0

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 29253 DATE: 1/15 

ADDRESS: 2509 CORBY ST 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: 20lt 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

DT PRE AND POSTVIDEO OF PORPERTY (DVD) 

Q^EXECUTIVE SUMMARY 

\Z EPA-PROVIDED PROPERTY SKETCH 

 SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

H'^RESTORATION AGREEMENT 

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

H^CONFIRMATION DATA 

B^PHOTOGRAPHS 

Q^AS-BUILT SKETCH 

0 ^ SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

O^PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

Ca^UTILITY CLEARANCES 

•^PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

A ^ Wfr.»i 3////// 

SIGN/^URE DATE 

30218420 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2509 CORBY ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 327 PPM @ 2"; NO EASEMENT 

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. 

TECHNOLOCIES. INC. 
Find Record 

Backfill: 

Sample Area: 29253 - 2509 CORBY ST 

Owner: 

D Owner Occupied 

Owner Name: 

lOMAHA HOUSING AUTHORITY 

Owner Addressl: 

I 

Owner AddressZ: 

|540 S 27 ST 

City: State: Zip Code: 

JOMAHA [NT {68105 

Owner Phone Alternate Phone: 

Contract: 

Contractor: |PRUDENT2010_S 

Contract Option (OPnON 2 

Remediation Query j Lead Remaining Query j Property Damage Query 

User Provided Owner Information 

Owner Name: 

1 

Owner Address: 

1 

aty: 

1 

State:

1

 Zip Code: 

1 

Owner Phone: 

1 

Alternate Phone: 

- 1 

Assessment: 

Qualifying Group (400 

Assessment Max XRF Value ( 484 

Resident: 

Resident Name: 

Property Address: 

|2509 CORBY ST 

Zip Code: 

|68111-

Resident Phone 
TECHNOLOGlfe, INC. 

EPA Property Close Out 

Property #: Z^"?.63- Property Address: Z^<^^ Ca-rhcy VT . 

Date/Time: Owner's Name: ^%-«»V {4ow.'>i"^ /4«c^*"^'^<^ 

Quads Excavated: V3> \ Contractor Group: Prudent Technologies, Unc., 

Excavation General Yes No 

1. If necessary, were the correct quadrant(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 the house? 

2. Has sod been laid in all areas that were excavated? / 

:i. 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? y 

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

time period) 

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

7. Was dainage to landscaping or plant matenals avoided? y 

Gates, Fences and Retaining Walls Yes No 

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

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

Was damage to gates or fences avoided? (If applicable) y 

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

Foundation, Siding and Gutters Yes No 

1. Was damage to the siding or trim avoided? y 

2. Was damage to the foundalion avoided? y 

3. Was dainage to windows avoided? y 

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

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

Sidewalks and Driveways (Concrete) Yes y No 

 Was damage to driveway surfaces avoided'? 

Was damage to walkway surfaces avoided? y 

I
Owners comments: 

Inspection notes: 

^ .>>-' y 

y\ ^^ 

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

EPA Representative ^<^ M^ Date: t-i^-'i 
29253 

CHNOLOGIES. INC. 

AS - BUILT DRAWING 

OLS # 292,S3 

Date Excavated: 11/04/2010 OMAHA LEAD SUPERFUND SITE USEPA Signcd-Off Date: 

Exterior Paint Norm Arrow < ' Omah a Lead • Site • Good Site Sket( : h 

• Poor 

Sampling Address: 2509 CORBY ST rt* Not paint I 1

Sample Number Lead Sample Samples Collected 

Concentration Collected ^ Firm: fnl ^ PA r.f. 

RYASCPXA-29253 Fl J ^ <^ DDm VA PI Date 9-ll-Z» ^ 

RYBSCPXA-29253 F2 2 2. S Dom fvl' H T me: 'ZW 6 -.« 

RYnsr;pyA.3ci5';-< R I M <} */ nnm rr/ . n Samples Analyzed RYDSCPXA-29253 B2 ,^ | ^ ppm car D 

.ppm D n XRF Unit: US'^I Z Book: /9 ? 

Dom n n Date: /d-0 2 -fl" ? 

Dom "U U" T me: A M 

Staff: MS W Number of Samples = H ! O 1 

J 

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

Al quadrarHs are as vMwg^ rroin Ihe street, lacing propeity 

Jt; NTERED 

\ 1 .SEP 1.9 2007 

Bl =327 PPM fa 2 " 

..^s.'i...' : ^ : 

Jn 

bl 

; 1 

; 1 

250 ^ C«-i« 

' > 

• 1 

!> 

c.i5?: .1. u; s 

} 

y ^ 

\ 1 

F2 

- - - - • • ) 

1 

; 1 ' 

'cortov. S-f: 

Rev 

•-.• r 

crtned vymsxnio«» 

—»• .•N I 

. ...• 1 NO E.ASEMENT 

HH' M MOM -

i«At4 01J3 

-M'M > 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
SERA 

<ip 

^ y 

Property Compietion 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 fiiture, excluding any 

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

Property ID: 

Property Address: 2509 Corby St 

Owner: Omaha Housing Authority 

Phone: 402-444-6900x251 

Restoration Items in Question: 

Item: The site is snow covered at this time and the sod is dormant. Being unable to 

Kem: inspect the sod; OHA cannot be certajn of satisfaction. Pmdent agrees that 

Item: warranty of work is extended during winter months through spring, if sod does not 

Hem: tai<e root and become healthy by the end of spring, Prudent to be responsible for 

Item: replacing sod at that time. 

Kem: 

Required corrections to complete the property: 

I I I agree restoration is completed. 

X I do not agree restoration is completed at (noted defldencies above) 

'yZ^4LyyyyAy^u.ti^^ y ^'^/yA//7i 0 

Owner's Signature Date 
Prudent Technologies. Inc. (Prudent) is under contract with the U. S. Envntrnmental Protection Agency (EPA) to clean up leadcontaminated soils at a number ofproperties located in Omaha. Nebraska, including Ihe property located at 2309 Corby StreeL 

Omaha, NE. The EPA requests your permission to allow Prudent to perform a soil cleanup at this property to remove leadcontaminated soil. By signing this form, the property owner grants pennission (o 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 propetty, please contact Prudent soulh ofTice .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 Infonnation 

Centers at (402) 731 -3045 (South Omaha office) or (402) 991 -9583 (North Omaha office). 

Property Access Granted By: Stanley Timm, Executive Director for Oinaha Housing Authority 

Please Print Name) 

Propefty Owner Signature: id^r 

(Date) /o 

PROPERTY INFORMATION 

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

RESIDENT NAME: Vacant Lot Owner Renter 

RESIDENT ADDRESS: 2509 Cofby Street, Omaha, NE. 

IF RENTAL, PROPERTY OWNED BY: The Omaha Housing Authority 

OWNER'S MAIUNG ADDRESS; 540 S. 2?"* Street, Omaha, NE, 68105 

OWNER'S TELEPHONE NUMBER - WORK: ( 402 ) 444-6900 X251 

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

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? YES NO N/A 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: _N/A NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 


N/A 


NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 


N/A 


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 ofCERCLA. 42 U.S.C. 9604. EPAs right ofaccess 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 otheruise enforcing the provisions ofthe title." 

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)822-9588 

Fax: (816) 363-3707 Fax: (402)733-1883 Fax: (210) 579-6577 
riOfWTRfJCfVO!'! 

TECHNOLOGRIES. INC. 

Property Status Form 

Address: ^ ^ O ^ Cd^^S y S ^ Date^ ll}3lz,Q( Q 

Ftioiue; 

?Ji/^c7)iAc [^QjirK ,s S / ^ fxc^^-^c i B^ ^^.e^-jTrx. 

r/l^ ^ . ^tfytC < yh /5 ^ 3 ijAcr^^r <U» r-S /^ ^ / ^ g^6J 

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1£ _J=JC1.. f^ i^T .cx ^ y ^<- (s

^ 

Property Owner Prudeeit Eimj}Jj»y-^e 

Sigoatiuirc: Sjgmiatiiire 

SnSfi Wiird •f-aiitwBy. .Suits 'iO.S •;^: ^i; IVifir}!c5l O^'iVO, OlltW 4-^co 

fiansfi-S Citvs win 6iM14 uiiri Aniortio, VX 7"iifl 

f-*h«>!ir-.i; 1210) rw.-i-'i.'iCfi 

^.•?^C1. If.--* 'i'*^ ^ 
29253 

y Omaha Lead Site 

Site Sketch 

SamDiina Address: 2509 CORBY ST 

Sample Number 

RYASCPXA-29253

RYBSCPXA-29253

RYCSCPXA-29253

RYDSCPXA-29253

RPgOeP)(A^g9239

RQZ3ePXA"g9g09

'RPgOCPXA-29g59

 Fl 

 F2 

 Bl 

 B2 

 BZ 

 02 

 PZ 

Lead 

Concentration 

Numt)er of Samples = \\ 

Exterior Paint North Arrow 

• Good 

•

Q 

 Poo

^ Not pain

r 

t 

1

Samples Collected 

Firm: _£jiA ffl CAt 

Date: 9'U't*tf 7 

Time: {2:</* -fin. 

Samples Analyzed 

XRF Unit: (aS'HZ Boole /9 f 

Date; /O-O Z -Q-? 

Time; JdL 

Staff; hsw 

Legend: F1 = Front Left. F2 = Front Right, Bi = Back Left, B2 = BackRight DZ = Drip Zone. GZ = Garden. PZ = Play 

Alt quadrants are as viewad from the etrset, facing property 

I 

^e.'i...'. 3J3 

I

i>\ bt 

I 

250 R Cer»»jj 5T. 

-j; ^ 

.,:.i5.%..\.ixe, 

^ .n FZ 

CorUi%X n . 

ENTERED 

SEP -i .9.2007 

Rev S Creaed^ «/3O/200710.45:30 046141.0121 
250

9 Corby St 40x160 

A ^ Printed: Nov 03,2010 www.dcgis.org/dogis 
Page 1 of 1 

"> 

Create Another Ticket Back to Irth Intemet Send Email 

• YOUR TICKET NUMBER IS 2632793. 

Original Call Date: 11/02/10 Time: 4:21 pm Op: SIVA18967 


Work to Begin Date: 11/04/10 Time: 4:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2509 Street: CORBY ST 


Twp: 15N Rng: 13E Sect-Qtr: 09-SE 


Twp: Rng: 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 MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Plione Nuniber Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICHA-RAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

QLNNE 1C QWEST LOCAL NETWORK ELM LOCATING

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 11/2/2010 
ENVIRONMENTAL 

ENGINEERmG AND 

TECMNOLOGIES CONSTRUCTION , mc . 

SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address: 2£o5_Qo/.L^_<i i Excavation Date: IhJl^jiQlO 

Crew: j2iH^JoylsuJ.lo.£,jL Backfill Date: 

Item Conditioii Hazards Corrective Action 

Overhead Lines 

Gas Line 

Water Line 

^j_6_ 

tUL 

aSL 

^^^Z. h 1 te fc 

Sewer Line n^ 

Septic/Leech 

Field M . Propane/Bntane fUL 

Sidewalk ^LQFoundation tlA. Retaining Walls 4J2- Fences ao- Trees IU . Structures ^Ij ^ 

Driveway n ^ 

Sprinkler System K ^ 

Other 

Crew Foreman 

Site Safety Office 

Date: 

^ 

8080 Wanf Cailany, Suite AttS 

4242 Medical Drive, Suite 7250 

Kansa iseoosiost s GJfy. MO 64114 San Antonio, TX 78229 

PlMtie:(816)36»^703 Omaha, NebRaska 68107 Phone: (21D) 822-9588 

Fax: (8t6) 363-3707 Phone: (402)733-1188 Fax: (210)579-6577 

1=ax: (402)733-1883 
i<i 

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