TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: /oUfiq O Date: ^ f M | 0 ^ 

Address: IU? ^ TnunixY (L\uiV\ /W^. 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 2009 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

i3eo ofproperty (DVD) 

cutive Summary 

Q^ ^^..Signed Access Agreement for subject property 

0 Painting Agreement 

D J8€ti\ement documents (i.e., for damage or to replace plants, etc.) 

>CK Photographs fp^Mire ^ 

B ^ Satisfactory restoration signed by Property Ovmer 

D Property close-out check list signed by EPA 

V y Property information from Douglas County Assessor's Office 

D confirmation that lead pamphlet "Renovate Right" was received by P0_ 

D ., , \ 

30203858 

D ; iimnn 

D . Superfund 

Professions^tnvirbiunenta

X^^m^-^.

l Engineers Signatur

, 

e T^ 

'M&.f'^-^ U i ^ 

at 
2505 North 24^ Suite 219 

Omaha, NE 68110 

(402) 504-4688 

Fax (402) 504-3281 

PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC. 

"Providing cost-effective environmental solutions" 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2009 

SAID# 64892 

1633 Country Club Ave 

• Dates worked: 06/29 to 06/30 2009 

• Pre property condition: Property was in fair condition and had stucco and brick siding 

with wood trim areas, paint was flaking ofT in some areas of the stucco and trim. 

Overall house was in good shape. 

• Problems encountered: None 

• Owner request/concerns: N/A 

• Inspection/closeout dates. Owner signed 07/20, Inspected by PE project manager. 
CONSENT OFR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: Cch^^^^^ T PROPERTY ADDRESS: /^_?v ^ y^X, ^ h ^ y.lCflp/^ O 

OWNER NAME: 

3 b \t^xO C^^yy^^T^ DAYTIME PHONE: S'5'S — 7 / " J ? 

CELL PHONE: E-MAIL: j'o^w*7 « C.-a^r> J ^ n (g)g^x . ri<:t~~ 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: ^^^^^^^Jl^^^ ^ 

CELL PHONE: E-MAIL: ^ ^ 

Professional Environmental Engineers, Inc. (PE) is under contract (#EP-R7-08-06) with 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 regardmg 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 PjtfClic 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 

"Renoteite Right Important Lead Information for Families, Child given the pamphlet "Renovate Right, Important Lead 

CarePn Infomiation for Families, Childe Care Providers, and Schools." 

Signature \ Date Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
PROPERTY ADDRESS A^<J> ^ Cc^i^^i^<-i^ ^p QQQ^ 

I PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTEO: 

PROPERTY ADDRESS ZIP CODE 

I have received a copy of the pamphlet, /temmrfeR^M : Importuit Laad HaxmllnhmMlH m For FmOos , (MUCa n 

Pravfdars Antf Scftoofs infomiing me of the polentiai risl( of ttw lead haz»d exposure fiom renovation activity to be 

peribnned on dwelling unit. I received this pamphlet before the work began. 

DATE ^ I 

Setf-CertWcatlon OpHon (For Tenant-Occupied Dwelling Only) 

If the lead pemphiet was delivered but a tenant signature VMS not obtainable, you may Check the a ^ 

[ J Refusal To Sg n - 1 certify that I have made a good faith eflbrt I D driver the pamphlet, Renovate Right Important Lead 

Hazad Informatkm for Families. Child Care Provklers ai d Schools; to the rental dwelling unit listed stove at the dale and 

time indk:ated arid that the occupant refused to sign the confimnatkm of receipt I further certify that I have left a copy of the 

pamphlet at the unit wtth occupant 

D Unavailable For Signalure - I certify that I have made a good felth effort to deliver the pamphlet, Renovate Right; 

important Lead Hazard Infonnation for Fonilies, Child Care ProvMere and Schoois, to the rental dwelling unit listed bdow 

and ttiat tt)e occupant was unavailable to sign ttie confirmation of receipt I furttier certify ttiat I have left a copy of ttie 

pamphlet at ttie unit by sKding it under ttie door or somewhere on tiie premises. 

PRMTHt NAME OF PERSON CERHFYMe ATTEMPTB) teJVERT DATE AND TME LEAD PAMPHLET 

DBJVBTr 

SIGNATURE OF PE PERSON CERnFYMO LEAD PAMPtAET DELI\CRr: 

Note Regarding Mailing Option ~ as an aUamathn to delivety iri person, you may tnsdl the lead pamphlet to the OM 

Pamphlet must be nMded at least 7 days before renovation. (Document wtth a certHicatd of malflng from the post oflioa). 

CONFIRMATION OF RECEPT OF LEAD PAMPHLET 08/08 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: /^3 ^ /cu^y^ (^/h DATE: 

BVID:_£ ^ 

AREA(S) TO BE PAIN 1 ED: 


A

HOUSE PROPER: _ COLOR: \\(M ^ 

HOUSE TRIM: COLOR: 

GARAGE: COLOR: 


'' 


•t. 


GARAGE TRIM: COLOR: 


\ 


PORCH: COLOR: 1 


y 

PORCH TRIM: COLOR: ^ ^ 
• ^


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


I AGREE TO THE COLORS LISTED ABOVE. ONCE THE PAINTING 

BEGINS. I UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 

PROPERTY OWNER SIGNATURE: PE ACCESOR SIGNATURE: 
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: ioi4ftq a 

Property Address: I lp?>?> CnUn'hrNl Cltjh /[jf>_. 

Owner's Name: ^ ^ ^^^ H Cnrr\a on 

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 ofother associated features including fascia, 

eaves, siding, all trim, porches, box beams, columns, rails, and exterior surfaces of X 

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 

two top coats? y^ 

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

5. Are all ofthe areas where contaminated materials have been spilled thoroughly 

vacuumed/ cleaned? ^ 

6. Did the contractor collect/vacuimi all falling and scraped paint chips on the 

entire property, roadways, alleyways, public access areas and also remove any 

other generated debris? X 

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? i9. Is there any evidence ofproperty 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? Y^ 

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

^ been left unresolved? 

Conmients: 

-Si _ 

Roperty Owner Signature / Date 

7^^o - c9 

Professional ^pwonmental Engineers Representative Date 
Douglas Coimty Accoimt Information Page 1 of2 M7.RX 

Douglas County, Nebraska Property Record - R0843770000 

Print Reoort 

NEW Feature - Parcel Dimensions available (S> scale 0-50 ft west of 52nd St - VlO W O n Ma D Information is valid as of 2009-6-3 Treasurer's Tax Reoort 

New Feature "* ^ •* Auto Sales Search 

Owner 

CARRIGAN JO ANN 

1633 COUNTRY CLUB AVE 

OMAHA NE 68104-0000 5S^-"7(33 

Property Informatio n 

Key Number 4377 OOOO 08 

Account Type: Residential 

Parcel Number 0843770000 

Parcel Address: 1633 COUNTRY CLUB AV 

OMAHA NE 68104-0000 

Legal Description: COUNTRY CLUB DIST LOT 14 BLOCK 28 LT 13 & S 10 FT 67 X 123 

Value Informatio n 

Land Improvement Total 

2009 

2008 

2007 

2006 

2005 

2004 

$22,300.00 

$22,300.00 

$22,300.00 

$22,300.00 

3 

5 

522,300.00 

522,300.00 

$149,300.00 

$149,300.00 

$149,300.00 

$149,300.00 

$149,300.00 

$124,900.00 

$171,600.00 

$171,600.00 

$171,600.00 

$171,600.00 

$171,600.00 

$147,200.00 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.2 8911.0 1.0 133.0 67.0 . No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R084... 6/8/2009 
Douglas County Account Information Page 2 of2 

Two Story 1633 Cmjn ^ Club Av 

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I CLICK TO ENLARGE IIVIAGE CLICK TO ENLARGE IMAGE 

Square Footage: 1440.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Good 

Unit Type: Condition: Average 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 7.0 

Exterior: Masonry Face Brick Units: 1.0 

Interior: Drywall Baths: 1.5 

Roof Cover: \ Slate Bedrooms: 3.0 

Roof Type: Gable Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1930 0% 1930 79 

Detail Type Detail Description Units 

Add On Fence Wood 1.0 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Block 8 ft 700.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Fixture Bath Half 1.0 

Garage Attached 300.0 

Porch End Solid Wall 240.0 

Porch Open Slab 120.0 

Porch Open Slab 150.0 

Porch Slab w/Steps 40.0 

User Roof leaks in spots 1.0 

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