TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: 3?>;fc7 Date: fj2A It's 

Address: SLg l\ "^-^^ ^ ^^ 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

'i Video ofproperty (DVD) 

gf Executive Summary 

H EPA-provided property sketch 

Or Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adja^^nt property 

a Restoration Agreement 

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

H Confirmation data 

a Photographs 

a As-built sketch 

S^ Satisfactory restoration signed by Property Ovvner 

a Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

a Utility clearances 

0 Property infonnationfix)m Douglas Coimty Assessor's Office 

D 

D 

D 

iMMaa­ ^ ^ -^ >at ^ e 

40311265 

illUllillil 

Superfund 
PROPERTY SlIMMARY 

Date: Ol/H/2009 Omaha Lead Site Remedial Action Contract # EP-R7-07-06/0004 Montii of: Dec/Jan 

Property Address: 2811 RUGGLES ST 

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: 

DZ = 177 PPM @ 4"; F2 = 158 PPM @ 3"; EA = 131 PPM @ SCRAPE 

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 chp/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Built sketchi) Shall includefinal 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 properly owner 

iii) Excavation digital video in MPEG, WMV (Windows Media Video) or SWF (Flash Player) format and/or 

photogr^hs 

iv) Signed form verifying satisfactory restoration 

v) Description of areas not meeting hiterim ROD cleanup criteria 

TECHNOLOCIES, INC. 
Find Record Clean Up Query Lead Remaining Query I Propetty Damage Query 

Backfill: 

Sample Area: 33167 - 2811 RUGGLES ST 

Owner: 

n Owner Occupied 

Owner Name: 

I BRYE TASHA L 

Owner Addressl: 

r 

Owner AddressZ: 

J2811 RUGGLES ST 

City: 

OMAHA 

State: Zip Code: 

[N E |6811 1 

Owner Phone: Alternate Phone: 

)(402) 505-9882 ; |(712) 347-5600 

Resident: 

Resident Name; 

BRYE TASHA L 

Property Address: 

12811 RUGGLES Sf 

Zip Code: 

|68111 

Resident Phone 

Contract: 

Contractor: 

|PRUDENT2008_S 

Group: 

1 

Assessment: 

Qualifying Group 

I PRIORITY 

Assessment XRF Date: r~—~"~ 

Assessment Max XRF Value: 

I 504.97 
TECHNOLOGIES, INC, 

Property #: 3'2)\fe7 

Date/Time: 

Quads Excavated: f2-^ VZ.-

EPA Property Close Out 

Property Address: 2&]\ KLu»jl«<l ^ 

Owner's Name: 

Contractor Group Prudent Technologies 

Excavation General 

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

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

Grading Sod and Vegetation 

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 diat were excavated? 

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

day time period) 

4. Are sodded areas generallyfirm and evenly graded? 

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

time period) 

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

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls 

1. Do gates open and close freely? (IfappUcable) 

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

3. Was damage to gates or fences avoided? (IfappUcable) 

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

Foundation, Siding and Gutters 

1. Was damage to the siding or trim avoided? 

2. Was damage to the foundation avoided? 

3. Was damage to windows avoided? 

4. Was damage to windows or door screens avoided? 

5. Was damage to downspouts or downspout extensions avoided? 

Sidewalks and Driveways (Concrete) 

1. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes No 

y 

l y 

Yes No 

y 

y 

y 

y 

y 

y 

y 

Yes No 

u^ 

l y 

^ 

AJA 

Yes No 

/ 

y 

y 

y 

Yes No 

y 

y 
Owners comments: 

Inspection notes: 

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

EPA ^QmQSQn\A\xy&y^/^x^^^^c^.^jJly:g& Date: ^-^//l/dt ' 
PAGE 01 

12/B1/2008 16:29 4027382071 
 OCAC 

&EPA 

Property Compl&tlon Agreement 

Hiis asnoooent doctmclita the completion of removal activitiei perfbrmcd on tho below lisud properly. 

The propor^ owiw'i tSfgatotn intUcatec tint the proptnty owner is satisfied widi the rcstontioa of th« 

9abj«CT ptoperty, and ihiit t n items are in quostion, now. or nt any time in the faam, excluding aay 

renulniDg wsmatif (30 lays total) except thoM itenzs lsM«d below, if any. 

TrofmtfJD: 

m^r^A^^y-^: ^ 2^q^^ H^W^^l^ ^ s ^ 

Owmer. \<Ui\iJK» l&y- ^ 

FhoM'. • S d ^ ^ 

RaBtocMhin itMns In QuBstion! 

ItMn 

ReqiiliMf corntlMm to compMB H M property: 

^ 

O 1 do not BgrM nMrtaration i» oompleted 

M:y V-a 

Date 

rnn/Ta n J iiiWi T-r n onnr i nr 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number ofproperties located in Omaha, Nebraska, including the ptoperty located at 

. The EPA requests your permission to allow Prudent to perform a soil cleanup at this 

property to temove 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. 

If you have any questions about the soil d/tUmp planned for your property, please contact Prudent Administrative Clerk for the 

Omaha Lead Site cleanup. Ms. DeborattfJohnson -^at (402) 733rl 188. General questions about the Omaha Lead Site cleanup can be 

directed to the EPA Public InformjilSi/Centers a/(^02) 73y3J»45 (South Omaha office) or (402) 991 -9583 (North Omaha office). 

Property Access Granted By: 

(Plea* Print Name) r 

Property Owner Signature: ^^4^/^t^#^ (Date) 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner ~ please print) 

RESIOENTNAME: "^\ gv,/gi. Owner 7 Renter 

^ 

RESIOENT ADDRESS;

r \ r\ -St fio^vrj^s^ tj ^ c ^ I t I 

IF RENTAL, PROPERTY OWNED BY: 

ER'S MAILINGi ASpRESS ATORESS; ^ SL o-LA_~^>>-L^ /\j ^ 0,^)1^

OWNER'S TELEPHONE NUMBER - HOME: J 1. WORK: 

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

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? 

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

_3_ 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.) 

AUTHORFfY 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 entty for "determining the need for response, or choosing or taking any response acdon 

under this title, or otherwise enforcing the provisions of the 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 
OLS#: 33167 

Date Eicavated: 10/27/2008 

USEPA Signed-OffDate: 

33167 

Oinah Exterton Pajrt NiMtti Airow 

Owtie a Lead Site r Waiw; TASHA L BRYE Q-good Site Sketch AddreM-.28ii RUGGLES a t • Poor 

Phone: H: 402-gO»^e2 W. 712-347-5600 4. Q Not pain) 

Sample Number Lead Sample /-.A B Samples Colleoted 

&)ncentra(ion Collectej*^'-'^^ Firm: 

RyASCPXA-33167 F1 / O l com 

Date: g-^Z-gS- ' 

PYBSCPXA-33167 F2 ^0 ^ DPfP c/ya Time: ^'.^ "^ 

RyCSCPXA-33167 Bl / ft 7 ppnn c/y D Samples Analyzed RYDSCPXA-33167 B2 —-JHZ-ppm 

RDZSCPXA-33167 D2 D XRF Unit: /03 7 Book: .iO . 

ROgOOPM-DOIflf -et- Sga*? ppm D D Date;_ ^-^-gA* " 

-pa— D Tine: a /'^j y "" ppw staff: _ ^/> Number of Samples > ^ \ 

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

All qutdrinl* ar» at linwud (tom the atiMt, tadno pramty . . . . . • I • • I . 1 . I .•... . . n . . L . , . 

I': 

CONTRAa #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: Date: \ o 5 ^| A ^ ^ 

Phone; ^ \ 3 ^ C:>'^nU BVID: 

Item NO lants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

M l H^ ?UvJtS ^ 1 ^ 

Pre-Existing Condition of Structures 

Doesyour Basement have^ history of leaking? Yes No 

Item NO Description & Location 

On Map 

Property Owner Prudent Employee 

Signature: / A Signature: 

k _ 

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 
• • 

w • ^ mkA iV^WWitVW 

33167 

Own Omaha Laad Site e r Itome: TASHA L BRYE 

Site Sketeh AMn»:2&M RUGGLES ST 

Phone: »• 402-505-^682 W 712-347-S$(X> 

S wnple Number Lead 

Concentratioti 

CoHecta*^*^^ 

RY;fiCPXAr33167 F1 101 ppm 

PYIlSCPXA-33167 F2 .SfiJS ppm 

RYisCPXA.33167 B1 lk2 ppm CkX D

RY[>SCPXA-33167 B2 ppm 33. RD;SCPXA-33167 DZ g(p ^ ppm 

ncaocrxAOOioT ec ppm n D 

RW!3CPXAP031G? P2- ppm D D 

Numberof!>amp(e8= I ^ 

ExterMpPaint North Anow 

C3^t)od 4/ • Natpairrt 

Finn; 

Date: 

Time; 

Samples Cofleoted 

• ^ ' O s ' 

S o 

Samples Analyzed 

XRF Unit) 16^ 1 Book: M"7 

T»ne:, /" ^ 

Staff: JJL 

Legen^l: Fl = Front Left. F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zo|>e. GZ = Garden, PZ = Play 

AM quaaf»im«»a> viewed from the stwettacinopwpmy 

'^ lENTEMSI); : l^iiit*k ^tiue; 

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 I 

PRUDENT TECHNOLOGIES. FIRST NATIONAL Q^ftOF OLATHE 

8080 WARD PARKWAY, SUITE T 83-172 

20411 

KANSAS CITY, MO 64114 

(816)363-3703 

$ /5' ^ 

yy ~ A , (SA!^^— 7 

r^iz^T- ' DOLLARS Q

D MEMO COPY NOT NEGOTIABLE V

if0 5Qi,;in'.i:ioiooi7 20i: ii'Oiu qu5 mi« a 

PRUOENT TECHNOLOGIES, INC. 20411 

":-M. ^^i[ ^cjle s 

6;ll».W^ 

f l^vxVP^-^^ 

PRUDENT TECHNOLOGIES, INC. 

2041£ 

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I M 
Page 1 of 1 

.'fA. 

S2l\ Po^^ces Sf 

http://douglasne.mapping-online.com/assessdoc/Photos/02/R18287700000001,jpg 10/2/2008 
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Douglas County-Omi 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner 

City 

Owner 

State 

Owner 

1828770000 

BRYE 

TASHA L 

2811 

RUGGLES 

ST 

OMAHA 

68111 

2811 

RUGGLES 

ST 

OMAHA 

NE 

68111 

Sec-TwnRng 

Addition 

Block 

Lot 

Legall 

Legal 2 

Legal 3 

LegaM 

Treasurer 

Website 

Unk 

Assessor 

Website 

Unk 

04-15-13 

MYERS RICHARDS & TILDENS ADD 

7 

3 

50X125 

http://webapps.dotcomm.org:8080measTax/feces/pages/taxlnfb.jsp? 

parc=1828770000 

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

accountno=R 1828770000 

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 = 50 feet appraisal, survey, or for zoning verification. 

««--_xr-k_T^_* ^r\„„„lo c rnuntV m 10/1/200 8 


http://www.dhon.org/ujjuntemet/DHONNoticeCreation/MessageText... 

Create Another Ticket i Back tolrth Intemet Send Email 

YOU R TICKET NUMBE R IS i 2157993. 


Original Call Date: 10/20/08 Time: 9:26 am Op: MADHURIMA18967 


Work to Begin Date: 10/22/08 Time: 10:00 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2811 Street: RUGGLES ST 


Twp: 15N Rng: 13E Sect-Qtr: 04-SE 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation project for soil 


Location of Work: LOCATE ENTIRE PROPERTY 


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


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: MADHURIMA Phone: (402)733-1188 


Alt. Contact: Phone: (618)401-2223 


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 Nuniber 

Utility 

Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047946 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON

Day:

 Alt:

 4024447197 

 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA

Day: 4067289343 

 Alt: 8887289343 

Emerg: 4067289343 

^ ^ Day: 4067289343 QLNNE 1C QWEST LOCAL NETWORK 

lof 2 10/20/2008 9:27 AM 
http://www.dhon.org^|tintemet/DHONNoticeCreation/MessageText.. 

Alt: 

Emerg: 8887289343 

2 of 2 10/20/2008 9:27 AM