PROPERTY SUMMARY

 

Date: 10/26/2007 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 Month of: October 

Property Address: 1712 N 28 Street 

A. EXECUTIVE SUMMARY 

A.I Issues Encountered: None 

A.2 Issues Resolved: Re-Seed will occur in November on any dead spots to encourage spring growth. 

A.3 Unique Findings: 

A.4 Other Relevant Information : Bush in B2 - 339 @ Scrape 

CONFIRMATION SAMPLING DATA/RESULTS: 

F2 - 153 @ 6" 

Bl-317@10" B2- 167 @ 10" 

Dl - 278 @ 13" 

El - 123 @ 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) Excavation digital video in MPEG, WMV (Windows Media Video) or SWF (Flash Player) format and/or 

photographs 

iii) Signed form verifying satisfactory restoration 

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

Superfund 

ECHNOLOCIES, INC. 

•

 

Name: Omaha Lead Site Date: North 

Address: Site Sketch Time: 

Phone: 

Team 6 £,0 »6-O BVID# XRF Code 

Sample Number Lead Concentration Confirmation Sample 

ppm PXA- Ppm PX A -

Px A - ppm 

ppm 

ppm 

ppm 

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Omaha Lead Site 46130 
Agreement) Allow Access To 

Property Jo Conduct Easement 

lite Kerned^ I ? W? '2 Sampling and Cleanup 

Uadter Cossforact EP-R7-07-OS, &e U. S. Isaviroiomeaial Rrotectioa Ageacy (EPA) has Coafcractisd Iftrudest 

Tecbnoiogies, lac. (Ptodeot), to cleanup lead coMamijifltJcfl on various residfisrtJai pfopesiies indw&ig 

yousr property. You caa help witli iisis activity by giviag pemassioa to conduct easemeot saoijiliag aad 

conduct cleanup on ymar property. If you sign tfass fbnn, Prudent will return im a ftw weeks and perform 

Jka work. We will coosri&iate seasiilifflg emd cleamBi) witii you gwio? to 

If you have aaiy questioias about iSia proposed work, please cosrfatf DSQ Gesrvey, EPA's Reject Officer for 

oisr Omaha Laad Site Contract Mr. G^vsyL bache d at (402) 731-07^. 

Pi-operfy Access Created By: \\ < J/ 

(Pl*B£»PrialNffiH*) 7 

Property Oroaer Sigaature: \, & 

^ 

PROPERTY 

(To be coEiplrfed by resfiesi Eafi/or proper^ - please print) 

RESIDENT MAKE: TS^LA t W^>~ QJwnner 

RESIDEMT ADDRESS: \ ~? f ^$? J1 

IF REMTOL. PROPERTY OWMED BY: xi r^j 

OWNER'S C3AILD1G ADDRESS; 

OWNER'S TELEPHONE NUBBER-HOdE: r^L ^ M - ~ WORK: 

AGE OF HOC3E?: YEARS. HOW IQHG HAVE YO LIVED HERE? YEARS. 

HAS THE EXTERIOR BEEH PAIMTEO OR COVERDED WITH SJDB1G SWCE1978? BO 

HAS THE INTERIOR BEEtJ PAHTED OR COVERED SINCE 1S78? K_ YES NO 

NUttBER OF OCCUPANTS UNDER S YEARS OLD: D NUE3BER OF OCCUPANTS6 YEARS OLD AND OLDER 

MUQBER OF CHILDREHT UNDER6 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR CORE PER WEEK: 

coaaEWTS OR SPECIAL IMSTRUCTIOMS: (I.E. DOGS. ENTRY GATES. ETC.) _ 

AUTHORITY FOR ENVIQRNMWrAL RESPONSE ACTIONS 

The activities to be implements by EPA under this agreement are pursuant to Section 104 of CERCLE. 42 U. S.C. 9604. EPA'sri^it of access to the propety is provided for in Section 104(e) of CERCLE, 42 U.S. C 9605(e), which 

provides entry for "determining the need for response, or choosing or taking any response action under this title, or 

othe'wise enforcing the provisions of the title." 

A 
EPA Property Close Out 

Property #: 26V?3 Property Address: /7/2 A/o«f*» Z8i>> 

Date/Time: Oc.i-23, Owner's Name: Ce.A/rA &A'»tJ 

Quads Excavated: p. Contractor Group Prudent Technologies 

Excavation General

 Yes No 

1 . If necessary, were the correct quadrants) excavated and restored? s 

2. If necessary, were the correct areas of drip zone excavated and restored? s 

Grading Sod and Vegetation Yes No 

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

from the house? s 

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

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) s 

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

s 

7. Was damage to landscaping or plant materials avoided? s 

Gates, Fences and Retaining Walls Yes No 

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) S 

Foundation, Siding and Gutters Yes No 

1. Was damage to the siding or trim avoided? / 

2. Was damage to the foundation avoided? S 

3. Was damage to windows avoided? S 

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

5. Was damage to downspouts or downspout extensions avoided? S 

Sidewalks and Driveways (Concrete) Yes No 

1. Was damage to driveway surfaces avoided? /

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

Inspection notes: 

H DtRO GHO NttOS TO 8t fiepkceet o/» /*« Soi+H nee, 

OF -fhe Qfiiptotc, 

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

EPA Representative £-_A- Date: 
Omaha Lead Site 

Site Sketch 

Omaha Lead Site 46130

 
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, if any. 

Property ID: £^k MM *3 

Property Address: IT i a r^ 7 ^ Vtv C,U

 

Owner: X~p o > ,-j ^ 

Phone: ~" 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

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

LJ I do not agree restoration is completed 

Owner's Signature Date 
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 

2212680000 

GAINES 

CERITA L 

1712N28ST 

OMAHA 

68111 

1712N28ST 

OMAHA 

NE 

68111 

Sec-Twn-Rng 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal2 

Legal 3 

Legal4 

Assessor 

Website Link 

16-15-13 

SHINNS 2ND ADD 

S 

12 

N60FT 

60X60 

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

accountno=R2212680000 

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 = 20 feet appraisal, survey, or for zoning verification. 

http://vvww.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 7/16/2007 
Find Record Clean Up Query Lead Remaining Query Property Damage Query Close 

ample Area: 26443 - 1712 N 28 ST 

Owner: Resident: Contract: 

n Owner Occupied Resident Name: Contractor:

 

Owner Name: [GAINES CERITA L JPRUDENT2007

 

JGAINES CERTTA L Property Address: Group:

 

Owner Addressl: J1712 N 28 ST

 

k i i 

Pj Zip Code: 

Assessment: Owner Address2: J68111 

j 1712 N 28 ST Resident Phone Qualifying Group

 

City: State: Zip Code: ]800

 i 

JOMAHA JNE J68111 Assessment XRF Date: 

Owne ] r Phone: Alternate Phone: 1

 

|(402) 346-1530 j(402) 345-5683 Assessment Max XRF Value: 

j 903.2 
Page 1 of2 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 1864705.
 

Original Call Date: 8/14/07 Time: 9:49 am Op: CYNDIE18967
 

Work to Begin Date: 8/16/07 Time: 10:15 am
 

State: NE County: DOUGLAS Place: OMAHA
 

Address: 1712 Street: N 28TH ST
 

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

Twp: Rng: Sect-Qtr:
 

Legal Given: C
 

Type of Work: Soil Remediation - Lead - Excavation
 

Location of Work: LOCATE ENTIRE PROPERTY
 

Remarks: FAX ALL CLEARS TO: (402)504-1005
 

Company : PRUDENT TECHNOLOGIES
 

Contact Name: CYNDIE Phone: (402)504-1004
 

Work Being Done For: EPA
 

Depth of Excavation: 14" Corner Lot: N Front: N Rear: N
 

Involves Tunneling or Horizontal Boring : N Explosives: N
 

CXCATV LEVEL3 MUD01 OMAHACOF OPPDGPR5 QLNNE1C
 

Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

Day: 8773668344 

LEVELS LEVELS COMMUNICATIONS, LLC NA Alt: 

Emerg: 8773668344 

Day: 4025047823 

MUD01 METROPOLITAN UTILITIES DISTRICT EDWINA Alt: 

Emerg: 4025047946 

Day: 4024447197 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343
 

http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/14/2007 
Page 2 of2 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Alt: 

Emerg: 8887289343 

QLNNE1C QWEST LOCAL NETWORK NA 

Day:

Alt: 

 4067289343 

Emerg: 8887289343 

http://www.dhon.org/irthinternet/DHONNoticeCreation/MessageText.asp?ret=<RESULTS... 8/14/2007 
Name: Date: 

No. Property Address Day Care AM Landscape Others 

(f) H/2 A/ 28 5/~. , CO DgfrD SOP 0/0 SGUTfr £2: 

\ ^ 

/ pfiA -J^&Lf-b 

(^ ' ' ^/ <T7 ' //)/a-Lf

 

^ / 
Name: Date: 

No. Property Address Day Care AM Landscape Others 

/7) H/2, A/ 28 Sh S (0 D&f\D sop OK) SOUTH- £2: