TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: H^O^ - Date: W ^ 

Address: S552. Pinp S.-fry 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGDVEERS Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

B ^ Video of property (DVD) bg^€ - Of ^ r 

®^ Executive Summary 

Signed Access Agreement for subject property 

y Painting Agreement . 

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

Photographs D^DC ^ (X\^ ^ 

Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

y Property information from Douglas County Assessor's Office 

y 

/ 

"^/^^y y !^r/g-<::^C^ 
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 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

SAID# 19604 

3332 Pine St 

• Dates worked 11/12 to 11/13 2008 

• Garage had damage to main door at the bottom, possibly rotting wood. Paint was flaking off 

all over with paint chips everywhere, there was prior damage to some of the siding and soffit 

areas, windows were broken on the garage, House had some ripped screens, damage to 

cellar door and paint chips all over yard from poor flaking paint on house. 

• Inspected 11/17 returned to re-paint back door, re-do east side of garage, and to re-vacuum 

paint chips. 12/02 issues resolved. 
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: Rl,O q 

Property Address: 

Owner's Name: ^A:yccA ^ ^7c^' , jU 11^ 

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 of the stated, excluded 

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

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 of the structure(s) primed as needed and painted with ^ ^ two top coats? 

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

> 

5. Are all of the areas where contaminated materials have been spilled thoroughly V 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 structure(s) in reasonably good condition? 

V 

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

barrier tape, etc. properly removed? Y

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

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 

y. that need to be moved back? 

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

been left unresolved? 

Comments: 

^--J^(-^c^ <t^ i k [yy 

Property Owner Signature 

Date 

Professional ^^ironmental Engineers Representative Date 
PROFESSIONAL M 

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

Omaha, NE 68110 

(402) 504-4688 H H Providmg cost-effective - imeniai solutions' Fax (402) 504-3281 

EPA Close-Out Form 

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

SAID: /9^/9V 

Property Address: 331>a P;n^ S f 

Owner'sName: ^<^^0>\:y^f V -^KtoW u 

Performance Standards/Close-Out Criteria 

YES NO 

1. Was the entire structure(s) painted with the exception of the 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 of the structure(s) primed as needed and painted with 

two top coats? y

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

y 

5. Are all of the 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 X 

other generated debris? 

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

^ 

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

barrier tape, etc. properly removed? \y 

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. i / 

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? 

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

lyn - ^Cic y ^oroL SCjrti^a>^i^y k 

l^^-issues fesoi^tJ 

'EPA COR ^nature 

Date 
Nov 09 08 10:28p Trad & Bob Kelly 4023452802 P.2 

CONSENT OFR ACCESS TO PROPERTY 


OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: /'?6'0 ^ PROPERTY ADDRESS : ^^,^2- pm^ S h 

OWNER NAME: \ 

DAYTIME PHONE: 

^ 

CELL PHONE: E-MAIL: 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 

CELLPHONE: E-MAIL: 

I'rofessiona) EnviroDiPcntal Engineers, Inc. <P£) is under contract (#£P-K7-(}8-0<i) witb the U.S. EnviroQ(n«;iitiil Proicctiun 

Ag«Mcy (EPA) to stabilize lead based paiat (LBP) oa ri^iileatifll structures at a number of properties located ui Omaha, 

Nebraska. The paint stabilization workit beiDg done to protect the soit cteaoups that wore pertorined by EPA coatractors. 

Paint stabiiizatioii activities will include: scmpiag of cracked or flakiog LBP from structures, applicatiou of a prime coat and 

two (2) coat» of paint. Moving parts At windows and doors are not includcdj aad wtti not be addressed. 

Your cooperation is requested in grving permission to this EPA coatractor (PE) to enter aad bave acce^is to this property for 

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

By signing tbis document I agree to allow an EPA contractor to conduct a sail cleanup at my property followiag comploUon of 

lead-based paini :>tabilizatiDn. T underiitaDd that th« stabilizatlau contractor can not provide assurances that the soil cleanup 

contractor will be bound to. I further understand tbat tbe soil cleanup contractor will make all reasonable elTorts lo ad<lres<j 

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

I fully understand that by signing this Con&ent for Access, (I) tbis 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 Lrbaa 

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

Providers, and Schools", (3) the Property Owner or tennni 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 tbe paint 

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

not to obsLruct: or tamper wieb any of the LBP stabilization actions, and (8) will participau in final property inspection and 

sign the Completion Agreemant and Property Owner Satisfaction Survey. 

Should yuu have any qniistions about the planed Lead liascd-Paint stabtli2atjou activities for yoor property, please conbict 

Professional Eavironmental Engineers, Inc. Project Manager, Willie Clay At 402-S04-46Sft. General questions about the 

Omaha Lead Site cleanup can be directed to Pauletta Fraoce-lselts, EPA Remedial Project Manager 4(C-731-2454, or the 

EPA Public Information Centers at 402-99.1-9583 (North Omaha oHice) or 402-731-3045 (South Omaha ofliee). 

^^ , I grant Bcces* to my property and was given the pamphlet D No, I do not grant access to my prapeity ani i was 

'^Renovate RiBht, Jnportaot Lead InfomiatSon for Families, Child given Ihe pamphkit "Renovate RI{|Kt, impaitont Lead 

Care Proviitefs, and Schools Infonnatlan forFamlHes, Childe Cxrs Providers, and Schools." 

 Signature Dile Signature Dale iignatura 

SPECIAL WSTftDCTIOHSAKD CONSIOERATIONS 

50/ZB 3SWd sy33Ni9N3 mm3 joyd 89G0TESt'ie It>:80 zeQZ/LZ/Z2 

I
Nov 09 08 10:28p Trad & Bob Kelly 4023452802 p.3 


Confirmation Of Receipt Of Lead Pamphlet 

PROPERTY ADDRESS ^ 3 3'2^ Tij^ ^ St . zip CODE 6 9 i 0' ^ 

PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED: 

PROPERTY ADDRESS ZIP CODE 

I have received a cap/ of Ihe pamphlet, /7»norato Rigb t Im^oitrnt Lead Hazard lahumaSon For Families, 

Cl^ld Care Prowders An d Schools informing me of the potential risk of the lead hazard exposure from 

renovation activity to be performed on dwelling unit [ received this pamphlet before the work Ixgan, 

K/Kt.ye^i Q. bi/Li Jr. UbAJe-zvU 1/"^^^' ^ 

0 ^ 

^ PRINTED NAME OF REaPIENT DATE 

T 

SeH-CflrtiRcation Option (For Tanant-Occupied DwelKngs Only) 

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

below: 

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

lead hazarej infairoation for femilies, chiid care providers and schoote; to the rental dwelling unit listed above at the 

dale and time indicated and that the ocoipait refused to sign the confirmation of receipt. I further certriy that I 

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

D Unavailable For Signature - 1 certi^ that I have made a good faith effort to deliver the pamphlet, nenovatB right; 

Important lead hazard infomiation for fannilies, child care providers and schools, to the rental dvi^lling unit listed 

below and tfial the occupant was unavailable to sign the ctyirinnation of leceipt I Either ceitify that I have left a 

copy of the pamphlet at the Lnit by sliding it under the door or somewhere on the preiTMses. 

PRINTED NAME OF PERSON CERTIFYING AHEMPTED DELIVERY DATE AND TIME LEAD 

PAMPHLET DEUVERY 

SIGNATURE OF PERSON CERTIFYING LEAD PAMPHLET DELIVERY: 

Mote Reganjing Mailiflg Option - as an altemative to delvery in pBison, you may mail the lead pamphlet to the owner 

and/or tenant Pamphlet must be mailed at least 7 days before renQvalior. (Docurtienl with a osftikaie of mailingfrom ttie post 

office) 

CONFIRMATION OF RECEIPT OF LEAD PAMPHLET wm 

90/ES 3D7d Sy33NI9N3 aiAN3 30ad asaeiesfTe 
 I1':88 2382/i2/S0 

Nov 09 08 10:29p Traci & Bob Kelly 4023452802 P.4 


PAINT STABILIZATION PRE-PROPERTY ASSESSMENT 

mOPERrr ADDRESS.-. y e -ov DATEPVxo-Vvc^ r09. Cp^lQb BVID iqcpOM 

PLANT & PERMANENT UUHOSCANNG TO BE REMOVE? NO YES c n 

IF, YES WHERE: 

PRE-EOSXtMCXONEimQII OF POUNDATION/SniUCnjil ^ i^ . BASEMENT LEAIQNG? 

NO ^—y \ YES •— ^ IF, YES WHERE: 

EXISTING PAINT ON WINDOWS, DOORS, FOUNDATION, SIDEWALK^( LE.)? NO 

YES CZ] IF, YES WHERE: 

VISUAL DESCRIPTION OF PROPERTY/STRUCniRE/eARAGE, (LE.] : (USE BACK SIOE IF 

NECESSARy) ( O . n r J 

4V^/^. n>^ ^ Q ^ /C^^^ a /^.=x^ CA^ /^ ^ 

^^^ivw ^ •.js:i 7 

PROPERTY CNimatSiraiATUKfc y y

y^ y y {^ylj -^ 

QCI /bR IBWd SSJ33NI9N3 aiAN3 JO^d 8908IE:SfIE 1^:98 Zmi/LZ/Zfi ' 
Nov 09 08 10:29p Traci & Bob Kelly 4023452802 p,5 

PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

n FROPeRJY ADDRESS:. ^^' ^ ^.^^ S^ DATE 

0)fw-.vr-^ ML rn^in^ BVID - iqG>0M 

AR£A(5) TO BE PAINTED: 

HOUSE PROPER: ^>- f COLOR ^^i-^^^^f . 

HOUSE TRIM LiJ ^ COLOR ^/ Z ^ 

GARAGE COLOR 

rSARASE TRI M COLOR 

I. 

DAOr H COLOR 

POBCHTRIM COLOR 

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

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

UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 

PROPEfCrY OVmER SIGNATURE: PE ACCaSOR StONATURE: 

yiiu^0ikM,/h. 

PAINT MATCH FORM OMie 

Sa33NI9N3 yiAN3 JD^d 89G0TE;S1?Te Tf-S© ZBBZ/iZ/ZQ Cn/qH 39Wel 
, Douglas County Account Information Page 1 of2 

Douglas County, Nebraska Property Record - R1220960000 

Print Report 

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

New Feature -»->-+ Auto Sales Search 

Owner 

KELLY JR ROBERT O 

ETAL To^Tc 

3332 PINE ST 

OMAHA NE 68105-0000 r3^vS-^0V I (G^CP-GPQUV^ 

Property Informatio n 

Key Number: \ 2096 0000 12 

Account Type: Residential 

Parcel Number: 

Parcel Address: 

Legal Description: 

1220960000 

3332 PINE ST 

OMAHA NE 68105-0000 

GRIFFIN & SMITHS 1ST SUB LOT 11 BLOCK 5 59 X 128 

Value Informatio n 

2008 

2007 

2006 

2005 

2004 

2003 

Land 

$6,900.00 

$6,900.00 

$6,900.00 

$6,900.00 

$6,900.00 

$6,900.00 

Improvement 

$168,700.00 

$168,700.00 

$96,200.00 

$96,200.00 

$96,200.00 

$96,200.00 

Total 

$175,600.00 

$175,600.00 

$103,100.00 

$103,100.00 

$103,100.00 

$103,100.00 

Sales Informatio n 

Sales Date: \ 2000-04-13 

Deed Type:

Price: 

Grantor: 

D 

$103,000.00 

Soolt; \ 2153 Page: i 201 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres 

0.17 

SF 

7552.0 

Units 

1.0 

Depth 

128.0 

Width 

59.0 

Vacant 

No 

Improvemen t Informatio n 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R12... 11/5/2008 
^Douglas County Account Infomiation Page 2 of 2 

Building 1 

ThtnlFteor 

396 0 

Boor Sff aj " 

Fir« Floor «*1 '• 6*00 

2 rC S'ORY FWSHED 

CLICK TO ENLARGE IMAGE 

Square Footage: 2468 0 Percent Complete: 100 0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

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

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.5 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gable Stories: 2.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1917 0 0% 1917 91 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 1264.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Fixture Bath Half 1.0 

Garage Detached 288.0 

Porch Slab Roof Ceil 24.0 

Porch Slab Roof Ceil 192.0 

User Attic Full Finish 396.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12... 11/5/2008 
JC Painting 

Property Address :5^?>SL^>n J -^" ^ °^* ^ / / ­ / 3 . ­ Q fi 

Start Date 1 | ­ i/Q.-g^f i Complete Date | j —13- 0 Q 

Amount Of Prime And Paint Used 

Prime (Gallons) 

Poly (Boxes) 5_ 

Paint (Color) U J V\^^\-^^ Amount (Gallons) c^ 0 

Paint (Color) A o AW Amount (Gallons) j 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons)