TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 27452 DATE: 12/15/2010 

ADDRESS: 4224 BURDETTE ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC YEAR: 2010 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

d PRE AND POST VIDEO OF PORPERTY (DVD) 

d EXECUTIVE SUMMARY 

a EPA-PROVIDED PROPERTY SKETCH 

d SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

d RESTORATION AGREEMENT 

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

Q CONFIRMATION DATA 

d PHOTOGRAPHS 

d AS-BUILT SKETCH 

d SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

H PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

a UTILITY CLEARANCES 

d PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

SIGNATURE " ~~ DATE 

30237470 

miiiii 

Superfund 
Find Record 

Backfill: 

Sample Area: 27452

Owner: 

n Owner Occupied 

Owner Name: 

|MALY JAMES R 

Owner Addressi: 

1 

Owner Address2: 

J14505N156ST 

City: 

JBENNINGTON 

Owner Phone 

j(402) 238-2065 

Contract: 

Remediation Query j Lead Remaining Query i Property Oamage Query 

- 4224 BURDETTE ST 

State: Zip Code: 

JNE J68007-

Aiternate Phone: 

1(402) 708-3309 

Contractor: JPRUDENT2010_S 

Contract Option |0PTI0N 1 

User Provided Owner Information 

Owner Name: 

Owner Address: 

City: State: Zip Code: 

Owner Phone: Alternate Phone: 

Assessment: 

Qualifying Group 1400 

Assessment Max XRF Value f 504.51 

Resident: 

Resident Name: 

Property Address: 

4224 BURDETTE ST 

Zip Code: 

J68111-

Resident Phone 
PROPERTY SUMMARY 

Date: 12/15/2010 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: December 

Property Address: 4224 BURDETTE 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: 

PZ = 180 PPM @ 4"; 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 (ifany 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. 
4

TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: 2.7 ^52 - Property Address:'-^^^'^ ^i>^^ ^ "^ ' 

Date/Time: Owner's Name: ''13a<^^^ KftUe ^ 

Quads Excavated: ^ 2 ^ Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

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

2. If necessary, were the correct areas ofdrip zone excavated and restored? / 

Grading Sod and Vegetation Yes No 

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

day time period) / 

Are sodded areas generally firm and evenly graded? / 

5. Arc tlie joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day / time period) 

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

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

Gates, Fences and Retaining Walls 

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

Yes 

X 

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 damage to retaining walls avoided? (If applicable) 

y 

y 

y 

Foundation, Siding and Gutters 

1. Was damage to the siding or trim avoided? 

Ye Yes

^ No 

2 Was damage to tlie foundation avoided? / 

Was damage to windows avoided? 

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

5 Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) 

1 Was damage lo driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes

y^ 

y 

No 
Owners comments: 

Inspection notes: 

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

EPA Representative P*^")^ Date: uMoj 'o 
[•ClINOliXllES. INC. AS - BUILT DRAWING 

OLS n 27452 

Dale Excavated: 09/30/2010 OMAHA LEAD SUPERFUND SITE 

I SEPA Signed-Off Date: 

^rVJ?r'. Omaha Exierior Paint North Arrow Lead Site Owner Name: ijame ^ f ^ A/la/ y Site • Good Sketch Address: 'iS£j ^ BurHfif^ P if f Q Poor Phone: H W Q Not paint r 

Sample Number Lead

Concentration

 Sample

 Collected 

. „ 

Firm:

Samples Collected 

r ft '>''•' ­ -

RYASCPXA- STH-S e F1 / 7 -^ ppm [ I D Date: . ^ • -i ­ 6 «;• 

RYBSCPXA-2 rVfl-S

RXCSCP)(A-SrHS£

RYDSCPXA-^rV^ ^

 F2 

 Bl 

 B2 

Z1 ^

2)5' ^

^•^ Z

 ppm

 ppm

 ppm

 EJ

 El

 [3'

 • 

n 

D 

Time: .±£c^r.. 

Samples Analyzed 

RDZSCPXA -G ^ ppm D D XRF Unit: JOo y Book: /7 7 

nczccpxA -Gir ppm n D Date: I ? ­ 2o-r>( o 

RPZSCPXA-2rv4r2 PZ ^O ^ ppm 0 D Time:

Staff:

 i4m 

 fTl-^uy 

Number of Samples = 

Legend: Fl = Front Left, F2 = Front Rigfit, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

AU quadrants are as viewjPd trorri the street, faang properTy ^.. . 

• • • * .• ' r>"' * '- ^ 

ENTERED 

ittC g b m' 

Q...345 :2.^.2. 

f • 

r. .5054/7P/^ . = 180PPM a 4" 

;i.j.75.....|. i ; 

1 :Z7^: 

L^iJi. 

yd, .itii y VK 

NO EASKMEM 

CONTRA a PRUDENT TECHNOLOGIES, INC. #: EP-S7-10-05 
«Em 

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: M ^ gjl j torfiPttj 

Owner: H\^£\ moi} uik 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

yQ^ agree restoration Is completed. 

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

uhl 10 

Owncr^ Signature Date 
• >1 

Prudetit Technologies, Inc. (Prudent) is under contract with the U. S, Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a numbo^f properties located in Omaha, Nebraska, including the property located at 

H2-^ M OVJL.'TCACAVI C •nv The EPA requests your permission to allow Prudent to perform a soil cleanup at this 

property to remove lead-contamirtated soil. By sigmng this form, the 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. 

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

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

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

Property Access Granted By 

Propert ^•J-1^QT,fO y Owner Signature: 

(Signature) (Date) 

PROPERTY INFORMATION 

(TcKbli e completed by resident and/or property owner — please print) 

RESIDENT NAME: 6^^ ^ /* / Owner Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: vM^os KJ is^"^ 1^ (^nr^;^..^^ fo g 6^ ^ <^ 7 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: J L WORK: 

AGE OF HOME?: YEARS. HOW LONG HAVE YOU LIVED HERE? 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'snght of access to the property is provided for in Section 104(e)of 

CERCLA, 42 U.S. C 9605(e), which provides entry for '"determinmg 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 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)579-6577 
ENV£RO^ME^fTAL& 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: L^2X ^ h^f<i^ ^ S<^ '^^*'' 

Phone: BVID: 

J^ery^P^..^^ At^n ^ PZ- . 

r^^ ^od • 

Property Owne^ Prudent Employe 

Signature: Signature: 

8080 Ward Parkway, Suite 405 5600 S 10 St n 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 

Co» . lO^ttt R7«J!«T7 
Owner Name: tjsmfi.*i R M^f u 

Address; ygg ^ Burcfe/fe iSf. 

Phone: ^• 

Sample Number 

RYASCPXA- eT*fS2 f"" 

RYBSCPXA-^rV^2 F2 

RYCSCPXA-f fV^e B1 


RYDSCPXA-2r4<5*^ B2 


RDZSCPXA 92­

nozscpxA -Gt 

RPZSCPXA-grvj^ PZ 

W: 

Lead 

Omaha Lead Site 

Site Sketch 

Sample 

Concentration Collected 

Xifi. ppm 

Z2± ppm 

ppm 

JlZiZ. 

ppm 

ppm D 

ppm 

.SJ2 ^ ppm 

Number of Samples = 

LAB 

D 

D 

D 

D 

Exterior Paint 

North Arrow 

• Good 

• Poor 

\ ^ Not paint \ 

Samples Collected 

Fim^: FPA F(?>r.^ 

Date: i^-M-^6? 

Time: 3- 2jOf>.rr>-

Samples Analyzed 

D XRF Unit: lOcTT Book: /7 7 

D Date /2 ' 2:^ -OCi' 

D Time Jim. Staff: j22sjaZ. 

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

AH quadrants are at viewed frontthe street, facing proper^ /ly c 

ENTERED 

DEC 0 6 2606 

345 

•BIV.\ 

t ­

i\ 

.9. as 

PZ 

SP m~iB 

.Fl t 

-.2.T1 

\.H. 

i 

iilALK 

BUrMH^^' Rev 4' 

046141.0123 
N 422

4 BURDETTE ST: 50 X 120 

A Printed

: Dec 06.2010 

www.dcsis.orc/doui.s 
Page 1 of 1 

"> 

Create Another Ticket Back to Irth Internet Send Emails 

YOUR TICKET NUMBER IS 2600849. 

Original Call Date: 9/24/10 Time: 4:46 pm Op: SIVA18967 


Work to Begin Date: 9/28/10 Time: 5:15 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 4224 Street: BURDETTE ST 


Twp: 15N Rng: 13E Sect-Qtr: 08-SE-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 


: 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 Nunlber utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITV OF OMAHA-TRAFFIC,SEWER RICHH-RAFFIC

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 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/24/2010 
mm ENVIRONMENTAL 

ENGINEERING AND 

TECHNOUk^Bs CONSTRUCTION , mc . 

SOLUTIONS 

SITE SAFT^TY HAZARD ANALYSIS 

, ^^ ^ f)^J.i-^ , q-3Jitl Address Excavation Date 

Crew :Jc4k Backfill Date: 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Stmctures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition HajArds Corrective Action 

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AO 

n<^ 

a € 

fif) 

iA.0 

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Site Safety Office 

Date: 

MSO Wanf^Bartany, Sute4<B seoosiost 4242 Medical Drive, Suite 7260 

Kansas C«ly;MO«4114 Omalia, NstMasIca 66107 San Antonio, TX 78229 

Plione: ^16) 363^3703 Phone: (402)733-1188 Phone: (21t»822:«588 

Fax:(816)363.3707 F^x: (402)733^1883 Fax: (210)579-6577 
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