• • • • 

TRANSMTTTAL of OMAHA LEAD STIE 

SOIL REMEDIATION FILE FOLDER 

SAID#: jL^ ^ ^ Date: 12,) )^/^ 9 

Address: l>t% l S C^l^ ^ 

Remediation Contractor: rbviio^J- ^ A Js^ o Year: '^v^ Q 

SOBLREMEDUTION 

PROPERTY FILE FOLDER DOCUMENTS 

0 Video of property (DVD) 

a Executive Summary 

a EPA-provided property sketch 

a Signed Access Agreement for subject property 

• Signed Access Agreement(s) for adjacent property 

a Restoration Agreement 

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

Confirmation data 

I Photographs 

As-built sketch 

^ 

Satisfectory restoration signed by Property Owner 

li Property close-out check list signed by EPA 

D Description of areas not meeting ROD cleanup critaia 

HI Utility clearances 

a Property information from Douglas County Assessor's Of&ce 

D 

D 

D 

^ ^ --ft*^ i, \o Signatoe'^7 ""SSe 

30054 125 

iiinNiiii 

Superfund 
Find Record 

Backfill: 

Sample Area: 14288 - 3063 S 42 ST 

Owner: 

D Ovmer Occupied 

Owner Name: 

jCORBOY LIV TK CATHERINE A 

Owner Addressl: 

Owner Address2: 

|3063 S 42 ST 

aty: State: ZipCode: 

[OMAHA |NE |68105 

Owner Phone: Alternate Phone: 

1 1 

Remediation Query I Lead Remaining Query I Property Damage Query 

Resident: 

Resident Name: 

|CORBOY CATHERINE A 

Property Address: 

|3063 S 42 s r 

Zip Code: 

[68105 

Resident Phone 

I " 

Contiact: 

Contractor: 

[PRUDENT2009_S 

Contract Option 

OFnON3 

Assessment: 

Qualifying Group 

[400 

Assessment Max XRF Value: 

r 515.6 
wmsBwmswwattKMBsr 

Date: 12/15/2009 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 TO#l Month of: November 

Property Address; 3063 S 42 ST 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A3 Unique Findings: NONE 

A.4 Other Relevant Information: AREA NOT EXCAVATED UC F2 4'X21' 287 PPM @ SCRAPE 

CONFIRMATION SAMPLING DATA/RESULTS: 

F2 = 160 PPM @ 3"; EA = 89 PPM @ SCRAPE H ) 

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 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 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. 
EPA Property Close Out 

Property #: ri/-^5 ^ Property Address: 3,0^* 5 b ^ ^ 

Date/Time: Owner's Name: ^'ci-Wcr>v«<» fo.^op. 

Quads Excavated: P-V Contractor Group: Prudent Technologii», Inc., 

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 that were excavated? 

3. Does the sod ^pear 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 generallytight? (Only evaluate if mspected at a 30 day 

time period) 

6.

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

7. Was damage to landscaping or plant materials avoided? 

Gates, Fences and Retaining Walls 

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

2. Were all gates or fences taken down during 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 

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 

y 

Yes No 

/ 

/ 

/ 

J 

y 

y 

y 

Yes No 

y 

y 

y 

y 

Yes No 

/ 

/ 

/ 

/ 

/ 

Yes No 

J 

J 
Owners comments: 

Inspection notes: 

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

EPA Representative £L. Date: ii/is/09 

^ 
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 future, excluding any 

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

Property ID: 

Property Address: 'hOU'\ "3. Mi 5 f 

Owner: (^ec4-Ker i jO^ (^orb^ y 

Phone: jHbl ^ ^SV-Q^^ S 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

J^ l agree restoration is completed, except as noted above. 

 I I do not agree restoration is coinpleted 

//////^f 

Owner's Signature Date 

I
Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcoo^mm^te<Lsoils at a nmnber of oropci^i^s located in Omaha, Nebraska, including the property located at 

^d/l a O 5 •*T oL JF"^ . The EPA requests your permission to allow Prudent to perform a soil cleanup at this 

property to remove lead-contaminated soil. By signing this form, the property owner grants pennission to Prtjdent to perform 

activities related to the cleanup including soil sampling, removal of lead-cotitaminated soil, and restoration ofthe referenced property. 

If you have any questions about the soil cleanup planned for your property, please contact Prudent's Ailniiiii.NiriKivi.- Clerk for fhe 

Omaha Lead Site cleanup, M~:. .Sisa .S .l.inip.iuj -at (402) 7,^.'-l is>i. General questions about the Omaha 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 By: 

(Please Print Name) 

Property Owner Signature. 

(Signature) ( (Date) 

PROPERTY INFORMATION 

iTo be comp iletedKjb i y resident and/or proper^ owner — please print) 

RESIDENT NAME: Owner Renter 

RESIDENT ADDRESS 
 30^3 s, y-^ 5/-

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAIUNG ADDRESS; Su*^^­

OWNER'S TELEPHONE NUMBER - HOME: fm, 5^l-0S33 WORK: 

( ) 

AGE £2 1£  OF HOME?: YEARS. HOW LONG HAVE YOU LIVED HERE? YEARS. 

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

NUMPE IBE R OF OCCUPANTS UNDER 7 YEARS OLD: C y 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: TTie activities to be implemented by EPA under this agreement 

are pursuant to SecUon 104 ofCERCLA, 42 U S.C. 9604. EPA's right of access to the property is provided for in Section 104(e) of 

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

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

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

KansasCity, 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 
ENV[RONlVrENT,\L& 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: 30/f3^ S. V^ ^"Z- Date: lO^^-O ^ 

Phone: ^Od^ Sr/ - 0^3 ^ BVID: /"/^ ^ 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

^ f\&k - f/ef^ry >^«-5 c^AA^A-4/ ^iiGfy\ 

Pre-Existing Condition of Structures 

Does your Basement have a history of leaking? Yes No y 

Item NO Description & Location 

On Map / / / - Ct^<^h >y^ elf/ iye (Vay d t^^ W 

pn - ^/^^ ^ M f7fiyctyh i^^-l^ Cuy&^-F) 

Property Owner Prudent Employee v 

Signature: 4^3^40-^^ f^m^^dd ?K_ ^ 

8080 Ward Parkway, Suite 405 ^ 5600 S 10 St 4242 Medical Drive, Suite 4250 

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

Phone: (816^ 363-3703 tifr\r\na. tAn'i \ Ti l ilO O 
iin 

•CHNOUHJIKS. INC. 

AS - BUILT DRAWING 

OLS#: 14288 

Date Kxcavated: 10/14/2009 

i;SKP.\Signe«l-OirDate: OMAHA LEAD SUPERFUND SITE 

Name: _ Omaha Lead Site Date: %/n//r Z North Anow 

Address: Slt« Sketch Time: I'.Tt 

Phone: 

ARIC.A NOT EXf AVATED; 

2/l,'C(4'X21")=109PPM 

Id: St,'RAPK f~l") 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENTTECHNOLOGIES, INC. 
Name: _ Omaha Lead Site Date: ^//a//7 3 North Arrow 

Address: Sfte Sketch Time: I'lTi ^ 

Phone: _ 

TeamJll£S__Gisy< = BVID # __Z^±2X5 L XRF Code /l ^ 

Sample Number Lead Concentration Confirmation Sample 

RrA5<lPXA - 1^7.?^ ppm t

I Yes n No i2r 

ppm ,'o.Yes CD No 2 ^ 

RVcS<lPyA- lU.^?? ppm "^.t Yes tn No £3'^ 

ppm ^o-Yes CD No ^ 

RDg:5>CPxA- m--«-'S? 

ppm •^vYes CD No CT 

ppm Yes • No CD 

ppm Yes • No • 
lULY 2WS - DOUGLAS COliNTY ASSESSO! 
Print Preview Page 1 of2 

Douglas County-Omaha, NE 

Pamel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

Owner 

City 

Owner 

State 

Owner 

1218000000 

CORBOY LIV 

TR 

CATHERINE A 

3063 S 42 ST 

OMAHA 

68105 

3063 8 42 ST 

OMAHA 

NE 

68105 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Unk 

GREEN VALLEYS 

2 

17 

LOT 17 BLOCK 2 

• -n 

0.17 

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

parc=1218000000 

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

accountno=R1218000000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/17/2009 

2 
Page 1 of2 

"> 

[ Create Another Ticket j [ Back to Irth Internet ] Send Email 

• YOUR TICKET NUMBER IS 2381403. 

Original Call Date: 10/07/09 Time: 9:29 am Op: SIVA18967 


Work to Begin Date: 10/09/09 Time: 10:00 am 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3063 Street: S 42ND ST 


Twp: 15N Rng: 13E Sect-Qtr: 32-NE-NW 


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 


: 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 MUD02 OMAHACOF 0PPDGPR6 QLNNEIF 


Service Area Contact Phone Nuniber Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

MUD02 METROPOLITAN UTILITIES DISTRICT SANDY

Day: 4025047823 

 Alt: 

Emerg: 4025047970 

OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

OPPDGPR6 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/7/2009 
Page 2 of2 

Day: 4067289343 

QLNNEl F QWEST LOCAL NETWORK NA Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 10/7/2009 
:^i^^^^"'TECHNOLOGIES. INC 

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Foundatioii: -^^/ir. 

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