TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SATO#: 9j/^nf. Date: lj\qo ^ 

Address: ^ / 5> pnpf^oilZ. A ^ 

RemediationConHactor: ft..p..,^ %,A. Tonr^ Year: . ?^(?9 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

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Video of property (DVD^ 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access Agreement(s) for adja^ient property 

Restoration Agreement 

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

Confirmation data 

Q^ 

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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 information from Douglas County Assessor's Office 

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Signature 

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30054248 

MiHinMi 

Superfund 
FROFEBTY SUMMARY 

Date; 9/15/2009 | Omaha Lead Site Remedial Action Contract ft EP-R7-07-06 TO#l | Montli of: August 

Property Address: 612 POPPLETON AV 

A. EXECUTIVE SUMMARY 

A l Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A J Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl = 291 PPM @ 13"; Bl = 200 PPM @ 13"; 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 sketchi) Shall include final lead levels v) Legend 

ii) Contamination left behind areas vi) Contractor identification 

iii) Property address vii) Date 

iv) BVID number 

7) Odier 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. 

TECHNOLOGIES, INC. 
Find Record Remediation Query j Lead Remaining Query j Property [>amage Query 

Badcfill: 

Sampie Area: 21006 - 612 POPPLETON AV 

Owner: 

• Owner Oocupied 

Owner Name: 

j FERRAGim RICHARD 

Owner Addressl: 

Owner Address2: 

|614 POPPLETON AVE 

Qty: State: Zip Code: 

jOMAHA [N E |6810 8 

Owner Phone: Alternate Phone: 

I 

Resident: 

Resident Name: 

I . 

Property Address: 

|612 POPPLETON AV 

Zip Code: 

|68108 

Resident Phone 

I 

Contract: 

Contractor: 

|PRUDENT2009_S 

Contract Option 

BASE 

Assessment: 

Qualifying Group 

poo 

Assessment Max XRF Value: 

r 405.58 
I1CHN0L0GIES,INC 

Property*: 3L^^0{f 

Date/Time: ^-Z)' ^ 

Quads Excavated: 0>)/p-l 

MEPA 

EPA Property Close Out 

Property Address: (»»0. foffU ^ ^ 

Owner's Name: ^»cVcw-o*. F c*ra cx<y i 

Contractor Group Prudent Technologies 

Excavation General Yes No 

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

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

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? y 

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

day time period) y 

4. Are sodded areas generally firm and evenly graded? y 

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

time period) y 

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

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

Gates, Fences and Retaining Walls Yes No 

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

y 

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) 

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 foundation avoided? y 

3. Was damage 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 No 

1. Was damage to driveway surfaces avoided? 

y 

2. Was damage to walkway surfaces avoided? 

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 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: /•* i <-j POPPW hvN A^^u; 

Owner: ' p y c V f elK.^<\r.o-V , 

Phone: Q ^ C r^q r C^/^^^ 

Restoration ttems In Question: 

Item: 

Item: 

Hem: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

^-Tkagre e restoration is completed. 

L J I do not agree restoration is completed at (noted deficiencies above) 

SQADys^^^: ^ ^ - ]^-^ ^ 

Owner's Signature Date 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protectian Agency (EPA) to clean up leadcontaminated soils at a number ofproperties located in Omaha, Nebiaska, including the property located at 

io 149^ ^'^PP f£'^0?^ ' ^ ^ VSK requests your permission to allow Prudent to perfonn a soil cleanup at this 

property ^ retiiove (eid^coiitafiunated soil. By signing this form, the property owner grants pemiission to Prudent to perform 

activities related to the cleaniq) 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 cleaniy. Ms. Siva S Jampana-at (402) 733-1188. OeiierBl questions about the Omaha Lead Site cleanup can be 

directed to the EPA Public Information Centers at (402) 731 -3045 (South Omaha ofBce) or (402) 991-9583 (North Omaha office). 

Property Access Granted By: R \ C Vl ^ V ^Q.C^/^GC.nr < 

(Please Print Naide) 

Property Owner Signature: m^ 

PROPERTY INFORIMATION 

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

RESIDENT NAME: Renter 

RESIDENT ADDRESS: ^_ y \^ , ^ , t 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 6/Jlp^pp><4^<^ 

OWNER'S TELEPHONE NUMBER - HOMEt(,(fl : . ^W^i^9l5.K. 

2.(5 AOE OF HOME?: lo O YEARS. HOW LONO HAVE YOU LIVED HERE? YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WrrH SIDING SINCE 1978 YES NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLO: . NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER 

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

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

AUU/^?vCL. 7 wc Q/p 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activifies to'be in^dnented by EPA under this agreement 

are pursuant to Section 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 "determining the need forresponse, or choosing or taking any response action 

uiuler this title, or otherwise enforcing the provisions ofthe title." 

TOes to'bB ir^emented by 1 

8080 Ward Parkway, Suite 405 2505 N. 24*^ Street, Suite 308 4242 Medical Drive, Suite 4260 

KansasCity, MO64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 

Fax: (816) 363-3707 ( 

Phone: (402)504-1004, 

Fax: (402)604-1005 ' 

Phone: (210)822-9688 

Fax: (210) 679.«S77 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: Date: L l'2L^ ( o ^ 

Phone: ^VlT^ BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

Pre-Existing Condition of Structures 

DoesyourBasement have a history of leaking? Yes No X 

Item NO Description & Location 

On Map ^Q^ y y 

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yyy y 

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Property Owner Prudent Employee 

Signature: v Signature: 

2 ^ '/VX^yg^rT-l— 

8080 Ward Parkwav. Suite 40S 

2S0S N. 24'^ Street. Suite 308 4242 Medical Drive. Suite 42S0 
% 

rCHNolOniKS. INC 

AS - BUILT DRAWING 

IU.-::.:y.:u(t(: 

OMAHA LEAD SUPERFUND SITE 

21006 

Omaha North Arrow Lead Site Exterior Paint Owner Name: RICHARD FERRAGUTI 

Site Sketch • Good 

AddrBSs: 612 POPPLETON AV DyPoor Phone: H: w. Q ^4ot paint i 

Sample Number Lead Sample Samples Collected LAB Concentration Collected Firm: •mgb Brf /s W 

RYASCPXA-21006 F1 \4r>l^Pom D Date: (^lH^lo^ 

RYDOOPXA-glOOO F2- ppm D Time: 2-'.m 

RyCSCPXA-21006 Bl Di^PPm D Samples Analyzed RYDCGPXA-21006 B2- ppm D D 

RDZSCPXA-ZIOOe BZ- .ppm D D XRF Unit: ^\ \ Book: \j

•WGZ6OPXA-21006 62 - .ppm D Date: U - 3 ?> -nC X 

ftPZOOr'XA 21000 PZ^ n

.ppm D Time: P Mj v l ^ ^

Staff: ^ ^ Number of Samples = jn "Zn ^ ; Q

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Omaha Lead Site 46130 hebXi^f^ \\< 

CONTRAa #: EP - R7-07-06 T0#1 PRUDENTTECHNOLOGIES, INC. 
% 21006 

Omah a Exterior Paint Lead Site hkxihAiTow Owner Name: RICHARD FERRAGUTI 

Site n Good Sketch Acidress: 612 POPPLETON AV n^Poor 

Phone: H? v;^ Q Notpaint 1 

Sample Number 

RYASCPXA-21006

nYDGCPXA--eiOOO

RYCSCPXA-21006

RYDCGPXA-glOOG

RD2.&UPXA-2IOeO

•RCZCCPXA 21006

RPgOOP)(A a 1000

Lead Sample Samples Collected LAB Concentration Colle^fed Firm: j21^__Qd_/5i4«i . 

 F1 -U^OUppm D Date: c^lftfjc H 

 Fg-

K ppm D Time: 2^'. 1^ 

 Bl 

LLIl^PPm D 

Samples Analyzed BS­ ppm D D 

 BZ- ppm D D XRF Unit: "^W Book: U ^ 

6 ^ ppm D D Date: 

 PZ^ ppm D D Time: M 

Staff: ^^o: Number of Samples = 'Z- I ; Q |

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Omaha Lead Site 46130 Q^^{j,itV (\ i 
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 

1943830000 

FERRAGUTI 

RICHARD 

612 

POPPLETON 

AV 

OMAHA 

68108 

614 

POPPLETON 

AVE 

OMAHA 

NE 

68108 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

26-15-13 

PARK WILD ADD 

1 

5 

36X160 

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

parc=1943830000 

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

accountno=R1943830000 

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 = 74 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis alias/dogis/printPreview.asDX?PrintODtData=Douff]as r,nimtv- fi/9S/?nno 
rag e i Ul .^ 

"> 

Create Another Ticket Back to inh Intemet Send Email 

YOUR TICKET NUMBER IS 2309014. 

Original Call Date: 7/02/09 Time: 1:06 pm Op: SIVA18967 

Work to Begin Date: 7/07/09 Time: 1:45 pm 

State: NE UGLAS Place: OMAHA 

Address: 612 Street: POPPLETON AVE 


Twp: 15N Rng: 13E Sect-Qtr: 26-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: SOIL LEAD REMEDIATON PROJECT 


Location of Work: LOCATE ENTIRE PROPERTY 


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


: FAX ALL CLEARS TO (402)733 1883 


: UNSURE CORNERS 


Company : PRUDENT TECHiJOLOGTES 

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 LEVEL3- MUD02 G»lAHACOF OPPDGPR6 QLNNEIF QWESTNE 

Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, DSTC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

LEVEL3 LEVELS COMMUNICATIONS. LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUD02 METROPOLITAN UTILrriES DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4^25047970 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RON

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

httn'/ZwAVW Hllf»Ti nr{t/irt\yin-tf^rrn^frr\lJnKTKfnfir.arr.t^r%*ir^^r\Xnr.r,nr^^'r.....j. n . ^T^T-ir^-w-rr rriri 
Page 2 of2 

OPPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day:

Alt:

 4067289343 

 4062071494 

Emerg: 8887289343 

QLNNEIF QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QWESTNE QWEST LONG DISTANCE 

Day: 8002834237 

Alt: 

Emerg: 8002834237 

httn://www Hhnn nro/irthinti^moi-frMJrwTKj^*:. ,/"< _ jJ ra r 
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ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

Crew: 

Address:

Site Safety Hazard Analysis 

^/2 - /P^^y,^ ^ >$L^. 

& 

Date: 1.2-^'r 

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 

Corrective 

Condition Hazards Action 

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Crew Forejifan Site Safety Officer 

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3080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 7250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

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

Fax: (402)504-1005 Fax: (210) 579-6577 
/

/