:SF,P,\Siencd-OiTnatc: OMAHA LEAD SUPERFUND SITE 

Name: ,rit(i...'-<. /^tj/,*../­' Omaha Lead Site Date: /J A.'<-••> North Arrow 

Address: To^-? s 33^' " Sita Sketch Time: 

Phone:' ^cs* jv/ ­ •jj-^'i" 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENT TECHNOLOGIES, INC. 
Name: ,tii:i-.u/ ^'.f.tij>..j -/ 

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Site Sketch 

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3022 S 33 ST 

March 2007 DOUGLAS COUNTY ASSESSO 
V 

Print Preview Page 1 of2 

Douglas County-Omaha, NE 

•w 

Parcel ID 1942520000 Addition PARKVALE 

Owner HEMSLEY n­ . L 

Name DONALD L ^'° ^ !* 

Property 

Address 3022 S 33 ST Lot 6 

City OMAHA Legal 1 40X130 

Zip 168105 Legal 2 

°^"®'' Address 'Leaal3 '-^^' ^ 

Owner 

Address 3022 S 33 ST Legal 4 

2 

°^"®'' City OMAHA I Acres j 0.12 1 

Owner 

"• 1 

. IP < iKQQsufer u/ahctfo http://webapps.dotcomm.org:8080/TreasTax/faces/pages/taxinfo.jsp? 

State S ,parc=1942520000 

Owner 

Zip 68105

Assessor

 Website

Link

 http://douglasne.mapping­

 online.com/DouglasCoNe/static/accountinfo.jsp? 

 accountno=R1942520000 

^-^ - 33-15-13 
Page 1 of 1 

"> 

YOUR TICKET NUMBER IS 2336440. 

Original Call Date:


Work to Begin Date:


State: NE 


Address: 3022 


 8/07/09 Time: 3:29 pm Op: SIVA18967 

 8/11/09 Time: 4:00 pm 

County: DOUGLAS Place: OMAHA 

Street: S 33RD ST 

Twp: 15N Rng: 13E 

Twp: Rng: 

Legal Given: C 

Sect-Qtr: 33-NW 

Sect-Qtr: 

Type of Work: SOIL LEAD REMEDIATION PROJECT 

Location of Work: LOCATE ENTIRE PROPERTY 

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

: 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 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact

CXCATV COX COMMUNICAHONS, INC HEIDI

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON 

OPPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

QLNNEIF QWEST LOCAL NETWORK NA 

 Phone Number 

Day: 4029340469 


 Alt: 4029340469 


Emerg: 4029329757 


Day: 4025047823 

 Alt: 

Emeig: 4025047970 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

Utility Type 

FA»: miR136S-3707 r-none; (iiio) BZVJ-saaU" Fax: (402) 604-1005 Fax: (2101579.€577 1 
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