TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 10413 Date: 7/ya'? 

Address: lSo9 S I S 3h 

RemedKitioii Contractor: PROFESSIONAL ENVKONMENTAL ENGDIEERS Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

y 

D 

y 

y 

Video of property (DVD) 

Executive Summary 

Sigjied Access Agreement for subject property 

Painting Agreement 

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

Photographs 

Satisfactory restoration signed by Property Owner 

Property close-out check list signed by EPA 

Property information from Douglas Coimty Assessor's Ofifice 

y 

D 

Ignature 

yi^i^u^J^y: ^ 

40318346 

Superfund 
r 

PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediafion • Abatement • Emergency Response 

2505 North 24% Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

SAID# 20473 

1309 S 25 St 

Dates worlced 11/18 to 11/09 2008 

Basement leaking on north side of foundation. Broken front porch windows, screens also. 

Siding damage. 

Inspected 12/02 No issues. 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Property Owner Close-Out Form 

(Lead-Based Paint Stabilization EPA Contract EP-R7-08-06) 

^ o m ^ 

SAID: 

Property Address: j^^C f S QS^ £}­

Owner's Name: 000.,^^ P\(\k(<nf) y 

Performance Standards/Close-Out Criteria 

2505 North 24^ Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

YES NO 

1. Was the entire structure(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 y 

garages. 

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

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

4. Was the paint products utilized equivalent to a 30 year product/quality? y 5. Are all ofthe areas where contaminated materials have been spilled thoroughly 

vacuumed/ cleaned? J 

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? y 

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

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, 

barrier tape, etc. properly removed? y 

9. Isthereany evidence ofproperty damage that was done by the contractor? Any 

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

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

that need to be moved back? y

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

been left unresolved? y 

Comments: 

1 

fyJQjuj -D, ChvJbyiAJrrK. 

Property Owher Signature Date 

/y-7yo<y 

Professiona In^o l Ertvuronmental Engineers Representative Date 
PROFESSIONAL 

2505 North 24'^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

EPA Close-Out Form 

(Lead-Based Paint Stabilization EPA Contract EP-R7-08-06) 

SAID: ^C)H~I ^ 

Property Address: i?-^o^ S- y)<r s i 

Owner's Name: (\yyxu. Af^a^rsc)r? 

Performance Standards/Close-Out Criteria YES NO 

1. Was the entire structure(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 y 

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? y 

4. Was the paint products utilized equivalent to a 30 year product/quality? y 

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

vacuumed/ cleaned? y 

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 surrounds the structure(s) in reasonably good condition? y 

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, 

barrier tape, etc. properly removed? y 

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. l y 

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

y that need to be moved back? 

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

been left unresolved? y 

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

/^^-// D /SS//eS 

lylii 'og 

iPA COR Signature Date 
JC Painting 

Property Address \'io q g . a^F^ S i Date (/ - / 8 - O q 

Start Date \ i - 1 ft, - o A Complete Date / / - / 9 -^ o fi 

Amount Of Prime And Paint Used 

Prime (Gallons) c ^ 

Poly (Boxes) 

Paint (Color) 5 uJ (QS'I S Amount (Gallons) jQ 

Paint (Color) 3-<J Q,o \2 ^ Amount (Gallons) 3 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons) 
•Jd 

CONSENT OFR ACCESS TO' H TaU'lF'ERTY ^ ^ , 

OMAHA LEAD STTE REMEDIAL ACTION-LEAD-BASED PAINT STABILIZATION T 

•% y 

Y^oYYMTiJsi-.yypy'y 3 PROPERTY ADDRESS: /^^P ^ 

OWNERNAME: 

DAYTIME PHONE: 

- Otf'^-oyy^^ CELLPHONE: E-MAEL: 

OWNER'S ADDRESS EF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 

•

CELL PHONE: E-MAIL: 

Professional Environmental Engineers, Inc (PE) is under contract (#EP-R7-08-06) with the U.S. Environmental Protection 

Agency (EPA) to stabilize lead based paint (LBP) on residential structures at a number of properties locaited in Omaha, 

Nebraska. The paint stabilization work is being done to protect the soil cleanups that were performed by EPA contractors. 

Paint stabilization activities will include: scraping of cracked or flaking LBP from structures, appUcation of a prime coat and 

two (2) coats of paint Moving parts of windows and doors are not included and will not be addressed. 

Your cooperation is requested in giving permission to this EPA contractor (PE) to enter and have access to this property for 

the purpose of stabilizing lead -based paint as outlined on the property identified above. 

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. I understand that the stabilization contractor can not provide assurances that the soil cleanup 

contractor wiU be bound to. I further understand that the soil cleanup contractor will make all reasonable efforts to address 

concerns that I, as the property owner, may have regarding soil cleanup at my property. 

I fully understand that by signing this Consent for Access, (1) this access wiU remain in effect until the work has been 

satisfiactorily completed, (2) that the Property Owner or Tenant, if applicable, will be given the Housing and Urban 

Development (HUD) and EPA pamphlet, "Renovate Right, Important Lead Hazard information for Families, Day Care 

Providers, and Schools", (3) the Property Owner or tenant will remove all obstructions from surfaces to be pamted, (4) will 

abide by health and safety guidance provided by EPA, (5) will allow photography ofproperty before and after the paint 

stabilization work, (6) will be contacted by a PE representative approximately 48 hours in advance of starting work, (7) agree 

not to obstruct or tamper with any ofthe LBP stabilization actions, and (8) will participate in fmal property inspection and 

sign the Completion Agreement and Property Owner Satisfaction Survey. 

Should you have any questions about the planed Lead Based-Paint stabilization activities for yonr property, please contact 

Professional Environmental Engmeers, Inc Project Manager, Willie Clay At 402-504-4688. General questions about the 

Omaha Lead Site cleanup can be directed to Pauletta France-Isetts, EPA Remedial Project Manager 402-731-2454, or the 

EPA Public Information Centers at 402-991-9583 (North Omaha office) or 402-731-3045 (South Omaha oflice). 

D Yes, I giant access to my property and w u given the pamphlet D No, I do not grant access to my property and I was 

"Renovate Right, Important Lead biforaiatkm for FamUies, Chikl given (he pamphlet "Renovate Right, important Lead 

Care Provkiers, and Schools." InfonnatkmforFamilies, ChiMe Care ProvMers, and Schools.' 

^J3'0<i i l {2)u0.1A(<l\ 

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yy^i^y 

Signaturli e I Date Slgnabiie Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
PROPERTY ADDRESS. ysc^y" j^^s - s y ZIP CODE ^^/(Zy 

PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED: 

PROPERTY ADDRESS ^ZIP CODE 

I liave received a copy of the pamphlet, Renovate R/g/if: Important Lead Hazard Information For Families, 

Child Care Providers And Schools informing me of the potential risk of the lead hazard exposure from 

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

PRINTED NAME OF RECIPIENT DATE 

)JlciM4 (ylynyy.y^.(ri\/ 

SIGNATURE OPRECIPIENT 

Self-Certification Option (For Tenant-Occupied Dwellings Only) 

If the lead pamphlet was delivered but a tenant signature was not obtainable, you may check the appropriate box 

below: 

y Refusal To Sign - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right important 

lead hazard informatkHt for femilies, child care providers and schools; to the rental dwelling unit listed above at the 

date and time indicated and that the occupant refused to sign the confirmation of receipt I further certify that I 

have left a copy of the pamphlet at the unit with occupant. 

D Unavailable For Signature - 1 certify that I have made a good faith effort to deliver the pamphlet renovate right; 

important lead hazard infonnatton for families, child care provklers and schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confinnation of receipt I further certify that I have left a 

copy of the pamphlet at the unit by sliding it under the door or somewhere on the premises. 

y/^/LyyZy-?^: ^ y-y^--<:yy 

PRINTED NAME OF PERSON CERTIFYING ATTEMPTED DEUVER Y DATE AN D TIME LEAD 

PAMPHLET DEUVER Y 

|^>«. 

^ac 

SIGNATURE OF PERSON CERTIFYING LEA D PAMPHLET DELIVERY: 

Note Regarding Mailing Option - as an altemative to delivery in person, you may mail the lead pamphlet to the owner 

and/or tenant Pamphlet must t)e mailed at least 7 days t)efore renovation. (Document with a certificatB of mailing from the post 

CONFIRMATION OF RECEIPT OF LEAD PAMPHLET 08/08 
PAINT STABILIZATION PRE-PROPERTY ASSESSMENT 

PROPERTY ADDRESS: y^O y S , C^ S S ^ DATE ^^ ~ " ^ ^ ^ ^ 

BVID y^yy 3 

PLANT & PERMANENT LANDSCAPING TO BE REMOVE? NO yv ^ YES |—1 

IF, YES WHERE: 

PRE-E XISUNG CONDmG^ OF FOUNDATION/STRUCTURE, Le. BASEMENT LEAKING? 

NO I 1 YES L-i ^ IF, YES WHERE: 

U i.4i .V-tv^ ^ ? yc-LL.->y-irJ,^^ 

EXISTING PAINT ON WINDOWS, DOORS, FOUNDATION, SIDEWALK,( I.E.)? tiOrzy ^ 

YES n m IF, YES WHERE: 

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VISUAL DESCRIPTION OF PROPERTY/STRUCTURE/GARAGE, (I.E.): (USE BACK SIDE IF 

NECESSARY) 

PROPEmY OWNER SIGNATURE 

L-TVi 
PAINT SmeiLEATHOIV! F^E-PROPERTY 

P7AB ASSESSMENT 

PROPBin ADDRESS:. y^fi^P S^^<y' y y DATE yy- ^ ^ 

— BVID -

AREA(S) TO BE PAINTED: 

HOUSE PROPER: U< ^ v' 

COLOR /lUu-o/, €\f.i$nyy. 

HOUSE TRIM 

v ' 

COLOR nxLTcA yiyy-inc[ 

GARAGE COLOR bu y cf l -e y/^///<•• 

GARAGE TRIM

PORCH 

_ 

_Uec, 

^f" ? COLOR 

COLOR nit^fd i

^

 y-^yti/K, ' 

i 

1 

PORCHTRIM 

(COMPLETE ALL 

^n 

SECTION, YES,

COLOR 

 NO, OR NON-APPLICABLE] 

inarc h y v/sr^/i i d' 

y 

I AGREE TO THE COLORS LISTED ABOVE. ONCE PAINTING BEGINS, X 

UNDERSTAND I CAN HO I CHANGE THE ABOVE SELECTED COLORS: 

PROPERTY OWNER SIGNATURE: 

fli [LA^\ ^\\Ax\hJr\^ 

PAINT MATCH FORM 08/08 
^ Douglas County Account Information Page 1 of2 

Douglas County, Nebraska Property Record - R2219500000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 9Cth St - VIe W OD Ma p Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature -•-•- * Auto Sales Search 

Owner 

ANDERSON MARY D 

1309 S 25 ST SMZ-/C>7 ^ 

OMAH SQS'%1^' ^ A NE 68105-0000 

Property Informatio n 

Key Number: 1950 0000 22 

Account Type: \ Residential 

Parcel Number: I 2219500000 

Parcel Address: 1309 S 25 ST 

OMAHA NE 68105-0000 

Legal Description: i SHULLS 2ND ADD LOT 20 BLOCK 12 N 1/2 25 X 126 

Value Informatio n 

Land Improvement Total 

2008 $3,600.00 $33,500.00 $37,100.00 

2007 $3,600.00 $33,500.00 $37,100.00 

2006 $3,600.00 $33,000.00 $36,600.00 

2005 $3,600.00 $33,000.00 $36,600.00 

2004 $3,600.00 $33,000.00 $36,600.00 

2003 $3,600.00 $33,000.00 $36,600.00 

Sales Informatio n 

Sales Date: 2002-05-29 

Deed Type: QC Book: i 2004 Page: 008982 

Price: $0.00 

Grantor: Lawrence S Anderson 

Grantee: Mary D Anderson 

Valid/Invalid: Invalid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.07 3150.0 1.0 126.0 25.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22... 11/5/2008 
V Douglas County Account Information Page 2 of 2 

Building 1 

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CLICK lOENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: ; 832.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 1 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: I Plaster Baths: 1.5 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year YearBuilt Physical Age Remodeled Remodeled Built 

1890 0% 1890 118 

Detail Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 560.0 

Basement Minimal Finish 200.0 

Fixture Additional Fixtures 1.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Fixture Bath Half 1.0 

Garage Detached 240.0 

Porch End Solid Wall 240.0 

Porch Slab Roof Ceil 160.0 

Porch Slab Roof Ceil 160.0 

User Attic Full Finish 272.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R22... 11/5/2008