TRANSMITTAL of OMAHA LEAD SITE 


PAINT STABILIZATION FILE FOLDER 


S AID #: 18527 

Address: 620 Dorcas St 

Remediation Contractor: Prudent Technologies Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video of property (DVD) 

Executive Summary 

Signed Access Agreement for subject property 

Painting Agreement 

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

D Photographs 

\y Satisfactory restoration signed by Property Owner 

D Property close-out check list signed by EPA 

[ / Property information from Douglas Cotmty Assessor's Office 

D 

D 

D 

_. Qam At ^ Muks— Signature ^ Date 

40310408 Hi 


Superfund 
PROPERTY SUMMARY 


Date: 10/03/08 LBP STABILJ7ATION EPA CONTRAT EP-R7-08-07 	 Month of: 

December 

Property Address: 620 Dorcas St 	 SAID: 18527 

A. EXECUTIVE SUMMARY 

A.1 Issues Encountered: None 

A.2 Issues Resolved: None 

A.3 Unique Findings: None 

122A.4 Other Relevant Information: None 

Access Date: 09/30/08 


Work Began Date: 10/09/08 


Closeout Date: 11/11/08 


Enclosures: 

1. Pre-Video 

2. Post-Video 

3. Property Status Form 

4. Signed Access Agreement 

5. Pre-Renovation Form 

6. Paint Match Form 

7. Tracking Form 

8. Douglas County Assessor Property Information Page 

9. EPA Property Closeout form 

10. Property Completion Agreement 

TECHNOLOCIES. INC. 

ENVIRONMENTAL A 

CONSTRUCTION 

TECHNOLOGIES, INC. SERVICES 

Property Status Form 

Address: (^ Z O ^\:^o^-C.cxV 5f . ^^' ' (C^f'^f/c^S 

Plant & Pennaneiit T .andaeaplnR To Remain In Place 

Iteiii# 

Description and Location r \ / if \, OnM(q[> 


I Svshe^s^ Cu^e$t) <ih<?dJc^ nd ^ it e fif^^^hkm . 


Pre'Existing Condition of Structures 

Does your Basement have a history of leaking? Yes — No- ~ 

Itein# Descr^o n & Location 

OnM{Q) 

Property Owner X y Prudent Employee 


Signature: t^^'Signature : ^^ae,^ ^ 


8080 Wud Pailwiy, 8iit» 405 2608 N. 24* Straet, Suite 308 4242 Medical Drive. Suite 4280 • a n AIOMHIM TVTSM O 
[2^5 ^ 1 


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

Environmental Protection Agency (EPA) to stabilize Lead Based Paint (LBP a pLnumber of p^perties im (Lt3P)

) att anumoer oi properties 

located in Omaha, Nebraska, including ^ e property located at f^^ Lh^i ^ -

The EPA requests your pemiission to allow Prudent to perform LBP Stabiiization at this property. By signing thisform,the property owner grants permission to Prudent to perfonn activitiesrelatedto LBP 

Stabilization including scraping paint and painting of thereferencedproperty. Further, the owner/tenant 

verifiestiiatthey have received tiie LBP pamphlet **Renovate Right." 

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

Administrative Clerk for the Lead Based Paint Stabilization, Mrs. Deborah Akercie-Johnson. 

at (402) 504-1004. General questions about the Omaha Lead Site cleanup can be directed totiieEPA 

Public Information Centers at (402) 731-3045 (Soutii Omaha ofEice) or (402) 991-9583 Q^Iortii Omaha 

office). . ^ 

PnwertvAceeiianntadBv: A*^ L-^C^V^KJH ^ r \ IT A ;^/ \ 


» (Ptepifj Print Name) 


Propaty Owner Signabre: 


(Date) 


PROPERTY INFORMATION 


(To becomplcttd by midentand/or praptrty owocr - picaae print) 


RESIDENT NAME: L^rcuO Kf^ao/i /"^Jmar ) Renter 

RESIDENT ADDRESS: d?Q(^ Uorc^a^ 

IF RENTAL. PROPERTY OWNED BY: 

^n\e ^ OVmER'8 MAIUNO ADDRESS: 

OWNER'S TELEPHONE NUMBER. HOME: l'^'^ ^ '^ ' ^^^WORK; J _ 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD: NUMBER OF OCCUPANTS 7 YEARS OLD AND OLDER:

. S 

NUMBER OPCHILDREN UNDER 7 YEARS OLD WHO PLAY IN THE YARD FOR 6 HOURS OR MORE PER WEEK: 

COMMENTS ORSPECIAL INSTRUCTIONS: (I.& DOOS. ENTRY QATES. ETC.) 

AUniOIUTY POIt ENVIRONMBNTAL KBSPONSE ACllONS; The acthriiiei to be implemented by EPA under 1 ^ 

ofCERCLA, 42 U.&C 9604. EPA'i fight of aeoeti to lhe property isprovidedforin Section 104(e) of CERCLA, 42 U.S. C 960S(e). which ptovidet entry 

Ibr "determiningthe need fbr response, or chooaing ortaldng any reiponie aclkm under thit title, or odierwiae enforcing die provisi^ 

080 Ward Paikway, 8ldt» 408 2808 N. 24* Stravt, Suite 308 4242 MMllcalDifv»,8ultft 4280 

I CHy, MO 84114 Oniaha, Nebraska 68110 Sen Antonio, TX 7ft9M 
Current Sample PrdM^^enovatio »rPk<
 n Form 

Effective until April 2010. 

Ctmflmiatlon of Receipt of Load Pamphlet 

sr I havereceiveda c»py of the pamphlet, Fienovate Right Important Lead Hazeni 

Infonnation for FamSies, ChSd Cam Provklers and Schools informing me of 

the potential risk of the lead hazard exposure from renovation activity to be 

perfbrmed in tny dwelling unit. I received this pamphlet before the work began. 

1/7 - f - o<i 

Date 

SeK-Certification Option (for tenant-occupied dwellinga only) — If the lead pamphlet was delivered but a tenant signature was not obtainable, you may dieck the appropriate box bek>w. 

Q Refuaal to sign — I certify that I have made a good M h effbrt to deliver the 

pamphlet, FiencNate FUght: Important Lead Hazani Infonration for FamSies, ChSd Care Pny\^ders and Schools, to the rental dwelling unit listed below at the 

date and time indicated and that the oocupant refused to sign the confirmation 

of receipt. I furttier certify that I have left a copy of the pamphlet at the unit with 

tha occupant. 

Q Unavailable for signature — I certify that I have made a good felth effort to 

deliver the pamphlet, fWiovate FV^ t Important Lead Hazani Intonnation fbr 

f^tnlSes, ChSd Care provki&v and Schools, to ttie rental dwelling unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit by sliding it 

under the dQ^. 

Printed name of person certifying Attempted delivery 


dateandtime 


yf lead pamphlet delivery 


/M^i^^^^ 

Signature of persotonn dertifyln oertnyingg leadpamphle leadpamphlet

t deliver deliveryy , 

n/iA/ji/ic^.. £/ ^ 

iUnitAddress 

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). 
paint match ferm /Vv>f/^ 

Paint matching form: — ^- ^ 

property address: ^^o Pr:*/^ccti ^ - BVID: i^^a i 

Area: Color: 

/<^<z//c?)^ 

Explanation: 

Area: Ba^en^c/if ^//iJ^a^ir^t/coior: ^ ocr/U^^ 

Explanation: 

Area: Color: 

Explanation: 

Area: color: 

Explanation: 

Area: color: 


Explanation: 


Page 1 

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Douglas County Account Infi^ni ation Page 1 of2 

Douglas County, Nebraska Property Record - R0222330000 

Print Report 

NEW Faature • Parcal Oimensions available Q scale 0-50 ft wast of OOth St - yjevy.P.n ..Map Information is valid as of 2008-9-4 Treasurer's fax Report 

New Feature ••-•• • Auto Sales Search 

Owner 

REGAN TIMOTHY J 

ETAL 

620 DORCAS ST 

OMAHA NE 68108-0000 

Property Informatio n 

Key Number: 2233 0000 02 

Account Type: Residential 

Parcel Number: 0222330000 

Parcel Address: 620 DORCAS ST 

OMAHA NE 68108-0000 

Legal Description: U^NDS SEC-TWN-RGE 26-15-13 W 40 E 234 FT SUB LT 5 LOT 6 40 X 90.5 

Value Informatio n 

Land Improvement Total 

2008 

2007 

2006 

2005 

2004 

2003 

$3,700.00 

$3,700.00 

$3,700.00 

$3,700.00 

$3,700.00 

$3,700.00 

$69,700.00 

$71,400.00 

$71,400.00 

$71,400.00 

$48,600.00 

$48,600.00 

$73,400.00 

$75,100.00 

$75,100.00 

$75,100.00 

$52,300.00 

$52,300.00 

Sales Informatio n 

Sales Data: 1993-04-27 

Deed Type: Book: 1949 Page: 422 

Price: $38,750.00 

Grantor: 

Grantee: 

Validflnvalld: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Unita Depth Widtii Vacant 

0.08 3600.0 1.0 90.0 40.0 No 

Improvemen t Informatio n 

1. ...... .113 1 . . I I lrt../*lrtn/^/xXT^/fifrt+./\/ort/>/\iir»+i*^fi ^ 1 o»^0*»/»/»/\il«+n/\^Ort O on/innnfi 
uougias v-ouniy Account iniormauon fage / or z 

Building 1 

2 STORY 

620OOftCAaST 

3HT 

ti l 

720.0 3<mni)fW'< 

1 1 <,?Ji 

;«; 

5,1 *«»».l^^lb.-. 

CL1CK..TP. ENLARQEJMASE CLICK IQ.£MLAME-IMAgE 

Square Footage: 1392.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 8.0 

Exterior: Frame Vinyl Units: 1.0 

interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Hip Stories: 2.0 

Floorcover: Allowance Foundation: Blocl( 

Sprinider Square Footage: 0.0 

YearBuilt Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

B u m Physical Age 

1920 0% 1920 89 

Detail Type Detail Description Unita 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 672.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch Slab Roof Ceil 120.0 

Porch Slab w/Steps 40.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R02... 9/24/2008 
Prudent Propeity Close-Out Form (Lead-Based Paint Stabilization) 

SAID: \?'^X 1 _ ^ ^ 

Property Address: (rtH ^ ptnyft^CU:iJ> ^SJ7 

Owner's Name: .SL^f^h^ 

Performance Standards/ciose-Out Criteria 	 YES MO 

Was the entire structure(s) painted with the exception of the stated, excluded areas? This would 


include painting of other associated features inciuding fascia, saves, siding, all trim, porches, box 


beams, columns, rails, and exterior surfaces of garages. i

2.	 Was all scraping and other preparattion woric completed satisfactorily? -JX3.	 Were all required areas ofthe strueture{s) primed as needed and painted with two top coats? X. 4.	 Was the paint products utilized equivalent to a 30 year product/quality? A 

Are all ofthe areas where co.ntaminated materials have been spilled 


thoroughly vacuumed/ deaned? 
 i 

5.	 Did the contractor cotiect/vacuum. ali failing and scraped paint chips on the entire property, 


roadways, aiieyways, public access areas and aiso remove any other generated debris? 


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

8.	 Are ail Items such as polyethylene sheeting, ladders, paint brushes, cones, barrier tape etc. 


properly removed? 
 t 

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. 


10.	 Are there any property items that were temporatily 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? 


Other Conslderations?property Owner Discussions?Additlonal Work that is Requi.^ed 
 i 

Cctj,^^^ ihu-m 

Prudent Re^esentative OA/K^-— Date ll//f^if^