Transmittal of Oniaha Lead Site 

Paint Stabilization File Folder 

Said # .P^f// ^ Date: ^^P'/ O 

Address: 3<5d9 /^/fV>/e4sT At/ 

Contractor: Citv of Omaha Year: ^ 6 7 0 

Paint Stabilization 

Property File Folder Documents 

O^Work Write Up 

__^;i Signed Access Agreement for subject property 

Pre-Renovation form signed by Property Owner 

Pre-Renovation Form for Occupant/Tenant, ifapplicable 

l^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 

_J_ Property information from Douglas County Assessor's Office 

^^Other (describe): ]J7\( }(H-QS 

7^-^ ^ ^ 3 -/s-^7J~-

City of Oinaha Representative Signature, Date 

Iki ^

EPA Representative Signature Jate 

30262465 

Superfund 
CITY OF OMAHA 

PURCHASING - ROOM 1003 Purchase Order 

1819 FARNAM STREET 

OMAHA, NE 68183-1003 

FAX* 402-444-5423 

/ 

V 

PURCHASE ORDER NO. 

1165335 

REVISION 

0 

PAGE 

1 

SHIP TO: 

CITY OF OMAHA 

HOUSING & COMM DEV RM #1111 

1819 FARNAM STREET 

OMAHA.NE 68183 

VENDOR: G& M PAINTING CO INC 

13707 CUMING ST 

OMAHA, NE 68154 

>. BILL TO: 

CITY OF OMAHA FINANCE 

DISBURSEMENTS ROOM #1007 

1819 FARNAM STREET 

OMAHA,NE 68183 

< 

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

CUSTOMER ACCOUNT NO. VENDOR NO. 

91298 

DATE OF ORDER/BUYER 

28-APR-10 H HURT 

REVISED DATE//BUYER 

PAYMENT TERMS SHIP VIA F.O.B. 

IMMEDIATE DESTINATION 

FREIGHT TERMS REQUESTOR/DELIVER TO CONFIRM TO / TELEPHONE 

MARUCA. T MARIE 

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

All pr.ices and amounts on this order are express sd in : US Dol: ar 

NEEDED: 3,960.0 0 N 

28-APR-lO 

EPA PAINT STABILIZATIOt* 


PROGRAM GROUP 8 9 121 S! 


3 8TH AVE Ec 3 009 

POPPLETON AVE 


o SHIP TO: 


Address at top of page 


SHIP TO: Adclress shown above. If shipment Is delayed or any items not available, advise at once. Pur­

chase order number must appear on all invoices, packages, packing lists, bill of lading, and correspondence. Tota 3,960.00 

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

nished with invoice. 

TAX EXEMPTION: The City of Omaha Is.exempt from Federal Excise Taxes and the Nebraska and City of 'nt.UL:\iiu'vi^ Omaha Sales Taxes. Federal I.D. 476006304; STATE I.D. 01-0316768; Fuel Dealers Lie. 91-0316768. Cily Purchasing Ageliiy Buyer 
Planning Department 

Omaha/Douglas Civic Center 

Inspector: Stev e Zivn y 1819 Farnam Stie«, Suite 1003 

r«ot^. 0;'i^/ir\ Omaha, Nebraska 68183 

Date : 2/16/1 0 (402) 444-5150 

Telefax (402) 546-0714 

Name : Bruce A. Thompsen R.E. Cunningham, RA,F.SAME 

jiSsmu^MUyor AddfCSS! 3009 Poppleton Av ^'^'^' 

OMAH A EXTERIO R PAINT STABILIZATION PROGRA M 

F O R TH E EPA OMAH A LEAD SITE 

The Contract bid documents corisist of the following sectioPxS: 

• General Responsibilities for the Confractor and Occupant. 

• 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 Planning Department.) 

• Corhply with Standards called for in the "Constmction and Rehabilitation 

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

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

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

Licensure, Title 178 Chapter 23 Lead Base Paint Regulations. 

• Coordinate daily construction schedule with the occupant 

• Submit information cut sheets for all substitutions or approved equals prior to 

written approval of the Construction Specialist. . 

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

activities. • 

• Keep work site and surrounding area free from 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 connected with the work, and leave all parts ofthe work areas in a 

neat, sanitary, lead safe and presentable condition. 

• Complete this project within 30 calendar days. 

The Occupant/Owner Shall. 

• Remove and store away any persorial property within twenty (20) feet of the area 

to be remediated. 

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

• Ensure that all household meitibers stay at least ten feet away from all work areas 

and also keep all pets at least ten feet away at all times until the work hasjjeen 

com.pieted and the area has passed a visual inspection. 

Initials^ 
3009 Poppleton AV (Continued) ' 

Lead Hazard Control Plan 

Interim Control of Lead based Paint Hazards 

Paint Stabilization 

• Stabilize all previously painted exterior wood, brick, metal or concrete 

surfaces ofthe dwelling to include but not limited to .the siding, fascia, 

eaves, trim, window trim, shutters, gutters, railings, downspouts, door trim 

and foundation. DO NOT INCLUDE WINDOWS OR MAN DOORS. 

• 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 pattem. Prime and apply two 

coats of approved finish coat. (Refer to Planning 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 constmction specialist. 

• All lead-based paint debris (chips and components) must be disposed of in 

a municipal solid waste landfill. 

Property Owner. Date 

np.rtv Ownftr ,/ ' e Property Owner / ' . Dat Date 

S LoA/ni\^hjry7)pjixim g>^'^ 

Witness Date 

Occupant (ifapplicable) Date 

Occupant (ifapplicable). 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 

up from 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? 

• Loose andflaking lead-based paint will be removed safely from fascia, eaves, 

siding, trim, window trim, door trim and foundation; 

• Surfaces 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 freated, 

• 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 confractors 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? 

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

• The City staff will prioritize homes based on the presence of children imder age 

six if known and the severity of the problem. 

Paint Stabilization is voluntary and will be done only with permission of the^wner. 

Initials 
Consent for Access to Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United 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): Bruce A Thompsen 

346-5120 

Addresses of Properties Covered by this Agreement 

Property Address 

City/State/Zip Code 

3009 Poppleton Ave. Omaha, NE 68105 . 

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

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

PURPOSE OF ACCESS 

The purpose ofthe 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 and further, provides the Grantee the right to perform any and all envirorunental 

response actions and activities it deems appropriate. 

ENVIRONMENT/U: 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: 3009 Poppleton Ave. 

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 compliance 

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 

environinental 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 aiiy of the activities undertaken by Grantee at the Property, 

tamper with any of Grantee's property, or take any actions regarding the use ofthe Property which 

will endanger human health or welfare or the environinent, 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 fransfer of ownership rights to the 

property. 

SAMPLING RESULTS 

Grantee agrees tp provide. Grantor with the results of any and all sampling and/or arialysis resulting 

from Grantee's response activities on the property. 

PRIOR CONDITIONS AGREEMENT 

The grantor agrees to the condition ofthe 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 authorized by this Agreement, following completion of the response 

activities. 

(2) 2/12/2007 
Address: 3009 Poppleton Ave., Omaha, NE, 68105 

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 will 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 propertv owner prior to the response activities: 

1. 

2. 

3. 

4. 

5. . -

Items NOT to be removed by contractor during removal activities: 

1. . 

2 . • • 

3 . . • • 

4. 

5. 

ADDITIONAL COMMENTS: 

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: /z/^ ^ ^ //rUyyt./>U/\/ l . Date j^y^^ ^ 

(3) vnrmn 
Douglas County Account Information Page 1 of2 

Douglas County, Nebraska Property Record - Rl23744000 0 

Print Report 

NEW Faatura - Parcel Dimsnaions availabie ffi scale 0-50 n west of 52nd St - VieW OH IMap Information is valid as of 2009-12-31 Treasurer's Tax Report 

New Feature -•?•.• • Auto Sales Search 

Owner 

THOMPSEN BRUCE A 

ETAL 

3511 WOOLWORTH AVE 

OMAHA NE 68105-0000 

Property Informatio n 

Key Number: 3744 000012 

Account Type: Residential 

Parcel Number: 1237440000 

Parcel Address: 3009 POPPLETON AV 

OMAHA NE 68105-0000 

Legal Description: HANSCOM PLACE LOT 1 BLOCK 10 W41.3 E 142 FT 41.3 X 50 

Value Informatio n 

Land Improvement Total 

2009 $3,700.00 $60,100.00 $63,800.00 

2008 $3,700.00 • $60,100.00 $63,800.00 

2007 $3,700.00 $60,100.00 $63,800.00 

2006 $3,700.00 $31,400.00 $35,100.00 

2005 $3,700.00 $31,400.00 $35,100.00 

2004 $3,700.00 $31,400.00 $35,100.00 

Land Informatio n 

Acres SF Units Depth Widtii Vacant 

0.04 2050.0 1.0 50.0 41.0 No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R123... 2/2/2010 
Douglas County Account Information Page 2 of 2 

1 1/2 STORY FINISHED 

1 <*«.Bm 

217 

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CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1111.0 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: Central Air to Air Rooms: 7.0 

Exterior: Frame Vinyl Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 3.0 

Roof Type: Gambrel Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1890 0% 1890 120 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Appliance Fireplace Metal 1.0 

Basement Bsmnt Block 8 ft 693.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch Open Slab 256.0 

Porch Slab Roof Ceiling 35.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountao=Rl23... 2/2/2010