PROPERTY SUMMARY

 

Date: 09/28/2007 Omaha Lead Site Remedial Action Contract # EP-R7-07-06 Month of: August 

Property Address; 1556 N 19 St 

A. EXECUTIVE SUMMARY 

A.I Issues Encountered: Map Error. New map Drawn. 

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: 

Easement 68 @ Scrape 

Fl - 146 @ 6" F2- 192 @ 6" 

B2 - 123 @ 6" 

Dl-34@14" 

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. 

:CHNOLOCIES, INC. 
11

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Name: f-jnt -\ao Omaha Lead Site Date: (ef^^/^>^> North Arrow 

Address: 3 /<5&>A/i /q*&. Site Sketch Time: /f^OpM 

 Phone: 7^-/kt*^ 

BV1D# XRFCode 

Sample Number Lead Concentration Confirmation Sample 

ppm ft Yes No 

ppm ^ Yes No -Kl 

ppm 5' Yes NO 8] 

ppm No O 

ppm psYes ^ No & 

ppm Yes d No d 

RYDSCPLA-26553 ppm Yes CD No O

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808 ppm 

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Omah Exterior Paint Nortti Arrow a Lead Site 

Q Good Sampling Address: Site Sketch

 

Q Poor 

Phone: H. ALT [5l Not paint 

Sampte Lead Sample Samples Collected Number LAB Concentration Collected Fjrm: pp/] FB-D& 

RYASCPXA-


RYBSCPXA- D Time: 3-

RYCSCPXA- ppm D

 Samples Analyzed 

RYDSCPXA- ppm n 

ROZSCPXA-^ DZ ppm n XRFUnit: _ Book: 

199 ppm R-or- P! D Date: ~7 

2.93 ppm n Time: P.fy R-OZr ^1'

 Staff: Number of Samples = ] ( 

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play 

All quadrants are as viewed from the street, facing property 

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^^ o^y^-Vr Agreemi^to Allow Access To

 

Omaha Lead - ? ,

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&& \ Property To^e^nduct Easement 

Site Remedial * v¥Pv £ Sampling and Cleanup Action V^-^/Xv.^..< 

Under Contract EP-R7-07-06, the U. S. Environmental Protection Agency (EPA) has Contracted Prudent 

Technologies, Inc. (Prudent), to cleanup lead contamination on various residential properties including 

your property. You can help with this activity by giving permission to conduct easement sampling and 

conduct cleanup on your property. If you sign this form, Prudent will return in a few weeks and perform 

the work. We will coordinate sampling and cleanup with you prior to commencement 

If you have any questions about the proposed work, please contact Dan Garvey, EPA's Project Officer for 

our Omaha Lead Site Contract Mr. Garvey can be reached at (402) 731-0788. 

Property Access Granted By: %/S7/7 /&. [A/f ////*?/X) 

(PUutPnutNamt) 

Property Owner Signature: /y^Ui? /C^i-^L^M-^^t^*^^ 2. 

' (Dnt») 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner - please print) 

<-p) n . 

Qen1er RESIDENT NAME: 4<v.\L ffi yi'U-A Hr^Jl^ [g3¥?ner dtW 

RESIDENT ADDRESS: |«g. ^ Q M ~^ i ^V ^"^~ <^WN<^QL AJ£ G^// f 

IF RENTAL. PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER -HOME: {HcQl r^D§> ~ *£>G>°3 WORK: 

AGE OF HOME?: YEARS. HOW LONG HAVE YO LIVED HERE? YEARS. 

HAS THE EXTERIOR BEEN PAINTED OR COVERDED WITH SIDING SINCE 19787 YESHAS THE INTERIOR BEEN PAINTED OR COVERED SINCE 1978? V^ YES NO 

NUMBER OF OCCUPANTS UNDER 6 YEARS OLD: )_ NUMBER OF OCCUPANTS6 YEARS OLD AND OLDER 

NUMBER OF CHILDRENT UNDER C YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 

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

AUTHORITY FOR ENVIQRMMENTAL 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's right of access to the property 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 

otherwise enforcing the provisions of the title." 
&EPA

 

EPA Property Close Out 

Property #: £ Property Address: iSS£ A> /9-M jy. 

Date/Time: Owner's Name: /j><.y>> *J.u.//vn» 

Quads Excavated: Contractor Group Prudent Technologies 

Excavation General Yes No 

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

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

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 

t/ day time period) 

4. Are sodded areas generally firm and evenly graded? i/ 

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

time period) LS 

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

7. Was damage to landscaping or plant materials avoided? i/ 

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) iS 

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? S 

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? «/ 

2. Was damage to walkway surfaces avoided? (/ 
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Sample Number 

. 46130 
46T30"

 
Print Preview Page 1 of L 

Douglas County-Omaha, NE 

Parcel ID 

Owner 

Name 

Property 

Address 

City 

Zip 

Owner 

Address 

Owner 

Address 2 

Owner City 

Owner 

State 

Owner Zip 

2229300002 

HODGE 

RUBYL 

1556N19ST 

OMAHA 

68110 

1556 N 19 ST 

OMAHA 

NE 

68110 

Sec-Twn-Rng 

Owner 

Address 

Addition 

Block 

Lot 

Legal 1 

Legal2 

Legal3 

Legal4 

Assessor 

Website Link 

15-15-13 

SMITHS -EV- ADD 

17 

3 

1/2 VAC ALLEY ADJ & S 1 FT & ALL 

LT2&N33FTLT3BLK17 

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

accountno=R2229300002 

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 = 31 feet appraisal, survey, or for zoning verification. 

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

 

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: 

Property Address: 

Owner: 

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. 

EH I do not agree restoration is completed 

Owner's Signature Date 
Page 1 of2 

Create Another Ticket Back to Irth Internet Send Email ~[ 

YOUR TICKET NUMBER IS 1846454. 

Original Call Date: 7/20/07 Time: 11:21 am Op: CYNDIE18967 

Work to Begin Date: 7/24/07 Time: 11:45 am 

State: NE County: DOUGLAS Place: OMAHA 

Address: 1556 Street: FLORENCE BLVD 

Twp: 15N Rng: 13E Sect-Qtr: 15-NW 

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: 13" Max Corner Lot: N Front: N Rear: N
 

Involves Tunneling or Horizontal Boring : N Explosives: N
 

CXCATV LEVELS MAGELLAN MUD01 OMAHACOF OPPDGPR5 QLNNE1C
 

Service Area Contact Phone Number Utility Type 

CXCATV COX COMMUNICATIONS, INC HEIDI

Day: 4029340469 

 Alt: 4029340469 

Emerg: 4029329757 

LEVELS LEVEL3 COMMUNICATIONS, LLC NA

Day: 8773668344 

 Alt: 

Emerg: 8773668344 

MAGELLAN MAGELLAN MIDSTREAM PARTNERS LP TONYA

Day: 9185747098 

 Alt: 

Emerg: 9185747098 

MUD01 METROPOLITAN UTILITIES DISTRICT EDWTNA

Day: 4025047823 

 Alt: 

Emerg: 4025047946 

Day: 4024447197 

http://www.dhon.org/irmmternet/DHONNoticeCreatiori/MessageText.asp?ret=<RESULTS... 7/20/2007 
Page 2 of 2 

OMAHACOF CITY OF OMAHA-TRAFFIC,SEWER RON 

Alt: 

Emerg: 

4024445161 

4024445160 

OPPDGPR5 OMAHA PUBLIC POWER DISTRICT NA 

Day: 4067289343 

Alt: 

Emerg: 8887289343 

QLNNE1C QWEST LOCAL NETWORK NA 

Day: 4067289343 

Alt: 

Emerg: 8887289343 

ht1p://www.dhon.org/irmintemet/DHO>WoticeCreation/MessageText.asp?ret=<RESULTS... 7/20/2007 
Find Record dean Up Query Lead Remaining Query Property Damage Query 

Sample Area: 26553 - 1556 N 19 ST 

Owner: Resident: Contract: 

' ; Owner Occupied Resident Name: Contractor: 

Owner Name: HODGE RUBY L JPRUDENT2007 

I HODGE RUBY L Property Address: Group: 

Owner Addressl: 1556 N 19 ST 

Owner Address2: 

Zip Code: 

[68110 Assessment: 

11556 N 19 ST Resident Phone Qualifying Group 

City: State: Zip Code: I [800 

jOMAHA NET J68110 I Assessment XRF Date: 

Owner Phone: Alternate Phone: I | | ' 

|(402) 734-1632 | ; Assessment Max XRF Value: 

. . 881_15