TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: r^.^an d Date: l^j ^^ j %cc ^ 

Address: ^^^ 3 N ^/.<^-f 

Remediation Contractor: pj?(.jr::)gf\l"f ~l9c.-{H^oic>Ci£S. jc^c.-1 Year: c^QO 8 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

\X Video of property (DVD) 

\X Executive Summary 

tx EPA-proyided property sketch 

0' Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

y Restoration Agreement 

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

' y Confirmation data 

y Photographs 

S^ As-built sketch 

S^ Satisfactory restoration signed by Property Owner 

M Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

y Utility clearances 

D Property infonnation from Douglas County Assessor's Office 

D 

40309576 

D 

D ' Superfund 

„/^nriX^,sMf - 2.h9ic9 

Signature v'^ Date 
PROPERTY SUMMARY 

Date: 12/20/2008 Oinaha Lead Site Remedial Action Contract # EP-R7-07-06/0004 Month of: Nov/Dec. 

Property Address: 353 N 41 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 = 294 PPM @ 6"; DZ = 88 PPM @ 6"; EA = 181 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 clip/photographs 

5) Documentation - Completed Close-out Checklist 

6) As-Built sketchi) Shall include final lead levels v) Legend 

ii) Contamination left: behind areas vi) Contractor identification 

iii) Property address vii) Date 

iv) BVTD number 

7) Other items to be included in the individual property file, if available, or obtained include: 

i) fte-excavation agreement details (if any are made with the property ovraier) 

ii) Property Status Form signed by property owner 

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

photographs 

iv) Signed form verilying satisfactory restoration 

v) Description of areas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES, INC. 
Rnd Record 

Backfill: 

Sample Area: 23607 - 353 N 4 1 ST 

Owner: 

n Owner Occupied 

Owner Name: 

I RILEY THOMAS C 

Owner Addressl: 

Owner AddressZ: 

|353 N 41 ST 

City: State: Zip Code: 

OMAHA |NE [68131 

Owner Phone: Alternate Phone: 

(402) 553-5717 

Qean Up Query Lead Remaining Query I

Resident: 

Resident Name: 

[RILEY "mOMAS C 

Property Address: 

[353 N 41 ST 

Zip Code: 

[68131 

Resident Phone 

 Property Damage Query 

Contract: 

Contractor: 

jPRUDEMT2008_S 

Group: 

I—: — 

Assessment: 

Qualifying Group 

jPLAY ZONE 

Assessment XRF Date: 

I ~ ~ 

Assessment Max XRF Value: 

I 626.67 
TECHNOLOGIES, INC. oEPA 

EPA Property Close Out 

Property #: '2.Zi>d~) Property Address: 3 ^ "3 'V 4 ' ^ 

Date/Time: Owner's Name: 

Quads Excavated: f~ ^^ 02 - Contractor Group Prudent Technologies 

Excavation General Yes 

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 Yes 

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 that 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 generally firm and evenly graded? / 

5. Are the joints between the 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 Yes 

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

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

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

X 

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

y 

Foundation, Siding and Gutters Yes 

1. Was damage to the siding or trim avoided? 

y 

2. Was damage to the foundation avoided? y 

3. Was damage to windows avoided? y 

4. Was damage to windows or door screens avoided? 

/ 

5. Was damage to downspouts or downspout extensions avoided? 

/ 

Sidewalks and Driveways (Concrete) 

Yes

1. Was damage to driveway surfaces avoided? 

/ 

2. Was damage to walkway surfaces avoided? 

T 

No 

No 

No 

No 

 No 
Owners comments: 

Inspection notes: 

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

EPA Representative J^c^ yg ^ Date: /a/a/o?? 
&EPA 

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 ofthe 

subject property, and that no items are in question, now, or at any time in the ftiture, excluding any 

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

Property ID: 

Property Address: fNj MV <^\ —

3 ^ < - M 

Restoration Items in Question: 

Hem: 

item: 

Item: 

Kem: 

item: 

Item: 

Required corrections to complete the property: 

L J I agree restoration is completed, except as noted above. 

L J I do not agree restoration is completed 

7/-y^^ -X P 

Date 
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number of prqwrties located in Omaha, Nebraska, including the property located at 

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

property to remove lead-contaminated soil. By signing this form, fte 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 cleanip) planned for your property, please contact Prudent's Administrative Clerk for the 

Omaha Lead Site cleanup. Ms. Madurima Duru -at (402) 733-1455. General questions about the Omaha Lead Site cleanup can be 

directed to the EPA Public Informationpeoters at (402) 731-3045 (Soudi Omaha ofBce) or (402) 991-9583 (Norfli Omaha ofQce). 

Property Access Granted By: /Z/L^ V 

lease Print Name) 

Property Owner Signi 

(Date) 

PROPERTY INFORMATION 

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

RESIDENT NAME: '^Tho/T)/^ ^ -fi XT)TdfU^^Ti- 7Z ICl.\ 7 X^T ^ Renter 

RESIDENT ADDRESS: U ^( ^ Shc^^r^ OM^H^ AJ£ 6?/3/ 355 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: ^0'2 . S^DOj^- i ^ ^ WORK: 

AGE OF HOME? ••^7 . YEARS. HOW LONG HAVE YOU LIVED HERE? / YEARS. 

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

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD a. 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 punuant to Section 104 of CERCLA, 42 U.S.C. 9604. EPA's right of access to the property is providedfor in Section 104(e) of 

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

under this title, or otherwise enforcing theprovisions 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 
t.:^jiii:'.r;i:k ^ : ^ 5 ^ 

^:d.:xm7mm^mm7im 

OLS#: 23607 ^ i O.MAHArLE'Aa>iSIJPEREUlVO;SEp#|' 

Date Excavated: 10/18/2008 

USEPA Signed-OfTDate: 

Name: '/'•^-"-^ ^//:-// 

Address: IS-} 4 / '//•^^ 

Phone; Vi i ­ rr 5 -T?/ 7 

Omaha Lead Site 

Stte Sketch 

Date:

Time:

 ^//7/^ 7 

 i-'^ ^ 

North Arrow 

Team / />^/ / X z M >ir>^a"<<*^BVlD # 2 J 6 ^ } XRF Code 

Sample Number Lead Concentration 

Q,ZC.Tt/S. I 

^iXXfod. 

8 Rpz;6QPXA - ^JgQZ 

~4niri na 

v/- Omaha Lead Site £A = J81 PPM @ SCRAPE 46130 

CONTRAa #: EP ­ R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
mnm rECHNOLOGIES, INC. 

Property Status Form 

Date: 

Phone: BVID: 

Address: SS 3 1^ M \ SV 

Plants & Permanent Landscaping 

Item# 

On Map Description and Location 

*TN?^~S«=—b^v;^\^^ •r\e'£-^—bo hsr­

.ds 

^ Dnp '>^>^^ ^ K ^ kW- ^ v^^^M 

1D W (^ ^^--e^dl , 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes No 

Itera# Description & Location 

On Map 

Prudent Em 

Signatvire: 

VA 

8080 Ward Parkway, Suite 405 2505 N. 24* Street, Suite 308 4242 Medical Drive, Suite 42^) 

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 
HX'-l, Omaha Lead Site Date: 67J 7 7o ? North Arrow Name: _lZj^£iif^ ^ f- Address ZST Site Sketch Time: tils ' : ?i~ J 4X W^ 

Phone: V^z^ - 5-1-? -jr7/ 7 

Team / /J^t/Xf?^ ./^^^^r-^BVID # Z^^^? XRF Code ^dS Q J 

Sample Number Lead Concentration Confirmation Sempie 

ppm A/Yes a G?.C.7t/£ J 

^fr(iJO J ppm 

ppm /7/Yes 

•

>gKy^.'?<^yOir>a 23G07 ppm •

/snz^ca. C3QQ7 ppm 

/;2_Yes CD 

J?A>jr.^CPX7i ' aSQQ l ppm />Yes C l 

ppm 

46130 
Page 1 of 1 

SEPTEMBER 2004 - DOUGLAS COUNTY ASSESSOR*__­

3SS N l+\ ^"1^ 

http://douglasne.mapping-online.com/assessdoc/Photos/10/R20194600000001. jpg 9/25/2008 
Print Preview Page 1 of 1 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

{City 

\zip 

Owner 

\ Address 

Owner 

Address 2 

Owner 

\city 

Owner 

\ State 

Owner 

\zip 

2019460000 

RILEY 

THOMAS 0 

353 N 41 ST 

OMAHA 

68131 

353 N 41 ST 

OMAHA 

NE 

68131 

Sec-TwnRng 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

20-15-13 

POPPLETON PARK 

19 

9 

1/2 VAC ALLEY & 

53X116 

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

parc=2019460000 

http://douglasne.mappingonline.com/DouglasCoNe/static/accountinfo.jsp? 

accountno=R2019460000 

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 - 68 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/24/2008 

Honi\^^\\S> 

idL'ym-^i^x. '•.^• ­

'Ss ^ S »;;;'-^TW»!=-r--S-' .«.-.kai...'.^^*^t-^V..^^^TM M ^ 
IIIIHIIIIIIIIIIHIII!'­ I 

Page 1 of2 

"> 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 2145004. 

Original Call Date; 10/01/0? Time: 10:01 am Op: RAMITA18967 

Work to Begin Date; 10/03/OJ Time: 10:30 am 

State: NE County: DOUGLAS Place: OMAHA 

Address: 353 Street: N 41ST ST 

Twp: 15N Rng: 13E Sect-Qtr: 17-SE,20-NE 

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: (4 02)733-1883 


: UNSURE CORNERS 


Company PRUDENT TECHNOLOGIES 


Contact Name RAMITA Phone: (402)733-1455 


Alt. Contact Phone: (402)733-1188 


Work Being Done For: epa 


Depth of Excavation: 6ft Corner Lot: N Front: Y Rear: Y 


Involves Tunneling or Horizontal Boring : N Explosives: N 


BSHPCLKS CXCATV MCLEODNE MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility 

Type 

BSHPCLKS NEBRASKA HEALTH 

SYSTEM NA 

Day: 4025523459 

Alt: 4025523347 

Emerg: 4025595111 

CXCATV COX COMMUNICATIONS, 

INC HEIDI 

Day: 4029340469 

Alt: 4029340469 

Emerg: 4029329757 

MCLEODNE MCLEODUSA NO NEED TO CALL OUT 

EMERGENCY 

Day: 8002891901 

Alt: 

Emerg: 8002891901 

MUDOl METROPOLITAN UTILITIES 

DISTRICT SANDY 

Day: 4025047823 

Alt: 

Emerg: 4025047946 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/1/2008 
Page 2 of 2 

CITY OF OMAHA- OMAHACOF RON TRAFFICSEWER 

OMAHA PUBLIC POWER OPPDGPR5 NA DISTRICT 

QLNNEIC QWEST LOCAL NETWORK NA 


Day: 4024447197 


Alt: 4024445161 


Emerg: 4024445160 


Day: 4067289343 


Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


Alt: 


Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/1/2008