TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 20^ 1 Date: l-jJi-^At 

Address: ///O 5 3 1 ^ ^ 

Remediatioii Contractor: r^u^t ^ 7^1"^^^ ^ Xvif> Year: 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

B^ Video of property (DVD) 

y Executive Summary 

y EPA-proyided property sketcli 

y Signed Access Agreement for subject property 

a Signed Access Ag;reement(s) for.adjacent property 

y Restoration Agreement 

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

y Confirmation data 

0 Photographs 

y As-built sketch 

y Satisfactory restoration signed by Property Owner 

sX Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

B Utility clearances 

\ y Property informationfirom Douglas County Assessor's Office 

D 40309580 

D MIPIHPi 

r-j Superfund 

s-fe^z • —W ^ 
PROPERTY SUMMARY 

Date: 12/20/2008 Omaha Lead Site Remedial Action Contract it EP-R7-07-06/0004 Month of: Nov/Dec 

1 Property Address: 1110 S 33 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 Fl PLANTS 3'X30' @ 397 PPM; AREA 

NOT EXCAVATED FIPLANTS 3'X3' @ 368 PPM 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 338 PPM @ 6"; DZ = 204 PPM @ 10"; Fl = 215 PPM @ 6"; F2 = 190 PPM @ 6"; EA = 185 PPM @ 

SCRAPE. 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant to contract specifications 

2) Signed Access Agreement includmg access agreements required for crossing other properties 

3) Pre-Excavation digital video cUp/photogr{q)hs 

4) Post-Excavation digital video clip/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Built sketch ­

i) Shall includefinal 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 properlyfile, 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) fonnat and/or 

photographs 

iv) Signed form verifying satisfactory restoration 

v) Description of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES, INC. 
Find Record I Clean Up Query Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 20897 ­ 1110 S 33 ST 

Owner: Resident: Contract: 

n Owner Omjpied Resident Name: Contractor: 

Owner Name: [PRESCOTT-VIVENaO JANET L |PRUDErn2qo8_s 

jPRESCOTT JANET L - — Property Address: Group: 

Owner Addressl: |1110S33ST ' " 

Owner AddressZ: 

- Zip Code: 

68105 Assessment: 

|1110S33ST Resident Phone Qualifying Group 

City: State: Zip Code: |PLAY ZONE 

JOMAHA |NE |68iq5 Assessment XRF Date: 

Owner Phone: Alternate Phone: I 

1(402)341-0863 1(402)341-0863 Assessment Max XRF Value: 

I 753.73 
TBCHNOLOGIBSi INCT 

Property #: 2.°%^1 

Date/Time: 

Quads Excavated: F», /^*- / &' / £>^ 

&EPk 

EPA Property Close Out 

Property Address: )\lo S 3% St 

Owner's Name: 

Contractor Group: Prudent Technologies, Inc., 

Excavation General 

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

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

Grading Sod and Vegetation 

1. 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? 

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

day time period) 

4. Are sodded areas generally firm and evenly graded? 

S. Are the joints between the sod strips generallytight? (Only evaluate if inspected at a 30 day 

time period) 

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

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls 

1. Do gates open and close freely? (IfappUcable) 

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

3. Was damage to gates or fences avoided? (IfappUcable) 

4. Was damage to retaining waUs avoided? (IfappUcable) 

Foundation, Siding and Gutters 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

4. Was damage to wmdows or door screens avoided? 

S. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes No 

/ 

/ 

Yes No 

/ 

X 

y 

/ 

/ 

X 

y 

Yes No 

/ 

/ 

7 

X 

Yes No 

/ 

X 

X 

y 

y 

Yes No 

X 

X 
Owners comments: 

Inspection notes: 

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

EPA Representative A.- ^. . Date: ii/aofr,-^ 

y 
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: \ 1|( 1 Q G T^3n^ ^ 

Owner: 

Phone: 

Restoration Items in Question: 

item: 

Item: 

item: 

Hem: 

Item: 

Item: 

Required corrections to complete the property: 

"pejbcCC ­ v;p 

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

L J I do not agree restoration is completed 

X7 X/, yn ^ 

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

. The EPA requests your pennission to allow Prudent to perform a soil cleanup at this 

property to remove lead-contaminated soil. By signing this^form, die property owner grants permission to Prudent to perform 

activities related to the cleanup including soil sampling, removal of lead-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 Clerk for the 

Omaha Lead Site cleanup. Ms. Madhurima Duru -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 (North 

Omaha office). 

Property Access Granted By: A (Please Print Name) 

W Ut^A ^ Ai Property Owner Signature: v, /^^"^"^ %/oy (Signature) (Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: v J g W^, Owner Renter 

RESIDEN RESli: T ADDRESS 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; ^ . _ r, \K o ^ y­

\\\D R -^sfc^ ^ f r)l..^JU v^>c c^(o ^ 

OWNER'S TELEPHONE NUMBER-HOME: J L WORK: 

H02) ?>M\ - n\ A ^^ 

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

^n YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 19787 _ TES" ri«o~ ^<A A ' ^ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: O 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: (I.E. DOGS, ENTRY GATES, ETC.) 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS; The activities to be implemented by EPA under this agreement 

ate 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 
AS - BUILT DRAWING; 

OMABA LEAD SUPERFUND SITE 

OLSV: 20897 

Date Excavated: 10/16/2008 

USEPA Slfficd-OffDate: 

20897 

Omaha Exterior Painl Noflh Arrow Laad Sit» Owner Name: JANET L (PRESCOTT) VIVEN 

Site SIcetch • Good 

Address: 1110 S 33 ST • Poor ^ 

Phone: H: 4(g-34i.qe63 Wft 402-*41-pB63 

[]) Notpaint 

Lead Sample Samples Collect^ Sample Number LAB 

Concentration Collected Fimi: ASi ^ 6<.fCS 

RYASCPXA-20807 Fl _J£i2_pp m D Date:. f/^/Q M 

RY8SCPXA-20607 F2 

W 0 3 ppm Q D Time: <? - i s 

RYCSCPXA-20897 Bl _!£*£_ ppm B D 

Samples Analyzed 

RYDSCPXA-20887 B2 dJL (X ppm D 

RDZSCPXA.20897 DZ 31SL ppm B D XRFUnit: il O Book: S 3 

RG2SCPXA-20807 GZ M. ppm B Dat«: 6//<./c V 

RPZSCPXA-20B97 PZ a ^TU ppm 0 Time: firm 

D 

Staff: L-A . Number of Samples = 7 

ENTERET 

(. Vn <. m \ 8 ms 

5lI3*—8$ 

l££Krg7(^ _R.:^: u.^ r 

AREA NOT EXCAVATED 


(Fl PLANTS, 3's30' @ 397 PPM] 


AREA NOT EXCAVATED 

[Fl PLANTS; 3'x3' @ 368 PPM ] 

Omihtt Lead Site 4(SI30 

EA = 185 PPM ® SCRAPE 

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

Property Status Form 

Address: Date: 

Phone: BVID: 

Plants & Permanent Landscaping 

Item# 

On Map Description and Location 

s*-*' b^vC ^ 

\tJ ^ 

^ 

a-^ci C:xcU.^..^ h'z..dd- ^ l ^ 

Pre-Existing Condition o^tructuAts () '^y ^ 

Does your Basement have a history of leaking? Yes,— No — |, 

Item# 

• e IA-NJUXSQVX

Descriptio Sc n & Location 

 cJlftv^^o^^'Vf^ gov.JH/^.%\«kg, ^o\a ­ UOJL.. Q\^ i^e^' 

• ^ 

On Map 

Property Owner Prudent Emplo; 

M 

>^ignaturey<-v.U W->toL* Signature: 

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 
-•e_ev-^o tA-^ fdjl ^ 

&^^ «Wt.L^ ^ ^ ^^ ' ^'^-^ oJ^-^^^'^-^^ 
20897 

Omaha Lead Site Exterior Paint North Arrow Owner Name: JANE r L (PRESCOTT) VlVEN Site Sketch Q Good Address: 1110 >33ST • Poor - > Phone: H: 4C 2-341-0863 W: 402-341-Ot 63 Q Notpaint 

Sample Numbejr Lead 

Concentratioh 

Sample 

Collected LAIi Samples (Colect . ^ 

RYASCPXAr208d7

RYBSCPXA-208i7

 F1 

 F2 

Mi2 

Mo3 

ppm 

ppm 

Date:

Time:

 i^ /

 ^

 3 

­ 551 

C± 

RYCSCPXA-208U7

RYDSCPXA-208!)7

 Bl 

 82 

J£ 

JJL ^ 

ppm 

ppm 

Q Samples Analyzed 

RDZSCPXA-208)>7

RGZSCPXA-208!)7

 OZ 

 GZ 

SUL M. ppm 

ppm 

XRF Unit: 

Date: 

31 0 Book: S 3 

B/JJPXO H 

RPZSCPXA-20807 PZ -siu ppm 0 Time: t^ m 

Number ofS; amples = . 7 Staff: L-A 

IJNTEREP 

{>y\ C JUN 1 8 i m 

I^l*-SiJ 

IEHr^7( ^ ;R></>: T.,^:,c 

t i Si 7;5V 

¥ i>- t ^ 

ACff^C. 

: / \:<6 S 33: \3T 

\ JL2 . ' i h-r. ^ 

: fl : 

:<( *«->^ """-^J: ^ •\-.\.i9.-^4r.r ^ 

Omaha Lead Site 46130 
.cy(L.i^..7\X7T^4<^LA.-^^Tk/iyL.JR<=^f^^L^(^(^^... .: 

R^.i^t?d/S.L(d_.......G^r^....09/Mr.(d^ .I.(i2...]2(Ln7^.(^.^/^ 
Page 1 of 1 

March 2007 DOUGLAS COUNTY ASSESSO 

wossisr 

http://douglasne.mapping-online.coiTi/assessdoc/Photos/l 9/Rl 9031400000001 .jpg 9/25/2008 
Print Preview Page 1 of 1 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner 

City 

Owner 

State 

Owner 

Zip 

1903140000 

PRESCOTT 

JANET L 

1110 S 33 ST 

OMAHA 

68105 

1110 S 33 ST 

OMAHA 

NE 

68105 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

28-15-13 

OAKHURST PARK 

1 

3 

50X150 

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

parc=1903140000 

http://douglasne.mappingonline.com/DouglasCoNe/static/accountinfo.jsp? 

accountno=R 1903140000 

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 = 60 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/24/2008 





Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2144995. 

Original Call Date: 10/01/08 Time: 9:57 am Op: RAMITA18967 


Work to Begin Date: 10/03/08 Time: 10:30 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 1110 Street: S 33RD ST 


Twp: 15N Rng: 13E Sect-Qtr: 21-SW,28-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation project for soil 


Location of Work: LOCATE ENTIRE PROPERTY 


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


: UNSURE CORNERS 


Company PRUDENT TECHNOLOGIES 


Contact Name RAMITA Phone: (402)733-1455 


Alt. Contact Phone: (402)733-1188 


Work Being Done For: epa 


Depth of Excavation: 6ft Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV LEVEL3 MCLEODNE MUDOl MUD02 OMAHACOF 0PPDGPR5 


0PPDGPR6 QLNNEIC QLNNEIF 


Utility Service Area Contact Phone Number Type 

Day: 4029340469 

nMr ATM COX COMMUNICATIONS, „„,r., 

Alt: 4029340469 CXCATV puj^ HEIDI 

Emerg: 4029329757 

Day: 8773668344 


LEVELS LEVEL3 COMMUNICATIONS, ^ ^ Alt: 


Emerg: 8773668344 

Day: 8002891901 

NO NEED TO CALL OUT MCLEODNE MCLEODUSA Alt: EMERGENCY 

Emerg: 8002891901 

METROPOLITAN UTILITIES MUDOI SANDY Day: 4025047823 

DISTRICT 

Alt: 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/1/2008 
Page 2 of2 

MUD02 

OMAHACOF 

0PPDGPR5 

METROPOLITAN UTILITIES 

DISTRICT 

CITY OF OMAHATRAFFIC,SEWER 

OMAHA PUBLIC POWER 

DISTRICT 

SANDY 

RON 

NA 

0PPDGPR6 SI^^S^T''^"'''"'''^" ^ N ^ 

QLNNEIC QWEST LOCAL NETWORK NA 

QLNNE 1F QWEST LOCAL NETWORK NA 

Emerg: 4025047946 

Day: 4025047823 


Ah: 


Emerg: 4025047946 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Ah: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Ah: 


Emerg: 8887289343 

Day: 4067289343 


Alt: 


Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/1/2008