TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID*: 22211 DATE: 1/15 

ADDRESS: 2559 MARCY ST 

REMEDIATION CONTRACTOR: PRUDENT TECHNOLOGIES. INC YEAR: 20lj> 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

0 PRE AND POST VIDEO OF PORPERTY (DVD) 

of EXECUTIVE SUMMARY 

^ EPA-PROVIDED PROPERTY SKETCH 

Sf SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

El RESTORATION AGREEMENT 

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

m CONFIRMATION DATA 

Q PHOTOGRAPHS 

Q AS-BUILT SKETCH 

0 SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

^ PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

0 UTILITY CLEARANCES 

H PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

n 

a 

D 

SIGNATURE DATE 

30217593 

iHMHIi 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2559 MARCY 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: UC (4'X30') = 280 PPM @ SCRAPE 

CONFIRMATION SAMPLING DATA/RESULTS: 

F2 = 163 PPM @ 2"; EA = 93 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 of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES. INC. 
Find Record 

Backfill: 

Sample Area: 22211 - 2559 MARCY ST 

Owner: 

n Owner Occupied 

Owner Name: 

)KM DEVELOPMENT LLC 

# Owner Addressl: 

|C/0 JASON MARTIN 

Owner Address2: 

|5213 MARY ST 

City: State: Zip Code: 

jOMAHA " " |N E |68112-

Owner Phone Alternate Phone: 

Contract: 

Contractor: |PRUDENT2010_S 

Contract Option JOPTION I 

Remediation Query I Lead Remaining Query j Property Damage Query 

User Provided Owner Information 

Owner Name: 

1 

Owner Address: 

1 

City: 

1 

State:

1

 Zip Code: 

1 

Owner Phone: 

1 "

Alternate Phone: 

1 

Assessment: 

Qualllying Group J400 

Assessment Max XRF Value ) 522.44 

Resident: 

Resident Name: 

I 

Property Address: 

|2559 MARCY ST 

Zip Code: 

|68105-

Resident Phone 

I 
1

)fS\s 

TECHNOLOCriES, INC. 

EFA Property Close Ouit 

Property #: 222/ I Property Address: 1,'^'yl AUrdc^ '^ K 

Date/Time: OwBcr'sName: />JJ U >C)e3ia 

Quads Excavated: ^"2 , Comtractoir Group: Prudenit TechmoSogies, Unc. 

Excavation GeneraJ Yes 

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

2. If aecessarv. were the correct are^s of drip zone excavated and restored? 

b/ 

Grading Sod and Vegetation Yes 

]. 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? y 

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

day lime period) / 

4. Are sodde4 areas generally firm and evenly graded? i / 

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

time period) J 

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

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

Gates, Fences and Retaining Walls 

Yes 

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

2. Were all ga(es 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

 Was damage to the siding or trim avoided? / 

2. Was damage to the foimdalion avoided? / 

3. Was damage to windows avoided? / 

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

5. Was damage to downspouts or downspout extensions avoided? 

/ 

Sidewalks and Driveways (Concrete) Yes feg 

I. Was damage lo diiveway surfaces avoided? 

7 ^ 2.

 Was damage to walkway surfaces avoided? 

No 

No 

No 

 No 

 No 
Owners comments: 

Inspection notes: 

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

EPA Representative V^ A^ ^Date: vtlt^jto 
;(-'HN()1(K;IF:S. INC. 

AS - BUILT DRAWING 

OLS #22211 

Date Excavated: 09/30/2010 

ISEPA Signed-Off Date: OMAHA LEAD SUPERFUND SITE 

22211 

Omaha Lead Site 461K) 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
&BV< 

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 fliture, excluding any 

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

Property ID: 

Property Address: 515-5-<^ M o \rc\j S*-. C^ww».c-.Ue». J fO£ ^8-/05- Owner: ^^ ^ ^.^^.^ ^ Jc^ l Mei^+-r^ 

Phone: Hoa.-6 ? (-Ofel 3 

Restoration Items in Question: 

Item: 

Sa'A 2t«*tJt.'-otjS''*u», ii*^ (e« ^ 

Item: 

Item: 

Item: 

Kem: 

Kem: 

Required corrections to complete the property: 

3^A re^e*l:c.t.w A>^ I 

" M I agree restoration Is completed. 

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

r^ni (o 

Owner's Signature Date 
t^/^We^ty ^ i 

^"-• l 

^ 

K 

O 

<i I0 

4i^ 

O^c- ^ :Z'5 ^ rV 'gft'fe/ei 

Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcoptammated sgjk at a immb»pf praperties located in Omaha, Nebraska, including the property located at 

f(yy - J t^T ) "" ^ ^ ^ ^^^i e EPA requests your permission to allow Prudent to perform a soil cleanup at tliis 

property to remove lead-contaminated soil. By signing 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 of the referenced property. 

If you 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 Information 

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

Property Access Granted By; cf^s^fT^A 

(Please Print Name) 

property Owner Signature: 

(Signature) (Date) 

PROPERTY INFORMATION 

(To b(*Bompletedby resident and/or property owner — please print) 

RESIDENT NAME: ^ S^ U^^^nQA Owner 

RESIDENT ADDRESS: 

qo; ^ ^^.^~rP 2 ^(j ^ 

IF RENTAL, PROPERTY OWNED BY: 

O^^IUNG A^E^ ^ (/%5e (jd t .SP)U^^" ^ > ^ ^ ^ ^^ ^ 

OWNER'S TELEPHONE NUMBER - HOME: fidPtC^J^J C\ ^ } ^ WORK: A^^ y f^tlfi € 

AGE OF HOME?:(af)r)r?) ^ YEARS. HOW LONG HAVE YOU LIVED HERE? <—^ YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? X 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: 
 d 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) ,.— \ / »-) 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities lo 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 "detennining the need for response, or choosing or taking any response action 

under this title, or otherwise enforcing the provisions of the title." 

8080 Ward Parkway, Suite 405 S600 S 10 St 4242 Medical Drive, Suite 4250 

KansasCity.'MO 64114 Omaha. Nebraska 68107 San Antonio. TX 78229 

Phone: (816) 363-3703 Phone; (402) 733-1188 Phone: (210)822-9688 

Fax:(816)363-3707 Fan; (402)733-1883 Fax: (210) 579-6677 
ENVrRO<NMEM,/VL& 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICE.S 

y^ - ^ ^ Property Status Form _ / / 

Address f<^^ % -S^^ik »-

' "ififf^^ 

Phone: BVm: 2L 2 2. / / 

tPt-M -PoaAiAry /» f/titj* ^ e<^ M A /> A^ 

asi9 /rtAAcs. x-r- ts ^r'-z^tt-^ fat S14»L^ 

'iif ^ B0^i£. )^d.n UM C T>iUi a<4> iA^Tb 

7l£AS* Ttir f l fZ ^ ^ 7 5 

: ^ ^ ^ ^\/ . 

Property Ow Prudent Employe 

Signature 

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)822-9688 

Cv . fU M S7«JS«77 
1 

22211 

Owner Name: PHYLLIS STOCKER 

Address: 2559 MARCY ST 

Phone: H: 402-593-9298 

Sampie Number 

RYASCPXA-22211 Fl 

RYBSCPXA-22211 F2 

RYCSCPXA-22211 B1 

RYDSCPXA-22211 B2 

RDZCCnXuni 22211 DZ 

RGZOCP)(A 2221 \­

-RPggCPXi^ 32211 PZ..-. 

Omaha Lead Site 

Site Sketch 

W: 402-636-2351 

Lead 

Concentration 

Sampie 

Collected LAB 

ppm D 

ppm D 

.-^4::> ppm n 

ppm D 

ppm D n 

ppm D D 

ppm D D 

Number of Samples = V 

Exterior Paint • Nortti Arrow 

• Good 

• Poor i 

\ ^ Not paint 

Sampies Collected 

Firm: fit*i ^ <r^/AA 

Date: '^hv/d'-^ 

Time: 9 ' Y ? 

Sampies Anal\/zed 

XRF Unit: \ Book :'=\ \ 

Date: qfi- 0 ^ 

Time: •li ^ 

Staff: 

^ 

rnaha Lead Site 461.iO 
H 255

9 marcy 

A 

• tmH' Printed: Dec 08. 2010 

«A\'u' dceis orc'doeis 
iHtC. CONSTRUCTION 

SOLUTIONS 

SITE SAFfeTY HAZARD ANALYSIS 

Address: -2r££2—0L-iiy-Ji2l- Excavation Date: 

Crew: Backfill Date: 

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 

a>e^ 

e^ 

h^' \V 

Ofc~ 

or-­ m 

pca ^ 

ciy<­

a^­

o*^— 

___ -

Hazards Corrective Action 

U C r - / P reuOi 

Site Safety Office 

Date: 

980 WaftfVarfaKay. Sute 40S 

flnaasG«yiHa«4114 

SSOOSIOSt 

OHKlia, MahMtlM oatOT 

4242 Medical Drive, Suite 7260 

San Antanlo, TX 7822S 

Phom: (402)733-1188 Phone: (2t0) 822f«588 

v c fStt) 363<47a7 Fa c (402)73»d8S3 Fax: (210) 6T»-65n