TRANSMITTAL of OMAHA LEAD STIE 

SOIL REMEDIATION FILE FOLDER 

SAID#:_g2il Date: i 4 4 ^ 

Address: 1^??, ^ 3 S faf 

Remediation Contractor: ^y^alUl i "V^LIA I ^NfL. Year: ^0 1 0 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

EPA-provided property sketch 

Signed Access Agreement for subject property 

Signed Access .^eement(s) for adjacent 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 meetmg ROD cleanup criteria 

Utility clearances 

Property information from Douglas County Assessor's Of&ce 

Signature Date 

30260727 iilil 

Superfund 
Find Record 

Backfill: 

Sample Area: 5344 -

Owner: 

n Owner Occupied 

Owner Name: 

|BUESCHER BRIAN 

Owner Addressi: 

Owner AddressZ: 

|1322S35AVE 

City: 

jOMAHA 

Remediation Query I Lead Remaining Query I

 1322 S 35 AV 

Resident: 

Resident Name: 

JKOHN JEFFREY T 

Property Address: 

J1322S35AV 

Zip Code: 

|68105 

Resident Phone 

State: Zip Code: 

1 

|NE |68105 

Owner Phone: Alternate Phone: 

'1 

 Property Damage Query 

Contract: 

Contractor: 

jPRUDEI^fT2009_S 

Contract Option 

jOPnON 1 

Assessment: 

Qualifying Group 

j400 

j 674.4 
PROPERTY SUMMARY 

Date: ///15/2010 | Omaha Lead Site Remedial Action Contract # EP-R7-07-06 T0#1 | MPQth of; \\j 0\f i-m 

Property Address: 1322 S 35 AVE 

A. EXECUTIVE SUMMARY 

A.l Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl = 55 PPM @ 6"; F2 = 102 PPM @ 6"; DZ = 54 PPM @ 12"; EA = 96 PPM @ SCRAPE (-1") 

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 cUp/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Built sketch -. 

i) Shall include fmal 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 (ifany 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 ofareas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES, INC. 
' TECHNOLOGIES, EMC. 

Property #: 5'^'^'^ 

Date/Time: 

Quads Excavated: r* ,pZ,PZ. 

EPA Property Close Out 

Property Address: \'3'2-7. $ - "?> A-"^ 

Owner's Name: 6j-\rci,v^ ^u€^cW* <" 

Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes No 

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

l / 

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

y 

Grading Sod and Vegetation Yes No 

1. Does the grading around the perimeter of the house in excavated areas generally slope away - / from Llie house? 

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

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

day time period) y 

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

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

6. Was the propert>' graded such tliat water will not pool on the property? / 

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

Gates, Fences and Retaining Walls Yes No 

1. Do gates open and close freely? (Ifapplicable) / 

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

3. Was damage lo gales or fences avoided? (If applicable) / 

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

Foundation, Siding and Gutters Yes No 

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

2. Was damage lo die foundation avoided? / 

3. Was damage lo windows avoided? 

/ 

4. Was damage to windows or door screens avoided? • / 

5, Was damage to downspouts or downspout extensions avoided? 

/ 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to drivewa\' surfaces avoided? i^ 

2. Was damage to walkway surfaces avoided? / 
j^2 - ^ 35 Av 

Owners comments: 

Inspection notes: 

p«"^ y - I I <i. ^ 

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

EPA Representative jQc*n j^iu^ Date: if i t jib 
•f'T" ^ •F"^"'i\i- •'•"••fp ^-jf«3ii^i^j3­ ^^ ZZ/flm ^m?^yr^iyProperty 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, ifany. 

Propert ID: 

Propert;' Address: j^g Q 5 . 3S" ^ /j ^ 

Owner: DA^ ^ -fSl/^s^/"" 

Phone: 4Po>-3^lb-?y73 

Restoration Items in Question: 

Item: 

^A'U^- O Glh^y^J'— ~^ ^icP^f-c^'^ fi^yiiyiiJ>'t-/yi fe.yY^oyy^ 

Item: 

Item: 

3 0 Ac ^ ^ l.y ^ '^J ^ d^^cjj/r p Zj- dre< j ^ ^ S/^yu.)r<~- ^.^ . 

Item: 

Item: 

Item: 

Required corrections to complete the property:. 

czy^ c--^^ ^^-^ ky/p>Zi 

lifi 

BTagrf56 restoration is com

-— r'^^ l^zy^AyJ:y^ "f:^-. D I do lot agree restoration is completed at (noted deficiencie ienciess above)

/y^^-0^ 

Owner'»Signature Date 
NO. 

• « 

TBCHNOLOGEES, INC. 

fiudwti Technoiogies, Inc. (Ptudao) is undo: concnox \vilh thit U. S, Enviroomental Proucticn Afjmcy (HPA) tu clew up IcadcoDiabiiiiinted soib a ^ number otpfopeftien iocdted in Qi tuha, Nebraska, iocluding the pcopciiy locitted at | 

[ 3 p 3- ^ . '3 C^A ^ . , The EPAregui sts yourpenmsnitm to flll<wPnadeat to pafonn a soil clearmp at this 

property to removb lea<l<aiitaiiiiiiatod sed. By sigoing th s fonn. Uie propeity owner giauis pqroussion to Prudent to perform 

aetfvjtici reltited to the cteaoap meludiog soil sampling, re moval of Iea<i-ooja[amii>at«d soil, and restoration of flie reforeneed property. 

Ifyou hav« any qoestiona about the soil clc&n.up pUansd I v your property, please contact Pruiieni's Ailmimsiroiivu Clcfk for the 

Omaha Lead Site aleanj^^ Ma. Swa S. J.'unpiii'm-M (402) nvnXH . General questions about the Omaha I^ead Site cletunip can be 

directed to the EPA Public In&tmntioh Ccntds et (402) 7' 1-3043 (Somh Oniaha oflfioe) or (402) 991-95S3 ^oit h Omaha office). 

Property Access Granted By j?ri&^ \?Lj^eUy 

(PlMie Print Name) 

Property Ownar Sigoaiure: //>'i?0-6 ^ 

PROPERTY INFORMATION 

(To be completed by rotdi s t And/or iproperty owner - please print) 

RESIDENT NAME: 3rc^/i ^ Dt^^d^ Renter 

RESIDENT ADDRESS: 

J . i3»3*^ . 3>5r Au^^ 6,/vJ^ A/E 6>f/^S' 

IP RENTAL, PROPERTY OWNED BY: 

ER'S MAILING ADDRESS;, ^ ^ . xi . • « i % ^ 

OWNER'S TELEPHONE NUMBER - HOME: t^O& i 3*{(if^>7' S WORK: 

lOd 2^ AGE Of HOME?: YEARS. HOW LONG HAVE YOU LIVED HERE? YEARS. 

HAS Ti^E EXTERK3R BEEN PAINTED OR COVEREotwiTH SIDING SINCE 1878? >A ^ ^.YES NO 

INUMB^R OF OCCUPANTS UNDER 7 YEARS OLD: l'>^ NUMBER OF OCCUPANTS 7 YEARS OLO AND OLDER 

NUMBER OF CHILDREN UNDER 7 YEARS OLO WHC i PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

I cbMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOIbS, ENTRY QATES. ETC.) / W. 

lun^Olil T Y FOR ENVIRONMENTAL RESPONSE ACTI< JNS: The activiiies to be implemenled by EPA under thjs agrecsneot 

i^visu i a to Section 104 ofCERCLA, 42 U.S.C. 9604. EPJ VS li ^ of access to ihc ptoperty is providecl Cor in SeeHion 104<«> of 

dERCLA, 42 U.S. C 9€0S{e), vvbit^ provides amy for "detentiining die tieed for response, or (ihooging or taking any response Action 

ujoder tbis title, or otherwise enforcing AJS provisions of the titl 

8080 Wlr^iParkw^y, Suite 405 

Kansas <C|ty,'M0 61*-(l4 

Phone: (Sifi) 363-3703 

Pax: (81J€)|i6S-3707 

560O S 10" street 

Omaha, I Nebraska 6S107 

Phone: (402) 733 -1188 

Fax: (< 02) 733-1883 

4242 Medical Drive, Suite 42S0 

San Antonif>, TX 78229 

Phone: (210)822-9588 

Fax; (210) 579-6577 
• • 

NO. 1502 P. 3/ 3 

NOV. 4. 2009 12;03PM 

ENVIRONMENTAL * 

COIVSTRUCTION 

SERVICES 

Propertjy Status Form 

Addreii Date:/0»/^? 

PhonI : \HOV 34(O- ^?y3 BVID: 

ItemNl Plaats «fe Permanent Landscaping To Remaia In Place 

OnMak Description & Location L>d \v \ ^ u< 

i_*/-^ ^''^^ '^^ ^ 

Ciw^Vi ^ TH) 

Conditioa of Structures 

1 your Basement have a history of leaking X 

Item NO Description & Location 

On Map A M y " \ tv^/t-fif. 

^ -H^ ^p/.v.k)«/- s^^^ r f \ 

o^ly <^J ^^ ^ ^ ^ frt&^y^f^' 

Property Owner Pmdent Employee 

A B^ignati; Signature: 

I iOSO Ward P^^ \ py, Surtp 405 fleOO SIO* Street 4242 McdkMl Drive, Suito 42S0 

Kansas Ctty, MO >4n>; Omjha, Nebraska 68107 San Aotonio, TX 78229 

: >hon6: (816) 5703, Phene: (402)733-1188 Phone: (210)8224588 

=aj<: (iB16I) 383'37 7 Fan: (402)733-1883 Fax: (210) 579-8577 
1^ UHNOl.OUrF.S. INC. 

AS - BUILT DRAWING 

Ol ,S«:53J4 

Oiitc Kxiiivatid: 1 l/lf./2(l(>!) 

OMAHA LEAD SUPERFUND SITE rsKl'.VSignecl-OtTniito: 

Omaha Lead Site 46904.783-01 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENT TECHNOLOGIES, INC. 
C'tm-aha Leai3 Site •lt9!:^.7J(5-!; I 
I "7 ? ^ 1^: A'' 
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Douglas County-Omaha, NE 

Parcel ID 0702470000 Addition BOULEVARD TERRACE 

Owner 

Name 

BUESCHER 

BRIAN Block 2 

Property

Address

 1322S35 

 AV Lot e 

City OMAHA Legal 1 46X123.2 

Zip 68105 Legal 2 

Owner 

Address Legal 3 

Owner 

Address 

2 

1322S35 

AVE Legal 4 

Owner 

City OMAHA Acres 

0.13 

Owner 

State NE 

Treasurer 

Website 

Link 

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

parc=0702470000 

Assessor http://douglasne.mappingWebsite online.com/DouglasCoNe/static/accountinfo.jsp? 

Link accountno=R0702470000 

Sec-TwnRng 
Pagel of2 

"> 

E ii 

• YOUR TICKET NUMBER IS 2400729. 

Original Call Date: 11/05/09

Work to Begin Date: 11/09/09

 Time.:

 Time:

 9:15 am 

 9:45 am 

Op: SIVA18967 

State: NE 

Address: 1322 

County: DOUGLAS 

Street: S 35TH AVE 

Place: OMAHA 

Twp: 15N

Twp:

 Rng: 13E

 Rng:

 Sect-Qtr: 28-NW 

 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)733-1.188 


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 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Nuniber Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day; 4029340469 

 Alt: 4029340469 

Emer?: 4029329757 

LEVEL3 LEVEL3 COMMUNICATIONS, LLC NA 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RICH/TRAFFIC

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 
ENViRONMEWTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

CD Sste Safety Hazard Analysis 

i^iyXZAddress: /JZ Z S i J S 

Crew: Bf.Mi 

Date: / / ^ ^ 5 

Corrective 

Item Condition Hazards Action 

Overhead Lines ^c<>cP /r7cy//-t/)/<& 

Gas Line hu^-tsJ. /l»*v^ ./o'c^g.'i-^ 

Water Line + -h 

Sewer Line .^Critx J A/9^ J /Che:..*-/-^ 

Septic / Leech 

field / u ^ 

Propane/Butane /t^'^ 

Sidewajk y * ^ t^S ^ /p/fujg. ^ 

Foundation '/~'^~ii 

Retaining Walls y y ^ 

Fences ^ C~r ^ 

Trees/ Bushes /^(ly f 

Structures -P^t. 

Drivewav A/X-- £JiiS - ^ A,>/-.,^c^»^ 

Sprinkler System Ayyi 

Other 

Crew F Site Safety Officer 

8080 Ward Parkway. Suite 405 2505 N. 24"' Street, Suite 308 4242 Wedicai uri'/e. Suite 7250 

KsnsasCity, MO 64114 Oniaha, NebrasKa 68110 San Antonio, TX 78223 

Phone: (816) 363-3703 Phone: (402) 504-1004 Phone: (210) 822-9686 • Csv linos cr\/...ie\r,c 

m22