TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAE)#: ^-7/ 7 Date: <^jldt>^ 

Address: t^7. C r^^c j A ^ ' 

Remediation Contractor: /VVAJX^/- ^^J ^ - T^r, Year: ^1.^0*=) 

SOIL REMEDIATION 

PROPERTY ¥ILE FOLDER DOCUMENTS 

^ Video of property (DVD) _^_ _ 

y Executive Summary 

0 EPA-provided property sketch 

II Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

Zl Restoration Agreement 

D Settlement documents (i.e., for damage arte replace plants, etc.) 

y Confinnation data 

0^ Photograph ._ s

y As-built sketch 

la Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

[3 Utility clearances 

Q^ Property information from Douglas County Assessor's Office 

D 

D^ 

D 

Sigjisiure/ Ignature/" 'Date 

30054247 

nmHniiii 

Superfund 
PROPERTY SUMMARY 

Date: 9/15/2009 | Omalia Lead Site Remedial Action Contract ft EP-R7-07-06 TO#l | Month of: August 

Property Address; 1425 CADY AV 

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: 

Fl = 291 PPM @ S"; Bl = 65 PPM @ 13"; DZ = 247 PPM @ 13" 

ATTACHMENTS 

1) Property sketch provided by EPA pxirsuant 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) Docimientation - Completed Close-out Checklist 

6) As-Built sketch ­

i) Shall include finallead levels v) Legend 

ii) Contamination left behind areas vi) Contractor identification 

iii) Property address vii) Date 

iv) BVID nimiber 

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. 

TECHNOLOGIES, INC. 
Rnd Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 28717 ­ 1425 CADY AV 

Owner: Resident: Contract: 

n Owner Ornipied Resident Name: Contractor: 

Owner Name: [TENANT jPRUDENT2009_S 

|GOSSErr MELVIA L Property Address: Contract Opbon 

Owner Addressl: 11425 CADY AV OPnON 1 

Zip Code: 

Owner Address2: |68110 Assessment: 

|5618 N 50 ST Resident Phone 

City: State: Zip Code: I '. Qualifying Group 

jOMAHA JNE |68104 |400/CHILD 

Owner Phone: Altemate Phone: Assessment Max XRF Value: 

j(402) 451-1023 j(402) 301-4210 r 787.97 
T1CHN0L0GIBS.INC 

EPA Property Close Out 

Property #: 3^ t I "^ Property Address: ItfJl^ G ^ ^ 

Date/Time: ^-'2''C>'V Owner's Name: JA.*Iv/voc ^ossctt ' 

Quads Excavated: &', F'/Z>2- Contractor Group Pnident Technologies 

Excavation General Yes No 

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

2. If necessary, were the correct area.s of drip zone excavated and restored? y 

Grading Sod and Vegetation 

Yes No 

1. Does the grading around the perimeter ofthe house in excavated areas generally slope away / from the house? 

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

y 

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 y day time period) 

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

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

time period) y

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

y 

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) y 

2. Were all gates or fences taken down during restoration activities reinstalled? (If applicable) 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 the siding or trim avoided? 

y 

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? y 

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

y 

5. Was damage to downspouts or downspout extensions avoided? 

y 

Sidewalks and Driveways (Concrete) 

Yes No 

I. Was damage to driveway surfaces avoided? 

y 

2. Was damage to walkway surfaces avoided? 

y 
Owners comments: 

Inspection notes: 

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

EPA Representative £L.j ^ Date: S'/^//o9 
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: j g g c ; ^g.A ^ ^^.^ _ 

Owner: W\du A ^ ^ CUc^ , ^Sn J 

Phone: 

Restoration Items in Question: 

Hem: 

Item: 

Hem: 

Item: 

Hem: 

Hem: 

Required corrections to complete the property: 

li l I agree restoration is completed. 

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

^-1^-C>c ^ 

Owner's Signature Date 

I
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean xtp leadcontaminated soils at a number of properties located in Omaha, Nebraska, including the property located at 

. 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, ttie property owner grants permissian to Prudent to pexform 

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

If you have any questicms about the soil cleanup plarmed for your property, please contact Prudent's Admimstrative Clerk for the 

Omaha Lead Site cleanup. Ms. Si\'a 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: (T\^\o\CU (oo^SeXV 

(Please Print Name) 

Property Owner Signature: rV\j|\> ^ jC j J\r<yh^ ^ ilS' ^ ^ 

^ ^ (Signaturer (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

&V r^rY^?>\^. VS^ ^?no ^ 

OWNER'S TELEPHONE NUMBER-HOME: I ) WORK: 

VO AOE OF HOME?: 1 V ^ ' YEARS. HOW LONO HAVE YOU 4HVEB-HERE? YEARS. 

'iicU HAS THE EXTERIOR BEEN PAINTED OR COVERED WrfH SIDING SINCE 19787 TES" "NO 1 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: " 3 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: (LE. 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 ofaccess 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 

KansasCity, MO64114 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 
C'ONSTRUt'TJO.N 

TECHNOLOGIES, INC. SFRVlCES 

Property Status Form 

Address: |M O-S ^^^"^^ ^v^<-

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

Pre-Existing Condition of Stnicturgs 

Does your Basement have a history of leaking? 

'^M^i-c^^Af ' i t'Oe^ri-Q^^U 

Item NO Description & Location 

On Map 

e_jLoeJL( ^ 

Property Owner Prudent Employ 

Signature: r<\5L\xoQ 0^v,4i ^ Signature: 

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

KansasCity, 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 
rciTsoi o(iiF,s. T\c AS - BUILT DRAWING 

()I.Ss:28717 

Date K\ia\attcl: (17/27/2009 OMAHA LEAD SUPERFUND SITE r>r.P.\ Stencd-OIT niitc: 

^ j * s.ii n 

Omaha North Arro* Lead Site Ov>fiMr Name: ^lEarlCer ^ S'./V^tA-«:i Site SItetch Address: /ffS S Ljxd- ^ /^SJ 

Phone: H. 'W; 

i 

Sample Number Lead 

Concentration Sample 

Collected LAB Samples Collected 

RYASCPXA­ .2^7/ 7 F1 —JL^JLPPT I D Date: S"-<?^ <?'/ 

R-mSCPXA­ .Ptff ?

RYCSCPXA-.i J" "^^ 7

RYDSCPXA-.a ?7/ 7

 F2 

 Bl 

 32 

-'^g) \ ppm 

^~ I ppm 

[_j_L^PPm D 

Time: rAl ) fhl 

Samples Analyzed 

RDZSCPXA-•a^'^'7 D2 \ \ o \ L g ppm D XRF UnIL 3 1 f Book; ^ V 

Lab RYCSCPUV-28717 ^ ppm D D Date: S-S/a-O'i 

ftesuB 466 ppm ­ ppm D D Time: .M L 

Number of Samples = j$ Staff: CAP 

=-r=T ..t !^ ^ 

V^; I 

t 

I !^-- ; 

4 

6 ' .(. 

^ 3 H* 

Bl - 65 PPM 

•). • 

WAffc- U&f i< .<- ' 1 'jfTc^e^f ; 

,N(>'i­ «c ,1­ 'ir-i«=—# ^ /)j>£ Cfil>^ A\j' 

If. • V &Z­

- ^ l) / = 247 PPAl 'u 13" 

fr-fr 

Fl = 291 PPM a 8" i-f d-V'T^* 

2QI 

• i*^—^N ; 

Omaha Lead Site CfH>f rt V 46130 y . ri fKy 

\ 0 K.VSliMKM' 

CONTRACT #: EP - R7-07^6 T0#1 PRUDENTTECHNOLOGIES, INC. 
J ? * ^,nn 

Onnaha Lead Site North Arrow Owner Name:iT&i^C«r2 3/Q^t^ ^ Site Sketch Address: i^S S ^^d' ^ _ &\ / . 

Phone; H; 'W: 

I 

Sample Number Lead Sample Samples Collected LAB Concentration CoHected Firm: PC CffS ^ 

RYASCPXA- AS:!/' J F1 1% % ppm D Date: :^-0k^'O<j 

RYBSCPXA- Cielf ? F2 Time; "f'M) / M 

RYCSCPXA-«ii^'?'7 Bl 3*^ 1 ppm 

Samples Analyzed RYDSCPXA-^^'^'^ B2 3 1 UPP'T^ D 

RDZSCPXA-"^r 7/ 7 DZ \ \o I Lg ppm a XRF Unit: a / / Bock: S ^ 

Lab RyCSCPLA-28717 Z Ppm n n Date: 

Result 465 ppm Ppm D D Time: AM, Staff: CAP Number of Samples = j$r [ 

T=t i I 

VseU/xa L ^OSSCJMT 

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Omaha Lead Site Cftb ( 7^V 4frl30 

''•*•.(• * r-^'r-tfe! 
l425CA0VAy 

UGUST 2004 - DOUGLAS COyNTY ASSESSOR 
Print Preview Page 1 of2 

Douglas County-Omaha, NE 

^~TPir~E 

Parcel ID

Owner 

Name 

Property

Address

City 

Zip 

Owner 

Address 

Owner 

Address 

Owner 

City 

Owner 

State 

Owner 

Zif> 

Sec-TwnRng 

 2410860000

GOSSETT 

MELVIA L 

 1425 CADY

 AV

OMAHA 

68110 

5618 N50 

ST 

OMAHA 

NE 

68104 

10-15-13 

 Addition 

Block 

, . 

 ^° ^ 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor

Website

Link

WASHINGTON SQUARE 

0 

26 

W30FT 

30X127 

0.09 

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

parc=2410860000 

 http://douglasne.mapping­

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

 accountno=R2410860000 

2 
Page I of2 

"> 

Crea^ Another Ticket Back to Irth intemet Send Email 

YOUR TICKET NUMBER IS 2319650. 

Original Call Date: 7/16/09 Time: 2:45 pm Op: SIVA18967 

Work to Begin Date: 7/20/09 Time: 3:15 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 1425 Street: CADY AVE 

Twp: 15N Rng: 13E Sect-Qtr: 10-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 


: 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: Y 


Involves Tunneling or Horizontal Boring ; N Explosives: N 


CXCATV MAGELLAN MCINEB MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Nuniber 

UtUity 

Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MAGELLAN MAGELLAN MIDSTREAM 

PARTNERS LP DEBORAH 

Day: 918574709S 

Alt: 

Emerg: 9185747098 

MCINEB MCI NOCALLPER 

MEMO 

Day: 8002893427 

Alt: 

Emerg: 8002893427 

MUDOl METROPOLITAN UTDLITIES 

DISTIUCT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

http://vsrvvw.dhon.org/irthinternetT)HONNoticeCreation/MessageText.asp?ret==<RESULTS... 7/16/2009 
Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RON 

<M^E©GWIS OMAHA PUBLIC POWHIDISTMCT NA 

QLNNEIC QWEST LOCAL NETWORK NA 

D^ : 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

Ak: 4062071494 

Emerg: 8887289343 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/16/2009 
OS 

ENVIRONMENTXtfJSt- t • "St 

" . v..,». CONSTRUCTfqjN;.^^. .,; 

TECHNOLOGIES, INC. SOLUTIONS 

Site Safety Hazard Analysis 

Address: /^JL S C^ y ^^ ^ 

Crew: Bf.7/30 

Date: "7'r^-c ? 

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 

Creeww Forem Foremaan 

Condition 

CfCX ^ 

I 

(itVltf ^ 

Ay^ 

ruy^ 

i^*t i./ ^ 

/^B»«c 

y ^ ^ 

y^. 

^ t ^ 

yy-^ 

P0m^ 

y t ^ 

Corrective 

Hazards Action 

^CWU» jU^*.^. ^ ccr«s J^y^ja 

Ita^yJ. /ffCj0* ^ 

1 

Ai^ft</ ^<bS^/«9 

Site Safety Officer 

8080 Ward Parkway, Suite 405 2505 H. 24- Street, Suite 308 4242 Medical Drive. Suite 7250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

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

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



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