TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID #: 252-3>o Date: \0J\%\'2^\ ^ 

Address: 3M-ll^ L^fou^g-Wre, Av 

Remediatioii Contractor: pQt-> oPrM'7 Wr-^ t<yy.CiC^ !•? q.^. /JMC' > Year: '2-rOlO__ 

SOIL REMEDL\.TION 

PROPERTY FILE FOLDER DOCUMENTS 

2f Video of property (DVD) 

\i Executive Siommaiy 

a EPA-provided property sketch 

0 Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

zf Restoration Agreement 

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

(Z Confirmation data 

a Photographs ' 

d As-built sketch 

A Satisfactory restoration signed by Property O-wner: 

SC Property close-out check Ust signed by EPA 

D Description of areas not meeting ROD cleanup criteria 

3 Utility clearances 

• Property infonnation from Douglas County Assessor's Office 

D 

D 

D 

Signature Date 

30260776 

Superfunc 
PROPERTY SUMMARY f^PhhcA 

DaterjAJi^ \b Omaha Lead Site Remedial Action Contract # EP-R7-10-05 Month of: S^JMQ^^ . 

Property Address 3414 LAFAYETTE AV. 

A. EXECUTIVE SUMIVIARY 

A.l Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: NONE 

CONFIRMATION SAMPLING DATA/RESULTS: 

F2 = 273 PPM @ 8", EA = 106 PPM @ SCRAPE 

ATTACHMENTS 

1) Property sketch provided by EPA pursuant lo contract specifications 

2) Signed Access Agreement including access agreements required for crossing other properties 

3) Pre-Excavation digital video clip/photographs 

4) Post-E.xcavation 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 (ifany are made with the property owner) 

ii) Property Status Fonn 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 ofareas not meeting Interim ROD cleanup criteria. 

TECHNOLOGIES, INC. 
Find Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 2523 0 - 3414 LAFAYETTE AV 

Owner: 

n Owner Occupied 

Owner Name: 

I BOHANNON LENZOLA H 

Owner Addressi: 

r 

Owner AddressZ: 

|3414 LAFAYETTE AVE 

City: State: Zip Code: 

|OMAHA [NE |68131 -

Owner Phone: Alternate Phone: 

(402) 551-1909 r 

Contract: 

Contractor: |PRUDENT_2010_S 

Contract Option |BASE 

User Provided Owner Information 

Owner Name: 

1 

Owner Address: 

1 

City: State: Zip Code: 

1 1 1 

Owner Phone: Alternate Phone: 

1 " 1 

Assessment: 

Qualifying Group pOO 

Assessment Max XRF Value: | 463.56 

Resident: 

Resident Name: 

I BOHANNON LENZOLA H 

Property Address: 

|3414 LAFAYETTE AV 

Zip Code: 

68131-

Resident Phone 
^'7 '^ TECHNOLOGIES, INC. 

i7-:i.^... 

EPA Property Close Out 

Property #: ^^'^ ^ Property Address: 3 ^ ' '^ ^'^ ^ ^-^ ^ ^ 

Date/Time: Owner'sName: ie«.i^2^"'^cc l^\>cSXok.AnoV\ 

Quads Excavated: p-7 _ Contractor Group: Pnident Technologies, Inc., 

Excavation General Yes No 

I. If necessary, were tlie correct quadraiit(s) excavated and restored? / 

2. If necessary, were tlie correct areas ofdrip zone excavated 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 tlie house? 

2. Has sod been laid in all areas that were e.xcavated? / 

:->. Does the sod appear to be generally healthy and growing? (Only evaluate if inspecied at a 30 

day time period) / 

4. Are sodded areas generally firm and evenly graded? / 

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

time period) / 

6. Was the property graded such thai water vwU not pool on the property? / 

7. Was dainage lo landscaping or plant materials avoided? 

y 

Gates, Fences and Retaining Walls Yes No 

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

y 

2. Were all gates or fences taken down during restoratioa activities reinstalled? (Ifapplicable) d 

3. Was damage lo gates or fences avoided? (If applicable) 

y 

4. Was daniage to retaining walls avoided? (Ifapplicable) 

y 

Foundation, Siding and Gutters Yes No 

1. Was damage to the siding or trim avoided? 

d 

2. Was dainage to the foundation avoided? 

y 

3. Was damage to windows avoided? y 

4. Was damage to windows or door screens avoided? d 

5. Was damage lo downspouts or downspout extensions avoided? 

y 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage lo driveway surfaces avoided? 

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

Inspection notes: 

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

EPA Representative BC^JI.A^ Date: 9(flio 
ra 

r;CHNOLOUIES, INC. 

AS - BUILT DRAWING 

OLS # 25230 

Date Excavated: 08/16/2010 

I'SEP.A Signed-orr Date: OMAHA LEAD SUPERFUND SITE 

Name: _ Omaha Lead Site Date: SP:>d<- 5 North Arrow 

Address: 3Y" / yyFA^in i Site Sketch Time: ID-^S^ 

Phone: 

"y 

Team fi:i:f->p/f><:tiyir:cy BVID# TiSTl^O XRF Code 5Tg> 

Sample Number 

Lead Concentration Confimnation Sample 

f ' Yes a No S 

fa Yes tn No S i xvcs/:yy/} - z^^y^^ l3-i.ft/ 3 PP^ CH Yes n No H 

il2Yes D No H 

ppm 0(1 Yes CD No B 

/7.-7 6 

Yes • No a 

Yes • No • 

CONTRACT #: EP-S7-10-05 PRUDENTTECHNOLOGIES, INC. 

46130 
m 8&tHH 

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 of the 

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, ifany. 

Property ID: :^>3 o 

Property Address: ^5 ^ 1 H L^^J^cc ^ o_ fif € _ /^^ ^ 

Owner: ^y^i^ +^ ^ cVrur.jc\^r>y\ -LM ye^^'^ ^ 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

I agree restoration is completed. 

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

Gy/cAiiyg/^r 3d)/d 

Date 0 ' 
Prudeni Technologies, Inc. (Prudent) is under contract with the U. S. Environmental Protection Agency (EPA) to clean up leadcontaminated soils at a number ol'Droperties located in Omaha, Nebraska, including the property located at 

3MI M LA)-^ N zTT f jflV tjy 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 pennission to Prudeni to perform 

activiiies related lo the cleanup including soil sampling, removal of lead-conlaminated soil, and restoration ofthe referenced property. 

Ifyou have any questions about the soil cleanup planned for your properly, please contaci Prudeni South (jinahu OIHcc for the Omaha 

Lead Site cleanup,.at (402) 733-1188; 733-1455. General questions aboyt the Omaha Lead Sile cleanup can be directed lo the EPA 

Public Informalion Centers al (402) 731^3^45 (South Omaha office). 

Property Access Granted By: 

Propeny Owner Signatur<^^''^d/^J/M,.y_A^£.^y i ^ 

PROPERTY INFORMATION 

(To be completed by resident and/or propert>' owner - please print) 

RESIDENT NAME ' • P^y:-<^1 ' Pl K n k a F\r\Cir\ eJwner y Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

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

AGE % - ^ OF HOME?: ll/\ l YEARS. HOW LONG HAVE YOU LIVED HERE? YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERED WITH SIDING SINCE 1978? Ly^^ S 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 5 HOURS OR MORE PER WEEK: 

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

CjriX^ ^ [<LAtl<2-. ' nJj O U ^ '^ ' • L , 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activiiies to be implemenled by EPA under this agreement 

are pursuant lo Section 104 ofCERCLA, 42 U.S.C. 9604. EPA's right ofaccess 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 taking any response action 

under this lille, or otherwise enforcing the provisions of the litle." 

8080 Ward Parkway, Suite 405 5600 S. 10'" Street 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68107 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)733-1455 Phone: (210)822-9588 

Fax: (816)363-3707 Fax: (402)733-1883 Fax: (210) 579-6577 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: 2>M\^ LiXi^ojudM-^ Ac^w '^«*^'' ^'^1 ^ D 

Phone: 55 ) - )^o c^ BVID: 

Tp,^gA;':a ( Ar^ Q F^ 

M0 plavx irj^ 

fOO [ Q-vvA Sc^Y-c^rPfe S^'SHK ^ & CLCx^^.^<-gy^ 

=d^^.XLi^=,^_u:^.=^J^o^__n^£L==^=S^^, 

M ^ fiey"«v^lssHc^ 

^ 4-eagg_ .P).^p.^3 - p i 

Property Owner Prudent Emplq^ee 

A - ^ Signature: Signature: 

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

KansasCity, MO64114 Omaha, Nebraska 68110 San Antonio, TX 78229 
Name: _ 

Address: 

Phone: 

3'-i i H AyiPAfV£7ri^ 

Omaha Lead Site 

Site Sketch 

Date: Sd^dc5 

Time: lo - 75" 

North Arrow 

Team /7ZAJ^/A,c.H7ircf<C BV1D# S>i^':>2>0 XRF Code ^6'7y 

Sample Number Lead Concentration Confirmation Sample 

/lV/3^yyyA4''-i,<:i.^< ^ 

7{yj/ypy:/^)y/:^-^'f^y^** ,/ 

ppty'^$y:A>'xy</- z ^•z.yy ^ 

/7.'7 ^'^ 

ppm 

ppm 

t^' Yes

Fa Yes

i>i Yes

62. Yes

0/lYes

Yes

Yes

 a 

n 

• 

 l^l 

n 

• 

• 

No

No

No

No

No

No

No

 S 

S 

Q 

S 

S 

 CD 

• 

IMi 

4

. i ^ n?^-^ ,11 ^ „ i 

41 

l-l. 

jy^' ^ 'AA^pyH'/^.y • i 

<ac^X-CJ <S>^J^ 

^ 4 

Q

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.vfe 

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(InAO 

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Page 1 of 1 

VPRIL 2009 -DOUGLAS COUNTY ASSESSO 

ffiiH U^ti h Ai/. 

http://douglasne.mapping-online.com/assessdoc/Photos/09/R06076200000001.jpg 6/11/2010 
Print Preview Page 1 of2 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

Owner 

City 

Owner 

State 

Owner 

Zip 

0607620000 

BOHANNON 

LENZOLA H 

3414 

LAFAYh11E 

AV 

OMAHA 

68131 

3414 

LAFAYETTE 

AVE 

OMAHA 

NE 

68131 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

BEMIS PARK 

2 

9 

44X126.95 

0.11 

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

parc=0607620000 

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

accountno=R0607620000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 6/14/2010 

2 
w / .^ I / ^\J.^\ J 

Create Another Ticket i Backsto Internet Send Email 

• YOUR TICKET NUMBER IS  2569963. 

Original Call Date: 8/17/10 Time: 1:11 pm Op: SIVA18967 


Work to Begin Date: 8/19/10 Time: 1:45 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 3414 Street: LAFAYETTE AVE 


Twp: 15N Rng: 13E Sect-Qtr: 16-NW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: Lead Soil Remediation Project 


Location of Work: LOCATE ENTIRE PROPERTY 


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


: UNSURE CORNERS 


Company : PRUDENT TECHNOLOGIES 


Contact Name: SIVA JAMPAMA Phone: (402)733-118! 


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 LEVELS MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Utility Service Area Contact Phone Number Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVELS COMMUNICATIONS, LEVELS NA Alt: 

LLC 

Emerg: 8773668344 


Day: 4025047823 


METROPOLITAN UTILITIES 

MUDOl SANDY Alt: 

DISTRICT 

Emerg: 4025047970 


Day: 4024447197 


CITY OF OMAHA- OMAHACOF RICH/TRAFFIC Alt: 4024445161 

TRAFFICSEWER 

Emerg: 4024445160 


dhon.org/irthinternet/.../MessageTextas... 1/2 
OPPDGPR5 OMAHA PUBLT 

DISTRICT 

TOWER ELM 

LOCATING 

||Day: 

Ah: 

4067289343 

4062071494 

Emerg: 8887289343 

QLNNEIC QWEST LOCAL NETWORK ELM 

LOCATING 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

dhon.org/irthinternet/.../MessageTextas... 2/2 
TECHMOL(Hil£S, INC. 

ENVIRONMENTAL 

ENGINEERING AND 

CONSTRUCTION 

SOLUTIONS 

SITE SAFETY HAZARD ANALYSIS 

A.^JA..iaik)^^44ci )f)£^ Address: -^ xcavation Date : ZAIM^ 

'\^ I AT 

Crew: -~sJL0.hJ3.-lUli:3.:e./. Backfill Date: 

Item Conditioii Hazards Corrective Action 

Overhead Lines wOoA 

Gas Line yfk. Water Line y ^ 

Sewer Line MA. Septic/Leech 

Field sdJL 

Propane/Butane M-A 

Sidewalk (AoncL St^V A i£. Foundation 
 0-ooAL 

Retaining Walls PiD 

Fences m 0 

Trees Cr 00 cA 

Structures IUL 

Driveway 9,Dcl^ llrlviiiyey 

Sprinkler System AVO 

Other JUI 

Crew Foreman Site Safety Office 

Date: 

4242 Medical Drive, Suite 7250 8080 Waiid BartMiay. Suite 405 5600 S 10 St 

Kansa San Antonio, TX 78229 s City, HO 64114 Omaha, Nebraska 68107 

Phone: (210)822.9588 Phone: {816)363-3703 Phone: (402)733-1188 

Fax: (210) 579-6577 Fax: (816) 383^3707 Fax: (402)733-1883