PROPERTY SUMMARY

 

Date: 09/24/2007 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 | Month of: September 

Property Address: 2569 Evans 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: 

El - 26 @ scrape 

Dl - 132 @ 13" 

Bl-65@8" B2- 206 @ 12" 

GA- 127 @ 12" 

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. 

Superfund 

TECHNOLOGIES, INC. 
Name: Omaha Lead Site Date: North Arrow 

Address: Site Sketch Time: 

Phone: 

Team ) BV1D# XRF Code 

Sample Number Lead Concentration Confirmation Sample 

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ppm 

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Omaha Lead Si 46130 



Name: _ 

Address: 

Phone: 

Omaha Lead Site

Site Sketch

 Date: 

 Time: 

North Arrow 

Team BVID# XRF Code 

Sample Number 

- 3135*4 

Lead Concentration 

31Q ^Oppm 

335 t38 "TM 

783 i«7 PPm 

.. ^ .. _ ppm 

ppm 

ppm 

ppm 

ppm 

CSC * _ _ A 

Confirmation Sample 

/~V Yes 

^2 Yes 

0) Yes 

Yes 

yes 

Yes 

Yes 

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Omaha Lead Sitd 46130 
^N" • -<*v,. AgreeAlt to a How a ccess to 

W / •$£& V the property inorder to conduct 

Site Remedial * v?^/r * environmental sampling and to 

Action \*m$i»r-j> remove lead-contaminated soil 

Prudent Technologies, Inc. (Pruden$ is under contract wife me U. S. Environmental Protection Agency 

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

including me properly located at t?^SC=>c

l £\>-<^vvJL &*~~ The EPA requests your 

permission to allow Prudent to perform a soil cleanup at this property to remove lead-contaminated soil 

By signing mis form, me property owner grants permission to Prudent to perform activities related to me 

cleanup including soil sampling, removal of lead-contaminated soil, andrestoration of die referenced 

property. After obtaining me owner's signature on mis form, Prudent Technologies, Inc. will contact me 

property owner (and residents) within the next few weeks to coordinate performance me work. 

If you have any questions about me soil cleanup planned for your property, please contact Prudent's 

Administrative Clerk for me OmahaLead Site cleanup, Ms. Cyndie Hinds at (402) 504-1004. General 

questions about me Omaha Lead Site cleanup can be directed to me EPA Public Information Centers at 

(402)731-3045 (south Omaha office) or (402) 991-9583 (north Omaha office). 

Property Access Granted By: 

CPUa»PrintNBm.) 

Property Owner Signature: *1 

S (Data) 

\ " 

PROPERTY INFORMATION 

(Tobecompleted by resident and/or property owner - please prirt) 

"F e>run> >run> RESDENTNAME: 'uViv iii ^ ^^> ^ A p -^1 QMfner Qenter

RESPEMT ADDRESS: rCl^/C^ g \ J ^ Y\ A_ S^V fSY>A AvQ _ K>g- ??\ \ \ 

f RENTAL. PROPERTY OWNED BY: 

OWNER-SHALMG ADDRESS: rQS£><3 C^if^yv^ R\- Qtnr>ALo^ t^>g- (3 '$ \\ \ 

OWNER'S TELEPHONE NUMBER -HOME: I^°^l M S!^ " Q I5 ^ WORK: I I _ 

AGE OF HOME?: _£;f_ YEARS. HOW LONG HAVE YOU LB/ED HERE? . YEARS. 

HAS THE EXTERIORBEEN PAMTED OR COVERED WITH SDM6SMCE 1978? _J^^ES _ NO 

NUMBER OFOCCUPANTS UNDER7 YEARS OLD: 4$D NUMBER OFOCCUPANTS 7YE ARS OLD AND OLDE R I 

NUMBER OFCHILDREN UNDER 7 YEARS OLDWHO PLAY M THE YARD FOR S HOURS ORMORE PER WEEK: QCOMME NTSOR SPECIAL WSTRUCTIONS: (LE. DOGS.ENTRY GATES. ETC.) V\ 0 WCAUTHORITY FORENVIRONMENTAL RESPONSE ACTIONS: The activities to be inqriemented by EPA under this 

agreement are pursuant to Section 104ofCERCLA,42U.S.C. 9604. EPA'sright of access to the property is 

provided for in Section 104{e) of CERCLA, 42 U.S. C 960S(e), which provides entry fir "determining the need for 

response, or choosing or taking any response action under this title, or otherwise enforcing the provisions of the 

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EPA Property Close Out Form

 

Property #: nszt 

Date/Time: .£,„/ 

Quads Excavated: QL 

. 200 7 

f 03- r G 

Property Address: 

Owner's Name: 

Contractor Group 

Excavation General Yes No 

1 .

2.

Grading 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

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

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

^ 

Sod and Vegetation

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

from the house? 

 Yes

</ 

 No 

Has sod been laid in all areas that were excavated? 

Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30 

day time period) 

^ 

t^ 

Are sodded areas generally firm and evenly graded? 

Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day 

time period) 

^ 

^ 

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

^ 

Was damage to landscaping or plant materials avoided? c/ 

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) i/ 

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

^ 

4. Was damage to retaining walls avoided? (If applicable) 

^ 

Foundation, Siding and Gutters Yes No 

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

2. Was damage to the foundation avoided? L/ 

3. Was damage to windows avoided? 

I/ 

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

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? (/ 
Owners comments: 

Inspection notes: 

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

EPA Representative Qc~, &«,, Date: 
Address: 

Phone: 

6UfionJl S BVID# 

Sample Number 

Omaha Lead! 46130 
So 

Omaha Lead Site 46130

 
SEPA DLOGIES, INC. 

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 sod warranty (90 days total) except those items listed below, if any. 

Property ID: 

Property Address: 

Owner: b\ 

Phone: 

Restoration Items in Question: 

Item: 

Item: 

Item: 

Item: 

Item: 

Item: 

Required corrections to complete the property: 

I agree restoration is completed, except as noted above. 

I do not agree restoration is completed 

Owner's^ignature T Date 
Find Record Clean Up Query Lead Remaining Query Property Damage Query Close 

ample Area: 31954 - 2569 EVANS ST 

Owner: Resident: Contract: 

1 n Owner Occupied Resident Name: Contractor: 

Owner Name: FERNANDEZ RUBY M |PRUDENT2007 

FERNANDEZ RUBY Property Address: | Group: 

Owner Addressl: 2569 EVANS ST 

i 

Owner Address2: 

Zip Code:

68111 

l 

Assessment: 

2569 EVANS ST Resident Phone Qualifying Group 

, City: State: Zip Code: j 800 

, OMAHA JNE 68111 Assessment XRF Date: 

i Owner Phone: Alternate Phone: 

I i Assessment Max XRF Value: 

916.47 
Print Preview rage i 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Properly 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

2100680000 

FERNANDEZ 

RUBY 

2569 EVANS 

ST 

OMAHA 

68111 

2569 EVANS 

ST 

OMAHA 

NE 

68111 

Sec-Twn-Rng 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal3 

Legal4 

Assessor 

Website Link 

09-15-13 

REDICKS-CLARK-ADD 

3 

5 

46.23X120 

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

accountno=R21 00680000 

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 = 37 feet appraisal, survey, or for zoning verification. 

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