TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: VL^WXi Date: ^ | l5 " 

Address: InMO <^ . ?>\ MP . 

Remediation Contractor: VYUliUl-V ^C K \ct^ Year: c^Q I Q 

SOILREMEDUTION 

PROPERTY FILE FOLDER DOCUMENTS 

ffl Video of property (DVD) 

n Executive Summary 

i EP A-provided property sketch 

4 Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

III Rfistoration Agreement 

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

E Confirmation data 

i Photographs 

i As-built sketch 

i Satisfectory restora.tion signed by Property Owner 

Property close-out dieck list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

11 Utility clearances 

i Property infonnationfrom Douglas County Assessor's OfBce 

D 

D 

D 

^ ^ ^ _^y^ 

JSignatuie Date 

30260798 iiiiii 

Superfund 
Find Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 22346 - 640 S 31 AV 

Owner: Resident: Contract: 

D Owner Occupied Resident Name: Contractor: 

Owner Name: |ROSELAND MARK S PRUDENT2009 S 

ODONNELL PATRICK S 

Property Address: ContractOptjon 

Owner Addressl: |640 S 31 AV [BASE 

Zip Code: 

Owner Address2: )68105 ; 

Assessment: 

624 S 31 AVE Resident Phone 

City: State: Zip Code: Qualifying Group 

I 

OMAHA ;|NE ; |68105 j poo j : 

Owner Phone: Alternate Phone: Assessment Max XRF Value: 

(402) 505-0961 j(402) 630-4995 \ I 839.141 
PROPERTY SUMMARY 

Date;!^/15/2010 | Omaha Lead Site Remedial Action Contract # EP-R7-07-06 T0#1 | Month of: •Ta[c7 

Property Address: 640 S 31 AVE 

A EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

Fl = 204 PPM @ 12"; F2 = 97 PPM @ 12"; EA = 102 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 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 (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. 

TECHNOLOCIES, INC. 
TECHNOLOGIES. INC. 

Property #: 2.'2-3^4 P 

Date/Time: 

Quads Excavated: f^ , f=2__ 

EPA Property Close Out 

Property .\ddress: Q> ^ ^ - 5 ' /4*^_ ^ 

Owner's Name: (^&*<"v''cl<l OJ.o'r^r^^^ 

ConJraclor Croup: Pni(!cnl Technologies, Inc., 

Excav: Ition General Yes No 

\. If neccssMPs. were ihe correci quadrani(s) excavated and restored? / 

2. If necessaiy. were the correci areas of drip zone excavaled ajid restored? / 

Grading Sod and Vegetation 

1. Docs the grading around Ihe perimeter of the house in e.xcavated areas generally slope away 

from ihe house? 

Yes

/ 

 No 

2. 

1 

4. 

5. 

6. 

Has sod been laid in all areas iJial were excavaled? 

Does ihe sod appear lo be generally healtliy and growing? (Only evaluate if inspected at a 30 

dav lime period) 

.KvQ. sodded areas generally finn and evenly graded? 

Are ihe joints between the sod stnps generally tight? (Only evaluate if inspected at a ."lO day 

lime period) 

Was the properly graded such tliat water will nol pool on the property? 

y 

i / 

/ 

/ 

J 

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

Gates, Fences and Retaining Walls 

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

2. 

.V 

Were all gales or fences tal^en do^vn during restoration activities reinstalled? (If applicable) 

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

Yes

y 

y 

7 

 No 

4. Was damage lo relaining walls avoided? (If applicable) y 

Foundation, Siding and Gutters 

I. Was damage lo ihc siding or trim avoided? 

2 Was daniage lo the foundation avoided? 

Yes

y 

y 

 No 

3. Was damage lo windows avoided' y 

-i. Was dainage lo windows or door screens avoided? y 

5. Was damage lo do'wnspouls or downspout extensions avoided? / 

Sidewalks and Driveways (Concrete) Yes No 

I. W.i.^ IIMMIM'J.C IO drivewav siirlaces avoicled':' y 

2. Was damage lo walkwa^' surfaces avoided? 7 
Owners comments: 

Inspection notes: 

pyio^e/iry OcjjiiCc, 

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

EPA Representative 7)^^ yj^ Date: s/s^/zd 
ENVIRONMENTAL & 

CONSTRUCTION TECHNOLOGIES SERVICES 

PROPERTY CONTACT ATTEMPTS 


Property ID; •2^^^^ ^ 

Property Address: f^ i ^ ^ • "^ ( mxg_ 

Owner Name: (f^orckT C>d(^.^y\ \ 

Owner Phone: (o"^o '^^^^S 

Below please find a listing of unsuccessful attempts to reach the above 

property owner. 

Date i&me Initials Result 

lO i4-*r^^ "^^7^^^^ ^ < ^ •to ynrrz-b 

/xv/-g 9jri^ cyfME&L P.O- -leM--yytJiK^^ys^ yyiu^aWfx^^ _ ^ H-f^yiio yr-yyx. SB C^xiJUj P.^. r f (. a 

5-S-/6) 

Sigi^ture Date 

Prudent Technologies, Inc., 

Po s/s/ii 

Acknowledgment signature Date 

EPA 

8080 Ward Partcway, Suite 405 2505 N. 24"* Street. Suite 308 4242 Medical Drive, Suite 7250 

Kansas City, iMO 64114 Omalia, Nebraslo 68110 San Antonio, TX 78229 

Phnne: /d02) S04-1004 Phone: (210)822-9588 
mmm ENVTRONMEIVT.AL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: Date: l|5|'^ ^ 

Phone: BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

Y ^ ^ ^ (y^ Q_a^<yc^^.yy K ^ oA ^ o ^ d 

M.^^—'4^^ a\yr~^/XA^ \Zt ^lAyA^^r.^^ . yk h. 9 0 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes No 

Item NO Description & Location 

On Map 

Property Owne Prudent Employee 

lgilat^^e^ 

8080 UUard Parkwav. Suite 405 2505 N. 24'" Street. Suite 308 4242 Medical Drive. Suite 4250 
Prudent Technologies, Inc. (Pnident) is under contract with Ihe U. S. Environmental Protection Agency (EPA) lo clean up leadcontaminated soils at a number ofproperties located in Omaha, Nebraska, including the property located at 

. The EPA requests your pennission 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 lead-contaminated soil, and restoration of the referenced property. 

Ifyou have any questions alxjut the soil cleanup planned for your property, please contact Prudent's Administniti\e Clerk for the 

Omaha Lead Site cleanup. Ms. Siva S. .laiiipana-at (402) 733-1188. General questions about the Omalia 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). 

Property Access Granted BVy-^ f^T/^ ^ CilT ^ ^ ( 7 ^cJir/t^Ay^=^ C 

(Please Print Name) 

Property Owner Signature: 7- 3 -^ / 

(Date) 

PROPERTY INFORMATION 

CTo be completed by resident and/or property owner — please print) 

RESIDENT NAME: r>.^^^ ^ ^yj ^ . Owner Rerrter 

RESIDENT ADDRESS: 

g)Mo S ^ \ ^^ 

IF RENTAL, PR< OWNED BY: PoT 0 ' FNcxcA^J 

OWNER'S MAILING ADDRESS; b^ ''^ ^ C^K.^J'VA N-^-^ 

OWNER'S TELEPHONE NUMBER - HOME WORK: 

AGE OF HOME? : J o f YEARS. HOW LONG HAVE YOU LIVED HERE? y YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WTTH SIDING SINCE 1978? -TES" -NO- ^-A CLA '-^*» . 

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

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 taldng any response action 

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

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

Kansas City, MO 64114 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)504-1005 Fax: (210» 579-6577 
^ ve t 2.0^ ^- ^ 
JIES. INC. 

AS - BUILT DRAWING 

OLS#:22346 

Date Excavated: 07/20/2009 

USEPA Signed-Off Date: OMAHA LEAD SUPERFIMD SITE 

Owne Omafta'LeatfSite r Name: MARK S ROSELAND 

Site Sketch Address: 640 S 31 AV 

Phone: H: W; 

Sample Number 

RYASCPXA-22346 

RYBSCPXA-22346 

RYCSCPXA-22346 

RYDSCPXA-22348 

RDZSCPXA-22346 

RCZSCPXA 22346 

ispgscpxA aaa4o 

Number of Samples 

h<^ UQ" ^ "^5 

h-i fcy 

ff WMfc 

\o^0 -^sSl ''^ 

r 

^.JJ. 

^Qgejb^ 

u:i. w^iyg^ 

Fl = 2»4 PPM (a. n^ L^ 

HHl: P^. 

i^ss; A.x> .il 

22346 

ExteriorPalnt North Arrow 

• Poor 

• Not paint 

Samples Collected 

Firm: HB - N\. T - NV6.V J 

Date; '^-'g;- ^ 

Time: R-4.5 A<v^ 

Samples Analyzed 

XRF Unit: 4a _ Book:q^ 

Date: 

Time: 

Staff: 

F2 = 97PPM'a:)2" 

ENTERED 

SEP 13 m't 

Omaha Lead Site EA = 102 PPM -a; SCRAPE (~1") 46130 

CONTRAa #: EP - R7-07-06 TO#l PRUDENT TECHNOLOGIES, INC. 
Total Quadran" •l^jare Footage to be Excavated = 1064 

Property Classificati on: 800 r Total Drip Zone Linear Footage to be Excavated = 0 

; 1 , i i i 1 ' 1 J i 

y ' ! ! ' 1 : 

1 Allev 

1 1 

1 • • ' ' • ' • - ( ; ! j 

""••'"T i 

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1 

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 1 1 •,,••

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T>Tr\yyy ' ! i yyAyyy , r <m J L r­ ,-,..j.v.;-_..,,.;.....-..'-:„.,; ,.^ •:.•.,,,:> _;•:.'' •,.,^,"-;V:.' . •...•v.-;-?-- :-\-. , •;,:;; •-:.=••':--'•,,.•.-., ,,-• i:--*:t^j-r-fe-.-••,.:-i-.-^^ 

. i • ' ^ i • 1, • • . ' • . , : , ' • • ' ' . . . : 

1 i 1 

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1 

- - • - I \ • ^- ' 

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Legend North Arrow Omaha Lead Site 

l?^;:J^ Concrete Omaha, Nebraska 

^ ^ z 

y/ \ To Be Excavated Property Number 

OLS-22346 h^- Existing Structure 

Scale i Property Address • Fence 1 Inch = 20 feet or 1 grid = 5 x 5 ft 

>(y> 

640 S 31 AV 

^ ^ ~" 

Quadrant Boundary Post Excavation Concentrations 5 (ppm) 

^^troiot Rniinrlarx / Fl B? PlavArp 3 

..a . J _<^ ...loo ' " • " • ' F2 DZ — Eas amen t

O 

Tr ee/S hrub ' < ,^.,y •' ' 

Bl Gar Jen_ Othe r 

Description of post excavation areas: Fl, front yard left-hand quadrant, F2, front yard right-hand quadrant; B1, backyard left-hand quadrant; B2, backyard nght-hand quadrant. 

DZ, dnp zone (1-3 foot area of soil around the foundation of the house). 
22346 

Omaha Noittt/tgiam Lead Site Hxlenof Paint Ormer Name: MAKK S ROSEiAND 

Srle Sketch y-GccK3 Address: 640 S 3t AV • Pocr 

P1ion«: H tt. n ^*3t paint 

Sample Number 

RVASCPXA-2234B

RYBSCPXA-22346

 F1 

 F2 

Lead 

Corcj?n!r3t>cin 

ppm 

Sacnpte 

Co^cctco 

LAB 

D 

• 

Firm: 

Date: 

Time' 

Samples Cotlectsd 

f' t-

^ • 

_Bi 

r^-v. - % 

iLl 

4 

ht^t 

NV6. y 

.RYCSCPXA-22346

RYDSCPXA 22346

 Bl 

 B2 

yyn a Samptes Analyzed 

RDZSCPXA-22346 DZ <><.. ppm n XRF Unit: 

RGgscpxA aa3'i6 —e g ppni D D Dale; _ 

RPJSCPXA 2J346—-Pi­ ppm D 

Numder c^ Samples = _J5* 

D 

D 

Time: _ 

Slartf. ^£^ , 

';'"?KtVu^> S 

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ENTERED 

SEP 1 3 i m 

Omaha I ead SiK 4613U 
X. Ct^\^ 1 VJ. 1 

/d/ 

http://douglasne.mapping-online.com/assessdoc/Photos/16/R21053800000001.jpg 6/12/2009 
Print Preview hnp://www.dogis.org/dogis_alias/dogis/priiitPreview.aspx?PrintOpt.. 

Douglas Count\'-Omaha, NF 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

2105380000 

ODONNELL 

PATRICK S 

640 8 31 AV 

OMAHA 

68105 

624 S 31 AVE 

OMAHA 

NE 

68105 

Sec-Twn-Rng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website Link 

Assessor 

Website Link 

REDICKS -WA- 2ND ADD 

2 

10 

S40FT 

40X130 j 

http://webapps.dotcomm.org;8080/TreasTax/face5/pages 

/taxinfo.jsp?parc=2105380000 

http://douglasne.mapping-online.com/DouglasCoNe/static 

/accountinfo.jsp?accountno=R2105380000 

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 = 36 feet 
Page 1 of2 

v "> 

Create Another Ticket Back to Irth Intemet Send Email 

. YOUR TICKET NUMBER IS 2313576. 

Original Call Date:

Work to Begin Date:

 7/09/09

 7/13/09

 Time: 11:00 am 

 Time: 11:30 am 

Op: SIVA18967 

State: NE 

Address: 640 

County: DOUGLAS 

Street: S 31ST AVE 

Place: OMAHA 

Twp: 15N Rng: 13E

Twp: Rng:

Legal Given: C 

 Sect-Qtr: 21-SW 

 Sect-Qtr: 

Type of Work: soil lead remediation 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 TECHNOLOGIES 

Contact Name: SIVA JAMPAMA Phone: (402)733-1188 

Work Being Done For: EPA 

Depth of Excavation: 6 FT Corner Lot: N 

Involves Tunneling or Horizontal Boring : N 

Front: Y

Explosives: N 

 Rear: 

CXCATV LEVEL3 MUDOl OMAHACOF 0PPDGPR5 TEC QLNNEIC 

Service Area Contact Phone Number Utility 

Type 

CXCATV COX COMMUNICATIONS, 

INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVELS COMMUNICATIONS, ^^^ 

Day: 8773668344 

Alt: 

Emerg: 8773668344 

MUDOl METROPOLITAN UnLITIE S 

DISTRICT SAIvTOY 

Day: 4025047823 

Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHATRAFFICSEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 7/9/2009 
Page 2 of2 

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 0PPDGPR5

 OMAHA PUBLIC POWER

 DISTRICT

 ,.,.

 NA

 Day: . ,^

 Alt;

 4067289343 

 An^-^rin-i ACA 

 4062071494 

Emerg: 8887289343 

PAETEC

QLNNEIC

 PAETEC COMMUNICATIONS

 QWEST LOCAL NETWORK

 ^J^^^STCY^^^^ ^^^

 NA

Day: 8002891901 

 ''^'^• 

Emerg: 8002891901 

Day: 4067289343 

 Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESlJLTS... 7/9/2009 
DS 

ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SOLUTIONS 

Site Safety Hazard Analysis 

CD 

Address: ^c((5 ^ . 3 ( /^c/g 

Crew: ^ ^ J 

Date: __A2z3j-^3— 

Item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic / Leech 

field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees 

Structures 

Drivewav 

Sprinkler System 

Other 

Crew Foreman 

Condition 

hy 

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JUJ*­

& ' ^ 

S r ^ 

u A ^ 

^// ^ 

/S^d ti^SL 

y t ^ 

/tev^ 

ioo^yyy "Cw^f 

Ex. l y 17-^1 

Corrective 

Hazards Action 

hf€,th^ifi j M ^ L ^ CjSJf /^'^ ^ 

k4U4fy4saO-/f 

4-

A^^dJi^aT^ 

JySi:. ^yfty>€» ^ 

c ^ fZ/uey^ 

hjiW. \<=>(id^ 

Site Safety Officer 

^^9^,^. 

S080 Ward F*arl*A/ay. Suite 405 2505 N. 24' Street, Suite 308 4242 Medical Drive, Suite 7250 

Kansas City. MO 64114 Omaha, Nebraska 68110 San Antonio. TX 78229 

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

Fs»; (S1B\ 363-3707 Fax: (402)504-1005 Fax: (210)579.«577 
/ • 
28/2009 

•iHB9 H 

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