TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 9*^ L2.I Date: 1)2.1/200^ 

Address: ZS/ 1 / / 2-S A ' 

Remediation Contractor: K^^^^^ 'Tt'Ui^/Lyl ^ Svi,. Year: 2a>ei2 

SOIL REMEDIATION 

PROPERTi^ FILE FOLDER DOCUMENTS 

\yf Video ofproperty (DVD) 

B^ Executive Summary 

ffl^ EPA-provided property sketch 

0''^ Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

Ef' Restoration Agreement 

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

y Confirmation data 

y Photographs 

0^ As-built sketch 

0^ Satisfectory restoration signed by Property Owner 

a Property close-out check list signed by EPA 

D Description of areas not meetii^ ROD cleanup criteria 

y Utility clearances 

0^ Property infonnationfirom Douglas County Assessor's Office 

D 

D 

D 

SigaSiSe^ Date 

40311266 

iinuiiiuii 

Superfund 
Find Record I 

Backfill: 

Sample Area: 29627 - 2813 N 28 AV 

Owner: 

n Owner Occupied 

Owner Name: 

|MCCREARY JOYCE 

— -

Owner Addressl: 

-

Owner Address2: 

|6729N106ST 

City: State: Zip Code: 

|OMAHA |NE |68122 

Owner Phone: Alternate Phone: 

1(402)491^0371 ^l -

Qean Up Query Lead Remaining Query I

Resident: 

Resident Name: 

r 

Property Address: 

|2813 N 28 AV 

Zip Code: 

|68111 

Resident Phone 

I 

 Property Damage Query 

Contract: 

Contractor: 

|PRUDEm7008_S 

Group: 

Assessment: 

Qualifying Group 

|i2qo "" " 

Assessment XRF Date: 

f — —. Assessment Max XRF Value: 

I 1619' 
TECHN0L0GI15,INC SERIV 

EPA Property Close Out 

Property #: 2^1,2-1 Property Address: 2S^I^ ^^2-8 A / 

Date/Time: Owner's Name: 

Quads Excavated: /^) Contractor Group Prudent Technologies 

Excavation General i(UiaJ( 'o"l" 

Yes No 

1. Ifnecessary, were the correct quadrant(s) excavated and restored? l / 

2. If necessary, were the correct areas of drip zone excavated and restored? iiV 

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? 

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 generallyfirm and evenly graded? ^ 

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

time period) IX ' 

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

7. Was damage to landscapmg or plant materials avoided? y " 

Gates, Fences and Retaining Walls Yes No 

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

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) 

Foundation, Siding and Gutters 

Yes No 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? r ^ \[fiC/i^ 

3. Was damage to windows avoided? k 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfeces 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^;^^I<iC^gl.<;j:^^g^^UL;^ Date: /^/y/d ? 
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: 2 S.!" ^ KJ ^8H ^ & A^^^ 

Owner: 

Phone: 

Restoration Items In Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

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

JZI I do not agree restoration is completed /Z^^txL-*— -^LilAj . ^ J 

'<L.&z^ 

WT^ - /^i /^ y dl 4., / ^ - 3-^. P 

)wner's Signature j Date 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a nuinbec of pronerties located in Omaha, Nebraska, including the property located at 

,P^\ 3 ^ *2-S'* ^ Sr T The EPA requests your permission to allow Pnident to perfoim a soil cleanup at this 

property to remove lead-contaminated soil. By signing this ftwm, the property owner grants pennission to Prudent to perform 

activities related to the cleanup including soil sampling, 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's Administrative Clerkfor the 

Omaha Lead Site cleanup. Ms. Madhurima Pum -at (402) 733-1188, 733-1455. 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 O^orth 

Omaha office). 

Property Access Granted 

I * / ' (Please Print Name) y 

Property Owner Signature: 

/ / / (Signature) X (Date) 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner ~ please print) 

RESIDENT NAIME: VcXf^. U \r^\ ^ Owner Renter 

RESIDENT ADDRESS: 

•Q •g» ^ A w C3>u>-JL.^ Ug Ca \\ o 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: J \_ WORK: 

i>\t^i Mq i -(<^9n i 

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

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

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: NUMBER OF OCCUPANTS 7 YEARS OLO ANO 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 
I- OMAHA LEADiSJJPEREUND SITK tt 

OLSH: 29627 

Date Excavated: 9/25/2008 

Date USEPA SigDed-Off: 

2962'/ 

Omaha Lead Site Exterior Paint North Arrmv 

Site Sk«tch • Good 

D Poor 

Swipllng Addrass: 2813N2BAV Q'Not paint 

Sampl Lead Sample Samples Collected e Number LAB Concentration Collected Firm:?EX/>^ OftT k 

RYASCPXA-29627 F1 (78 ppm D Date: Ul-inioA 

RYBSCPXA-29627 F2 I S3 ppm D Time: 2'MSn ^ 

RYCSCPXA-29827 B1 Ifel*^ ppm D Samples Analyzed RYDSCPXA-29627 B2 20^ ppm 

nDgoopjw-aoea?—ee- ppm o n XRF Unit: (iSH O Book: 2o a 

noZ0OrKA-iM027 62- ppm a D Date:_ "i-f4>-oa fyzsopxA aoaa?—PZ- .ppm D Time: D .M. Staff: Number of Samples = | L{ | | Q | nsu/ 

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Orip Zone, GZ = Garden, PZ = Play 

All quadranls are as vletMdftomtfie street, fadng property 

B1 = 133PPM@6" y ^ 

.i.y^;. 2Sf^ 

t 

;^i B i i 

m 

.,.). 

:S 4 

•3­ m-.i\- I53..LC3 

F\ Ml 

4tel Wi»lK 

n-z^.^v....:. iUv2a(«.N Cmed'Zti-l-cfc-OS 044701 0U.1 

NO EASEMENT 

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

Property Status Form 

Address: jis\ 3 K) 2^%VW ^i^ ^^^^= 

Phone: BVID: 

Plants & Permanent Landscaping 

Item# 

QnMap Description and Location 

Pre-Existing Condition of Structures 

DoesyourBasementhaveahistory of leaking? Yes — No 

Iteni# Description & Location 

QnMap 

vnerr \ 

Signature Signature: 

roperty Owne Prudent Employee 

Yy^^-^^^L^ 

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 
ENVIRONMENTAL & 

CONSTRLCTION 

TECHNOLOGIES, INC. SERVICES 

Ms. Joyce Mccreary 09/10/2008 

2813 N 28* Av 

QmahaNE 68110 

Regarding the Property at 2813 N 28**^ Av, we are requesting your signature on the 

Enclosed access agreement for remediation action for lead contamination in the soil. This 

would allow Prudent Technologies to remove the contaminated soil then replace it with 

clean tested soil and new sod. The process will be completed at no charge to the property 

owner. The sod will be watered for thirty days then responsibility falls to the owner. All 

quadrants of this property tested high for lead levels. 

Sincere: 

Ram 

402 

ENCLOSURE 

1. Access Agreement 

2. Property Status Form 

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 
19621 

Omaha Lead Site 

Site Sketch 

Sampling Address: 2813N28AV 

Sample Number 

RYASCPXA-29627

RYBSCPXA-29627

RYCSCPXA-29627

RYDSCPXA-29627

RDZOOPXA 20627

RQZOCPXA-20627

RPZOOPXA 20627

Lead Sample LAB Concentration Collected 

 F1 D 

1 7 9 Dom F2 D 

 B1 D ppm 82 n 

 BZ- D D 

 GZ- D D 

 PZ- n D 

Number of Samples = | l \ j { Q ] 

Exterior Paint NorthArrow 

• Good 

• Poor 

Q'Not paint 

Samples Collected 

Date: lfl2RlQri 

Time: 2.^ MS PM 

Samples Analyzed 

XRF Unit: (nS^O Book: Z0 & 

Date: _ 

Time: JEdL 

Staff: n sw 

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

All quadrants are as viewed from the street,fedng pioperty 

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N.-28.S/. |.Rtv2008.N Crewed: 26-Fel)-08 044701.0123 
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Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner 

City 

Owner 

State 

Owner 

Zip 

0755070000 

IVICCREARY 

JOYCE 

2813 N28 

AV 

OMAHA 

68111 

6729 N106 

ST 

OIVIAHA 

NE 

68122 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

09-15-13 

CATALPA 2ND ADD 

0 

4 

46X128 

http://webapps.dotcx>mm.org:8080/TreasTax/faces/pages/taxinfo.jsp? 

parc=0755070000 

http.7/douglasne.mapplngonline.com/DouglasCoNe/static/accountinfo.jsp? 

accountno=R0755070000 

Disclaimer Map and parcel data are believed to be accurate, but accuracy Is not Map Scale guaranteed. This is not a legal document and should not be substituted for a title search, 1 inch = 74 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas Coimty-... 9/9/2008