TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 28949 DATE: 1/15 

ADDRESS: 2523 MIAMI ST 

REMEDIATION CONTRACTOR: PRUDENTTECHNOLOGIES. INC. YEAR: 201(t 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

m PRE AND POST VIDEO OF PORPERTY (DVD) 

0 EXECUTIVE SUMMARY 

0 EPA-PROVIDED PROPERTY SKETCH 

TZ SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT{S) FOR ADJACENT PROPERTY 

tZi RESTORATION AGREEMENT 

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

(^CONFIRMATION DATA 

m PHOTOGRAPHS 

[p^AS-BUILT SKETCH 

D^SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

DT PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

n DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

[Z UTILITY CLEARANCES 

TZ PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

SIGNATURE DATE 

30218366 

Muni 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2523 MIAMI ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Infomiation: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 190 PPM @ 13"; B2 = 510 PPM @ 13"; EA = 150 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 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 ofareas not meeting Interim ROD cleanup criteria. 

TECHNOLOCIES. INC. 
Find Record i 

Backfill: 

Remediation Query Lead Remaining Query Property Damage Query 

.^J 

Sample Area: 28949 ­ 2523 MIAMI ST 

Owner: User Provided Owner Information Resident: 

n Owner Occupied 

Owner Name: Owner Name: Resident Name: 

!|WYNN MARLA M 

Owner Addressl: 

r ^^ 

Owner Address2: 

|6244 READ ST 

City: 

[OMAHA 

Owner Phone 

State: Zip Code: 

NE J68152-

Alternate Phone: 

Owner Address: 

r 

City: 

I • 

Owner Phone: 

State: Zip Code: 

"i— ) 

Alternate Phone: 

Property Address: 

(2523 MIAMI ST 

ZlpCod^ 

jesnT­ ~ 

Resident Phone 

1(402)571-4676 

Contract: Assessment: 

Contractor: jPRUDENT2010_S Qualifying Group |400 

I 

Contract Option foPTlOIN 2 Assessment Max XRF Value 485.64 
, •, ... -"•'. ;J^'X ; 

TECHNOLOGIES, INC. 

EPA Property Close Out 

Property #: ^^^ ^ Property Address: Z.^Z' ^ <^-i<x.xv^X Sf-. 

Date/Time: Owner's Name; M^i^l,^ COt^^wirx 

Quads Excavated: ^t , S2 _ Contractor Group: Prudent Technologies, Inc., 

Excavation General Yes 

I. If necessarv. were the correct quadrant(s) excavated and restored? / 

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

Gi-ading Sod and Vegetation Yes

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? / 

3. Does die 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. Arc tlie joints between the sod strips generally tight? (Only evaluate if inspected al a 30 day 

lime period) / 

6. Was the property graded such diat water will not pool on the property'^ / 

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

Gates, Fences and Retaining WaUs Yes

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

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

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

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

Foundation, Siding and Gutters Yes

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

2. Was damage to the foundation avoided? / 

3. Was damage to windows avoided'? / 

I / ' 4.

 Was damage to windows or door screens avoided? 

/ 5

 Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

I W;is d;miage (o djivewny surfaces avoided? 

Was damage to walkway surfaces avoided? 

T 

No 

 No 

 No 

 No 

No 
Owners comments: 

Inspection notes: ^*< 

y

>?' 

y y 

^' y y 7 

*'

^y y 

y 

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

EPA Representative Saa-^oi^ Date: ilzr/n 
EUHNULOGIES. INC. 

AS - BUILT DRAWING 

OLS # 28949 

Date Excavated: 11/15/2010 

I SEPA Signcd-OfT Date: OMAHA LEAD SUPERFUND SITE 

28949 

Omah Exterior Painl Owne a Lead Site r Name: MARLA M WYNN_ • Good Site Sketch Address: 2523 MIAMI ST • Poor Phone: H ^ Not paint 

Sample Number 

RYASCPXA-28949 

RYBSCPXA-28949 

Fl 

F2 

Lead 

Concentration 

25 3 ppm 

Z.'\~\ ppm 

Sample 

Collected LAB 

D 

D 

Samples Collected 

Firm ^-^U^y^ ' <^ 

Date: 'TVT' 

Time: >'IJ 

RYCSCPXA-28949 

RYDSCPXA-28949 

Bl 

82 

H3' i

HPiCe

 ppm 

 ppm 

D 

D Samples Analyzed 

-RS£SCPXA-2«949­ G2­

-OS­ ppm 

ppm 

ppm 

D 

D 

D 

Number of Samples = '-j 

n 

D 

D 

XRF Unit: I OO l Book:

Date: 

Time: 

Staff: 

ft -ZS-Ofo 

MSv/ 

 lCc9 

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

An quadrants are as viewed from the street, facing properly 

EN TEIIEI)­

- : •• j ' 

4^3 ..l.H^.i^.. . 

__^ 

Bl = 190 PPMfl> 13" 

^^ i ^ Bz l , . I 

I ; 

B2 = 510 PPM fl 13" 

• Criy

25 3 ' 7*=i"i i 

- MAP ERROR: LOT DOES NOT 

BORDER MIAMI ST. 

Fl • .r- z 

'.. ­ •,•.•.••.:.••.. . 

M (CCi'rttSt 

EA = 150 PPM (d SCRAPE (~l") 

04<> II 

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

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 fiiture, excluding any 

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

Property ID: 

Property Address: ^ ^^ ^ ^ ^^ ^ ^ ^ -^ ^ 

^"^••^ ^ A g t/vlsh ^J=>-

Phone: ^ ^ ^ , ^n \ - ^ J-^Ll L 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

I I I agree restoration is completed. 

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

rVcyu/a 3^'y^^^yw^ 

Owner's Signature Date ' I 
.\\ 

\'h'zy\ s 31 %^ 

^9 /^'a-c^ ' 
fXIHNkJIOCili N t 

Prudent Technologies, Inc. (Pnident) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontanjinated soite at a nim^cxjaf propetties'locatBd in Omaha, Nebraska, including ihe imtperty located at 

y ^ S"^ ^ ' ^ /I'lJ'A/VlJfh t EPA requests your pennission to aUow Pnident to perfonn a soil cleanup at this 

property to removFlead-contaminated soil. By signing this fonn, the property owner grants pennission to Prudent to perfinm 

activities related to the cleanup including soU samplmg, lemoval of lead-contaminated soil, uid restoration ofthe referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact Prudent South Omaha Office for the Omaha 

Lead Site cleanup,,at (402) 733-1188; 733-1455. General questions about the Omaha Lead Site cleanup can be directed to the EPA 

Public InfoimatiQn Centers at (402) 731 •3045 (South Omaha office). 

Property Access Granted By:. /VUrIc M^ \M\j7\n 

(Please Prim Name) 

Property Owner Signature: ^^'-^^ ^ ^^Mh (Date) 

PROPERTY INFORMATION 

yfr^h t completed bv resident amyor property owner — please print) 

RESIDENT NAIHE: Renter 

RESIDENT ADDRESS: 

'^"77.-^ l/CiAU^i 

IF RENTAL. PROPERTY OWNED BY: 

OWNER'S MAILIN JUG ADDRESS AODRI ; -i j ._ 

OWNER'S TELEPHONE NUMBER • HOME:. .d^ 'fT/yac «««. J 1 

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

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

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


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


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


AUTHORrrY FOR ENVIRONMENTAL RESPONSE ACTIONS; Tbe activities to be implemented 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 form Section 104(e)of 

CERCLA, 42 U.S. C 9605(e), which provides entiy for "determining the need for response, or choosing or taking any response action 

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

8080 Ward Parkway, Suite 405 5600 S. IO*" Street 4242 Medical Drive, Suite 4250 

Kartsas City, MO 64114 Omaha, Nebraska 68107 San Antonio, TX 78229 

Phone: (816) 383-3703 Phone: (402)733-1455 Phone: (210)822-9588 
28949 

Owner Name: MARLA MWYN N 

Address: 2523 MIAMI ST 

Phone: ^• 

Sample Numt)er 

RYASCPXA-28949

RYBSCPXA-28949

RYCSCPXA-28949

RYDSCPXA-28949

RDZOCrXA-20040

ROZOCPXA 20040

RPZSCPXA 280^19

 Fl 

 F2 

 Bl 

 B2 

 DZGZP Z -

Omaha Lead Site 

Site Sketch 

W: 

Lead 

Concentration 

Z 5 3 ppm 

2.*^ ! ppm 

HB" ^ ppm 

Hfl ^ ppm 

ppm 

ppm 

ppm 

Number of Samples =

Sample 

Collected 

^ . 

a 

D 

D 

D 

^ 

LAB 

D 

D 

D 

n 

n 

D 

D 

Exterior Paint North AfTow 

• Good 

• Poor 

gf'No t paint 

Samples Collected 

Firm: 

Date: S 

Time: yi l 

XRF Unit:

Date:

Time:

Staff:

Samples Analyzed 

 100 7 Book: lL> ^ 

flr 'Zb-Oi o 

 Krr\ 

 MS W 

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

All quadrants are as viewed from the street, facing property 

lENTEBER 

i m 21 2006 ; 

;.. . . 

: I 

; ! 

' .4?»3-..!.^ 66 

;..!.. : 

: 1 : 

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--yzJ' ' -CrL­

=n 

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,•-[- . 

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; M:ici»li Sf 

R«v4 046141 
Douglas County Page 1 of 1 

http://www.dcgis.org/dogis/ 11/2/2010 
Ticket Text and Map display fjMJ'icket: # 2632364 Page 1 of2 

Original Call Date: 11/02/10

Work to Begin Date: 11/04/10

 Time: 12:01 pm 

 Time: 12:30 pm 

Op: SIVA18 967 

State: NE 

Address: 2523 

County: DOUGLAS 

Street: MIAMI ST 

Place: OMAHA 

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 Phone Number 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 RICH/TRAFFIC

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 

View Map : ; Close Map 

http://www.dhon.org/irthintemet/MessageText/MessageTextAndMap.asp?NoticeID=DHO... 11/2/2010 
TBOHN! laLO^i , CONSTRUCTION 

mc. SOLUTIONS 

SITE SAFfeTY HAZARD ANALYSIS 

2^ y /V/^v^- & - Address: Excavation Date: 

Crew: BackfiU Date: 

Item 

Overliead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic/Leech 

Field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Driveway 

Sprinkler System 

Other 

Crew Foreman 

Condition Hazards Corrective Action 

c^<­

e^ 

(h^' \p 

oreay^ 

pcc ^ 

a y ^ 

t r ^ 

o*— 

' 

_ ^ 

Site Safety Office 

Date: 

080 Waitf^RartgNay. 5ulB 4(B SSOOSIOSt 4242 Medical Drive, StJtte 72S0 

Caisasia)^illO««114 l€8107 San Antonto, TX 78229 

4iane: (819) SSS-aTOS (402) 733-1108 Phone: (2t0) 8224588 

?« : ^16)363.47107 Paor. (4Q2)73»>1<83 Fax: (210)679-6577 
iftmi 

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