CHNonjcTBrracr 

PROPERTY SUMMARV SHE)ET 

Omaha Lead Site Remedial Action Contract #EP-S7-10-05 

Said: 15929: PrppeftyAddress;2713 SZOST 

Executive Summary: 

• Issues Encountered: None . i 30261383 

. • , Issues Resolved: None .. IMHI 

• Unique Finding's: . ^ Superfund 

•. Other Relevant Information: 

• CONFIRMATION SAMPLING DATA/RESULTS: B2=313 PPM @2"; Fl= 56 PPM @4"; EA= 85 PPM 

@Scrape; F2= 63 PPM @4". 

Attacliments: 

Documents Included in the Property File: Yes No N/A 

Property sketch provided by EPA pursuant to contract specifications V 

Signed Access Agreement; including access agreements obtained (if required) for crossing V 

onto adjacent properties 

Pre-excavationagreerTientdetails(if any are made with the PropertyOwner) V 

Pre-Excavatipn digitial video clip -V. * ' 

Sampling data sheet . \ .. \ ^ : . 

Post-Excavation digital video clip V 

Documentation - Completed EPA close-out checklist V ; 

As-Built sketch . . V 

Omaha Lead Site Database sample information document. V. 

Signedform verifying satisfactory restoration V 

Other Documents: 

30 day SOD warranty pictures 

V 

Utility clearances document 

V 

Property information from Douglas County Assessor's office. V 

Settlenient documents (i.e. for any damages; replacement of plants, etc.) V 

Site safety hazard analysis document with pictures. V 

Legend: Yes - included In the File; No - Not included ih the File; N/A - Does not Apply. 

Prudent Representative: EPA Acceptance: -fj } 

>N 

ipi' 

.^^ 

y 

Date: Date: 

V

>^ 

Prudent Technologies, Inc. | 2505 N. 24TH Street, Suite 308 |Omaha, NE 68110 USA | Tel. 402.504.1004 | 

Fax: 402.504.1005 

Environmental Engineering & Services | Remediation | Construction 
15929 

Omaha Lead Site 

Samolina Address: Z7J 3 S Z O S + Site Sketch 

Phone: H:*fdi-3<f Z ALT: 

Sample Number 

RYASCPXA- IS9Z 9 

RYBSCPXA- IS929 

RYCSCPXA- IS92 9 

RYDSCPXA-ie%9 

F1 

F2 

81 

82 

Lead 

Concentration 

^ 6 5 ppm 

^ / ^ ppm 

21 1 ppm 

•702 ppm 

Sampte 

Collected 

i^ 

RDZSCPXA ID9tl9 n 

nozccPXA i09£L9 c z " ppm D 

RPZSCPXA IG^ 9 pg " " ppm n 

Number of Samples = J M

Legend: Fl = Front Lett, F2 = Front Right, Bl = Back Left, B2 =

 i

LAB 

D 

n 

D 

D 

n 

D 

n 

j r\ 

Exterior Paint North Arrow 

• Good 

• Poor 

g^Not paint ^ 

Samples Collected 

Firm: PE T^C , Jc'A//f X 

Date: Lj/2q/6ft 

Time: q- h At^ 

Samples Analyzed 

XRF Unit: C.gVQ Book: 2m . 

Oate: _ fg - M • Qft 

Time: _ 

Staff: 

nsu/ 

 Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, tacing pir.ipe r >y»..^^ 

.BMT EBEP. 

JUN 0 2 2008 

METAU 

COMC 

SVC*** ?0*T 

WAvu ^ 

2T? 1702 

I vS 

I 

LS; 

( 

.Zlil3... S. ZO bX 

I 

fl f l 

% 5 i 5/3 

I 

ALt-EV 

Q 

S. ZO ST. 

Rev.>.RI. fljAr.ti.iiii.« 
PROPERTY ACCESS FORM 

prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental PFOtection Agency 

(EPA) to clean up lead-contaminated soils at a number ofproperties located in Omaha, Nebraska, including the 

property located at e^Z I \'? s > ^ » aPOt W Sr^ . The EPA requests your permission to allow Prudent to 

perform a soil cleanup at this property tp 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 leadcontaminated soil, and restoration ofthe referenced property. 

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

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 Omaha office) or (402) 991-9583 

(North Omaha office). 

Ifyour property has a gravel or dirt driveways or parking areas then the removal and replacement ofthe soil 

and/or gravel during the remediation process does not make your illegal gravel/dirt driveways or parking areas legal. 

IBv:/^(^<!>z)/e^^ 2yy/x.sa>^ 

(PleascPrim Name) 

Property Access Granted I 

Property Owner Signature^.Z)7a^4nykJ Z)ztliyi'^ ^oji^|2-o 11 

^— \ (Signature) (Date)

) 

Pfoperty Accessed by: 

Ot^i-!:^- -LWyks.. (Prudent Employee Name) 

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

1. RESIDENTNAME: VcXC-ay \ W \jr\\~ Owner Renter 

2. IF RENTAL, PROPERTY OWNED BY: VAa.r'u n rv ^ hOoj i ( 

3. OWNER'S MAIUNG ADDRESS; J11\* ^ ^ t -D n K P^lr O KAUJUA ' ^ ^ 

4. OWNER'S TELEPHONE NUMBER - HOME: (Vo2-) SSS " WORK: ( > 

5. TENANT'S TELEPHONE NUMBER - HOME: ( )- WORK: ( — 1 

6. AGE OF HOME?rv.., YEARS. HOW LONG HAVE YOU LIVED HERE? YEARS. 

7. HAS THE EXTERIOR BEEN PAIN R COVERED WITH SIDING SINCE 1978? YES NO 

8. # OF OCCUPANTS UNDER AGE OF 7: # OFOCCUPANTS AT OR OVER 7 YEARS OLD 

9. # OF CHILDREN UNDER AGE OF 7 WHO PLAY IN THE YARD FOifS^OURS OR MORE PER WEEK 

10. COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, NEIGhBQBING PROPERTY 

ETC.) 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONSL The acfivities to be implementad 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 ft>r in Section 104(e) of CERCLA, 42 U.S. C 9605(e), which provides entry fbr "determining tiie need fbr 

response, or choosing or taking any response action under this titie, or otherwise enforcing the provisions of the 

titie." 

Prudent Technologies Inc. 5600 S. IO*** St. Omaha, NE 68107, 

402.733.1188 (Office) 402.733.1883 (Fax) 
ENVIRONMENTAL & 

CONSTRUCTION 

SERVICES 

Property Status Form 

Address: ^T\ 3 S ^ 9-OHv S. h ' Date: \0\\^ \ ^ P I ; 

Phone: , ^ ^ BVID: ) S ^ 2^* ^ 

Mop.- ^sr3 - <-fSo "7 

NOTICE TO BE GIVEN/rb: OWNER ^TENANT BOTH 

HOW MUCH NOTICE IS NEEDED: 24 HOURS / 48 HOURS 72 HOURS 

OTHER NOTICE NEEDED (PLEASE SPECIFY): 

PHONE # AND NAME TO WHOM NOTICE NEEDS TO BE GIVEN: 

WILL NEIGHBORING PROPERTY^ED TO BE USED FOR ACCESS? YES NO 

IF NEIGHBORING PROPERTY WILL NEED TO BE ACCESSED WHAT IS THE ADDRESS: 

yy \IAS AN ACCESS FORM OBTAINED FROM THE NEIGHBOR? YES l^O ^ 

Iwi ILL A FENCE NEED TO BE TAKEN DOWN TO OBTAIN ACCESS? YES (D 

IF ANSWERED YES TO NUMBER 12 PLEASE PROVIDE LOCATION OF FENCE: 

IS THERE PRE-EXISTIJs«rfACIAL DAMAGE TO THE PROPERTY AND IF SO PLEASE PROVIDED LOCATION AND DESCRIPTION 

o, FSUCH: YES 02 'SPECIFY: 

IS THERE PRE-EXISTING C0NCRH;|T3AMAG E TO THE PROPERTY AND IF SO PLEASE PROVIDED LOCATION AND 

DESCRIPTION OF SUCH: YES {N O J SPECIFY: 

Property Owner Prudent Employee 

Q , 

Signati ^yr^^ yy/(7eti7l^y^MU//y^ ' '^ Signature: . \y^i)dyZ\W cXkr^li^ 

DATE: 7^yy^/^yl 

Prudent Technologies Inc. 5600 S. lO"* St. Omaha, NE 68107, 

402.733.1188 (Office) 402.733.1883 (Fax) 
ENVIRONMENTAL i 

CONSTRUCTION 

TECHNOLOGIES SERVICES , INC. 

Property Inspection Form , 

Address: S'^'T ^3 S ;2oHv ^| . Date: lb|l$|2_ol ) 

Phone: Mr> •) - SS " g , - L[Sf> 1 BVID: IS^l . ^ 

Pre-Existing Damage: Please write in detail and included location 

and description of damage: 

Concrete Damage: 

<^2_t'(-<-\ Vid e '^^'sJ^^. ^ 

Facial Damage Including Siding: 

|0£> 

Does Basement have history of leaking or flooding? YES NO 

Does Homeowner want sod replaced in all areas? YES NO IfNO please provide what 

areas are not to be sodded and what needs to be replaced instead of sod (i.e. mulch, rock, 

leave bare) if mulch or rock please specify what type and color; 

QaA. oM o^Ljux r pi ,v=2_^ B2_. "J 

ANY OTHER DAMAGE OR REQUESTS: 

^ •'f>r^ov^• ^ W>W 6 \^3^Mf^^«^. OJr BX- % ^ vM J

Property Owner Prudent Employ^ 

Signature :y7k:i^J^i^!^ y^-^^-^*^ " Signature: 

DATE; /^ , ^fy/yy DATE: 
C0NS3EReCTliQS 

TECHNOLOGIESi INC. SERVICES 

XBI CLEARANCE SHEET 


PROPERTYADDRESS: SCl. iS^'^C^^ 


PROPERTY ID: I S^^^ 


MAP HAS BEEN REVIEWED AND NO MISSED AREAS EXIST: ^YEJ NO 

WAS CONTAMINATION LEFT BEHIND? IF YES WHERE A W DIMENSIONS: M 0 

CREW: Y\l,^r^^ . DATE DEPTH QUADRAINT m^mo 

iN[''y 1/^ Fl XR fJ. F TECH / q/ .F2 / Iph 

Bi READINGS DOCUMENTED IN /

LOG BOOK? (?E§:) NO s k.// B2 K)^ 

GARDEN / 

/ • PI.AYZONE 

EASEMENT 1/3 i:^ ^5 

/ 

• 
TECHNOLOGIES, INC. 

•EPA Property, Cl<>s0^ Out';; ;.-.^' 

Propertj'#:A6^.2<H 

Pate/Tinie-: ' , ;••": y 

PropertyAddress: ^^V ^ 5^?< ?

Owrier's'Nainer/Kar.v^v.^^VvA'L^

 St ­

 •• . •• 

Quads Excayatbri: ,p | 12: , S '^ ' Contractor Groiip: Priident Technologiies, Inc., 

Excavation General. • Yes No 

,L- If iiecessary, were the correct quadraiTt(s) excavated and restored?' . ' / 

2. If necessary, were the correct areas of drip 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 tlie 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 ifinspected at a 30 

day time period) y 

4.. Are sodded areas generally firm aiid evenly graded? , : ., y 

5. . Are die joints between tlie sodstrips geiieraiiy tight?.(Only evaluateif inspecteda^ 

•-• • '.• time.period) •' .••••' '.. •'. V • •'.• •'• •••-•.'.•.:'•.'.•'­ • • >

 • •'. 

6. Was die pioperty graded suchtiiat water will not pool on the property? 'y. .7.. Was darnage to landscaping or plant materials avoided? y 

Gates, Fences and Retaining Walls Yes No 

. 1.. Do, gates, open and close freely? (Ifapplicable) . , y 

2. Were ail gates or fences taken down during restoration activities reinstalled? (If applicable) •y. 

.3 . Was damage.lo.gates or ferices avoided? (If apjiiicable).. y 

...4." Was dainage to retaining walls ayoided? (Ifapplicable) • .. y 

Fouiidation, Sidiiig.and Glitters . . Yes No-. 

1. "Was damage to the siding or tiiin avoided?. • . • /y 

2. Was daiiiageto the foundation avoided?- . • y 

3. Was damage to windows avoided? 7 

4. Was damage to wiiidows or door screens avoided? 7 

5. Was dajnage to downspouts or downspout e.xteiisipns avoided? / 

Sidewalk.*! and Driveways (Concrete) Yes / No 

1. . Was dajnage lo diiveway surfaces avoided? 

/ 

2. Was damage to walkway surfaces avoided? 

/ 
•.Owneri 'cohiimeiiits: 

.Inspectiojo. .notes: 

RemovaJ and restoration activates compJete incJuding tJie 30-day sod warranty; 

EPA Representative g*^,H ^Daie:_ rt\'^^" 
mji 

TECHKOLOCiES. INC. 

Sample Area: 15V29 - 2713 S ZO St 

Date Excavated: 11/03/2011 

Sampled By: Ljohnson 

tlYA.'iCPXA- 15929

RYBSCPXA- (S92'>

RYCSCPXA- IS9Z 9

HYDSCPXA)S%9

BOaSCPXA. toOa'?

 Fl 

 f 2 

 Bl 

 62 

 OZ 

-B«6fePXA 109£ » Gi? 

JIPXSCPXA ftj'gg? f'^-

AS - BUILT DRAWING 

OMAHA LEAD SUPERFUND SITE 

CONTRACT #: EP-S7-10-05 

Om^h a L«a d Site 

Sitft Sketc h 

Lfead 

CiViCftnJranor. 

965 ppm 

ppm 

. 2T7-_ ppm 

1 0 2 

. pprn 

ppm 

ppm 

.ppm 

$&f(ip*6 

CoSectec 

at 

sr 

a 

D 

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Numbef ol Samples -• M

I_A8 

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a 

D 

D 

D 

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 ( ^ 

l.«g8ivd: Fl - Front Lett. F i J; Front Riijht, e i = Sack Left, 82 ^ Back Rigti! 02

15929 \ 

tiiterfor Paint 

• Gooa 

D P«" 

Q'Moi Oairt) 

Sampfes Colleeted 

0«te S i 21/0 8 

Itme 

Samples AnaVieti 

XRF-'Unrt: CnS¥ 0 80ok ZjOX ­

oaie r» -11 -nft 

Time M±^ 

S\Dif nsu/ - Onp Zorie. GZ •= Garden, PZ = Ptay 

Prudent Technologies. Inc | 2505 N. 24TH Street. Suite 308 jOmaba, NE 68110 USA | Tel. 402.504.10041 Fax: 402304.1005 

Environmental Engineering & Services | Remediation | Construction 
• • 

r 

Find Record ..<emedKi<ion Query Lead Remaining Query Property Dainage Query O K 

Property M b Oean-up Info liJ^fM^..i||'[^Ji Customer Calis Sidewaik itepair 

Sampre Area: 15929 - 2713 S 20 ST 

I Sample Date „ Quadrant ^i Paramete - XRF Re . XRF Res Exc - Marker Place -. Lead Remainin - In* » Sampied B. QA Confirmee - Lab_Re 

' 11/3/2011 B2 LEAD 313 mg/kg 2 Ljohnson N/A 

11/3/2011 E1 LEAD 85 mg/kg 1 ; _ Ljohnson N/A 

[ 1 11/3/2011 F l " LEAD 56 mg/kg 4 B L H Ljohnson ^^ __ "IX _ 11/3/2011,F2 LEAD 63 mg/kg i Q E Ljohnson NfA " t "" 

LEAD mglkg 0 N/A ' ~ | 

Record: M r M MS ' ^ No Filter Search 
Find Record 

Property Infb Clean-up ttifo Sampie Infb

Sample Area: 15929 - 2713 S 20 ST 

Lab_Resul. Lab Result Unit; . 

0 mg/kg 

0 -^9 

Oijmg/kg 

mg(kg_ 

0| mg/kg 

^mediation Query

 custoroer Cails

 Lead Remaining Query

 Sidewrailc Repair 

 Property Damage Query 

Remarks 

.U... y 

-4­

-4 -

Record: M < > W • % , r4o Filter Search M. 
, Tfiis^ agreepent.db6Hiiiieritsi.t^^^^^ c6mpleiion;pf: Femovai: aptivities .peifprraed on tbe befow; listed pcopeity; 

; Tide; pFpp.e"iiiy ;awHfii;'s -signaiui;^^ progeni]^; awfier iis satisfied' with- the restoratiq*): of^tlie." 

;subject'property,; aitd' tliat hb iteiiis'.aj-e-jn q.uestiQn-j, nowtj. prat.atoy';.tiine.ih^.the-futuE^^^^ 

remaining-warcsdity. f3 0'day^^^ 

Piropeirty ID: , I ^ ^ '2_^ <^ 

Property Addf-ess; ^- ^ y ^ Q.^ ZlC^^tZ Z 

Owffi€r Pwy<\ —/o VCLA—-^ 

lOSSvS - ; 

Restoratloir (ferns iir Questloit: 

RSIB: 

Item: 

Hem:. 

.Eiemr 

iCem: 

fSem: -

Requnired c6Frx$ctfons to compEeCathe property: 

I agree festoratibn is completed 

I.do.nof.agtee restoration is complefed at (noted def(ciencies.abb\/e} 

» l IM|2--t( 

Owne r's- SigiiaHu rc Datfe • 
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IRTH One Call Page 1 of 1 

Digaers Hotlin* 

Of xcth Nebraska 

Home Ticket 

Ticket Creation Logout 

Create Another Ticket Go to Home Page Send Email 

• YOUR TICKET NUlllBER IS 2892027. 


Original Call Date: 11/01/11 Time: 3:45 pm Op: ASHLEIGH18967 


Work to Begin Date: 11/03/11 Time: 4:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2713 Street: S 20TH ST 


Twp: 15N Rng: 13E Sect-Qtr: 27-SW,34-NW 


Twp: Rng:.- ..• Sect-Qtr: '•'*.-,, 


Legal Given: C 


Type of Work: LEAD SOIL REMEDIATION PROJECT 


Location of Work: ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)733-1883 


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: ASHLEIGH ANIKPUTA Phone: (402)733-1188 


Alt. Contact: NONE 


Work Beina Done For: EPA 


'«•' ' 


;y\ 

http://www.dhon.org/IRTHOneCall/Ticket/TicketCreation.aspx?ViewTicketID=881800 11/1/2011 

•H 

2713 S20ST 

A Printed: Oct 18.2011 

www.dcgis.org/dogis 
Address 71 773 S. y/^ Date /C>y?'^7 / 

Analysis Completed By_ /6 ^y7Zy<ByfzJy.&.— Prudent Technologies Health and Safety Officer 

Location 

F1F2 

Item B1B2 Condition Hazards Corrective Action 

Overhead Power Lines Electrocution BLBi- T^gj^.PlZiTNff^^t; ' ^ 

Gas Lines Underground Gas, water Call Digger Hotline Prior to perform locates prior to 

Water Lines Utilities leaks beginning work on property 

Sewer Line If utilities are not located contact Supervisor, Safety 

Septic Tank Personnel to notify them ofissue 

Propane/Butane Go to another property to work as directed 

Foundation (DZ) 

yyc)^^\ 

Driveway 

/^o,^q_^ 

Side walk 

/ygfZjyyyZ Soa^? _ (U^urj^Zjy 

Trees / y^ ^LzfteA. 

Plants/Garden GZ 

7^/. P/2. n(^t^^ 

Access to Property 

-/?e>/u.~

Busy Street (need to close f^id^i^ ^ji . off Lane) 

7Z^l <: hz^^^v^. ^ M^ L^5fi ^ 

7e s 7^f4cj /Ot&M /naye . ^T^yC/ y4^ ^ S/Je. ^ 

Hand Dig 

j7b_ Pets /bees/wasps/ticks/red 

ants/spiders AJgti^C /'^o y^^y Poison Ivy/Poison Oak 

j(yi^y^<?'f -py^ y, 

Miscellaneous 

.A/J ^ ^ 

Time Print Name ofeach Signature ofeach Changes in conditions resulting ui additional 

Date Reviewed Reviewed 

E ^ 

»rew member sin per it^/t y 

/ crew member safety assessment ifapplicable 

t r 

JL 

Z<xA. C^.^ ^^ g 

Audited by