Transmittal of Oinaha Lead Site 

Paint Stabilization File Folder 

Said# ^^7^ ' Date: ^^-^-/ 0 

Address: ^^i^P- ^ 70 cglcS^S 7 ^ 

Contractor; Citv of Omaha Year: ^f l /€> 

Paint Stabilization 

Property File Folder Documents 

Work Write Up 

Signed Access Agreement for subject property 

Pre-.Renovation form signed by Property Owner 

Pre-Renovation Form for Occupant/Tenant, ifapplicable 

jy/^Painting Agreement/City of Omaha Purchase Order 

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

Renovation Recordkeeping Checklist signed by Certified Renovator 

l^PropertV informationfi"om Douglas County Assessor's Office 

j/othe r (describe): {fi)0f0 t 3 

7g>-^ ^^» ^ j'-/r-7ju 

City of Omaha Representative Signature Date 

LJorv 3wUo 1 ^ 

EPA Representative Signature ~t Date ~ 

30262455 

HIHIIIIIHIi 

Superfund 
1 

C ; Y OF OMAHA 

PURCHASING - ROOM 1003 Purchase Order 

1819 FARNAM STREET REVISION PAGE PURCHASE ORDER NO. 

OMAHA. NE 68183-1003 

1164752 FAX# 402-444-5423 

SHIPTO: 

CITYOFOMAHA. 

HOUSING & COMM DEV RM #1111 

1319 F.ARNAM STREET 

0MAHA,NE 68183 

BRAD BATES PAINTING VENDOR: >. 3141 s o 52 ST BILL TO: • < 

CITY OF OMAHA FINANCE OMAHA, NE 68106 DISBURSEMENTS ROOM #1007 

1819 FARNAM STREET 

OMAHA.NE 68183 

ORIGINAL PURCHASE ORDER -VENDOR'S COPY (SEE INSTRUCTIONS BELOW) 

CUSTOMER ACCOUNT NO. VENDOR NO. DATE OF ORDER/ BUYER REVISED DATE//BUYER 

72990 05-APR-10 HHURT 

PAYMENT TERMS 

SHIP VIA F.O.B. 

NET 30 DAYS 

DESTINATION 

FREIGHT TERMS REQUESTOR/DELiVER TO CONFIRM TO / TELEPHONE 

MARUCA. T MARIE (402) 551-0927 

< ITEM PART NUMBER / DESCRIPTION DELIVERY DATE QUANTITY UNIT UNIT PRICE EXTENSION 

All prices and amounts on. this order are express ;d in : US Doi:ar 


NEEDED: 1,925.0 0 N 

07,-APR-lO 

EPA PAINT STABILIZATION 


PROGRAM GROUP 81 2622 N 


2 5TH ST	 • 
 o SHIP TO:	 i . 
 Address at top of page 


SHIP TO: Address shown above. If shipment is dielayed or any items nol available, advise at once. Pur­

chase order number must appear on all invoices, packages, packing lists, bill of lading, and correspondence. 1,925.00 

SHIPPING CHARGES TO BE-PREPAID, IF APPLICABLE AND ADDED TO INVOICED, copy to be fur­ Total C J

nished with invoice. 

TAX EXEMPTION: The City of.Omaha is exempt from Federal Excise Taxes and the Nebraska and City of AdiL.i.-^«.N--^ Oniaha Saies Taxes. Federal I.D. 476006304; STATE I.D. 01-0316768; Fuel Dealers Lie. 91-0316768. Cily Piiichasing Aar i / Buyer ^ 
Planning Department 

Omaha/Douglas Civic Center 

Inspector: To m Roz a 1819 Farnam Stre«, Suite 1003 

i-N„4.„. 0/1 A/1 r\ Omaha, Nebraska 68183 

Date : .2/10/10 (402)444-5150 

Telefax (402) 546-0714 

Name: Lucille Woods R.E.Gunningham,RA, F.SAME 

Jim Suttle,Mayor Address: 2622 N 25 St ''^'^' 

OMAHA EXTERIOR PAINT STABILIZATION PROGRAM 

F OR THE EPA OMAHA LEAD SITE 

The Contract bid documents consist ofthe following sections:. • . .General Responsibilities for the Contractor and Occupant. 

o Lead Hazard Control Plan, Interim Control of Lead Based Paint Hazards. 

The Contractor Shall: 

• Comply with HUD's "Guidelines for the Evaluation and Control of Lead-Based 

Paint Hazards in Housing." (Copies are available at the Plamiing Department.) 

• Comply with Standards called for in the "Construction and Rehabilitation 

Specifications, Housing and Community Development Division, City of Omaha, 

Nebraska." (Copies are available at the Plarming Department.) 

• Comply with the State ofNebraska Health and Human Services Regulation and 

Licensure, Title 178 Chapter 23 Lead Base Paint Regulations. 

• Coordinate daily constructipn schedule with the occupant 

• Subrnit information cut sheets for all isubstitutions or approved equals prior to 

written approval ofthe Construction Specialist. 

• Repair or replace all items damaged or disturbed during paint stabilization 

activities. 

• Keep work site and surrounding areafreefrom accumulations of waste materials 

or rubbish caused by the work at all times. 

• Upondaily completion of work: clean up all rubbish, excess material, equipment, 

and etc., that is coimected with the work, and leave all parts ofthe work areas in a 

neat, sanitary, lead safe and presentable condition. 

« Coniplctethisproject within 30 calendar days. 

The Occiipant/Owner Shall 

• Remove and store awaiy any personal property within twenty (20) feet ofthe area 

to be remediated. 

• Provide access to electricity and water throughout the paint stabilization process. 

• Ensure that all household members stay at least ten feet awayfrom all work areas 

and also keep all pets at least ten feet away at alltimes until the work has been 

completed and the area has passed a visual inspection. ^ . , 

Initials ^ > ^ ' 
2622 Sf 25 St (Continued) 

Lead Hazard Control Plan 

Interim Control of Lead based Paint Hazards 

Paint Stabilization 

, • Prepare and paint all previously painted exterior surfaces ofthe dwelling 

to include but not limited to the fascia, eaves, trim, window trim, door trim 

and foundation, jncludie all siding. Do not include doors or windows. 

• Prepare and paint all previously painted surfaces by following the Safe 

Work Practices protocol for EPA exterior lead based paint stabilization, 

•

 ' All paint colors to match existing paint patteim. Prime and apply two coats 

of approved finish coat. (Refer to Plarming Dept. approved paint list) 

•

 IF SPRAYED, ONE COAT SHALL BE BACK-BRUSHED OR 

BACK-ROLLED. 

Lead Based Paint Waste 

Lead-based paint waste must be handled as follows 

• All paint chips and component debris must be double bagged for disposal. 

• Clean paint chips from ground around perimeter of dwelling before 

starting, during and after the project. 

•

 All lead painted components and debris must be removed from the site 

daily unless otherwise approved by the construction specialist. 

o All lead-based pairit debris (chips and components) must be disposed of in 

a municipal solid vvaste landfill. 

^^^yCUi<.£A::> /^^^zft^d^i^ 

Property Owner J^i^-'fiSi Date 

Property Owner Date 

Witness 

Date 

Occupant (ifapplicable) 

Date 

Occupant (ifapplicable) 

Date 

Witness Date 
Exterior Lead-based Paint Stabilization Program Managed by the City of 

Omaha for EPA Region 7 

Omaha Lead Site 

The purpose of this program is to prevent yards where lead-contaminated soil is cleaned 

upfrom becoming re-contaminated by deteriorating exterior lead-based paint. This is 

not a home repair program. 

Which Homes Are Eligible? 

• Homes where soil clean-up has been or will be done and an EPA contractor has 

identified deteriorating exterior lead-based paint. 

• Homes are eligible.only by referral from the EPA. 

What work will be done? 

• Looseand flaking lead^based paint will be removed safely from fascia, eaves, 

siding, trim, window trim, door trim and foundation. 

• iSurfaces will be primed and painted to match existing paint color as closely as 

possible. 

What will not be done? 

• Surfaces which have no paint will not be treated. 

• Windows or doors will not be included. 

• Rotten wood will not be replaced. . 

• No housing repair will be done.. 

Who will perform the work? 

• EPA contractors will test paint on exterior house surfaces and give the results to 

the City of Omaha Paint Stabilization Program. 

• City Construction Specialists will prepare a work.plan and contact the property 

owner for permission to proceed. 

• Work will be competitively bid by approved, trained contractors. 

When will the work be done? 

• This program began in 2007-and will continue for several years. 

• The City staff will prioritize homes based on the presence ofchildren under age 

six if known and the severity of the problem. 

Paint Stabilization is voluntary and will be done only with permission ofthe owner. 

Initials ^ ^ ' 
Consent for Access to Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes theUnited States Environmental Protection 

Agency (USEPA) or its authorized representatives, collectively the Grantee, to enter and perform 

certain environmental response activities upon the following described premises: 

Owner's Name: Davtime Phone: 

Owner Name(s): Lucille Woods 402-714-8699 

Addresses of Properties Covered by this Agreement 

Property Address 

City/State/Zip Code 

2622 N. 25th St. 

Omaha, NE 68110 

Grantor understands that this grant does not limit EPA's right of access under the Comprehensive 

Environmental Response and Liabilitv Act fCERCLAl 42 USC. & 9601-9675. or anv other law. 

PURPOSE OF ACCESS 

The purpose of the response action is to stabilize loose or flaking exterior lead-based paint on 

residential properties, including day-care facilities, where remediation of lead contaminated soil has 

or will take place. Sampling of soil may be conducted. This consent shall allow Grantee onto 

Grantor's property andfiirther, provides the Grantee the right to perform any and all environmental 

response actions and activities it deems appropriate. 

ENVIRONMENTAL RESPONSE ACTIONS 

The environmental response actions to be performed on subject property may include the following 

activities: 

1. Locating equipment and/or machinery on subject property in preparation for and in the course of 

the response activities. 

2. Obtaining samples from Grantor's property. 

2/12/2007 (1) 
Address: 2622 N. 25th St. 

Consent for Access to Propertv (Page 2) 

3. Plarming and implementing the response action on the Grantor's property. This will include 

1) removal of loose or flaking paint identified by EPA using lead-safe methods in cornpliance 

with HUD/EPA regulations and 2) repainting according to the attached specifications. 

TERM 

This access agreement shall be operable for the period of time it takes to complete the 

environmental response activities. Upon completion of the response actions, all rights and 

privileges given by the Grantor shall cease on that date, unless extended by a subsequent 

agreement. 

AGREEMENT NOT TO INTERFERE 

Grantor agrees not to interfere with any of the activities undertaken by Grantee at the Property, 

tamper v^th any of Grantee*s property, or take any actions regarding the use ofthe Property which 

will .endanger human health or welfare or the environment, or allow others to use the Property in 

such manner during the term of this consent. Grantor agrees to provide notice and a copy of this 

agreement to prospective purchasers, lessees, assigns, or grantees ofthe property or any portion of 

it. Grantor agrees to provide 30-day notice to EPA prior to any transfer of ownership rights to the 

property. 

SAMPLING RESULTS 

Grantee agrees to provide Grantor with the results of any and all sampling and/or analysis resulting 

from Grantee's response activities on.the property. 

PRIOR CONDITIONS AGREEMENT 

The grantor agrees to the condition of the property prior to remediation and indicates on Page 3 any 

items to be removed by the Grantor before activities commence. 

RESTORATION OF PROPERTY 

Except for the above stated paint stabilization, the Grantee agrees that said property will be restored 

as nearly as possible to its original state and condition as found immediately preceding the 

beginning of activities autiiorized by this Agreement, following completion of the response 

activities. 

(2) 2/12/2007 
Address: 2622 N. 25th St., Omaha, NE, 68110 

CURRENT CONDITION / PROPOSED RESPONSE ACTIVITIES 

The purpose of this section is to provide a mutual agreement as to conditions of property prior to 

contractor activities. This wall also serve as documentation for the purpose of assuring that 

restoration activities are completed to the satisfaction of the property owner and the United States 

Environmental Protection Agency (EPA), 

Items to be removed bv property owner prior to the response activities: 

1. 

2. 

3. . • 

4. 

5 . , • • 

Items NOT to be removed bv contractor during removal activities: 

1. 

2. 

3 . • . 

4 . • 

5 . , • 

ADDITIONAL COMMENTS: 

^KCiu/t^ Cux^raAf^ /H t>^k 

I have read the foregoing document and understand that it is an agreement granting permission to 

the.Grantee to enter the above described premises for the purpose of conducting environmental 

response activities, and I agree to its terms and conditions. I acknowledge that I have received the 

pamphlet "Renovate Right". 

Grantor's Signature: k/^gn^^i_^ Date ^-/S^/ 0 

n,). mmooi 
Douglas Coiuity Account Information http://douglasne.mapping-online.conVDouglasCoNe/static/accountinfo., 

Doijglais County, Nebraska Propert y Record - R2003680002 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - VICW OH Information is valid as of Map 2009-12-31 Treasurer's Tax Report 

New Feature •* -• .^ Auto Sales Search 

OWner 

WOODS LUCILLE 

2622 N 25 ST 

OMAHA NE 68110-0000 

Propert y Informatio n 

Key Number 0368 0002 20 

Account Type: Residential 

Parcel Number: 2003680002 

Parcel Address: 2622 N 25 ST 

OMAHA NE 68110-0000 

Legal Description: PATRICK PLACE LOT 2 BLOCK 2 ALL LTS 1 & 2 90 X 110 

Vcilue

2009 

2008 

2007 

2006 

2005 

2004 

 Informatio n 

Land 

$2,800.00 

$2,800.00 

$2,800:00 

$2,800.00 

$2,800.00 

$2,800.00 

Improvement 

$60,300.00 

$60,300.00 

$60,300.00 

$60,300.00 

$60,300.00 

$14,700.00 

Total 

$63,100.00 

$63,100.00 

$63,100.00 

$63,100.00 

$63,100.00 

$17,500.00 

Land Informatio n 

Acres SF U

0.22 9900.0 

nits Depth 

1.0 110.0 

Width 

90.0 

Vacant 

No 

Iniprovemen t

Building 1 

 Informatio n 

I of 2 1/25/2010 9:28 AM 
Doyglas County Account Information http://douglasne.mapping-oniine.com/DouglasCoNe/static/accountinfo.. 

2eG2N25ST 

Roof 

OMacIlM 

312.0 Sq. Ft. 

ti r» 

t 1/2 STORY FIN 

anrnnt Block 9 1 

864.D Sq Ft. 

CLICK TO ENI.ARGE IMAGE 

Square Footage: 1760.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

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

HVAC: Central Air to Air Rooms: 7.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.5 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Hip/Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1908 1988 0% 1908 102 

Detail Type Detail Description Units 

Add On Brick Veneer 200.0 

Appliance Allowance 1.0 

Appliance Security System 1.0 

Basement Bsmnt Block 8 ft 864.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Fixture Bath Half 1.0 

Garage Detached 312.0 

Porch EncI Screen 176.0 

User ASBESTOS 1.0 

2 of 2 1/25/2010 9:28 AM