TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 236^4 Date: 7^% ^ f 

Address: ^^312. (IctSS S f 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGDVEERS Year: 2008 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

M Video of property (DVD) 

US ' Executive Simimary 

M Signed Access Agreement for subject property 

^ Painting Agreement 

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

M Photographs 

'Ql Satisfactory restoration signed by Property Owner 

M Property close-out check list signed by EPA 

W Property information from Douglas Coimty Assessor's OfGce 

i^d^ 
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 

SAID# 23844 

4312 Cass St 

• Dates worked 03/24 to 03/25 2009 

• House had mostly siding and the front porch was painted as well as the window trims, paint 

on porch was very poor and flaking off. Garage was also painted and was also in poor 

condition with flaking paint. 

• Inspected 04/22 No issues 
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 

Property Owner Close-Out Form 

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

SAID: r;??)gW 

Property Address: ^317 2 C/^S>5 -^ ^ 

Owner's Name: LjQui^ J A ^ Mg^T&i^g / 

Performance Standards/Close-Out Criteria YES NO 

1. Was the entire structure(s) painted with the exception ofthe 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 

garages. 

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

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? 

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

vacuumed/ cleaned? y

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 y other generated debris? 

1. 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 ofproperty 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 

been left unresolved? 

Comments: 

PrtJ^erty Owe r Signature 

J>' /^-^f 

Professional Environmental Engineers Representative Date 
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 

EPA Close-Out Form 

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

SAID: ai^^^ ^ 

Property Address: 

Owner's Name: 

Performance Standards/Close-Out Criteria YES NO 

1. Was the entire structure(s) painted with the exception ofthe 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 

/

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? y 

6. Did the confractor 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? / 

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

barrier tape, etc. properly removed? / 

9. 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. y^ 

10. Are there any property items that were temporarily re-located by the confractor 

that need to be moved back? 

y 

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

been left unresolved? 

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

d6J,/fy..^y!.K^<.J^t£t^ "^h^foi 

PA COR Signature 
CONSENT OFR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID: ^2::>bi- ^ PROPERTY ADDRESS: ^SiZ c^^ ^ ^ 

OWNER NAME: 

ly(XA/t XuiK^/^jr^ry DAYTIME PHONE: 33"< ^ " 9<^ ^ ^ 

CELLPHONE: {^oj ) ^^^-^OG ^ E-MAIL: 5"/ ^ " 6 7? / 

OWNER'S ADDRESS IF DIFFERENT: ^32occ<y^S s/r 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE: 

CELL PHONE: E-MAIL: 

Professional Environmental Engineers, Inc. (PE) is under contract (#EP-R7-08-06) witii tlie U.S. Environmentai Protection 

Agency (EPA) to stabilize lead based paint (LBP) on residential structures at a number of properties located in Omaha, 

Nebraslta. Tlie 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. This program is free and no cost will be incurred by property owner. 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 regarding 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 ofproperty 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 ofthe 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). 

1 ^ 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 ProvldeK, and Schpols." Information for Families, Childe Care Providers, and Schools." 

Signature VJ Date Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
0@oi]lfoEr[nii]i!to@[ffl ©ff [i(i(g©opt © f L(iiid] FaoiiTipCiDdit 

PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED: 

PROPERTY ADDRESS ZIP CODE 

have received a copy of the pamphlet, Renovate l^ght: Important L@ad H§mrd Information For Families, 

Child Care Providws And Schools informing me of the potential risk of the lead hazard exposure from 

renovation activity to be performed on dwelling unit. I received this pamphlet t)efore the vrark t)egan. 

L' HATI PRINTED NAME OF RECIPIENT .

 ^ OATE 

y

CsiGNATUREOFRECinE 

Self-Certification Option (For Tenant-Occupied Dweliings Only) 

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

below: 

I J Refusal To Sign - 1 certify that I have made a good faith effort to deliver ttie pamphlet, renovateright:important 

lead hazard informatkMi for families, chikl care providers and schools; to the rental dwelling unit listed above at the 

date and time Indicated and that the occupant refused to sign the confirmation of receipt. I fiirther certify that I 

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

Ll Unavailable For Signature - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right; 

important lead hazard infonnation for families, child care provklers and schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confimiatbn of receipt. I further certify that I have left a 

copy of the pamphlet at the unit by sliding it under the door or somewhere on the premises. 

PRMTEO NAMEEO OFF PER PERSOI N CERTIFYMG AHEMPTEO DELIVERY DATE AND TIME LEAD 

PAMPHLET DELIVERY 

y\\ \ "^'r^^/KcU-' 

SIGNATURToRP E OFyPERSO E N CERTIFYINO LEAD PAMPHLET DELIVERY: 

Isgirdieig filing Op&m - as an aHemative to delivery in person, you may mail the lead pamphlet to the owner 

aiid/ortenaritPamphteS must te maii©i:l atteasi7 daj^ tefore iinorata. (Document wdJh a csrtitoi® of mailing from the post 

CONFIPxMATlOW OF RECEIPT OFLEAD PAMPHLET 08/08 
pmm'BTimmmjmM PREyM@PEmY mBEBBmwm 

DATlBVID Z3^H4 

PLANT & PERMANENT yi^DSCAPie<«©T® BE REMOVE? NO n>n YES r n 

IF, YES WHERE: 

1 . '. ! 

PRE-EmnNG CONDmON OF FOUNDATION/STRUCTURE i.e. BASEMENT LEAKING? | 

NO ^^^-^ YES ' ' IF, YES WHERE: 

EXISTING PAINT ON WINDOW^, DOORS, FOUNDATION, SIDEWALK,( LE.)? NO CI} 

YESl ^ IF, YES WHERE: 

VISUAL DESCRIPTION OF PROPERTY/STRUCniRE/GARAGE, (LE.): (USE BACK SIDE IF 

NECESSARY) 
.ft.-* • 

•S^f^';! pmmi mmcu mBEBBMEm 

BVID ^^^H M 

AREA(S) TO Bi PAINUDs 

HOUSE PROPERS ____ _ COLOR 

HOUS So^ E TRIM COLOR 

GARAGE. COLOR 

GARAGE TRIM. .GOLOR^ 

PORCH. .GOUML 

3c&'T^-^— PORCHTRIM. .COLOR. 

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

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


UNDERSTAND I CAN NOT CHANGE THE ABOVE SELECTED COLORS: 

JiS!^. j^cMi Douglas County Account Information Page 1 of2 

Douglas County, Nebraska Property Record - R2018400000 

Print Report 

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

New Feature -•->« • Auto Sales Search 

Owner 

RUTHERFORD DAV] 

4320 CASS ST 5"SG-°{C)CP^ 

OMAHA NE 6813 

Property Informati o 

Key Number: 1840 0000 20 

Account Type: Residential 

Parcel Number: 2018400000 

Parcel Address: 4312 CASS ST 

OMAHA NE 68131-0000 

Legal Description: POPPLETON PARK LOT 18 BLOCK 12 50 X 122.85 

Value Informatio n 

Land Improvement Total 

2008 $6,400.00 $79,600.00 $86,000.00 

2007 $6,400.00 $75,400.00 $81,800.00 

2006 $6,400.00 $75,400.00 $81,800.00 

2005 $6,400.00 $75,400.00 $81,800.00 

2004 $6,400.00 $54,700.00 $61,100.00 

2003 $6,400.00 $54,700.00 $61,100.00 

Sales Informatio n 

Sales Date: 1995-04-23 

Deed Type: D Book: \ 2005 Page: 56I 

Price: $52,900.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.14 6150.0 1.0 123.0 50.0 No 

Improvemen t Informatio n 

littp://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R20... 11/5/2008 
Douglas County Account Information Page 2 of2 

Building 1 

11/2 Story 4312 Cass St 

'!ii''**^s 

»« WnttCtoit f « »H S*tmtfttot i»» 7MS«4t 

«:r 

»!mtis»<*.iK nno-m 1 

CLJCKjrO CLICK TO ENLARGE IMAGE ENLARGE IMAGE 

Square Footage: 1252.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Average 

Built As: Rancii Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 6.0 

Exterior: Frame Aluminum Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1920 0% 1920 88 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 756.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Garage Detached 324.0 

Porch Slab Roof Ceil 128.0 

User Fence,dog 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R20... 11/5/2008