PROPERTY SUMMARY

 

Date: 11/14/2007 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 Month of: November 

Property Address: 420 N 40 St 

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: 

CONFIRMATION SAMPLING DATA/RESULTS: 

B2 - 140 @ 8" 

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) 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. 

TECHNOLOGIES, INC. 

In /0*7

 

f/•!

 
*»-*•?-... 
Agreement to allow access to 

Ornaha Lead the property in order to conduct 

Site Remedial environmental sampling and to 

remove leacJ-contaminated soil ^A ction

 

A '""" //)

 

Prudent Technologies, Inc. (Prudent) is under contract with the U. S. Emironmental Protection Agency 

(EPA) to clean up lead-contaminated soils at a number of properties located in Omaha, Nebraska, 

including the property located at *i/J2f) A/ *~/fl «SZ ~T . The EPA requests your 

permission to allow Prudent to perform a soil deaoup at this property to remove Icad-coctuQiicated soil 

By signing this form, the property owner grants permission to Prudent to perform activities related to the 

cleanup including soil sampling, removal of lead-contaminated soil, and restoration of the referenced 

property. After obtaining the owner's .signature on this form, Prudent Technologies, Inc mil contact (he 

yr. jperty owner (aud residents) within the next few weeks to coordinate performance the work 

*'. you have any questions about the soil cleanup planned for your property, please contact Prudent7 s 

,-uiministrative Clerk for the Omaha Lead Site cleanup, Ms. Cyndie Binds at (402) 504-1004. General 

ijtiesnons 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: _ 

Property Owner Signature: 

(jSignaturiJf / (Date)

 

PROPERTY INFORMATION 

(To be completed by resident and'or property owner - pleaseprrat) 

RESIDENT KAttE: A 

RESIDENT AD DRESS: 3 n A/_— MU _______ 

IF RENTAL. PROPERTY OWNED BY 

OWNER'S UAILWG ADDRESS; /ij rf(' 

OWNER'S TELEPHONE NUMBER -HOME: $ V/ < < 

AGE OF HOME?: / / YEARS. HOW LONG HAVE YOU LIVED HERE? ^ YEARS. 

HAS THE EXTERIOR BEEN PAIHTED OR COVERED WITH SDING SINCE 1378? ^ YES _ NO 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: /*jt _ MUM0ER Of OCCUPAHTS7 YEARS OLD AND OLDER 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY M THt YARD f Oft 5 HOWS OH UOKE PCH WEEK. 

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

AUTHOR!T V FOR ENVIRONMENTAL RESPONSE ACTIONS^ The activities to be implemented by EPA under t^us 

V-' agreer^entarepunuflnttoSedicsti 104of CSRCLA,42U.S.C. 9604. EPA's right of access to the property h \ 

f' proviaect rcr in secuon 104<e> or CERCLA, 42U.S. c 9003(e), wnich provides entry for -determining d*ne«d fc r

 response or djoosing or taking any respons? atlioniiridertliistitli;, or otherwise eriforcingtria provisions of thie 

title." 

AUTHORITY:
EPA Property Close Out 

Property*: Property Address: V3o /V ViVA X/te*/-

Date/Time: "/U Owner's Name: 6f)fib>*» frttoc 

Quads Excavated: Contractor Group Prudent Technologies 

Excavation General Yes No 

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

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? 

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

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? j 

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?

 y 

Gates, Fences and Retaining Walls Yes No 

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

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? I/ 

2. Was damage to the foundation avoided? S 

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) Yes No 

1 . Was damage to driveway surfaces avoided? i/ 

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

Inspection notes: 

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

EPA Representative _ A^, Jj._ Date: 

ff 
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 ED: 

Property Address: (j^ ^cD J^ LI O^*^~ 

Owner: T5 A-Q \^jA^^ ^\"V^C_ 

Phone: "$<-\\- 5~5~ 3<-r / ?>°5- -*W2-& 

Restoration Kerns in Question: 

Hem: 

ttem: 

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 
*h ENTERED dM»» *fs/°*

 

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* •

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

2246320000 

RUCKER 

ENTERPRISE 

TRUST 

412N39ST 

OMAHA 

68131 

821 N 69 ST 

OMAHA 

NE 

68132 

Sec-Twn-Rng 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal3 

Legal4 

Assessor 

Website Link 

17-15-13 

STEWART PLACE 

0 

29 

49X130 

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

accountno=R2246320000 

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 = 26 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 7/16/2007