PROPERTY SUMMARY

 

Date: 10/05/2007 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 Month of: October 

Property Address; 1812 Lake 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: 

Bl-185@6" B2-230@6" 

Easement 92 @ 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 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, 
V -.

 Name: G-o.rre.-ft~ £vr£- Omaha Lead Site Date: B-lg-^ North Arrow 

Address: t&IZ. Lalte.'St-. Site Sketch Time: i2- i<? 

Phone: £76-"770fi" 

Team Fh^ UCT/tfW BVID# 2-^6^3 XRFCode /<?37 BoeK- /Z9 / 

Sample Number Lead Concentrat on Confirmation Sample 

>pm ft Yes

 CJ No & R"i&$Cf*XA ~ 2.8 &>£)'?>

 ^09 >pm F2- Yes

 d No 5, EVCLSO^XA ~ "2,5^63

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Omaha Lead Site 46130 

i 

Omaha Lead Site Date. North Arrow 

Address: /8/Z. La]ie_^ir. Site Sketch Time: 

Phone: < 

Name: _J 

Team BVID# 2-^4,3 XRFCode 

Sample Number Lead Concentration Confirmation Sample 

233 ppm ft Yes O No 

ppm r^Yes n NO 

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ppm #?Yes n NO 

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Omaha Lead Site 4< 
07^1.23. 20()72;11:51AM)245]OMAHA PLANNIN G DEPT,.402-444-6140
 

Agre@fhfentto allowaccessto Omaha Lead the property in order to conduct 

Site Remedial environmental sampling and to 

Action remove lead-contaminated soil 

Prudent Technologies, foe. (frudenQ is under contract wiih me U. S. Environmental ftottcuoa Agency 

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

including ma properly located at \fi\^ \^^\ KTo <Xv. Ti« EPA remtab your 

permission to allow Undent to perform a soJ cleanup at this property to remove lead<cantommatai soil. 

By signing mis form, me property owner grants permission to Rudent to perform acovinas related to me 

cleanup including soil sampling, removal of lead-contaminated soil, tut restoration of me referenced 

property. After obtaining the owner's signature on (his form, ftudent Technologies, Inc. will contact me 

property owner (end 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 Rodent's 

AdmmistrBtiv* Clerk for flie Chnaat]I.«ad Site cleanup, Ms. Cyndte Hinds at (402) 504-1004. General 

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

(402) 731-3045 (souto Om*a offite) or (402) 991-9583 (norm Omaha office). 

Property Access Granted By: 

Property Owner Signature: 

PROPERTY INFORMATION 

0

(Tg be completed^ resident and/or proparty owner - pbae print) 

RESDENTHAOE v Qtenlar 

RESDENT ADDRESS: \ 

W RENTAL.PROPERTY OWNED Jt/\/\ f^jL&^. 

OWNER'SMAB.BI6ADDRESS; . l\ 

CnMNCR-STElfPHONE NUMBER -HOBE. J. | WORK; 

AOE OF KOBE?: YEAR*. HOWLOllc HA/ 

HAS THE EX1ERIOR BEEN PAMTEO OR COVERED WITH SDHC SMCE 1378? 

NUMBER Of OCCUPANTS UNDER7 YEARS OLD: UUttBEROF OCCUPANTS7 YEARS OLD AND OLDER. 

NUMBER OF CHILDREN UNDER 1 YEARS OLD WHO PLAY M THE YARD FOR S HOURS OR MORE PER WEEK: 

COHBENTOORSPECIALHSTRUCTIONS: (l£.DOGS.ENTRY GATES.ETC.) 

AUTHORITY FOR ENVIRON MENTAL RESPONSE ACTIONS, The activities to be implemeMed fay EPA unda-this 

agreemeiAflrepur&uanttoSeaicnl04DfC£RCLA,42U.S.C. 9604. EPA'srigttof access to thepreparty is 

providod for in Section )Q4(e) of CERCtA, 42 U.S. C 9tfOS(e), which pnsridas enoy for "detwniwng the need for 

e, or cftoteine or ukine any response action under this title, or otherwise en&nang the provisions of the 

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EPA Property Close Out

 

Property#: Property Address: 

Date/Time: Qc-f, 5, looi Owner's Name: c 

Quads Excavated: Contractor Group Prudent Technologies 

Excavation General Yes No 

\ . If necessary, were the correct quadrant(s) excavated and restored? S 

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

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? y 

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

day time period) S 

4. Are sodded areas generally firm and evenly graded? s 

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

tune period) s 

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 Yes No 

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

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

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? «/ 

3. Was damage to windows avoided? i/ 

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

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? i/ 
Owners comments: 

Inspection notes: 

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

EPA Representative jQc^> &*-, Date: / ^ 
Name: &<*.rre.'ti~ fsvrfAddress: JfilZ. Latte^^A-. 

Phone: fa'?t-~T70£' 

Omaha Lead Site 

Site Sketch 

Date:

Time:

 /3-/f?-T 

 (2-:^ 

North Arrow 

f 

Team i^l &UJ BVID# XRFCode /<737 

Sample Number Lead Concentration 

233 

Confirmation Sample 

46130 
PLANKIN G DtPT. 402-444-6140
 N o , 767 6 P , Sep . 21 2007 " 6: 

AERA 

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 Hems listed below, if any. 

Property m: 

Property Add**: 

Owaer; 

'njio^ 

Restoration items In Question: 

Rem 

Ram 

Item 

ttsrn 

Requli'ed corrections to complete the property: 

I agree restoration is competed, except as noted above. 

[~] f do not agree restoration is completed 

-e ~7 

Date 
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 Omaha Lead Site 

 Site Sketch 

Date:

Time:

 &~l&-*> 

 j2-:if 

North Anow 

BV1D# XRFCode 

Sample 'Number Lead Concentration Confirmation Sample 

*»-*•"•. Omaha Lead Site 46130 
Print Preview rage i 

Douglas County-Omaha, NE 

Parcel ID 1600610000 Sec-Twn-Rng 10-15-13 

Owner 

Name 

CITY OF 

OMAHA 

Owner 

Address CIO JAMES THELE 

Property 

Address 

1812 LAKE ST Addition LAKE ADD 

City OMAHA Block 

Zip 68110 Lot 

Owner 

Address 

CIO JAMES 

THELE Legal 1 S SOW 42.66 FT 

Owner 

Address 2 

1819 FARNAM 

ST#1111 Legal 2 42.66 X 50 

Owner City OMAHA Legal 3 

Owner 

State 

NE Legal4 

Owner Zip 68183 Assessor 

Website Link 

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

accountno=R1600610000 

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 = 15 feet appraisal, survey, or for zoning verification. 

*»-<r."V 

http://www.dogis.org/dogis_alias/dogi^rintPreview.aspx?PrintOptData=Douglas County-... 7/16/2007 
> Print Preview Page 1 of 1 

Douglas County-Omaha, NE 

Parcel ID 1600600000 Sec-Twn-Rng 10-15-13 

Owner CITY OF Owner CIO FINANCE DEPT Name OJ^AHA--c^--. Address 

Property / 2502N18ST Addition LAKE ADD Address \. 

City OMAHA Block 1 

Zip 68110 Lot 7 

Owner CIO FINANCE Legal 1 S 43 E 100 FT Address DEPT 

Owner 1819FARNAM Legal 2 <^" 43/100 ) Address 2 ST 

Owner City OMAHA Legal 3 

Owner NE Legal 4 State 

http://douglasne. mapping- Assessor Owner Zip 68183 online. com/DouglasCoNe/static/accountinfo.jsp? Website Link accountno=R1 600600000 

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 = 39 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 8/30/2007 
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 

1600590000 

CITY OF 

OMAHA 

2508 N 18ST 

OMAHA 

68110 

C/0 JAMES 

THELE 

1819FARNAM 

ST # 1 1 1 1 

OMAHA 

NE 

68183 

Sec-Twn-Rng 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal 4 

Assessor 

Website Link 

10-15-13 

C/0 JAMES THELE 

LAKE ADD 

1 

6 

N12W42.66FTLT7& 

N19E100FTLT7& 

S21_FJ 

^ x^-<A X^ ^\ 

12)Xtt2.66-19)x 100-21 fc 142.9 ) \&- v

* ' ^^ ' 

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

accountno=R1 600590000 

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 = 51 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 8/30/2007 
Print Preview Page 1 of 1 

Douglas County-Om^hB, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

1600610000 

CITY OF 

OMAHA 

181 2 LAKES! 

OMAHA 

68110 

C/0 JAMES 

THELE 

1819FARNAM 

ST # 1 1 1 1 

OMAHA 

NE 

68183 

Sec-Twn-Rng 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal 2 ^ 

Legal 3 

Legal 4 

Assessor 

Website Link 

10-15-13 

C/O JAMES THELE 

LAKE ADD 

1 

7 

S 50 W 42.66 FT 

42^66 X 5cT) 

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

accountno=R1 60061 0000 

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 = 32 feet appraisal, survey, or for zoning verification. 

http://www.dogis.org/dogis_alias/dogis/printPreview.aspx?PrintOptData=Douglas County-... 8/30/2007 
Find Record dean Up Query I Lead Remaining Query 3 Property Damage Query 1 Close 1 

ample Area: 28663 - 1812 LAKE ST 

Owner: Resident: Contract: 

d Owner Occupied Resident Name: Contractor:

 

Owner Name: JVACANT LOT JPRUDENT2007

 

IOTY OF OMAHA Property Address: Group:

 

Owner Addressl: |1812 LAKE ST ! f t f-^. J— m II— ]C/0 JAMES THELE Zip Code: 

Assessment: Owner Address2: J68110

 

J1819FARNAMST# 1111 Resident Phone Qualifying Group

 

City: State: Zip Code: |800

i 

IOMAHA JNE Jesiss Assessment XRF Date: 

Owne 1 j ' • "" ' r Phone: Alternate Phone: 

j ! Assessment Max XRF Value:

 

j 892.47 

; 

 1 
Page 1 of2 

Create Another Ticket Back to Irth Internet Send Email 

YOUR TICKET NUMBER IS 1848754. 

Original Call Date: 7/24/07 Time: 9:57 am Op: CYNDIE18967
 

Work to Begin Date: 7/26/07 Time: 10:30 am
 

State: NE County: DOUGLAS Place: OMAHA
 

Address: 1812 Street: LAKE ST
 

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

Twp: Rng: Sect-Qtr:
 

Legal Given: C
 

Type of Work: Soil Excavation - lead
 

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" Max Corner Lot: N Front: N Rear:
 

Involves Tunneling or Horizontal Boring : N Explosives: N
 

CXCATV MAGELLAN MUD01 OMAHACOF OPPDGPR5 QLNNE1C
 

Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

MAGELLAN MAGELLAN MIDSTREAM PARTNERS LP TONYA

Day: 9185747098 

 Alt: 

Emerg: 9185747098 

MUD01 METROPOLITAN UTILITIES DISTRICT ED WINA

Day: 4025047823 

 Alt: 

Emerg: 4025047946 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON

Day: 4024447197 

 Alt: 4024445161 

Emerg: 4024445160 

Day: 4067289343 

http://www.dhon.org/irtWntemet/DHO 7/24/2007 
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... 7/24/2007 
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 

1600610000 

CITY OF 

OMAHA 

1812 LAKE ST 

OMAHA 

68110 

C/O JAMES 

THELE 

1819 FARNAM 

ST#1111 

OMAHA 

NE 

68183 

Sec-Twn-Rng 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal 2 

Legal 3 

Legal4 

Assessor 

Website Link 

10-15-13 

C/O JAMES THELE 

LAKE ADD 

1 

7 

S SOW 42.66 FT 

42.66 X 50 

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

accountno=R1 60061 0000 

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 = 15 feet appraisal, survey, or for zoning verification. 

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