TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAE)#: 7i^7^q Date: ) I5~ 

Address: \^\ ^ Q,-l 1 ^ f 

Remediadon Contractor. ?f\)JfJJ^^ XllU [it^ Year: ^CTlo 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

12 Video of property (DVD) 

E Executive Summary 

h EPA-provided property sketch 

E Signed Access Agreementfor subject property 

D Signed Access Agreement(s) for adjacent property 

III Restoration Agreement 

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

dl Confiimation data 

01 Photographs 

lb As-built sketch 

D Sadsfiwtory restoration signed by Property Owner 

4 Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

E Utility clearances 

Ul Property information from Douglas County Assessor's Office 

D 

D 

D 

Signature Date 

30218600 

llU i 

Superfund 
Hnd Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 20299 - 1317 S 27 ST 

Owner: Resident: Contract: 

n Owner Occupied Resident Name: Contractor: t Owner Name: [ANDERSON CHARLAS/BERRY |PRUDEN72009_S 

[l^IMBACH RONNALD L Property Address: Contract Option 

Owner Addressl: |1317 S 27 s r JBASE 

Zip Code: 

Owner Address2: [68105 Assessment: 

[3818 S 34 s r Resident Phone 

aty: State: Zip Code: 1 Qualifying Group 

jOMAHA JNE {68107 J400/CHILD 

Owner Phone: Alternate Phone: Assessment Max XRF Value* 

|(402) 734-3061 |(402) 639-4724 1 741.52 

t 
PROPERTY SUMMARY 

Date: /15/2010 | Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l | Month of Q g C 

Property Address; 1317 S 27 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 = 246 PPM @ 6"; B2 = 258 PPM @ 6"; DZ = 392 PPM @ 13"; EA = 135 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 Checkhst 

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 of areas not meeting Interim ROD cleanup criteria. 
TECHNOUOGIBS, INC. 

Property #: Z (^ Z*^ ^ 

Date/Time: 

Quads Excavated: 02 - 8 \ 6>2^ 

EPA Property Close Out 

Property Address: \'^< 7 9-2 7 *>i"' 

Owner's Name: ^a>r^a\A L ^'-^^QCVVS. 

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 of drip zone excavated and restored? y 

Grading Sod and Vegetation Yes No 

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

from the house? y

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? y 

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

time period) y

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

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? (Ifapplicable) y 

4. Was damage to retaining walls avoided? (Ifapplicable) y 

Foundation, Siding and Gutters Yes No 

1. Was damage to the siding or trun avoided? J 

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? y 

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

5. Was damage to downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? / 

2. Was damage to walkway surfaces avoided? y 
3i:> ^ S^ ^ V 

Owners comments: 

Inspection notes: 

v^ y ^ d/>^ 

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

EPA Representative 9'-^ ^ ^ ^Date: IIPIIQ 
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 tliat no items arc in question, now, or at any time in the fiiture, excluding any 

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

Property ID: ^ ^ ^'f ^ 

Property Address^ J^/ 7

Owner: 

 ^ 7 jZ"? "^^ ^ 

Phone: yS^ r ^^^ ^ / ^*^^ ' ^^O^ ^ 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

u/\ a agree restoration is completed. 

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

(TU /Ji^/r-^r 

Owner's Signature Date 
TECHHOLOGmS,WC. 

lfTudt!«Lle<amoVogjea.\i)c. (PnidcoQ is vjwiiet cerBtoAva%%«\J,S.fe«i(t«nmeinte\I^tecifitai Agency (EPA) to clean up leadcortMfjo^ 3!?i\s ^ anumbefcttft^operties located in Omaha, Nebraska, including the property located at 

/ ^ / f ^ . ^ / ^ y • The EPA requests your permission to allow Prudent to perfonn a soil cleanup at this 

]fcopert/to ranove lead-cft&timinated soil. By sigmng thisform, the property owner grants permission to Prudent to perform 

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

tf you have any questions about the soil cleanup planned for your property, please contact Prudent's Admim.sirauvy Ck-rk for the 

Omaha Lead Site cleanup. Is/Is Siva S Jampana-at (402) liiiiiSS. Geiieral questions about the Omaha Lead Site cleanup can be 

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

Property Access Granted By: K ^ N L ^ S ^ f /^ l Q fhC ^ T T 

^ please Print Name) 

Property Owner Signature: / ( P^v >>^--w^ -~ 

(Signature) (Date) 

PROPERTY INFORMATION 

(To becompleted bymident and/or property owner - please print) 

Owne Renter r 

RESIDENT NAME: 

RESIDENT ADDRESS / J / 7 3 d ^ yyiyir 

IF RENTAL, PROPERTY OWNED °^^ ^ y|^ J _ ^ / f^ J / ^ /^ C / / 

OWNER'S MAILING ADDRESS-.^ ^ ^ g , ^ ^ $ </^ ^ ^ ^ / 6 7 

OWNER'S TELEPHONE NUMBER - HOME: < t / J T " J <^ ^ /wORK: 

AOE OF HOME?: / 1 ^ ^ YEARS. HOW LONO HAVE YOU LIVED HERE? f^^xZo^if EARS i . 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? J- ^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 S HOURS OR MORE PER WEEKCOMMENTS 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 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), whioh 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 Wanl Parkway, Suite 405 5600 S 10* Street 4242 Medical Drive, Suite 42S0 Kansas Crty, MO 641U 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 Fa v '"•"•• — 
TECHNOLOGIES, INC. 

Property Status Form 

Address: /3/ 7 :S' ^ 1 ^T T Date: /Ac^'^ f 

Phone: BVID: 

- Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

h fil/^k 

^/uc^f 

Up ^i^ki ftufii^ I 

W^4 ioMf/de of 6m0i jt/oyji/tfiju(/l Ime Adiri id lepT 

Pre-Existing Condition of Struct^re/j^^^^^^P^^^ pu f ^l/fi^ /^iCHf 

Does your Basement have a history of leaking? Yes X. No 

Item NO Description & Location 

On Map 

Property Owner Prudent Employee/] 

Signature:^^ f ' Signature: f^^ //A__^-^'~" 

8050 Ward Parkway, Suite 406 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 Pav. (210) 579-6577 
^HNOl (KHF.S. INC, 

AS - BUILT DRAWING 

OI,f*:20299 

Date Excavatc-d: 12/01/2009 

ISEPASigntdOtrOatc: OMAHA LEAD SUPERFUND SITE 

Name: ^nj ^ Jr-J-^H^ W^ ^ Omaha Lead Stte Date: '7//i:/£'^ 

Address.: nr-7. y ^ S ^ T Site Sketch Time; /e,' f ^ 

Phone: 

Omaha Lead Site 46130 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENT TECHNOLOGIES, INC. 
Name: ^ai^l J /-'j-gi f k^ ^ Omah^ Laad SHe Date: 7//^/^ ^ NorthAnow - • 

Address^^5^^3 r SHB Sketch Time: /olZj " 

Phone: C^E2^E2S ^ / 

6.1 ^^-^ ff. 

Omaha Lead Site 46130 
Pagel ofl 

r I3n 5 ^^ 

http://douglasne.mapping-online.com/assessdoc/Photos/18/Tl22186900000001.jpg 11/20/2009 
Dougla

s County NE GIS Map 

LEGEND 1 

Minor Streets 

i « i 

14J 

144 

OUi«r 

A ' 

Major Streets, 

Hdiu, StrviiU 

^ Mjii;<&lrti.;l> y 

Interstates 

InUff-^UL-^ 

Parcels n 

Hydro r"i 

2007 Color Aerial 

DnvenDv l\('/^CUIDH ' 

Disclaimer: This map is not guaranteed 

to be accurate, correct, cun'ent, or 

complete and conclusions drawn 

are the responsibility of the user. 
utilities 


YOUR TICKET NUMBER IS 2410483. 


Original Call Date: 11/19/09

work to Begin Date: 11/24/09

 Time: Time: 7:37 pm 

 7:15 am 

op: SIVA18967 

State: NE 

Address: 1317 

County: DOUGLAS 

Street: S 27TH ST 

Place: OMAHA 

TWp: 15N

Twp: Rng: 13E

 Rng: Sect-Qtr: 28-NE  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 LEVEL3 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Number utility Type 


CXCATV cox COMMUNICATIONS, INC HEIDI Day: 4029340469 


Alt: 4029340469 


Emerg: 4029329757 


LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA Day: 8773668344 


Alt: 


Emerg: 8773668344 


MUD02 METROPOLITAN UTILITIES DISTRICT SANDY Day: 4025047823 


Alt: 


Emerg: 4025047970 


OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


0PPDGPR6 OMAHA PUBLIC POWER DISTRICT NA Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


QLNNEIF QWEST LOCAL NETWORK NA Day: 4067289343 


Alt: 4062071494 


Emerg: 8887289343 


Page 1 

ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

Site Safety Hazard Analysis 

^ 

-> 

Address: Z^/ ? S . yL ^ 

Crew: 

Date: // • ,'?o- 0*=) 

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 

Crew Foreman 

Condition 

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1 

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F' 

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Ex. 

Bf. 

Hazards 

mof/^/y<sh >^3y4w^ 

Corrective 

Action 

lJ>.<e^ ^yot/ J 

1 

k&y j /a£:yf ^ 

US-S y/s/-C€yrc^^ 

»* 

Site Safety Officer 

8080 Ward Parkway, Suite 405 2505 N. 24'" street, Suite 308 4242 Medical 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 

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