TEdHNOLoCI^S. fNC:. 

PROPERTY SUMMARY SHEET 

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

Said: 27707 Property Address: 2617 BURDETTE ST 

Executive Summary: 

Issues Encountered: None 

Issues Resolved: None 

Unique Findings: 

Other Relevant Information: 

Confirmation sampling data/results: B2= 359 PPM @ 2"; EA=150 PPM @Scrape. 

Attachments : 

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-excavation agreement details (if any are made with the Property owner) V 

Pre-Excavation digital video clip V 

Sampling data sheet V 

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 

Signed form verifying satisfactory restoration V 

Other Documents: 

30 day SOD warranty pictures y 

Utility clearances document V 

Property information from Douglas County Assessor's office. V 

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

Site safety hazard analysis document v\/ith pictures. V 

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

Prudent Representative: \y ^ EPA Acceptance: 

30263035 

Date: 

\r ...,yh 

Superfund 

Prudent Technologies, Inc. | 2505 N. 24TH Street, Suite 308 |0maha, NE 68110 USA | Tel. 402.504.1004 j 

Fax: 402.504.1005 

Environmental Engineerings Services | Remediation | Construction 
27707 

Omah Exterior Paint North Arrow Owne a Lead Site r NJame: BERNARD J MORELLO • Gocxl Site Sketch Ad d ress: 2617 BURDETTE ST • Poor 

Phone : H: 402-342-2820 W: r ^ Not paint 

Sample Number Lead 

Concentration 

Sample 

Collected LAB 

Firm:

Samples Collected 

 FPfi. Ffe P O 

RYASCPXA-27707

RYBSCPXA-27707

RYCSCPXA-27707

RYDSCPXA-27707

 Fl 

 F2 

 Bl 

 82 

2& 0 

1^2. 2(i?C>

^3 8

ppm 

ppm 

 ppm 

 ppm 

D 

D 

D 

D 

Date:

Time:

 5 jZWl ots> 

 3-S g p^-

Samples Analyzed 

RDZQCr)(A-27707

' nCgCCPiXA 27707

 &Z 

 GZ 

ppm 

ppm a 

D 

D 

XRF Unit: QO Z

Date 5 '3J ­

 Book: J.ft(o 

 O O 

RPZOGr)(A^27707 P£ ppm D Time: JIJ ^ 

Numbe Staff: A15W r of Samples = | U 

Legend: F1 = Front Lefl, F2 = Front Right. B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

^^f M/1 

HAV.26.2a05 

\ 

.2/ ^ 

.u 

^17 

5+ 

f 2 \ f' l 

^ ­

161 ?B^ 

• : ' 

- V - wm • ft- ' "h ' 

%HDi^^ ^ Rev 4 W6141.012.1 
770^ PROPERTY ACCESS FORM 

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

(EPA) to clean up lead-contaminated soiLs at a numbei' of properties located in Omaha. Nebraska, including the 

property located at '2.^/' ^ &U.^O^^fTG. S f The EPA requests your permission to allow Prudent to 

perform a soil cleanup at this 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 leadcontaminated soil, and restoration of the referenced properly. 

If you 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). 

If your property has a gravel or dirt driveways or parlving areas then the removal and replacement of the soil 

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

l^roi'erly Aijtes.s Granted 

(Please Print Name) 

1./? / • /

Property Owner Signature: yi (Signature) (Dale) 

Propertv Accessed by: v "^ , f i , ) ,- i i ;' (Prudent Employee Name) l.:lA-U-i_»-Vi-_: .KvL.kALt;.t::L.t.-.:L..-. 

PROPERTY INFORMATION (TobTo bee complete com pie d by jresident and/pr prqpert^f owner ­ please print)

1 RESIDENT NAME: O L U Li 1/ / / 1 l\ A \ \ IIJ } Owner Renter 

2. IF RENTAL, PROPERTY OWNED BY: 

3. OWNER'S MAILING ADDRESS; 

4. OWNER'S TELEPHONE NUMBER - HOME: _J J Z WORK: _L

5. TENANT'S TELEPHONE NUMBER - HOME: ( ) WORK: J _ 

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

7. HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? YES NO 

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

9. # OF CHILDREN UNDER AGE OF 7 WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

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

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to 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 "determining the need for 

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

title." 

Prudent Technologies Inc. 5600 S. 10'" St. Omaha, NE 68107, 

402.733.1188 (Office) 402.733.1883 (Fax) 
TECHNOLOGIES, INC. 

ENVIRONMENTAL & 

CONSTRUCTION 

SERVICES 

Address 

: mHllrdi ^ Property Stat, FOTM ^^^^ ^J^^j^ ^ 

NOTICE TO BE GIVEN TO): (^NER mitiERVJ TENANT BOTH f^^'^^ VdcMItt 

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:/» i 

Momo 1102 3il2 i^to 

WILL NEIGHBORING PROPERTY NEED TO BE USED FOR ACCESS? YES NO 


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


WAS AN ACCESS FORM OBTAINED FROM THE NEIGHBOR? YES NO 


/ILL A FENCE NEED TO BE TAKEN DOWN TO OBTAIN ACCESS? YES NO 
 \y 

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


IS THERE PRE-EXISTING FACIAL DAMAGE TO THE PROPERTY AND IF SO PLEASE PROVIDED LOCATION AND DESCRIPTION 

OF SUCH: YES NO SPECIFY: 

IS THERE PRE-EXISTING CONCRETE DAMAGE TO THE PROPERTY AND IF SO PLEASE PROVIDED LOCATION AND 

DESCRIPTION OF SUCH: YES NO SPECIFY: 

Property Owner Prudent Emp 

Signature: Signature; 

DATE: 

\tii Prudent Technologies Inc. 5600 S. 10"' St. Omaha, NE 68107, 

402.733.1188 (Office) 402.733.1883 (Fax) 
ENVIRONMENTAL* 

CONSTRUCTION 

TECHNOLOCIES SERVICES , INC. 

« ^ Property Inspection Form i i 

Address: Mll ' $Utditt f S h T>^te:^/23/H 

Phone: M0^^3^22-? ^ BVID: Jl' 

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

and description of damage: 

Concrete Damage: 

Does Homeowner want sod replaced in all areas? YES NO If NO 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: 

a 

ANY OTHER DAMAGE OR REQUESTS: 

Property Owner Prudent Employee 

Signature: Signature: 

DATE: DATE: 
TECHNOLOGIES, INC. 

ENVIRONMENTAL & 

CONSTRUCTION 

SERVICES 

XRF CLEARANCE SHEET 

PROPERTY .ADDRESS: 2-^7 /Sv/rt/^He. 

/ 

PROPERTY ID: 35/(5y 

MAP HAS BEEN REVIEWED AND NO MISSED AREAS EXIST: /¥ES , ..••' NO 

WAS CONTAMINATION LEFT BEHIND? IF YES WHERE AND DIMENSIONS: iy 

CREW: \COAy\--/ 

XRF TECH:/J^q,aA'"' 

DATE DEPTH QUADRANT 

Fl 

F2 

READING 

READINGS D05SI=lMENTED 

LOGBOOK? YES NO •1/i^ ^ • " 

Bl 

B2 

GARDEN 

•••« 7 

FLAYZONE 

ly 5 EASEMENT ig<3 

——' — 
# 

JliiMi 

•reCHNOLOGIES, INC. ^•^EPA 

EFA Property Close Out 

Property #:^770 7 Property Address^ 2 <©'"7 6K«st.eHe 'J^ : 

Date/Time: Owner's Name: ^<?r vva «><^ Ha\^\\o 

Quads Excavated: ^2 _ Contractor Group: Prudent Technologies, inc.. 

Excavation General Ves No 

I. If necessary, were Oie correct quadrant(s) excavated and restored? / 

2. If necessar\', were the correct areas of drip zone excavated and restored? / 

Grading Sod amd Vegetation Yes No 

• 1. Does the grading around tlie perimeter of the house in excavated area.s generally slope away / from llie house? 

2. Has sod been laid in all areas tlial were excavated? y 

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

day time period) / 

4. Are sodded areas generally fimi and evenly graded? / 

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

time period) y 

6. Was tlie. propeity graded such tliat 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 

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

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

3. Was daraage lo gates or fences avoided? (Tf applicable) 

y 

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

/ 

Foimnidfttion, Siding and Gutters Yes No 

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

2. Wfis damage to Uie foundation avoided? y 

3. Was damage to v\ando\vs avoided? y 

4. Was damage t;o windows or door screens avoided? y 

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

Sidewalks and Driveways (Comcrete) Yes No 

1. Was damage to dJiveway surfaces avoided? 

~7\ 

2. Was damage to walltway surfaces avoided? 

y 
i 

# 

j Owissrs c&mmsni&i. 

Inspectiioo iTiotes:: 

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

EPA Represent3tr:/-e Date: 9 lit hi 
rECHNOLOGlES, tNC. 

AS - BUILT DRAWING 

OLS#27707 

Date E-vcavated: 07/14/20J1 OMAHA LEAD SUPERFUND SITE .Sampled By: Issac 

27707 

Exterior Paint North Arrow Owner Name: BERNAI^D J MORELLO Omah a Lea d Site • Good Address: 26U BURDETTE ST Site Sketch • Poor Phone:. H: 402-342-2820 W: \ [3 ' Not paint 

Sample Number Lead Sample LA8 Samples Collected 

Concentration Collected Fimi: Tpg. To .0 ^ 

RyASCPXA-27707 Fl 2& 0 ppm D Date: _ S]Z<^1 C'C^ 

RY8SCPXA-27707 F2 i5 1 ppm D Time: S' Srt p)-.-­

RYCSCP)CA-27707 Bl 2 (f O ppm D Samples Analyzed RYDSCPXA-2770r B2 ^•^ S ppm D 

ISO2OGPXA"27707 • -BZ ppm D n XRF Unit: QO Z Book: Ifii n 

•nCZSCPXiA 3770;^ -J3Z ppm n [Tate: D 5-3'-g^-^ -Pg ppm a Time: D rtn Staff: Numljer of Samples = l i A»5W 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right D2 = Drip Zone, G2 = Garden, PZ = Play 

All quadrants ara at viewed from the sliest, facing property 

fim ^ 

ENTEEED 

.H0.2.S.28Oa., 

...s.t .'..fe ^ M 32 = 359??^3'6--2" 

^ -

ItM'/ 

^ • 

Z3<^ 757 

,.-. = :53??'.:'-a;SCR/'iPZ 

t­

~v^"ir^ 

h.iHot^H i '* 

CONTRACT #: EP-S7-10-05 PRUDENT TECHNOLOGIES, INC. 
Sample M b P^ Calls SMiewaft Repair 

^ Sample Area: 27707 - 2617 BURDETTE 

Sample Date • Quadrant H Paramete . >KF Re ­ :<RF Res » Exc ­r Marker Place ­ Lead Remainin » Ins » Sampled B -t QA Coninnec » Lab_Res 

7/14/2011 B2 LEAD 359 mgdcg 2 D ISSAC N-'A 

7.-U.'2011E1 LEAD 150 m.g.'kg 1 L) L3 ISSAC fi'A 

* LEAD mg'kg 0 • , • fi'A 

Record: M Search 
Sampie M b caNs SideMaft 1 > Sample Area: 27707 - 2617 BURDETTE ST 

Lab_Resul ^ Lab Result Unit' » . _ Rerrrarks h 

__ 0 rngkltg 

0 mgi'kg 

* 0 ms'ltg 

Recorit M Search -IiiL 
%iEP/k 

This agifeeineciit doeainenlis the campbtion; of rewiovaJ activities performed on tfie beJo^A' fis,ted ptr-opeity. 

The pro-pierty owner's sigiaature irxficates thait the-ptopeiity ©.wtier is satisfied witlti the restoraticMs of tfae 

stLbjecJ. pirepert}}:, aradi tliat no istems are tn. c|uestton,, nom, OF ait any time in the ftiKitFe, exciudifig aiiy 

remaiming warranty (.30 days total!) excep:t those i,liein.s, listed betow, if any. 

IPiroperJj '"^ 2llv~l / 

Property AddB»ss: ^^ 7 iSi/fidl•Its sr 

Owner: !k£4JAgJ> M^elb 

Fhooe: 7^.^'^f^ 

RestoraSon: Itesns in Questton: 

ItervK 

Eiem: 

RenK 

iienr. 

Iftetm: 

Reqatired corsFectk>ns to Cfym^ie the |pgrop«rty: 

Ui4 t agree Fes4ofatfon is compteted. 

I \ do not. ag#ee restoration rs completed st (rtoted deficierieies above) 

Owmer'^s Sigisaittr.re y / / Date ' 

/ 

I

http://www.dhon.or|jMTintemet/DHONNoticeCreation/MessageText.. 

Create Another Ticket Back to Irth Internet Send Email 

YOUR nCKE T NUMBER IS 2792140. 

Original Call Date: 7/11/11 Time: 8:37 am Op: ASHLEIGH18967 


Work to Begin Date: 7/13/11 Time: 9:00 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2617 Street: BURDETTE ST 


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


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: LEAD SOIL REMEDIATION PROJECT 


Location of Work: LOCATE ENTIRE PROPERTY 


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


: UNSURE CORNERS 


Company : 

Contact Name: 

PRUDENT TECHNOLOGIES 

ASHLEIGH ANIKPUTA Phone: (402)733-1188 

Work Being Done For: EPA 

Depth of Excavation: 6FT Corner Lot; 

Involves Tunneling or Horizontal Boring : 

CXCATV MUDOl OMAHACOF 0PPDGPR5 

N Front: Y

N Explosives: N 

QLNNEIC 

 Rear: 

Utility Service Area Contact Phone Number Type 

COX Day: 4029340469 

HEIDI COX CXCATV COMMUNICATIONS, Alt: 4029340469 COMMUNICATIONS INC Emerg: 4029329757 

Day: 4025047823 

METROPOLITAN MUDOl SANDY MUD Alt: UTILITIES DISTRICT 

Emerg: 

Day: 4024447197 


CITY OF OMAHA- RICH/TRAFFIC OMAHACOF Alt: 4024446725 TRAFFICSEWER OMAHA 

Emerg: 4024445160 


Day: 4067289343 


OMAHA PUBLIC 0PPDGPR5 ELM LOCATING Alt: 4062071494 POWER DISTRICT 

Emerg: 8887289343 


Day: 4067289343 
 QWEST LOCAL QLNNEIC NETWORK ELM LOCATING Alt: 4062071494 


lof2 7/11/2011 8:38 AM 

N 261

7 BURDETTE ST 

A 

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