TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SATDJ^; , 2/Zx<?| Date: Q.\ l ^ 

Address: ^^ic ^ fmr^JUfl^ Av/ -

Remediation Contractor: '^(\iA M ^/fl/l \v\ t Year: ^ 0 | <3 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

1^ Video of property (DVD) 

0 Executive Summary 

^ EPA-provided property sketch 

/ Signed Access Agreement for subject property 

D Signed Access Agrecment(s) for adjacent property 

0 Restoration Agreement 

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

Confirmation data 

Photographs 

As-built slcetch 

Satisfectory restoration signed by Property Owner 

Property close-out check list signed by EPA 

n Description of areas not meeting ROD cleanup criteria 

Utility clearances 

Property informationfrom Douglas County Assessor's Office 

D 

D 

D 

^ ^ 3,uli> 

"Signature — Date 

30262418 

iHini 

Superfund 
Find Record Remediation Query I Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 2281 - 3369 GRAND AV 

Owner: Resident: Contract: 

t • Owner Occupied 

Owner Name: 

|WEST LOST LAKE LLC 

Owner Addressl: 

Resident Name: 

1 

Property Address: 

|3369 GRAND AV 

Contractor: 

|PRUDENT2009_S 

Contract Option 

OPTIONS 

Owner Address2: 

)1323 WILLIAM ST 

City: 

|OMAHA 

Owner Phone: 

State: Zip Code: 

|NE |68108 

Alternate Phone: 

1 

Zip Code: 

|68111 

Resident Phone 

1 

m 

Assessment: 

Qualifying Group 

poo 

Assessment Max XRF Value: 

r 622.8 

\ 
/ 

PROPERTY SUMMARY 

Date: J/15/2010 | Omalia Lead Site Remedial Action Contract # EP-R7-07-06 TO#l | Month of: Q C T 

Property Address; 3369 GRAND AVE 

A. EXECUTIVE SUMMARY 

A.l Issues Encountered: NONE 

A.2 Issues Resolved: NONE 

A.3 Unique Findings: NONE 

A.4 Other Relevant Information: AREA NOT EXCAVATED PER P.O. REQUEST; DZ/BUSHES (2'Xl .5') 

= 443 PPM @ SCRAPE . 

CONFIRMATION SAMPLING DATA/RESULTS: 

Bl = 338 PPM @ 14"; B2 = 324 PPM @ 14"; DZ = 333 PPM @ 14"; EA = 179 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 Checklist 

6) As-Built sketch ­

i) 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 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. 

TEGHNOLOCIES, INC. 
^HNOIOGIBS, INC. 

EPA Property Close Out 

Property #: 2-2 ^ Property Address: SS^*? <^><5>'wA A / 

Date/Time: Owner's Name 

Quads Excavated: fl) ^2, P ^ Contractor Groupp: Prudent Technologiesnnc, 

Excavation General 

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

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

Grading Sod and Vegetation 

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

from tlic house? 

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

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

day lime period) 

4. Are sodded areas generally finn and evenly graded? 

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

time penod) 

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? (Ifapplicable) 

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

3 Was damage to gates or fences avoided? (Ifapplicable) 

4. Was damage to reiaining walls avoided'^ (If applicable) 

Foundation, Siding and Gutters 

1. Was damage to the siding or trim avoided? 

2. Was damage to tlie foundadon avoided? 

3 Was damage lo 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 lo driveway surfaces avoided? 

2 Was damage to walkway surfaces avoided? 

Yes No 

J 

J 

Yes No 

J 

/ 

J 

i7 

y 

y 

y 

Yes No 

/ 

/ 

7 

J 

Yes No 

• 

y 

/ 

/ 

/ 

Yes No 

/ 

• 
Z^^ ^ ^Ta/\J A-\fe^ 

Owners comments: 

i 

1 

Inspection notes:

• 

1 

i 

i

! 

I 

1 

1 

i

 ^ff'*^ i 

1 

i 

i 

i 

1 

1 

i 

1 

1 

1 

1 

1 

\ 

1 

1 

1 

Removal andrestoration activates complete including the 30-day sod wa xanty 

EPA Representative Q»- ^ Date: >M to 
li 

i(» 

-;; ^ „«*.-"' 

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 

remaimng warranty (30 days total) except those items listed below, ifany 

PropertylD: ^^J> / 

Property Address: J^^ f ^M//7 ) >^>^ 

Owner 

Phone: ^^^^ 3S^ 1 (It/I / WftH 3^-^6)6 

Restoration Items in Question: 

Required corrections to complete the property: 

^ 1 agree restoration is completed. 

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

//-^^-^ ^ 

Owner's Signature Date 

I
Prudent Technologies, Inc. (Prudent) is under contract with the U S. Enviixmmental Protection Agency (EPA) to clean up leadcgqtwiinvtod soiJ^BLa number oCffropprties located in Oniaha, Nebraska, including the property located at 

e3'f0 i (^K:7rfl/7) 'ff/Jfp Tlic EPA requests your permission to allow Prudent to perform a soil cleanup at this 

property to remove lead-contaminated sod By signing this form, die property owner grants pennission to Prudent to perform 

activities related to 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 property, please contact Prudent's AcliniiiiMnilnu Clcik for the 

Omaha Lead Site cleanup. Ms Siva .S Jiiinixinii-at (402) 73."<-l ISX. 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) 991-9S83 (North Omaha office) 

Propeity Access Granted By: 'FiifV7CK /(^/y^i 

(Please PrinrName) . (,r lease mpriMam^j^^.^ 

Property Owner Signature 

y ^ ' (SigDBtunjT (Date) 

PROPERTY INFOmN; lATION 

by resMcBt tailwejmtipcrt ^ y owner — please print) 

RESIDENT NAME: ^f/ni^f/ 777£&C £i £ Owner Renter. 

RESIOENTADORES r ADORERJ : ^ 

IF RENTAL, PROJERTIfl^bVVNEB BY: y . .. . 

OWNER' A?!^T7/^/?rW ^ /^mnk ^^f^^ 

OWNER'S TELEPHONE NUMBER - HOME: J L 3i<f-Sdld ^ ^^fftf JXV. 7 

J 1 

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

HAS THE EXTERIOR BEEN PAINTED OR COVERED WrTH SIDING SINCE 19787 J L ^YES _|St_ 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: 

COMMCNtS ORJVECIAL INSTRUtfTIONS: (I.E. DOGS. ENTRY GATES, ETC.). „ 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS, The activities to be implemented by EPA under this agreement 

are pursuant lo Section 104 of CERCLA, 42 U S C 9604 EPA's right ofaccess to the property is provided for m Section 104(e) of 

CERCLA, 42 U.S. C 960S(e), which provides entry for "detomming the need for response, or choosmg or taking any response action 

under this title, or otherwise enforcing the provisions 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 
ENVIRONMENTAL & 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address Date: 

Phone: BVID: 

Item NO Plants & Permanent Landscaping To Remain In Place 

On Map Description & Location 

film 

Pre-Eiisting Condition of Structures 

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

Item NO Description & Location 

On Map 

Property Owner VryiAcnt Employee, 

Signature: Signature: 

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 
# 

IIF.S. INC 

AS - BUILT DRAWING 

OI,S#:2281 

Date Kxcavatcd: 10/14/2009 

LSEPA OMAHA LEAD SUPERFUND SITE Signed-Off Date: 

T'rTW Exterior Paint Omaha rtn !K\ Lead Site • £ood Site Sketch 

[7] Poor 

Sampling Address: .^?)G.°^ HraHr / A v • Not pant i 

Sample Nunnber Lead Sannple Samples Cojiected 

Concentration Collected LAB Firm: BJum7K/mmd / 

RYASCPXA-SS 8 / P1 n Date: r^-fn-n/^ 

RYBSCPXA-22(9/ F2 38< o ppm D Time: 

RYCSCPXA-^2a/ Bl f^<9/° ppm n Samplds Analyzed RYDSCPXA-eca/ B2 ¥Q(a ppm n 

RDZSCPXA- SSe / DZ gflgQpp m n XRF Unit: /SO^Book : 

nCZOOPXA 3SQ / GZ ppm D n Date: 

RPZSCPXA SSO / ^^ ' ~ ppm D D Time: 

Staff: Number of Samples = | ^ \ 

Legend: Fl = Front Left. F2 = Front Right, Bl = Back Left, B2 = Back RigM DZ = Drip Zone, GZ = Garden, PZ = Play All quaaranlB are as viewed from the street, facing property /\ i i EV 

G«!«At«iP Kv. 

KA = 179 PPM r« SC RAFF. (~1") 

CONTRACT #: EP - R7-07-06 T0#1 PRUDENT TECHNOLOGIES, INC. 
Omah Exterior Paint North Arrow a Lead Site • jGood Site Sketch 

0 Poor 

Sampling Acldress: 3 3 ( md Av 

Q Not paint 1 

Sample Number Lead Sample 

Samples Cojiected LAB Concentration Collected Fimn: B7um/Kirr)m d 

RYASCPXA-^23/ Fl 

2dA ppm 

D Date: Q-Id'717 ^ 

RYBSCPXA-225/ P2 3Q G ppm 

D Time: 

RYCSCPXA-^'^a/ Bl _d££.ppm 

D 

Samples Analyzed RYDSCPXA-ef<3/ B2 D 

RDZSCPXA- 22a / DZ 2d.£Qppm D XRF Unit: /^n^^Book : 

nozscpxA SSQ / CZ ppm n D 

Date: 

ppm n D 

Time: 

Staff: Number pf Samples = 6^ 

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

All quadrants are as viewed from the street, facing property AJ_|_ g y 

Rev20O8.DI. Created: 16-May-08 04(3141 012.1 
yfxy^^ GR.^Nt) AV 
Flint Preview Page 1 of2 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 

2 

Owner 

City 

Owner 

State 

Owner 

Zip 

Sec-TwnRng 

1800750000 

WEST LOST 

LAKE LLC 

3369 GRAND 

AV 

OIVIAHA 

68111 

1323 

WILLIAIVI ST 

OMAHA 

NE 

68108 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Acres 

Treasurer 

Website 

Link 

Assessor 

Website 

Link 

MONMOUTH PARK 

1 

13 

LT12&E1.5N94FTLT13 

0.15 

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

parc=1800750000 

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

accountno=R1800750000 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 9/16/2009 
Page 1 of2 

"> 

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YOUR TICKET NUMBER IS 2375366. 

Original Call Date: 9/29/09 Time: 2:35 pm Op: SIVA18967 

Work to Begin Date: 10/01/09 Time: 3:00 pm 

State: NE County: DOUGLAS Place: OMAHA 

Address: 3369 Street: GRAND AVE 

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


Involves Tunneling or Horizontal Boring : N Explosives: N 


ALT872 CXCATV METRO MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Service Area Contact Phone Number Utility Type 

Day: 4067289343 

ALT872 WINDSTREAM COMMUNICATION NA Alt: 4062071494 

Emerg: 8887289343 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 4024572307 

METRO METRO COMM. COLLEGE CHRIS Alt: 4026727033 

Emerg: 4024572313 

Day: 4025047823 

MUDOl METROPOLITAN UTILITIES DISTRICT SANDY Alt: 

Emerg: 4025047970 

http://www.dhon.org/iithintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 9/29/2009 
Page 2 of2 

OMAHACOF CITY OF OMAHA-TRAFFIC.SEWER RON 

Day: 4024447197 

Alt: 4024445161 

Emerg: 4024445160 

0PPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

QLNNE IC QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 4062071494 

Emerg: 8887289343 

http://www.dhon.org/irthintemet/DHONNoticeCr«ation/MessageText.asp?ret=<RESULTS... 9/29/2009 
TECHNOLOGIES, INC. 

Site Safety Hazard Analysis 

Address: 77^ ^ rr?j^.^**J 

Crew: ^^ftft^tfJ Lj/>^/vcsV^^ r 

Date: 9-^ 6 - <?? 

item 

Overhead Lines 

Gas Line 

Water Line 

Sewer Line 

Septic / Leech 

field 

Propane/Butane 

Sidewalk 

Foundation 

Retaining Walls 

Fences 

Trees/ Bushes 

Structures 

Driveway 

Sprinkler System 

Other 

rema;r7 

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ENVIRONMENTAL S. 

CONSTRUCTION 

SOLUTIONS 

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8080 Ward Parkv/ay. Suite 4G5 2606 N. 24"" Street. Suite 306 4242 Medfcal Drii/e. Suite 7250 

Kansas City. MO 64114 Omaha. Nebraska S8110 San Antonio TX 78229 

Phone: (816) 363-3703 Phone: <402) 504-1004 Phone: <210) 822-9588 

Fax­ !402> 504-1005 Fax- (210! 579-657" 

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