0

SAID#: 28029

TRANSMITTAL OF OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

 DATE; 1/15 

ADDRESS: 2613 GRANT ST 

REMEDIATION CONTRAaOR: PRUDENT TECHNOLOGIES. INC. YEAR: 20l4> 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

^ PRE AND POST VIDEO OF PORPERTY (DVD) 

^ EXECUTIVE SUMMARY 

^ EPA-PROVIDED PROPERTY SKETCH 

I ^ SIGNED ACCESS AGREEMENT FOR SUBJECT PROPERTY 

D SIGNED ACCESS AGREEMENT(S) FOR ADJACENT PROPERTY 

H RESTORATION AGREEMENT 

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

M CONFIRMATION DATA 

 PHOTOGRAPHS 

[Z AS-BUILT SKETCH 

E T SATISFACTORY RESTORATION SIGNED BY PROPERTY OWNER 

\S PROPERTY CLOSE-OUT CHECK LIST SIGNED BY EPA 

D DESCRIPTION OF AREAS NOT MEETING ROD CLEANUP CRITERIA 

[ ? UTILITY CLEARANCES 

•'^PROPERTY INFORMATION FROM DOUGLAS COUNTY ASSESSOR'S OFFICE 

D 

D 

D 

^-B-Jfc- il'ln 

SIGNATURE^ JRE^ * " DATE 

30217616 

Superfund 
PROPERTY SUMMARY 

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

Property Address: 2613 GRANT 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: 

F2 = 121 PPM @ 6"; EA = 283 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 Checldist 

6) As-Buih 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) Other items to be included in the individual property fde, 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. 
Find Record 

Backfill: 

Sample Area: 28029 - 2613 GRANT ST 

Owner: 

• Owner Occupied 

Owner Name: 

lOTY OF OMAHA 

Owner Addressl: 

|C/0 PLANNING DEPARTMEm" 

Owner AddressZ: 

/|1819 FARNAM ST #1111 

jCity: State: Zip Code: 

; lOMAHA ~ |NE 168183-

Owner Phone Alternate Phone: 

r 

Contract: 

Contract Option JOPTION 2 

Remediation Query Lead Remaining Query I Property Damage Query 

User Provided Owner Information 

Owner Name: 

1 

Owner Address: 

1 

City: State: Zip Code: 

1 1 1 Alternate Phone: Owner Phone: 1 " 1 

Assessment: 

Qualifying Group |46o 

Assessment Max XRF Value j 733.6 

Resident: 

Resident Name: 

|TtNANTS-9UNITAFT. 

Property Address: 

)2613 GRANT ST 

Zip Code: 

|68111-

Resident Phone 
3

TECHNOIXXJIES. INC. 

Property#: Z'6C>2J\ 

Date/Time: 

Quads Excavated: Y "2 ^ 

myGrh 

EPA Property Cllose Out 

Property Address: Z^^' ^ ^"^^^ ^ ^ • 

Owner's Name: C^i-<^ °S-^v'''^ \ 

Contractor Group; Frudent Technologies, Inc., 

Excavation General Yes No 

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

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

Grading Sod and Vegetation Yes No 

1. Does the grading around the perimeter of the house in excavated areas generally slope away 

from the house? y

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

3. Does the 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? y 

5. Ar

tim

e

e

 di

 period

e joint

) 

s between tlie sod strips generally tight? (Only evaluate if inspected at a 30 day X

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

y 

7. Was damage to landscaping or plant materials avoided? 

y 

Gates, Fences aad Retaining Walls Yes No 

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

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

 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 

Was daniage to the siding or trim avoided? y^ 

2. Was daniage to the foundation avoided? y 

3. Was damage lo windows avoided? y 

4, Was damage to windows or door screens avoided? y^ 

5. Was daniage lo downspouts or downspout extensions avoided? y 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to diivewav surfaces avoided'?* 

2. Was damage to walkway surfaces avoided? 
Owners comments: 

Inspection notes: 

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

EPA Representative Qo^- ^ __Date; lZ['\\\t> 
ra 

CHNOLOGIES, INC, 

AS - BUILT DRAWING 

OLS # 28029 

Date Excavated: 10/18/2010 OMAHA LEAD SUPERFUND SITE ISEPASigned-OfTDate: 

Omaha Lead Site Exterior Paint 

e.e^Qd.3 tn Arr 

Site Sketch • Good 

• Poor 

Sampling Address: gC/ 3 Grsn f (^f - ^ Not paint 

Sample Lead Sample Samples Collected Number LAB Concentration Collected 

RYASCPXA- ^aOfSF 1 15. ppm 0 n Date: /0'S7 - ^-OiO 

RYBSCPXA-(J<S023 F2 ppm Time: J^lO d A/1 . .Am. RYCSCPXA- S806 3 B1 'Of t ppm Q n Samples Analyzed RYDSCPXA-^80f3 B2 _di5L ppm B D RPZSCPXA eSOSQDZ _=: ppm D D XRF Unit: /caC«fa Book: 2ls^ 

RQZSCPXA g:30S9'^ - — ppm D D Date: l o -o«-/ 0 

— ppm D D Time: P M 

Staff: MS>*/ Number of Samples = I 

Legend: F1 = Front Left, F2 = Front Right, Bl = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

Al[ quadrants are as viewed from the street, facing property 

• 'I— * »i S« 

E£^T£:tlEI> 

OCT 0 8 2010 

loe. ^ 5 

61 

+ 

/ 3 tffj'^iirsT Zk 

K2= 121 PPM (a 6' 15 $fQ 

^y Pi. ?z. 

^LL^ iWik."^ 

.&.8ftNT.5r; Rev2U«i.BL Creaiod 16-Mir>Jl8 

EA = 283 PPM fl SCRAPE (-1' 

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

SEPA 

Property Completion Agreement 

This agreement docinnents the completion of removal activities performed on the below listed propert)'. 

The propeily owner's signature indicates that the property owner is satisfied with the restoration of the 

subject propeity, 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: 

.>^ l / •. /;. i • 1 / 

Owner: 

f . •• / / . ./,• • 

Phone: '/<• / v'/V '/.>'// 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

l/ l I agree restoration is completed. 

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

^yy Ai iZi l Owner's Signatii re Date 
Pnident Technologies, Inc. (Prudent) Is under contract with Ihe U, S. Envlionmenlal Protection Agency (ilPA) lo clean up Icadcontaminalcii soils at a number of properties located in Omalia, Nebraska, including the property located al 

ixdlh G^^A J SPt-<'r . The EPA requests your pennission to allow Prudent to perrorm a soil cleanup at this 

property lo remove lead-conlaminaled soil. By signing Ihis form, tiic property owner grants permission to Prudent to perform 

activities related lo the cleanup including soil sampling, removal oflead-conlaminated soil, and restoration of the rerercnced properly. 

ir you have any questions about the soil cleanup planned for your property, please contact Prudent south office .For Ihe Omaha Lead 

Site cleanup-at (402) 733-1188. General questions about the Omaha Lead Site cleanup con be directed to the EPA Public Information 

Centers al (402) 731 -3045 (South Omaha ofTice) or (402) 991 -9583 (North Omaha oiTice). 

Property Access Granted By: A/'i/l:A-r*\ LMAJI J 

(Please Print Name) 

Property Owner Signatu S'-Ot / -J0(O 

V t > (Signature Siena )

(Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS^ / ^ \ 

2y,i% ^a ^ "yr 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: J L WORK: 

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

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 19787 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 S HOURS OR MORE PER WEEK: 


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


AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONSi The activities lo be implemcnlcd by EPA under Ihis agreement 

arc pursuant lo Section 104 of CERCLA, 42 U.S.C. 9604. EPA's right of access lo Ihe property is provided for in Section 104(e) of 

CERCLA, 42 U.S. C 960S(e), which provides entry for "determining lhe need for response, or choosing or taking any response action 

under ihis title, or otherwise enlbrcing the provisions of the title." 

8080 Ward Parkway, Suite 406 5600 S 10 St 4242 Medical Drive, Suite 4250 

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

Phone: (816) 363-3703 Phone: (402)733-1188 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)733-1883 Fax: (210) 579-6577 
^^Qg. 9 

Omah Exterior Paint Noith Arrow a Lead Site 

Sit • Good e Sketch • Poor f 

Samplinq Address: £.Q1 3 G/'tSH i (jf ' • • 

^ Not paint 

Sample Numt>er Lead 

Concentration 

Sample 

Collected LAB Samples Collected 

Firm: VClHl ^ 

RYASCPXA- SQOSSf i 25u ppm iZ D Date: 10-07-^010 

RYBSCPXA-e5025 F2 Sif i ppm B or Time: /^.-flf l P.M. 

RYCSCPXA- SS0S 3 B1 

RYDSCPXA-efl0^5 B2 

/Of l

to 9

 Dom 

 ppm 

Q D 

D Samples Analyzed 

RPZSCPXA agOg J DZ . ^ ppm n D XRF Unit: \OPA/o Book: 2li A 

RQZSCPXA ga p g 3 fig 

RPZSCPXA SQ0S3P Z 

In:

_=

 ppm 

 ppm 

n 

n 

n 

n 

Date:

Time:

 l o -£A-f O 

 P M 

Number of Samples = | ^ \ \ Staff: ^BU / 

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

An quadrants are as viewed from the street, facing property 

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R<)v2008.BL Created: 16.Msy.08 046141.0123 
BTO>r?HO 

N 2613 Grant 

Printed: Dec 08. 2010 A \\\v\\.clcsis,ors''cio2is 

^ 
TEOHNOL^ks, CONSTRUCTION mc. SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

Address , 2,fc/V <ryr.Jh/ y Excavation Date: 

Crew: Backfill Date: 

Item Condition Hazards Corrective Action 

Overhead Lines c^ ^ 

Gas Line e ^ 

Water Line h^^ Sewe \ J r Line 

Septic/Leech 

Field 

Propane/Butane ' — 

Sidewalk cvt 

Foundation ar^ 

Retaining Walls 

Fences p<us^ 

Trees a>r<~ 

Structures tr ^ 

Driveway o*— 

Sprinkler System 

Other ^ 

Crew Foreman Site Safety Office 

Date: 

»OWai«f«>rtMay. Suite 4dS IS los t 4242 Medical Driva, Suita 7250 

OmdAar tMmM a tt107 San Antonio, TX 78229 

taoK (8«t) 3^<3703 Pliona: (402)733-1188 Phone: (210) 822-4688 

DC fStt) 363>3707 Fax: (4<ia)73»4883 Fax: (210) W»<677 

x'J 

W^fiJ&SiS - • -,.' ! • . ^ ­ .