TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 2,^ % 7 Date: y/juj^j 

Address: 4'20(/:> Ujirj' S v 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

yi/ Video of property (DVD) 

M Executive Summary 

Signed Access Agreement for subject property 

Painting Agreement 

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

B Photographs 

B^ Satisfactory restoration signed by Property Owner 

H Property close-out check list signed by EPA 

M Property information from Douglas Coimty Assessor's Office 

a \ • . • 

D 

Signature / Date 

40318191 

iiiiiii 

Superfund 
PROFESSIONAL 

2505 North 24^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. J

ri Omaha, NE 68110 

3 (402) 504-4688 "Providing cost-effective environmental solutions" k

H 

Fax (402) 504-3281 

Consulting • Engineering Design • Remediafion • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

SAID# 29967 

4206 Wirt St 

• Dates worked 12/03 to 12/11 2008 

• House had many damaged areas on soffit and eaves. Missing boards and gutters. Transit 

was damaged in areas and had some cracks. Lattice was broken in areas nad foundation had 

cracks in it all over. Window trims were in very poor condition with flaking paint. 

• Inspected 12/17 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) 

SAID: J^^ J <i? 1 

Property Address: 'fQ^ G UJlE^i 

Owner's Name: Mi'M// ^ M ^ L)OO^LFC ^ 

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 l ^ 

garages. 

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

3. Were all required areas ofthe structure(s) primed as needed and painted with 

two top coats? U 

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

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 L­ other generated debris? 

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

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

barrier tape, etc. properly removed? U9. Is there any evidence of property damage that was done by the contractor? Any 

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

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

that need to be moved back? / _ 

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

been left unresolved? < -

Comments: 

^ M UM^ .;. IhK. Property Owner Signature Date 

Professioional^nvfron n onmenta n l Engineers Representative Date 
PROFESSIONAL 

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

Omaha, NE 68110 

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

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: 29^(o i 

Property Address: QloCo iJ^n {h 

Owner's Name: C{ \ > <\) r^v >. e fY\c- (^ o ^ f^ tf 

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 

y two top coats? 

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

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? c ^ 

8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, y barrier tape, etc. properly removed? 

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

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

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 

y been left unresolved? 

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

EPA COR Signature 

' Date' 
 1 

CONSENT CFR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: Q^^Co l PROPERTY ADDRESS: , 'O'r^O 0> LiJ i r "^ S fOWNER NAME: 

EC?; ^ (W^O«,.i^, DAYTIME PHONE: n^S^' ^ 'Q^'^ E 

CELLPHONE: E-MAIL: 

OWNER'S ADDRESS IF DIFFERENT: _ 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 

CELLPHONE: E-MAIL: 1 

1 1 

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

Agency (EPA) to stabilize lead based paint (LBP) on residential structures at a number of properties located 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, application 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 will 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 will remain in effect until the work has been 

satisfactorily 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 painted, (4) will 

abide by health and safety guidance provided by EPA, (5) will allow photography of property 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 of the LBP stabilization actions, and (8) will participate in final 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 your property, please contact 

Professional Environmental Engineers, 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 office). 

^\Yes , I grant access to my property and was given the pamphlet D No, I do not grant access to my property and I was 

'"Renovate Right, Important Lead Infomiation for Families, Child given the pamphlet "Renovate Right, Important Lead 

Care Providers, and Schools." Information for Families, Childe Care Providers, and Schools." 

( Signature Date N ^ Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
Confirmation Of Receipt Of Lead Pamphlet 

BV1D^5Q967___ 

PROPERTY ADDRESS ^/SOT n Lj ^ •'^ ^ S/ ~ ZIP CODE. 

PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED: 

PROPERTY ADDRESS ^ZIP CODE 

I have received a copy of the pamphlet, Renovate Right: 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 perfomied on dwelling unit. I received this pamphlet before the work began. 

\^/lA ^A^fi- ^ IK^Ah 7A-y/ /; '^ o -oS 

PRINTED NAME OF RECIPIENT DATE 

JA^L^ . K cjQ ^ ^ 

IGNATURE OF RECIPIENT 

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: 

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

lead hazard infonnation for families, 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 ofthe 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 infonnation for families, child care providers 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. 

£ ^ anrip r ,s 

PRINTED NAME OF PERSO •S N CERTIFYING AHEMPTED DELIVERY DATE AND TIME LEAD 

PAMPHLET DELIVERY 

CERTIFYING LEAD 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 be mailed at least 7 days before renovation. (Document with a certificate of mailing from the post 

office). 

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

PROPERTY ADDRESS: y^OC n CJ/r f J^ / DATE 

RVin 

PLANT & PERMANENT LANDSCAPING TO BE REMOVE? NO [ ^ YES [—I 

IF, YES WHERE: 

PRE-EXISUN G CONDIUQ N O F FOUNDATION/STRUCTURE , i.e. BASEMENT LEAKING? 

NO ' ' YES ' ' IF, YES WHERE: 

EXISTING PAINT ON WINDOWS, DOORS, FOUNDATION, SIDEWALK,( LE.)? NOrtO Q 

YES t m IF, YES WHERE: 

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

NECESSARY) 

• * 

. 

PROPERTY OWNER SIGNATURE 

V1W\....... \^C\0o. ^ 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: ^^^^C ? Lji r ^ S ^ DATE 

c-^9^r. -/ BVID — 

AREA(S) TO BE PAINTED: 5 ^ CO j'<y 

HOUSE PROPER: ^LL. COLOK. 

J ^^^^v f a ^ HOUSE TRIM COLOR fbaYl 

GARAGE. COLOR 

GARAGE TRIM COLOR. 

PORCH COLOR. 

PORCH TRIM .COLOR 

(COMPLETE ALL SECTION, YES, NO, OR NON-APPLICABLE) 

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


UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 


PROPERTY OWNER SIGNATURE: PE ACCESSOR SIGNATURE: 

C/ <\^uu 

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

Douglas County, Nebraska Property Record - R1711870000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 90th St - Vie W Ofl Ma p Information is valid as of 2008-9-4 Treasurer's Tax Report 

New Feature -•->- • Auto Sales Search 

Owner 

MC DOUGLE EFFIE L 

ETAL 

4206 WIRT ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Number: j 1187 0000 17 

Account Type: \ Residential 

Parcel Number: 1711870000 

Parcel Address: 

Legal Description: 

4206 WIRT ST 

OMAHA NE 68111-0000 

MAPLEWOOD LOT 3 BLOCK 1 W 53.1 FT LTS 2 & 

Value Informatio n 

2008 

2007 

2006 

2005 

2004 

2003 

Land 

$5,600.00 

$5,600.00 

$5,600.00 

$5,600.00 

$5,600.00 

$5,600.00 

Improvement 

$47,700.00 

$47,700.00 

$47,700.00 

$23,700.00 

$21,500.00 

$21,500.00 

Total 

$53,300.00 

$53,300.00 

$53,300.00 

$29,300.00 

$27,100.00 

$27,100.00 

Land Informatio n 

Acres

0.11 

 SF 

4876.0 

Units 

1.0 

Depth 

92.0 

Width 

53.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 11/5/2008 
Douglas County Account Information Page 2 of2 

•JJf& 

Fim floor '•$i. 

•&44.tim n 

3»a mt) m " 

"1 

«•; *t *s . IL. 

t—TM**, . ,|SS8T0«YTO C .J - , 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: j 1276.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Average 

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

HVAC: i Forced Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: i Gable Stories: 1.5 

Floorcover: i Allowance Foundation: Block 

Sprini^ier Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1923 0 0% 1923 85 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 816.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch End Solid Wall 128.0 

User Attic Full Finish 332.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 11/5/2008