TRANSMITTAL of OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: 19S7 ^ Date: /A^/^ f 

Address: 3^7 3 M h ^ ^?f" 

Remediation Contractor: PROFESSIONAL ENVIRONMENTAL ENGINEERS Year: 20»8 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

5 / Video of property (DVD) 

t / Executive Suimriary 

y Signed Access Agreement for subject property 

M Painting Agreement 

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

B Photographs ._ 

y Satisfactory restoration signed by Property Owner 

y Property close-out check list signed by EPA 

M Property information from Douglas County Assessor's Office 

^yy^yM.^yy^ yihsM-

Signature Date 

Iiiiii 

Superfund 
PROFESSIONAL p 2505 North 24'^ Suite 219 ENVIRONMENTAL ENGINEERS, INC. Omaha, NE 68110 J ^ • H 

(402) 504-4688 "Providing cost-effective environmental solutions" Fax (402) 504-3281 

•

11^ 

mConsulting • Engineering Design • Remediation • Abatement • Emei-gency Response 

Lead Base Stabilization Omaha, Ne 

Close Out Report 

SAID# 19577 

3518 Pine St 

• Dates worked 12/12 to 12/13 2008 

• Large home that is mostly sided and soffits were painted. Areas around the gutters were in 

poor condition due to some water damage. Damage to some ofthe trim areas. 

• Inspected 11/17 No issues 
PROFESSiONAL 

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

(402) 504-4688 "Providing cost-effective environmentai 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: I^S1~7 

Property Address: 3 S I ^ P i 0 ^ S ^ 

Owner's Name: ^VkeNvO A f^.Y-V ^ /^CV>Q^ 

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? 

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

two top coats? 

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? 

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 surrounds the structure(s) in reasonably good condition? Ji. 8. Are all items such as polyethylene sheeting, ladders, paint brushes, cones, 

barrier tape, etc. properly removed? X 

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. A, 

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

that need to be moved back? X 

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

been left unresolved? /

Comments: 

' Kr QJ njyy-y ^^y

PropiBrty Owner Signature Date 

yy-y y - ^ 

Professional Environmental Engineers Representative Date 
PROFESSiONAL 

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

(402) 504-4688 Providmg t-o-st'eifec'ttve ef-<i.-u-onmeniai soiuiioni>' Fax (402) 504-3281 

EPA Close-Out Form 

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

SAID: /9S77 

Property Address: 2^S~ I "^ r//!^ S J^ 

Owner's Name: CYlO\ve-. V ^ y\^^C^e r 

Performance Standards/Close-Out Criteria 

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? 

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

two top coats? 

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? 

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? 

1 7. Is the grass area that surroimds the structure(s) in reasonably good condition? 

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

barrier tape, etc. properly removed? 

1 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. 

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? 

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

YES 

y 

y ^ 

y 

^ 

y 

y y 

l y ' 

i . y 

NO 1 

y ^ 

y

A 

1 

l[lny 

TPA COR Signature 

Date 
CONSENT OFR ACCESS TO PROPERTY 

OMAHA LEAD SITE REMEDIAL ACTION - LEAD-BASED PAINT STABILIZATION 

PROPERTYID: /QST l PROPERTY ADDRESS: 3S" / ^ P,n^ ^ y 

OWNER NAME: 

\jcx^\e.V f rV^f^cVse^r DAYTIME PHONE: Tyy^ -09J6 

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 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 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 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). 

D 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 \^jg^mij&o n for Families, Child given the pamphlet "Renovate Right, Important Lead 

Car>PraT)ders, and Schg Information for Families, Childe Care Providers, and Schools." 

//- U 7 

Siiature ^ Oate Signature 

SPECIAL INSTRUCTIONS AND CONSIDERATIONS 
Confirmation Of Receipt Of Lead Pamphiet 

BVID iQsn n 

PROPERTY ADDRESS 2>5\ ^ VvO ^ S a ^ZIP CODE. 

PROPERTY ADDRESS OF OWNER IF DIFFERENT THAN PROPERTY BEING PAINTED: 

PROPERTY ADDRESS ^ZIP CODE 

I have received a copy of the pamphlet, Renovate Right: Important Lead Hazard Information For Families, 

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

renovation activity to be perfomied on dwelling unit. I received this pamphlet before the work began. 

N/ p4Al /.y-//y y /yi ^ XW//^"y-y / ) r 

/^PRINTED NAME OF RECIPIENT y/y ^ DATE 

SIGNATURE OF RECIPIENT 

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

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

below: 

W Refusal To Sign - 1 certify that I have made a good faith effort to deliver the pamphlet, renovate right: important 

lead hazard infomiation for families, child 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 further certify that I 

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

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

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

below and that the occupant was unavailable to sign the confimiation 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. 

PRINTED NAME OF PERSON CERTIFYING AHEMPTED DELIVERY DATE AND TIME LEAD 

PAMPHLET DELIVERY 

SIGNATURE OF PERSON CERTIFYING LEAD PAMPHLET DELIVERY: 

Note Regarding Mailing Option - as an altemative to delivery in person, you may mail the lead pamphlet to the owner 

and/or tenant. Pamphlet must be mailed at least 7 days before renovation. (Document with a certificate of mailing from the post 

office). 

CONFIRMATION OF RECEIPT OF LEAD PAMPHLET 08/08 
PAINT STABiLiZATION PRE-PROPERTY ASSESSIVIENT 

PROPERTY ADDRESS: _ B-sv^ DATE 

Rvin 

PLANT & PERMANENT LANDSCAPING TO BE REMOVE? NO |—| YES r~l |; IF, YES WHERE: 

, 

PRE-EXISinNG CONDIHGAI OF FOUNDATION/STRUCTURE Le. BASEMENT LEAKING? 

NO ' ' YES ' ' IF, YES WHERE: 

EXISTING PAINT ON WINDOWS, DOORS, FOUNDATION, SIDEWALK,( LE.)? NOj—| 

YES CZI IF, YES WHERE: 

VISUAL DESCRIPTION OF PROPERTY/STRUCTURE/GARAGE, (I.E.): (USE BACK SIDE IF 

HECESSARY) 
PAiNT STABiLiZATION PRE-PROPERTY 

PAINT MATCH ASSESSIMENT 

PROPERTY ADDRESS: j>^\ ^ V i^P^ S> ^ DATE 

^ n h

BVID iQ^n 

AREA(S) TO BE PAINTED: 

HOUSE PROPER: COLOR 

HOUSE TRIM COLOR 

GARAGE COLOR 

GARAGE TRIM COLOR 

PORCH COLOR 

PORCH TRIM. 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: 


PE ACCESSOR SIGNATURE: 

i !l 

PAiNT MATCH FORM 08/08 
Douglas County Account Information Page 1 of 3 

Douglas County, Nebraska Property Record - R1221220000 

Print Report 

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

New Feature -•-•- * Auto Sales Search 

Owner 

ERLBACHER DANIEL R 

ETAL 

3518 PINE ST 

OMAHA NE 68105-0000 MWb-Qq^Q:> 

Property Informatio n 

Key Number: \ 2122 0000 12 

Account Type: Residential 

Parcel Number: 1221220000 

Parcel Address: 3518 PINE ST 

OMAHA NE 68105-0000 

Legal Description: GRIFFIN & SMITHS 1ST SUB LOT 17 BLOCK 6 E 44 FT LT 16 & W 6 FT 50 X 128 

Value Information 

Land Improvement Total 

2008 $6,400.00 $212,200.00 $218,600.00 

2007 $6,400.00 $212,200.00 $218,600.00 

2006 $6,400.00 $93,500.00 $99,900.00 

2005 $6,400.00 $93,500.00 $99,900.00 

2004 $6,400.00 $93,500.00 $99,900.00 

2003 $6,400.00 $93,500.00 $99,900.00 

Sales Informatio n 

Sales Date: 2002-12-20 

Deed Type: WD Book: 2232 Page: 470 

Price: $169,950.00 

Grantor: 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Sales Date: I 1990-09-17 

Deed Type: \ D Book: 1884 Page: I 680 

Price: $43,000.00 

Grantor: 

littp://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R12... 11/5/2008 
Douglas County Account Information Page 2 of 3 

Grantee: 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.14 6400.0 1.0 128.0 50.0 No 

Improvemen t Informatio n 

Building 1 

„

ro

 SSTOBC! 

'"^ ' 

 FrslHocr t063.Dsq$ 

seat 

&5 

« 9 

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""""»¥"" 

jfj^i 

Second Floor 

8aoo$<i rt. 1 jfet? 5 

»« 1 

J12_ 

Tnm Boor 

2WSTORyF»«»« 0 

CLICK TO ENLARGE IMAGE 

Square Footage: 2334.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Good 

Built As: 2 1/2 Story Fin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 8.0 

Exterior: Frame Aluminum Units: 1.0 

Interior: Drywall Baths: 2.5 

Roof Cover: Composition Shingle Bedrooms: 5.0 

Roof Type: Gable Stories: 2.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year YearBuilt Physical Age Remodeled Remodeled Built 

1915 0% 1915 93 

Deta/7 Type Detail Description Units 

Add On Fence Chain Link 1.0 

Appliance Allowance 1.0 

Appliance Fireplace Masonry 1.0 

Basement Bsmnt Block 8 ft 940.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp ?accountno=R12... 11/5/2008 
JC Painting 

Property Address '5 5 I fi ^crLO . <r P Date M n v/ i 3 

Start Date KIQV / \SL Complete Date KlQ>s^ \ " ^ 

Amount Of Prime And Paint Used 

Prime (Gallons) 

Poly (Boxes) j _ 

Paint (Color) VjJV\\\€_

Paint (Color) (r^ifZi ^

Paint (Color)

Paint (Color)

Paint (Color)

 Amount (Gallons) 

 Amount (Gallons) |_ 

 Amount (Gallons) 

 Amount (Gallons) 

 Amount (Gallons)