0 

of OMAHA LEAD SITE 

PAMT STABILEZATION FILE FOLDER 

SAID#: P4qfS" 1 Date: ^pj^o/zOl O 

Address: j^O l M . S4 ^ ."NJ " 

Stabilization Contractor: Professional EnvlroBimental Engineers Year: 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

Video ofproperty (DVD) 

Executive Summary 

Signed Access Agreement for subject property 

Pre-Renovation Form signed by Property Owner 

Pre-Renovation Form for Occupant/Tenant, if applicable 

Painting Agreement 

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

Renovation Recordkeeping Checklist signed by Certified Renovator 

Photographs 

Satisfactory close-out check list signed by Property Owner 

Property close-out check list signed by EPA 

Property informationfix)m Douglas County Assessor's Office 

Hazard analysis, if prepared 

Safety Audit 

Other (describe): 

^W^ 

EPA COR Signature TJate" 

(afterfile folder review) 

30204194 in 

Superfund 
Professiopa fessional Environmenta Environme l Engineers: EPA Paint Stabilization 2010 

SAID# 

Property Address f 5^ ^ N ^^ H ^ ^ 

Stories/Siding type l,S<rrOlj/ I OlPPiAttJJt^ rhl/fSd(o^^ O^l/yjOOt^ T^l h 

Garage? fTrfMCt/^^^ TO Hdu^i^ ^ VcS 

Access signed \M\£l 

Pre-video _ U? i^jn 

Post video Mio 

Contractor Assigned fl y 

Date started L>'11-1 0 

Weather/temp 

Date ended /^-/r-/d 

Paint used ^^p/u/cf- ; .^g^ / /^Ji-Zo 

Prime used 

Poiy used /_ 

Probiems/issues 

y\r{) Dr\\^ 
CONSENm T FOR ACCESS TO PROPERT )mR Y 


OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTY ID; ft4-^ TV] PROPERTY ADDRESS; | fSC)"~i tsJx fS 4 f ^ 

OWNER NAME 

DAYTIME PHONE: yi^^->?//'^^r ^ 

CELLPHONE: E-MAIL: <^^^c//? li^a/^/< ] Aohvi^il' Cdyyj 

OWNER'S ADDRESS IF DIFFERENT: 

TENANT'S NAME IF APPLICABLE: 

DAYTIME PHONE; 

CELLPHONE; E-MAIL: 

Professional Environmental Engmeers, 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 stabiiization 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, if the 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 I, as the property owner, may have regarding soil cleanup at 

my property. 

^es , I have read and un0|rstand the paragraph above. 

fiJ-C& ^ 

Signature of Property Owner Date y^2k ly^A 

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-lsetts, 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). 

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 Sch Information fbr Families, Childe Care Providers, and Schools." 

S2b_ y y 0

Signature i/ Date Signature Date 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
PAINT STABILIZATION PRE-PROPERTY 

PAINT MATCH ASSESSMENT 

PROPERTY ADDRESS: /5b 7 p.sf ^ - DATE: y9-/ d 

BV.D: ^1-9^7 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: Ih^S^/^^'j /A31 > COLOR: 1^0 ^'-/— SM^( S 

HOUSE TRINI: (^60 0 1 ^ ^ COLOR: 

^ 

GARAGE: -Vyggg / W^> f-^fty^-P O COLOR: 

GARAGE TRIM: (I r COLOR: 

PORCH: H* - {-j^of L CEJl^eh- ^ COLOR: N 

\ Q

PORCH TRIM: / W 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: 
PRE-RENOVATION FORM - OWNER 

This form is to be used by thefirms contracted by the Environmental Protection Agency-Region 7 to perform Lead-Based 

Paint stabilization activities at the Omaha Lead Site, Omaha, Nebraska. 

Owner Confirmation 

Pamphlet Receipt 

D I have received a copy of the lead hazard information pamphlet, Renovate Right: Important Lead Hazard Information for 

Families, Child Care Providers and Schools, informing me of the potential risk of the lead hazard exposurefix)m renovation 

activity to be performed in/on my dwelling unit. 1 received this pamphlet before the work began. 

Owner Acknowledgment 

D (A) I confirm that I own and live in this property, that no child under the age of 6 resides here, that no pregnant woman 

resides here, and that this property is not a child-occupied facility. 

Note: A child resides in the primary residence of his/her custodial parents, legal guardians, foster parents, or 

informal caretaker if the child lives and sleeps most of time at the caretaker's residence. 

Note: A child-occupied facility is a pre-1978 building visited regularly by the same child, under 6 years of age, on at 

least two different days within any week, for at least 3 hours each day, provided that the visits total at least 60 hours 

annually. 

D (B) I understand that the renovation firm, contracted by the Environmental Protection Agency (EPA), will be using leadsafe work practices required by EPA's Renovation, Repair and Painting Rule. 

^y]^r()^ iy^^< 

Printed Name ofOwner-Occupant 

Signature ofOwner-Occupant Date 
Douglas Coimty Account Informa|ion Page 1 of4 • f 

^ H^'\5n ^ 

Douglas County, Nebraska Property Record - R2410070000 

Print Reoort 

View Interactive GIS Mao Infbrmation is valid as of 2010-5-28 Treasurer's Tax Reoort 

New Feature ->-•- • Subdivision Sales Search 

Owner 

KNAPE AARON P 

blAL 

1507N54ST ^ v, > Q . ^ ^ 

OMAHANE 68104-0000 Q^ A iLn i ) { 

Property Informatio n 

Key Number. 1007 0000 24 

Account Type: Residential 

Parcel Number 2410070000 

Parcel Address: 1507 N 54 ST 

OMAHANE 68104-0000 

Legal Description: WASHINGTON HILL LOT 2 BLOCK 3 N 63 1/2 W 136 FT 63 1/2 X 136 

Value Informatio n 

Land Improvement Total 

2010 $13,700.00 $121,500.00 $135,200.00 

2009 $13,700.00 $121,500.00 $135,200.00 

2008 $13,700.00 $121,500.00 $135,200.00 

2007 $13,700.00 $121,500.00 $135,200.00 

2006 $13,700.00 $104,900.00 $118,600.00 

2005 $13,700.00 $104,900.00 $118,600.00 

Sales Informatio n 

Sales Date: 2006-07-13 

Deed Type: WD Soofr: 2006 Page: 081577 

Price: $143,000.00 

Grantor Maybell-Grasser Marsha J 

Grantee: J nape Aaron P ETAL 

Valld/lnvalld: Valid 

Exclusion Reason: 

Sales Date: 2004-11-12 

Deed Type: WD Book: 2004 Page: 150303 

Price: $138,500.00 

Grantor: NEILLMOLLARD 

http://douglasne.mapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R241... 6/5/2010 
Douglas County Account Inform; Page 3 of4 i^i^ 

1 1/2 Story Fm 

K<i 37S 

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CPT' S*K "J: W 

CLICK TO ENLARGE IMAGE CLICK TO ENLARGE IMAGE 

Square Footage: 

Perimeter 

Unit Type: 

Built As: 

HVAC: 

Exterior: 

Interior: 

Roof Cover: 

Roof Type: 

Floorcover: 

1266.0 

0.0 

1 1/2 Story Fin 

Central Air to Air 

Masonry Common Brick 

Drywall 

Composition Shingle 

Gabie 

Allowance 

Percent Complete: 100.0% 

Quality: | Average 

Condition: \ Average 

Condo Square Footage: 0.0 

Rooms: 6.0 

Units: 1.0 

Baths: 1.5 

Bedrooms: 2.0 

Stories: 1.5 

Foundation: Block 

Sprinkler Square Footage: 0.0 

year Su//t 

Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1940 1940 69 

Detail Type Detail Description Units 

Add On 

Appliance 

Basement 

Sprinkler System 

Allowance 

Bsmnt Block 8 ft 

1.0 

1.0 

896.0 

Fixture 

Fixture 

Fixture 

Garage 

Porch 

Porch 

Porch 

Base Fixtures 

Bath Full 

Bath Half 

Attached 

Slab w/Steps 

Slab w/Steps 

Wood Deck 

1.0 

1.0 

1.0 

220.0 

60.0 

16.0 

168.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R241... 6/5/2010 
(effective April 2010) 0 0 

RENOVATION RECORDKEEPING CHECKLIST 

Name of Firm: fO'f/hfy 

Date and Location of Renovation: ^ ^ I f -^l O 

Brief Description of Renovation: yyfAjjy^ yyfy\j(yiQJ^ /UAJyu {Uyiy^y ptfl^iv - t

Name of Assigned Renovator:: , ^JXuuJyj lyrX^^ 

Name(s) of Trained Workers: !pT (XffJjfi^^ IZ«y ^ LpL-fi^ ^A^a'cPrin-i^yName of Dust Sampling Technician, Inspector, and/or Risk Assessor, if used: 

Q^ Copies of renovator and dust sampling technician qualifications (training certificates, certifications) on file. 

IB^Certified renovator provided training to workers on (check all that apply): 

(^Posting waming signs Q-Setting up plastic containment barriers 

[YMqintflining containment [TAvoiding spread of dust to adjacent areas 

Q-Waste handling •^ost-renovation cleaning 

n Test kits used by certified renovator to determine whether lead was present on components affected by 

renovation (identify kits used and describe sampling locations and results: 

Beaming signs posted at entrance to work area. 

Q^or k area contained to prevent spread of dust and debris. 

Hwindows in and within 20 feet of the work area are closed 

Q^Doors in and within 20 feet of the work areas are closed and sealed 

H^oors that must be used in the work area are covered to allow passage but prevent spread ofdust. 

B-^ound covered by plastic sheeting extending 10 feet from work area - plastic anchored to the 

building and weighted down by heavy objects. 

D If necessary, vertical containment installedto prevent migration ofdust and debris to adjacent 

property. 

Q-^aste contained on-site and while being transported off-site. 

Renovation Recordkeeping Checklist Omaha Lead Site 
(effective April 2010) 0 0 

^JA^rk site properly cleaned after renovation. 

QAll chips and debris picked up, protective sheeting misted, folded dirty side inward, and taped for 

removal. 

0wor k area HEPA vacuumed to get paint chips from ground surface, if necessary. 

D Certified renovator performed post-renovation cleaning verification (describe results): 

LLK I certify under penalty of law that the above information is true and complete. 

y/yy 

Name and Title Date 

Renovation Recordkeeping Checklist Omaha Lead Site 
•

 « 

PROFESSIONAL 

2505 North 24 ^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 

"Providing cost-effective environmental solutions" ^^ jj^g! 5M^28? 

Consulting • Engineering Design • Remediation • Abatement • Emergency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

2010 

SAID#84957 

1507 N 54 St. 

• Dates worked: 06/17/10 to 06/18/10 

• Pre property condition: House lias brick siding with painted wood trims that had 

flaking paint and in fair to poor condition. Few visible paint chips in yard. 

• Problems encountered: None. 

• Owner request/concerns: N/A 

• Inspection/closeout dates: Owner 06/22/10, inspected by PE project manager. 
, # 0

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 • Abatemeni • Emergency Response 2010 

Property Owner Close-Out Form 

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

SAID: ^ff^^ 

Property Address: /6d ^ /if-^YS f 

Owner's Name: Jp//)/ { j^y) a r> l 

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 garages. X 

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? K 

4. Was the paint products utilized equivalent to a 25 year product/quality? ^ 1 

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

vacuumed/ cleaned? X 

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? 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? 2L 

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. X 

10. Are you satisfied with the work performed? : ^ 

11. Are there any property items that were temporarily re-located by the contractor that 

need to be moved back? X- Yl. Are there any (known) lingering issues with the property owner(s) that have been left 

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

"^rC^/I lA ^ ^ IQ 

roperty Owner ^i^ature Date 

/'X^-/i ? ^ ^ 

Professional Envifonni^tal Engineers Signature Date