TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: :^^^Z^ ^ Date: iP^/clT y tPay^P 

Address: rri2j 7 X . ^ ^ .T^T 

Stabilization Contractor: Prudent Technologies, Inc. Year: 2010_ 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

] / Video ofproperty (DVD) 

y Executive Simmiary 

y Signed Access Agreement for subject property 

2J Pre-Renovation Form signed by Property Owner 

D Pre-Renovation Form for Occupant/Tenant, if applicable 

y f Faulting Agreement 

D Settlement documents (i.e., for damage or to replace plants, etc.) 

y Renovation Recordkeeping Checklist signed by Certified Renovator 

^ Photographs 

y Satisfactory close-out check list signed by Property Owner 

y Property close-out check list signed by EPA 

y Property infonnationfixtm Douglas County Assessor's Office 

p

D

D

 Hazard analysis, if prepared 

 Safety Audit 

 Other (describe): 

0 7 „

jdent TechnologyZ/lnc./Signature

EPA COR Sienature

(afterfile folder review) . 

 /^/c^/cPaZz f 

 Date' 

1/7/aoV 

 Date 

30217855 

ininiffiw 

Superfund 
TBCHNQLOGIBS. INC 

Property Summary 

Date: 7/19/2010 LBP STABILIZATION EPA CONTRACT EP-R7-08-07 Month of: July 

Property Address : 1109 8 28 St. SAID #: 21049 

A. Executive Summarv: 

a. Issues Encountered: NONE 

b. Issues Resolved: NONE 

c. Unique Findings: NONE 

d. Other Relevant Information: 

i. Access Date: 06/08/2010 

ii. Work Began: 06/23/2010 

iii. Close-Out Date: 06/23/2010 

B. Enclosures: 

1. Pre-Stabilization Video 

2. Post-Stabilization Video 

3. Signed Access Agreement Form 

4. Pre - Renovation Form signed by Property Owner 

5. Pre - Renovation Form signed by Occupant/ Tenant, if applicable 

6. Advance-Notice, Stabilization Video Agreement Form 

7. Property Paint Match Form 

8. Property Access Assessment Form 

9. Renovation Recordkeeping Checklist signed by Certified Renovator 

10. Signed Property Completion Agreement Form 

11. Property Close-Out Check list Signed by EPA 

12. Douglas County Assessor Property Information 

13. Work-Site Hazards Analysis Checklist 

14. Pre- Stabilization Property Hazard Assessment Photographs 
' TECHNOOLOCIBS. D4C.~ 

Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) with the U. S. 

Enviroimiental Protection Agency (EPA) to stabilize Lead Based Paint (LBP) at a ntmiber ofproperties 

located in Omaha, Nebraska, including the property located at: liOGf ^ Q ^ S^— 

The EPA requests your pennission to allow Prudent to perform LBP Stabilization at this property. By 

signing this form, the property owner grants pemiission to Prudent to perfonn activities related to LBP 

Stabilization including scraping paint and painting ofthe referenced property. Further, the 

owner/tenant verifies that they have received the LBP pamphlet "Renovate Right." 

By signing this document I agree to allow an EPA contractor to conduct a soil cleanup at my property 

following completion of lead-based paint stabilization, ifthe soil cleanup has not already been 

perfonned. I imderstand that the stabilization contractor cannot provide assurances of which 

contractor will be bound to the soil cleanup. I further understand that the soil cleanup contractor will 

make all reasonable efforts to address concems that I, as the property owner, may have regarding soil 

cleanup at my property. 

l/f]Y Yes, I have read and imderstand the paragraph above. 

fy,^lqu^. zri<Z^yo 6^-6t-TQ 

Property Owrier's Signature Date 

Ifyou have any questions about the LBP stabilization planned for your property, please contact 

Pmdent's Customer Relations/Office Manager for the Lead Based Paint Stabilization, Mr. Chandra 

Shekar at 402- 504-1004 or 402-889-3821. General questions about the Omaha Lead Site cleanup can 

be du-ected to the EPA Public Information Centers at (402) 731-3045 (South Omaha office) or (402) 

991-9583 (North Omaha office). 

Propertv Access Granted Bv: 

Property Owner's Signatiure Date 

Please Print N^ e 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone:(402)504-1004 Phone:(210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
TBCHNOLOCIBS. IN C 

PROPERTY INFORMATION 

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

RESIDENTNAME: \^/OCjg JXA^J ^ Owner / Tenant y 

RESIDENT ADDRESS: \ \ O ^ -Q p.% ^ ^f- (3 K>.JUL YJ^f-T" 4 ^ © P' 

IF RENTAL, PROPERTY OWNED BY: £-v\v^:

X

 ^,^. a ^\(7(r^a^ . ^ 

OWNER' ^pHy , ^^^ c>u.^oJU^ S MAILING ADDRESS: <=; M 3 <, d 

OWNER'S TELEPHONE NUMBER: 

Home: Work: Cell:^t>l ^612 - (^2-^^ ? 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: Y J 

TOTAL NUMBER OF OCCUPANTS: 

NUMBER OF CHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 5 HOURS 

OR MORE PER WEEK: 

COMMENTS OR SPECIAL INSTRUCTIONS (such as dogs, entrv gates, etc.): 

AUTHORITY FOR ENVIRONMENTAL RESPONSE ACTIONS: The activities to be implemented 

by EPA under this agreement are pursuant to Section 104 of CERCLA, 42 U.S.C. 9604. EPA's right 

of access to the property is provided for in Section 104(e) of CERCLA, 42 U.S. C 9605(e), which 

provides entry for "detennining the need for response, or choosing or taking any response action under 

thistitle, or otherwise enforcing the provisions ofthe title." 

Property Owner Signature 

(Signature) Date 

8080 Ward Parkway, Suite 405 2505 N. 24'" street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
^l«»NaiLOCIB&INC. 

PRE & POST PAINT STABILIZATION VIDEO AND PICTURES 

I understand that prudent Technologies (Prudent) will be conning out to shoot a PreStabilization video and to take pictures of my property. Prudent will use the videos and 

pictures to document the current property status/condition. Also, Prudent will shoot a video 

shot following the completion of the paint stabilization. I give permission to videos and 

pictures of my property. 

Please list any special conditions that Prudent employees need to be aware of before 

shooting a video (such as pets, prior notice, etc.). 

lVC>ci 7 y<k ^ 

Property Address 

F}ir-r\<St^X^ ^^I'l^y d 6<i O^ '^d y Owner's Nam€ Signature Date 

ADVANCE NOTICE REQUIREMENT 

After signing the access you allow Prudent to begin Lead Based Paint Stabilization. All 

Plants, weeds and any vehicles or items on open porch (enclosed porches will NOT be 

stabilized) must be removed prior to stabilization. All Pets must be out of yard during 

stabilization. Please indicate below how much advance notice you need to have the abovementioned tasks completed. If you are a landlord you will need to contact the tenant as 

Prudent will only inform the propeily owners. 

Do you have any pets that reside in yard: 

Notice needed: 

Phone number to call to give notice: 

Whom we are giving notice to: 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
PRE-RENOVATION FORM - OWNER 

This form is to be used by thefirms contracted by the Environmental Protection Agency-Region 7 to perform Lead-Based 

Paint stabilization activities at the Omaha Lead Site, Omaha, Nebraska. 

Owner Confirmation 

Pamphlet Receipt 

D I have received a copy ofthe lead hazard information pamphlet. Renovate Right: Importand Lead Hazard Information for 

Families, Child Care Providers and Schools, informing me ofthe potential risk ofthe lead hazard exposure fk»m renovation 

activity to be performed in/on my dwelling unit. I received this pamphlet before the work began. 

Owner Acknowledgment 

D(A) I confirm that I own and live in this property, that no child under the age of 6 resides here, that no pregnant woman 

resides here, and that this property is not a child-occupied facility. 

Note: A child resides in the primary residence of his/her custodial parents, legal guardians, foster parents, or 

informal caretaker ifthe child lives and sleeps most of time at the caretaker's residence. 

Note: A child-occupied facility is a pre-1978 building visited regularly by the same child, under 6 years of age, on at 

least two different days within any week, for at least 3 hours each day, provided that the visits total at least 60 hours 

annually. 

D (B) 1 understand that the renovation firm, contracted by the Environmental Protection Agency (EPA), will be using leadsafe work practices required by EPA's Renovation, Repair and Painting Rule. 

Printed Name of Owner-Occupant 

Signature of Owner-Occupant Date 
BIBS, INC 

PAINT MATCHING FORM: 

1. TO BE FILLED OUT ONLY IF MATCHING COLOR 

PROPERTY ADDRESS: klO ^ 4 X- ^ ^ T 

BVID: 

The following notes are for the benefit of paint crew only. 

Paint Yes Paint No Location Paint Description 

Siding y 

Soffit 

^ 

Fascia v 

Comer Trim y 

Window Trims y 

Door Trims ^ 

Front Porch Ceiling 1 / 

Front Porch Ceiling Beams 1 / 

Front Porch Floor Z r-. - i - —- /

1/ y • Otrp ^ 

Front Porch Railings y 

Front Porch Steps 

7v^Y»e 

Siding Baseboards y 

Foundation Z 

Garage/Shed •k- i* ^ 

n/?^<^ 

" . • 

I UNDERSTAND SHERWIN WILLLAMS WILL MATCH MY CURRENT COLORS. 

Homeowner signature: ^ryy y 1 Cjj^/^ ^ ^ l/2.xfVlKjQ Date:/^<;S Q" ^ / ^ 

8080 Ward Parkway Parkwav,. Suite 406 2505 N. 24'" Street, Suite 3084242 Medical Drive., Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax; (402)504-1005 Fax:(210)579-6677 
~ - - I I I M l r I ;CHNOU>&IES,INC 

ACCESS ASSESSMENIT FORM: 1^0'^ C U? C(^ 


House siding (circle all applicable) 

*Transite is same as asbestos 

**Also called aluminum siding 

***Also called roof shingles 

Ifthe siding is aluminum (metal), is it original 

factory finish or painted over? Circle one. 

If the siding is Wood/Asphalt/Roof shingles, is it 

painted? Circle one. 

Does this property require lots of scrapping? 

Does this property require a lift or scaffolding to 

reach upper levels? 

Does this property have lots of plants/ivy or items 

in the areas where,painting is required? If yes 

explain. 

Does this property have any significant structural 

damage? If yes, EXPLAIN? 

Does this propertv have a: Garage / Shed 

Garage: Yes //No/ 

Shed: Yes/^T 

If yes, describe the location & siding material of 

garage / shed. 

Is this property vacant or occupied - circle one 

Are there any pets at this property? If yes explain. 

Are there any low hanging power lines? , 

Do we need neighbor's access? If yes please 

explain and get neighbor's property address and 

owner information. 

/Wood^/ Transite* / Vinyl / Pre-finished Metal** / 

wiw I Concrete / Concrete blocks / wood 

shingles / Asphalt shingles*** / Stucco / 

Original Factory Finish 

Painted Over j i / ^ 

Shingles painted 

Shingles not painted n ' 

^e^ l No 

Yes//(© 

YeslfQ) 

Yes/ ^ 

Garage: Attached / Detached 

Garage siding: Wood / Transite* / Vinyl / Prefinished Metal** / Brick / Concrete / Concrete 

blocks / wood shingles / Asphalt shingles*** / 

Stucco / 

rccdupiest/Vacant 

Yesl^oJ 

"^e^Ho 

Yes/fe) 

8080 Ward Parkway. Suite 405 2505 N. 24'-' Street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816)363-3703 Phone: (402) 504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TDRIIDH 

C\.«^ ' i=»-^y 

J 

& . p«ot€> 

ACCESS INFORMATION 

BVID: 

PROPERTY ADDRESS: //^- ^ -^ - ^< r yj ^ 

Property Owned By: 

(If new property owner) 

Owners Phone No's: 

Home: Work: 

CeW:-^'-^--•^^^ - Fax: ~ 

Access Contractor: ASW PDA MES PE Other (Prudent) 

DATE TIME ACCESSOR CONRACT DETAIL 

f0(fy/9jf7/o ^ZZj^Z^f ^ -. 

'•^ / ^" i " 

Comments: 

8080 Ward Parkway, Suite 405 2505 N, 24'" street. Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: <210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
(effective April 2010) 

# # 

RENOVATION RECORDKEEPING CHECKLIST 

Nameof Firm Tru^Mi-

Date and Location of Renovation: Start Date:to 'o^^ V*^ End Date: L'^3zc> Location ://(9 9 ^ ' ^ - ^ 

Brief Description of Renovation: j^^J^^/^ggy ^ g^^y/^ ^T^^,.^...-—"^y^^ 

Name of Assigned Renovator: /yfiyyyyj / /f>^y''<iyf^j>^ 

Name(s) of Trained Workers: />^^>t>-tyt_-^{^L^^ yzy^jJUly j &^^^^X^^-Jo. Cr^pAyicJ^l^^^ 

Name of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: 

Copies of renovator and dust sampling technician qualifications (training certificates, certifications) on file. 

g^JScrtified renovator provided training to workers on (check all that apply): 

^^^^^-Posting waming signs ^"^tting up plastic containment barriers 

^^Maintaining containment ^^-Avoiding spread ofdust to adjacent areas 

'^-Waste handling Post-renovation cleaning 

Test kits used by certified renovator to determine whether lead was present on components affected by 

renovation (identify kits used and describe sampling locations and results: 

^i^f^mang signs posted at entrance to work area. 

^..^Work area contained to prevent spread ofdust and debris. 

t-^Windows in and within 20 feet ofthe work area are closed 

/C^^lSoors in and within 20 feet ofthe work areas are closed and sealed 

^^Doors that must be used in the work area are covered to allow passage but prevent spread ofdust. 

Ground covered by plastic sheeting extending 10 feetfi-om work area - plastic anchored to the 

building and weighted down by heavy objects! 

Ifnecessary, vertical containment installed to prevent migration ofdust and debris to adjacent 

property. 

Waste contained on-site and while being transported off-site. 

Renovation Recordkeeping Checklist Omaha Lead Site 
(effective April 2010) 

# # 

t-W6rk site properly cleaned after renovation. 

^-"AlTchips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

removal. 

c.WWk'area HEPA vacuumed to get paint chips from ground surface, ifnecessary. 

Certified renovator perfonned post-renovation cleaning verification (describe results): 

1 certify under penalty of law that the above information is true and complete. 

Yo-^3'-Z2) 

Name and Title Date 

Renovation Recordkeeping Checklist Omaha Lead Site 
# # 

J^^^^^^ 2 ENVIRONMENTAL & CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

OMAHA LEAD BASED PAINT REMEDIATION 

Property Owner Close-Out Form 2010 

(Lead-Based Paint Stabilization EPA Confract EP-R7-08-07) 

SAID: ^•Tg^^C; ^ 

Property Address: y-fiZ? ^ A^. :? ^ .^^ . 

Owner's Name: ^A,//fZ^fy ^ /^Z. Z-^yiiAyZ>Z> 

Performance Standards/Close-Out Criteria YES NO 

I. Was the entire stmcture(s) painted with the exception ofthe stated, excluded areas? This 

would include painting of other associated features including fascia, eaves, siding, all trim, 

porches, box beams, columns, rails, and exterior surfaces of garages. 

2. Was all scraping and other preparation work completed satisfactorily? 

3. Were all required areas ofthe stmcture(s) primed as needed and painted with two top coats? 

4. Was the paint products utilized equivalent to a 25 year product/quality? 

5. Are all ofthe areas where contaminated materials have been spilled thoroughly vacuumed/ 

cleaned? 

6. Did the contractor collect/vacuum all falling and scraped paint chips on the entire property, 

roadways, alleyways, public access areas and also remove any other generated debris? 

7. Is the grass area that surrounds the stmcture(s) in reasonably good condition? . 

8. Are all items such as polyethylene sheeting, ladders, paint bmshes, cones, barrier tape, etc. 

properly removed? 

9. Isthereanyevidenceofproperty damage that was done by the contractor? Any property 

damage needs to be completed prior to the EPA Close-Out. 

10. Are you satisfied with the work performed? 

11. Are there any property items that were temporarily re-located by the contractor that need 

to be moved back? 

12. Are there any (known) lingering issues with the property owner(s) that have been left 

unresolved? 

Other Considerations/Property Owner Discussions/Additional Work that is Required: 

E>n^G^i/c,^^'SQ^a ^ 

Proparty OwnerSigni Date It C>^<^3 -y d K-> ^ 

dent Technologies, In^^^ignature Date 

8080 Ward Parkway, Suite 405 2505 N. 24'" street. Suite 218 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816)363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
ENVIRONMENTAL & CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

OMAHA LEAD BASED PAINT REMEDIATION 

EPA Close-Out Form 2010 

(Lead-Based Paint Stabilization EPA Confract EP-R7-08-07) 

SAID: 3\0^'1 ]h 

Property Address: )io<f .^ /sg:"" ,'?F 

Owner's Name: 

Performance Standards/Close-Out Criteria YES NO 

1. Was the entire striicture(s) painted with the exception ofthe stated, excluded 

areas? This would include painting of other associated features including fascia, 

eaves, siding, all trim, porches, box beams, columns, rails, and exterior surfaces of 1/ 

garages. 

2. Was all scraping and other preparation work completed satisfactorily? -y 3. Were all required areas ofthe structure(s) primed as needed and painted with 

two top coats? 

4. Was the paint products utilized equivalent to a 25 year product/quality? -iy­ 5. Are all ofthe areas where contaminated materials have been spilled thoroughly y vacuumed/ cleaned? 

6. Did the contractor collect/vacuum all falling and scraped paint chips on the 

entire property, roadways, alleyways, public access areas and also remove any 

y other generated debris? 

7. Is the grass area that surroimds the stmcture(s) in reasonably good condition? ^y 

8 . Are all itenis such as polyethylene sheeting, ladders, paint bmshes, cones, 

\y barrier tape, etc. properly removed? 

9. Is there any evidence ofproperty damage that was done by the contractor? Any 

property damage needs to be completed prior to the EPA Close-Out. 

10. Has the Property Owner signed the completion form? y 11. Are there any property items that were temporarily re-located by the contractor 

that need to be moved baick? y

12. Are there any (known) lingering issues with the property owner(s) that have y been left unresolved? 

other Considerations/Property Owner Discussions/Additional Work that is Required: 

'^/lIlD - \J(yC-lCitaf^'^ pO^lrtT ckiCy^ flf»aA«L \uruJSA^ 

L ^ (ant^iLr da^i ) 

Js:soe!> HeioiiAj dB?h'\^fQ 

0 ^ bJJey 9m mw 

EPA COR Signatilre 

8080 Ward Parkway, Suite 405 2505 N. 24*" street. Suite 218 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
# 

TBCHNOLOCIBS, INCT 

Checklist for the Worksite Hazard Analysis 

Address: 

Crew: Date: 

Item OK? Hazard Corrective Action 

Overhead Lines 1 /M-i V\n «-iC»,- W9 /j> c=> t^: ^ r f V «/• zD'-> 

In-transit Vehicle Clearance 

Levels around high wires 5 - S.-c^ 

Vehicle Clearance around 

high wires when working \5<? C_aCc£. - tAS<* *7. 9 0 ^ dirfj fl ih^y ^ * ^ 

Phone lines e)c47.^n/ ',Sr>$ : y 

Cable lines 

Gas Line / 

Water Line / 

Sewer Line 

\ 

Septic Tank \ 

Propane/Butane ] Access to/on Property 

Neighbor Access Required 

High Traffic Area {\ 

Garage ' " •NDnjt? - — — _-_^ 

Structures 

Driveway 

Sidewalk 

Foundation 

> 

Retaining Walls / 

Fences / 

Trees 

Foliage \ 

General Condition of yard \ 

Damaged Areas: sink 

holes/rotted wood 

Sprinkler System 

Pets 

Insects \ 

Weather Conditions 

Unsafe driving conditions 

Unsafe neighborhood 

Crew Foreman /] Site Safety Officer 

oAq/?^rc? 

8080 Ward Parkway, Suite 405 2505 N. 24'" street, Suite 308 4242 Medical Drive, Suite 4250 

KansasCity, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402) 504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 

Douglas County Account liifiannatio n£3mi8 n Page 1 of4 

Douglas County, Nebraska Property Record - R1234900000 

Print Reoort 

View Interactive GIS Mao Information is valid as of 2010-5-28 Treasurer's Tax Reoort 

New Feature •^•4«# Subdivision Saies Search 

Owner 

ELIZONDO ENRIQUE 

5426 S 20 ST 

OMAHA NE 68107-0000 

Property Informatio n 

Key Number: 3490 0000 12 

Account Type: Residential 

Parcel Number: ^jae^poeeee-—^....^^^^ 

Parcel Address/ /fl09S28ST ^" ^ 

OMAHA NE 68105-0000 J 

Legal Description: >IANGCOM rLAert:Of22 BLOCK 1 N 40 FT 40 X 150 

Value Informatio n 

Land Improvement Total 

2010 $4,600.00 $54,100.00 $58,700.00 

2009 $4,600.00 $56,400.00 $61,000.00 

2008 $4,600.00 $56,400.00 $61,000.00 

2007 $4,600.00 $56,400.00 $61,000.00 

2006 $4,600.00 $54,600.00 $59,200.00 

2005 $4,600.00 $54,600.00 $59,200.00 

Sales Informatio n 

Sales Date: 

Deed Type: 

Price: 

Grantor 

1999-11-12 

D 

$38,950.00 

: SooAt: 2138 Page: 712 

Grantee: 

Valid/Invalid: 

Exclusion Reason: 

Valid 

Sales Date: 

Deed Type: 

Price: 

Grantor 

1999-05-14 

D 

$20,000.00 

; Book: 2122 Page: 557 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl23... 6/3/2010 
Douglas County Account li]£jirmatio n ^ a n Page 2 of4 

Grantee; 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Series SF Units Depth Width Vacant 

0.13 6000.0 1.0 150.0 40.0 No 

Land Attributes 

Attribute Attribute Description 

Negative Influence View 

Negative Influence Traffic 5 

Improvemen t Informatio n 

Building 1 

FlntFkxxr 

TTO.O Sq, R. 

TS 

SIO SF nn esm nakicf. Tint lir .<Ms Ranch 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 770.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: Ranch Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 3.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1,0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.0 

Fioorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1875 1999 0% 1937 73 

Detail Type Detail Description Units 

http://douglasne.mapping-online.eom/DouglasCoNe/static/accountinfo.j sp?accountno=R 123... 6/3/2010 
Douglas County Account Informatio nfiMT n Page 3 of4 

Appliance 

Basement 

Basement 

Fixture 

Fixture 

Porch 

Porch 

Allowance 

Bsmnt Block 8 ft 

Finished 

Base Fixtures 

Bath Full 

Slab Roof Ceiling 

Slab Roof Ceiling 

1.0 

770.0 

510.0 

1.0 

1.0 

119.0 

208.0 

http://douglasne.mapping-online.eom/DouglasCoNe/static/accountinfo.j sp?accountno=Rl 23... 6/3/2010