TRANSMPCT^ <i|f>pAHA LEAD SITE 

SOIL llEMDtAM)N FILE FOLDER 

SAID#: 106 ^ 3 Date: ^/l/oj 

Address: Jf^n£> ^ /5'Sh 

Remediatioii Contractor: r^y^'^^.J- /-etA- JLyiC; Year: ^.firfii 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

4 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adja^«nt property 

Restoration Agreement 

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

Confirmation data 

Photographs 

As-built sketch 

Satisfectory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Description of areas not meeting ROD cleanup criteria 

Utility clearances 

[ / Property infonnation from Douglas County Assessor's Of&ce 

D 

D 

D 

Ooan 

Signaturiree 

^ Hi^ 

30054235 inn 

Superfund 

CH^ototii^s.iric. 
Rnd Record 

Backfill: 

Sample Area: 10643 - 4506 S 15 ST 

Owner: 

n Owner Occupied 

Owner Name: 

VANDERPOOL SHONNA M 

Owner Addressl: 

Owner AddressZ: 

4506 S 15 ST 

City: State: Zip Code: 

IOMAHA :NE 68107 

Owner Phone Alternate Phone: 

Remediation Query 1-ead Remaining Query

Resident: 

Resident Name: 

JOHNSON CINDY L 

Property Address: 

4506 S 15 ST 

Zip Code: 

68107 

Resident Phone 

 Property Damage Query 

Contract: 

Contractor: 

PRUDENf2609_S 

Contract Option 

BASE 

Assessment: 

Quaiifying Group 

400 

Assessment Max XRF Value 

470 
TECHNOLOGIES. INC 

Property #: lOi^ l 

Date/Time: 

Quads Excavated: Pl^ 0'2-

EPA 

EPA Property Close Out 

Property Address: tt.So(> -5 /5 S r 

Owner's Name: 

Contractor Group Prudent Technologies 

Excavation General Yes No 

1. If necessary, were the correct quadrant(s) excavated and restored? / 

2. If necessary, were the correct areas ofdrip zone excavated and restored? / 

Grading Sod and Vegetation Yes No 

1. Does the grading around the perimeter ofthe 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? / 

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

time period) / 

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

7. Was damage to landscaping or plant materials avoided? y 

Gates, Fences and Retaining Walls Yes No 

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

/ 

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

3. Was damage to gates or fences avoided? (If applicable) / 

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

/ 

Foundation, Siding and Gutters Yes No 

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 windows or door screens avoided? / 

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

Sidewalks and Driveways (Concrete) Ye^ No 

1. Was damage to driveway surfaces avoided? 

(/ 

2. Was damage to walkway surfaces avoided? 

( / 
606 S 15 St­

§ 

Owners comments: 

Inspection notes: 

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

EPA Representative ^9^ j ^ ^ Date: ij/e/of 
« 

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 future, excluding any 

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

Property ID: 

Property Address: ^^ 6 C 5 fSH^ % ^ 

Owner: ^cx W 

c.\(- zr*^ ».^^IJL>J! ^ L^ ^ 

Phone: 

Restoration Items In Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

] ^ I agree restoration is completed, except as noted above. 

L J I do not agree restoration is completed 

yK\%XJe '^^..AJ^ ^ l.ni-O') 

Owner's Signature Date 
# 

Prudent Technologies, Inc. (Pmdent) is unda- contract with the U. S. Environmental Protection Agency (EPA) to clean up leadoontaminated soils at a number ofproperties located in Omaha, Nebraska, including the property located at 

. The EPA requests your pemiission to allow Pnident to perform a soil cleanup at this 

property to remove lead-contaminated soil. By signing this form,tfieproperty owner grants pemiission to Pnident to perform 

activities related to the cleanup including soil sanq>ling, removal of leadHxmtaminated soiL and restoration ofthe refotnoed 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. Siva S. Jampana-at (402) 733-1188. General questions about the Omaha Lead Site cleanup can be 

directed to the EPA PubUc Infomiation Centers at (402) 731 -3045 (SouthOmaha office) or (402) 991-9383 (North Omaha office). 

Property Access Granted By: 

(Please Print Name) . 

Property Owner Signature: 

(Signature) (Date) 

PROPERTY INFORMATION 

'Tt I (To be completed by reddcnt aiul/or properly owner — please print) 

RESIDENT NAME: .S U-orJ/Qc^ \)o.\juc=}tejr^OQ [ Renter er 

RESIDENT

rr^?^- .s i<^ n...L.!^^./.^i^i 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS: 

Q<^C. s 1 ^ ,<rh. 

OWNER'S TELEPHONE NUMBER-HOME: l^Oi ^ nf S I'Oc ^ lCS> WORK: 

J 1 •: 

AOE OF HOME?•.l!2J : _ YEARS. HOW LONO HAVE YOU LIVED HERE? i£. YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDINQ SINCE 1978? YES NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: L y NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 8 HOURS OR MORE PER WEEK: 

COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOOS. ENTRY GATES, ETC.) 

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

are pursuant to Sectian 104 ofCERCLA, 42 U.S.C. 9604. EPA's right ofaccess to the property is provided for in Section 104(e) of 

CERCLA, 42 U.S. C 9605(e), which provides entry for "detennining die need for response, or choosing or taking any response action 

under this title, or otherwise enfcrcing the provisions ofthe title." 

8080 Ward Parkway, Suite 406 2605 N. 24*" Street, Suite 308 4242 Medical Drive, Suite 4260 

KansasCity, MO64114 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)604-1005 Fax: (210) 579.6577 
3 

ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: Yf^^ ^- ^ ^ ^ Date: ^-^-'-^ ^ 

Phone: f'^Z-a^^^ ^ BVID: ^(^^ ^ 

Item NO Plants &. Permanent Landscaping To Remain In Place 

On Map Description & Location 

Mou t qftEBt^ (h^hi ^ / 

9­

(£i 'g.AA^ So^l 

Pre-Existing Condition of Structures \JoT^: Hx J 

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

Item NO Description & Location 

On Map 

Property Owner Prudent Employee Jh 7?/V^ 

Signature 

8080 Ward Parlcway, Suite 405 2505 N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraslca 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 
JIES, INC. 

AS - BUILT DRAWING 

OLS#:10643 

Date Excavated: 07/02/2009 OMAHA LEAD SUPERFUND SITE USEPA Signed-OfTDate: 

Name: \/iM\t- €lui . Omaha Lead Site Date: Nonh Anow 

Address: U</)L. i.'~l 5 sr. Site Sketch Time: * ^•^/ 

Phone: 

Team v\A\\fc fiv\M ^,b' BVID# JCtSi XRF Code 7g g 

Sample Number Lead Conoentratton ConfimfaVon Sample 

^to 83­

/?WOSrPXA-/At>U^ fcs •^^ £^ 

gt>ZS^PxA-/oy^ 3 t^*^zi'^^ ppm No * ^ Oles n No D ­ ('.hyes • ppm No ra' Yes • Kk> D 

j> I f ^, 

EA = 281 PPM % SCRAPE (-1") 

CONTRAa #: EP - R7-07-06 T0#1 PRUDENT TECHNOLOGIES, INC. 
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4.50fc s 15 Sh 

http://douglasne.mapping-online.coni/assessdoc/Photos/33/R05457900000001.ipg 6/12/2009 
Print Preview Page 1 ot2 

# 0 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

Owner 

City 

Owner 

State 

Owner 

\zip 

0545790000 

VANDERPOOL 

SHONNA M 

4506 S 15 ST 

OMAHA 

68107 

4506 S 15 ST 

OMAHA 

NE 

68107 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

03-14-13 

BEGLEY PARK 

8 

2 

50X126 

http://webapps.dotcomnn.org:8080/TreasTax/faces/pages/taxinfo.jsp? 

parc=0545790000 

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

accountno=R0545790000 

Disclaimer: Map and parcel data are believed to be accurate, but accuracy is not 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas%20Cou... 6/11/2009 

2 
• • 

Page 1 of2 

• YOUR TICKET NUMBER IS 2298590. 

Original Call Date: 6/19/09 Time: 9:36 am Op: SIVA18967 

Work to Begin Date: 6/23/09 Time: 10:15 am 

State: NE County: DOUGLAS Place: OMAHA 

Address: 4506 Street: S 15TH ST 

Twp: 14N Rng: 13E Sect-Qtr: 03-NE-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 


.: F7^ ALL CLEARS TO (402)733 1883 


: UNSURE COMMENTS 


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 DIGITEL LEVEL3 MUD02 OMAHACOF OPPDGPR6 PAETEC 


QLNNEIF 


Service Area Contact Phone Nuniber 

Utility 

Type 

CXCATV COX COMMUNICATIONS, 

INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

DIGITEL LIGHTCORE NA 

Day: 

Alt: 

8665624349 

8008509048 

Emerg 8665624349 

LEVELS LEVELS COMMUNICATIONS, 

LLC NA 

Day: 

Alt: 

Emerg 

8773668344 

8773668344 

MUD02 METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 

Alt: 

4025047823 
• • « 

Page 2 of2 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHATRAFFIC.SEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR6 OMAHA PUBLIC POWER 

DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

PAETEC PAETEC COMMUNICATIONS NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

QLNNEIF QWEST LOCAL NETWORK NA 

Day:

Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 
# 

ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

Site Safety Hazard Analysis 

Address: ^^C , ^.y < Ex. 

Crew: Bf. 

Date: C^'lSrO^ 

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 

Cxew Forjeman 

Condition 

c^z ^ 

i>W*<»ei 

•^CV^V^MI 

X>4 . 

n/^ 

HC« / 

^ ^ 

/>oe^t. 

-f^A.1^ 

/ih ^ 

^ ^ 

A>y» 

/i-AOCorrective 

Hazards Action 

yc> ^ A4-n»/*»c ^ J 

/lie - fifCJ^ 

/•**J loc^ ^ 

^4 ^ U^ r 

ln4-yJ hcafi ^ 

Site Safety Officer 

8080 Ward Parkway, Suite 405 2505 N. 24" Street, Suite 308 4242 Medica! Drive, Soite 725C 

KansasCity. MO 641U Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402) 504-1004 Phone: (210) 822-9588 

Pav i9.\f.\ •xfK^.-yau Fax: (402) 504-1005 Fax: (210)579-6577