TRANSMITTAL of OMAHA LEAD SITE 

SOIL REMEDIATION FILE FOLDER 

SAID#: ^ Date: '^tjjlJp^B 

Address: ,9y)^fl MiAAil ^" f 

Remediation Contractor: P.^onP M "T ~fe cU . Tf iMr Year: o^^-9< 

SOIL REMEDIATION 

PROPERTY FILE FOLDER DOCUMENTS 

Ef Video of property (DVD) 

a Executive Suirmiary 

\^ EPA-provided property sketch 

y Signed Access Agreement for subject property 

D Signed Access Agreement(s) for adjacent property 

0 Restoration Agreement 

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

[^ Confirmation data 

y Photographs 

y As-built sketch 

y Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

n Description ofareas not meeting ROD cleanup criteria 

y Utility clearances 

y Property information fi-om Douglas County Assessor's Office 

D 

Signatur^ Date 

4031 381 

Superfund 
PROPERTY SUMMARY 

Date: 09/15/2008 Omaha Lead Site Remedial Action Contract # EP-R7-07-06/0004 Month of: Aug/Sept 

Property Address: 2025 MIAMI 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: 

Fl=198 PPM @ 6"; DZ=288 PPM @, 6"; EA=107 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) 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) Descriptionof areas not meeting Interim ROD cleanup criteria. 

TECHNOLOCIES, INC. 
Rnd Record Qean Up Query Lead Remaining Query I Property Damage Query 

Backfill: 

Sample Area: 29154

Owner: 

n Owner Occupied 

Owner Name: 

|BASS SHAWN R 

Owner Addressl:

Owner Address2:

|2025 MIAMI ST 

City: 

|OMAHA 

Owner Phone: 

1(402)341-7557 

­ 2025 MIAMI ST 

State: Zip Code: 

|NE |68110 

Alternate Phone:

|(402) 351-6023 

| 

| 

| 

Resident: 

Resident Name: 

BASS SHAWN R 

Property Address: 

2025 MIAMI ST 

Zip Code: 

168110 

Resident Phone 

r 

Contract: 

Contractor: 

Group: 

Assessnient: 

Qualifying Group 

iPRIORmr 

Assessment XRF Date: 

I 

Assessment Max XRF Value: 

I 473.6 
dEBV 

EPA Property Close Out 

Property #: 2.<=l ITlf. Property Address: 202£ rfiavvii Sh 

Date/Time: (a/092^/o3 Owner's Name: ShR*** B»ts 

Quads Excavated: F j t)2. Contractor Group Prudent Technologies 

Excavation General 

1. Ifnecessary, were the correct quadrant(s) excavated and restored? 

2. Ifnecessary, were the correct areas ofdrip 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 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 

I. 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) 

I. Was damage to driveway surfaces avoided? 

2. Was damage to walkway surfaces avoided? 

Yes No 

y 

y 

Yes No 

y 

y 

y 

y 

y 

y 

/ 

Yes No 

y 

y 

y 

y 

Yes No 

y 

y 

y 

y 

y 

Yes No 

y 

y 
Owners comments: 

Inspection notes: 

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

EPA Representative SO^JSL . Date: g/^t/ojt 
I

&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 future, excluding any 

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

Property ID: 2.'=) | CZ^ 

Property Address: X^ o xi S ^A\ av ^ § ^ 

Owner: 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

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

LJ I do not agree restoration is completed 

•^Owner's Signature Date 
W0 M •• 

,y,> <• ' " " * '\7/..skm9ff~r~7*fTl^.'111177^ y i •""'•'• '^ 

Piudtst T tchndo^ts, Inc. (Pmd«ii$ is undtr contmct <ri& th» U. S. EnTironBtutal Prottction Agmcy (^A) to dtioa 19 Itad­ eoataBaiat»dso£tta»i22a!b«ofprop«ti«s!ocst»dir.'^ ' "'^-•• • ' '' * ^ . . < _. 

ThjHPAr : jil cltaniq) stdas 

IfyouhKTt zn^ qutdicns about tht soil clisaif plmntd for ycur proptrty, pitast contact Prudtra'iAfaicisSratvt GItik for thIt tp , • ' — > • - TM • • • .-.^- ^ .... . ,.^,.j * TM ,* .. ,....-....».. . ^ ^ i 

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• •••'^•- ;3;gr.isa-y; (pti»j 

PROPERTY WPCRKATJON 

SKcAUIfx I?. 6C71S< (3 ) =.--• 

c^oag> vS'^v ^ ' ^ t^^A^^jL^ kSe^ (^ ^ \ ^ ^ 

IF RENTAL. PROPERTY OWNED BY: 

OWNER'S MIAILWG ADDMSS; . 

.^_§-^S :^ti?:i=:L__^___£D±:^fi:f^ _K>^ 

OVWER-sj-;-—;;---fR-HOllE; H n 3^/^55 ^ _ '•—' 

AGE , 0 /Q O ^EARS. HOW LONG HAVE YOU LIVED HERE? _^S__ _ YEARS 

HASTHE EXTERIOR BEEK WTIH SIDING SINCE 1378? YES ) ( VO 

^ -

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: If i NUMBER OF OCOJPANTS? YEARS OLD AND OLDER 

MUHOCIt O^ rHfinf?i=N nvrffT 7 v^asf; nt " wmnp t a v m THFVflwn ••o»» s HOUR S OW vnw!? "p ^ w??irCOMMENTS OR SPECIAL tHSTRUCTIOHS; (!.E DOCS ENinY GATtS. ETC.) 

ar» j'"jrsaanl to Ss ;, .•-.,••1 - - -..-.- ..^^ f 

CERCLA, 42 US .gth? nt»^ . ordioosngortaJcngaEjrrt^oia* action 

o ^w >V<<.\^ rd»K,d«i^. Suits 4SS 2S8S N. - 4242 ^fdi^iC^Jj :^:„i). Sut84230 

KaauiiM .-.If riju £41 id OaiA<.- SanAoioii.u 7*^:7.1x23 
AS - BUILT DRAWING fi 

OMAHA LEAD SUPERFUND SITE OLS#: 29154 

Date Excavated: 7/23/2008 

Date USEPA Signed-OfT: 

Omaha Lead Site Dale: /-^Z-C S North Amn / 

Site Sketch Time: / / M^ 

Phone: v^ y ~ 'Ty/'- ; s-r y 

Team>^5^'-rr^.fi ;.^ / BVmH ,j? ^ / ^ Y XRFCode /<3Q V 

Sample Number Lead Concentration Confimnation Sample 

-?^7y T ^ ppm i^ f Yes n No C9 f?YeiacpyA - ;?.9/A-V .£di3_ r ^ Yes a No C3r RYQ-aCPXA - <2^/g-y f f Yes n No IXT 

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ppm Yes Cl No a 

ppm Yes • No • 

^ J^ 

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i : ^ 

-;^ l-^-^-~Xw­ ^ •rfi i'^jiyjl^.J tt 

DZ=288PPM a 6" 

£77l.flM.J7^7L.... ~Fe7\a3QMzs\ h 

^LuJJL3iA.SLll... 

IiZ.±f/!Si^J7/CL 

Fl = 198 PPM a 6" 

i^ FT - ^ 2 -

nrr 

^ ^ t^y7/7 

/^.'•^yh .i2 ^ 

EA = 1(17 PPM a SCRAPE 

CONTRACT #: EP - R7-07-06 / 0004 PRUDENT TECHNOLOGIES, INC. 
IRUDFK rECHNOLOGIES, INC. 

Property Status Form 

Address: Date: -r 

Phone: f^.^ ^ BVID: n. Q, ^ 

Plants & Permanent Landscaping 

Item# 

On Map Description and Location 

/tje-^jui^^V^ Je>-<^ Sy=><^ ­

^ I » 1 l-,^ to-e ^oL^J^iJZfH , 

?3 

Pre-Existing Condition of Structures 

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

Item# Description & Location 

On Map 

Property Owner Prudent Employi 

Signatur^AObUTY] ^(V^/ ^ Signature: 

CXy--^-'^ \ - \ 

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 
• • 

Name: jr^^, y f ^ T^f i jTrT Omaha Lead Site Date: y-.i^-O' S North Arrow —i 

Address: ^OJt.f fj^.k^.' s:h Site Sketch Time: ll . } 0 

Phone: "/yy^ ~'.?/} — J^<:> ^ 

Team ^'SlA)-^^.yC.^7 . . BVID#^< ^ r < ^ _ XRFCode, /60< / 

Sample Number Lead Concentration Confirmation Sample 

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ppm Yes No 

ppm Yes n No • 

lh77h\~J7y 
Name:jT^^/y f^/?£ . jr < Omaha Lead Site Date; />^:?-g' T North Arroxif 

Address: tfOjiS f}l7ti-iti,' ^ Site Sketch Time; fj'J O 

Phone: '/^p^—r^f— y«- y ^ 

Team^^<!6^-%-/^,^^ ^ BVID#^ ^ / <' ^ XRFCode f QQ ^ 

Sample Number Lead Concentration Confirmation Sample 

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Print Preview Pj^e 1 of 1 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner 

City 

Owner 

State 

°^"^ ^ Zip 

0212300000 

BASS 

SHAWN R 

2025 MIAMI 

ST 

OMAHA 

68110 

2025 MIAMI 

ST 

OMAHA 

NE 

 68110 

^r.n -

Addition 

Block 

Lot 

LegaM 

Legal 2 

Legal 3 

Legal 4 

Treasurer 

Website 

Unk 

Assessor

Website

Unk

 !,„.,,.,3 

LANDS 

SUB 8 SUB 3 LT 55 

40X122 

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

parc=0212300000 

 http://douglasne.mapping­

 online.com/DouglasCoNe/static/accountinfo.jsp? 

 accountno=R0212300000 

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 » 38 feet appraisal, survey, or fbr zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas%20County-O. 6/12/2008 

^0^5" MIAMI ST 
R0212300000000 Ljpg (JPEG Image, 640x480 pixels) http://douglasne.mapping-online.com/assessdoc/Photos/06/R021230.. 

,UGUST 2004 - DOUGLAS COUNTY ASSESSOR 

c5oo?5 rYMAfY)! S T 

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http://www.dhon.or^jgjjintemet/DHONNoticeCreation/MessageText.. 

Create Another Ticket Back to Irth Intemet 

>end Email 

YOUR TICKET NUMBER IS  2081824. 

Original Call Date: 7/14/08 Time: 5:23 pm Op: RAMITA18967 


Work to Begin Date: 7/16/08 Time: 6:00 pm 


State: NE County: DOUGLAS Place: OMAHA 


Address: 2025 Street: MIAMI ST 


Twp: 15N Rng: 13E Sect-Qtr: 10-SW 


Twp: Rng: Sect-Qtr: 


Legal Given: C 


Type of Work: lead remediation 


Location of Work: LOCATE ENTIRE PROPERTY LOCATE ENTIRE PROPERTY 


Remarks: FAX ALL CLEARS TO: (402)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: 


Involves Tunneling or Horizontal Boring : N Explosives: N 


CXCATV MAGELLAN MUDOl OMAHACOF 0PPDGPR5 QLNNEIC 


Utility Service Area Contact

 Phone Number Type 

Day: 4029340469 

CXCATV COX COMMUNICATIONS, INC HEIDI Alt: 4029340469 

Emerg: 4029329757 

Day: 9185747098 

MAGELL/^ MIDSTREAM MAGELLAN TONYA

 Alt: PARTNERS LP 

Emerg: 9185747098 

Day: 4025047823 

METROPOLITAN UTILITIES MUDOl EDWINA

 Alt: DISTRICT 

Emerg: 4025047946 

Day: 4024447197 


OMAHACOF CITY OF OMAHA-TRAFFICSEWER RON 

Alt: 4024445161 


Emerg: 4024445160 


OMAHA PUBLIC POWER 

Day: 4067289343 0PPDGPR5 

NA DISTRICT 

lof 2 

7/14/2008 5:24 PM 
http://www.dhon.or^|giintemet/DHONNoticeCreation/MessageText... r^agii . 

Alt: 8887289343 


Emerg: 4067289343 


Day: 4067289343 


QLNNE 1C QWEST LOCAL NETWORK NA Alt: 


Emerg: 8887289343 

2 of 2 7/14/2008 5:24 PM