TRANSMITTAL of OMAHA LEAO SffTE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 20M4 L Date: 

Address: 41 ^ Vlmh/s.]^pfV^ Ave^ 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 2009 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUIVIENTS 

{ y Video of property (DVD) 

« 

^ y Executive Summary 

y' ^ Signed Access Agreement for subject property 

^y ^ Painting Agreement 

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

y ^ Photographs p>r<g-^fVO pflgT 

^jy^ Satisfactory restoration signed by Property Owner 

D Property close-out check Ust signed by EPA 

y ^ Property information from Douglas County Assessor's Office 

y ^ confirmation that lead pamphlet "Renovate Right" was received by PO 

D 

D 

D 

Professiortal^nvironmentantall Eri ngineer s Si gnature 

->^#2 

EPA Signature 

30094409 iiliil 

Superfund 
PROFESSIONAL 

ENVIRONMENTAL ENGINEERS, INC.

"Providing cost-effective environmental solutions"

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Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2009 

SAID# 20044 

415 Woolworth Ave. 

• Dates worked: 08/01 to 08/03 2009 

• Pre property condition: House had vinyl siding with wood painted areas that were in 

poor condition. Paint chips all over the yard. 

• Problems encountered: None 

• Owner request/concerns: N/A 

• Inspection/closeout dates. Owner signed 08/04 2009. Property inspected by PE project 

manager. 
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 Des.gn • Remediation • Abatement • Emeigency Response 

Property Owner Close-Out Form 

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

SAID: 2^4 4 

Property Address: ^/S ^ CJod//J JfT ^ /df M 

Owner's Name: /Dj'C-L' . /Cn^olnJPerformance Standards/Close-Out Criteria YES NO 

I. Was the entire structure(s) painted with the exception ofthe stated, excluded 

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

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

garages. 

2. Was all scraping and other preparation work completed satisfactorily? 7^ 

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

two top coats? 

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.

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 ofth

 pain

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 product/quality

 been spilled thoroughl

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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 smrounds the structure(s) in reasonably good condition? 

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

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. 7 

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? 7 

Comments: 

y-^^/p9 

Property Ovraer Signature Date 

<^-y-^^ 

Professional Environmental Engineers Representative Date 
CONSENT FOR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: ZOO^ ^ PROPERTY ADDRESS: ^/ y 6^^^^dU^y/ /^'f/l \\\pf> 

OWNER NAME 

73Jna y o yt i) yyt t vCn DAYTIME PHONE: //?/(/• - 9^ 5 " ^ 1 

CELL PHONE: E-MAIL: 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 


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 are being performed by EPA contractors. 

Paint stabilization activities will include: scraping ofcracked or flaking LBP from structures, application ofa prime coat and two 

(2) coats of paint. Moving parts of windows and doors are not included and will not bc addressed. 

Your cooperation is requested in giving permission to this EPA contractor (PE) to enter and have access to this properly 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, ifthe soil cleanup has not already been performed. 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 1, as the property owner, may have regarding soil cleanup at 

my property. 

1^ Yes, I have read and understand the par^raph abovi 

/TC-'^to/v.-/' 

Signature of P|6perty Otwner Date 

1 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). 

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

\ Care Providers, and Schoo choote. b " Information for Families, Childe Care Providers, and Schools." 

)±n ^/icfit/^ 

Signature Date Signature Date ^ 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
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I AfiREi TO THE COLORS USTED ABOVE. ONCE BEGINS I 

UNDERSTAND I CAN NOT CHANGE THE ABOVE COLORS: 

PAsurGaKraHPOffifloaEos 
Douglas County Account Information Page 1 of2 

Douglas County, Nebraska Property Record - R0902400000 __-_„„„ - __„_._.-. . __«..~~.~TM_TMTM.—TM J __,__,.-...... .....-.„.­ -iTM-.-.........TM-

Print Report 

Information is valid as of 2009-6-16 NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of S2nd St - VlO W O n Ma P 

Treasurer's Tax Report 

New Feature «•••- • Auto Sales Search 

Owner 

SMITH SHARON K 

415 WOOLWORTH AVE 

OMAHA NE 68108-0000 •SMU-SM^O-i.-^^ iscftVJ^ 

Property Informatio n 

Key Number. 0240 OOOO 09 

Account Type: Residential 

Parcel Number: 0902400000 

Parcel Address: 415 WOOLWORTH AV rso^s 

OMAHA NE 68108-0000 

Legal Description: CREDIT FONCIER LOT 3 BLOCK 21 15 FT STRIP ADJ ON N & E 55 FT 55X147 

Value Informatio n 

Land Improvement Total 

2009 $5,400.00 $30,900.00 $36,300.00 

2008 $5,400.00 $30,900.00 $36,300.00 

2007 $5,400.00 $27,200.00 $32,600.00 

2006 $5,400.00 $27,200.00 $32,600.00 

2005 $5,400.00 $27,200.00 $32,600.00 

2004 $5,400.00 $19,400.00 $24,800.00 

Land Informatio n 

Acres SF Unite Depth WidOi Vacant 

0.18 8085.0 1.0 147.0 55.0 No 

Improvemen t Informatio n 

Building 1 

http://dougIasne.mapping-onIine.com/DougIasCoNe/static/accoimtinfo.jsp?accoimtno=R090... 7/9/2009 
Douglas County Account Information Page 2 of2 

1 1/2 Story Fin 415 Woolworth Av 

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Square Footage: 936.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Fair 

BuiitAs: 1 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 6.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywali Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year YearBuitt Physical Age Remodeled Remodeled Buitt 

1890 0% 1890 119 

Deteil Type Deteil Description Unite 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 792.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch Slab Roof Ceil 120.0 

Porch Slab Roof Ceil 120.0 

User Half of 2nd floor fin per owner 1.0 

http://dougIasne.mapping-onIine.com/DougIasCoNe/static/accountinfo.jsp?accoimtno=R090... 7/9/2009 
IVIC Services, LLC 

Property Address ^ 1 ^ XINKTW-^" ^ l^/^ate ^-^'C R 

Start Date t>-\-QP\ End Date 9^'?^-Of\ 

Amount Of Prime And Paint Used 

Prime (Gallons) 

Poly (Boxes) 

Paint (Color) Amount (Gallons) 

9) 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons) 

Paint (Color) Amount (Gallons)