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HomeMy WebLinkAboutMP16-150 [-QyE DR O` 1 . 19 tC��uU JJ v VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.cyebrook.org TRUSTEES ACTING BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE March 13,2023 Steven A. Schurkman,Trustee of the Article IV Subtrust of the Marion Z. Dineen Revocable Trust FBO Stephen P. Lukse 42 Hillandale Road Rye Brook,New York 10573 Re: 42 Hillandale Road,Rye Brook,New York 10573 Parcel ID#: 130.77-1-4 As per the Certification letter from National Environmental Specialists, Inc. dated October 16, 2017, the removal of an underground oil tank under Mechanical Permit #16-150 issued on 11/15/2016 has been satisfactorily completed. Sincerely, Steven E. Fews Acting Building&Fire Inspector /to QyE BR(�v� �9az BUILDING DEPARTMENT BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : W 2 DATE: �� ��' Qyn PERMIT# ISSUED: \A '�A\ JECT: ' ✓` LOCK: ( LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION p ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER DRnU,� o im W 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑ VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 0 ASSISTANT BUILDING INSPECTOR (914) 939-0668 FAX(914) 939-5801 - - - - - - - - - - - -- - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - - ADDRESS: qz DATE: PERMIT# 1 1 S ISSUED: SECT: I U BLOCK: ( LOT: LOCATION: OCCUPANCY: U ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED 7�REJECTED/REINSPECTION ❑ SITE INSPECTION W`j1 '� L- REQUIRED ❑ FOOTING !Q ❑ FOOTING DRAINAGE 0 FOUNDATION 0 UNDERGROUND PLUMBING P�` NOTES ON INSPECTION: ❑ ROUGH PLUMBING 0 ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK 0 FIRE SPRINKLER c ❑ FINAL PLUMBING 0 FINAL 0 OTHER 1 c n IL lc. c -1<--) d c3 s d U-) a cc k A IT, o v a rzl a y far 0-0 _ a _ >, o mac, Q ro S a a Ca co, �►/ ICI � �-.� ,� w � {j W '� � v ,° � = ,'te�r/♦, E..� ��-y v� oo z + x � � ',� r � DO �„1 " AG �„ a .o o U U V W 140 ' '� H '�` "' - 3 fir ' z o , � ° � z L cn R O 2 0 7U 4." I�1 ✓y U 1� 1 , BUILDING DkOARTMENT r w chv�l�mC�,� IFCFE IF VILLAGE OF R411,90OK 938 KING STREET RYE BROd r,NY 10573 NOV 10 2016 (914)939-0668 XAX(914)939-5801 Www- t brook.or VILLAGE OF RYE BROOK BUILDING DEPARTMENT Application for Permit to Remove, Abandon and/or Install Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT#: Approval Date: NOV 1 5 Application Fee: Approval Signature: Permit Fees: Disapproved: Other: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1.Application Completed by Bonded,Licensed Contractor. 2.Copy of Licensed Contractor's Liability&Workers Compensation Insurance. (Naming the Village of Rye Brook as Certificate Holder) 3.Fee per Tank: Removal,Abandonment,or Installation: S 175.00 per Tank. 4.Dig Safely New York#(dial 81 1): 1 10'3 lsz - �_-> . Cp 3 Z 5.Inspection by Building Department for removal/abandonment and/or installation. 6. Submit all Manifests&Reports(after work has been completed). 7.Certificate of Compliance will be provided when all requirements are fulfilled. Application dated, tJ6 ,is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove,abandon,and/or install a Fuel Tank as herein described.The applicant and property owner,by signing this document agree that the subject fuel tank(s)will be removed,abandoned and/or installed in conformance with all applicable Village,County,State&Federal laws, codes,rules and regulations. Indicate Permit Type:Installation V)•Removal ( )•Abandonment( )/Above Ground ( )•Buried in Ground ( ) 1. Address: L4rQ �-l\ lc\c,u _�kC C,_,_C_\ 4_� ;�(LL�Y_ SBL: I Zone: 2. Property Owner&Address:9)c,.,D.-1 Phone#:q I L4-q�J(i- -4 2`-) I Cell#: email: 3. Contractor&Address: Phone#:q 1 LA-q,-A t 2 Cell#: emaiL• r1C-ferny 4. Applicant:Eli Phone#: 9I t_I- a�_t t -5L--t�i Z_ Cell#: email: G r e Y.,.,r �. v i 5. Indicate Fuel Type:Fuel Oil$�•L.P.Gas( )•Gasoline( )•Other( ): 6. Number and Capacity of each Tank:( 1) u"_D_T 7. Exact Location(s)of each Tank: 12/18/15 STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: C1,2:C_k 'y'\ __Z' "v��-d ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the C_r_x for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this /SA Sworn to before me this day of dV l ,20 ; p lay of Ak5\1e 0IX-f ,20 1 c ° 3 C 3 n o spy' Signature of Property Owner E Stnature of Applicant o n $1 Print Name of Prop Owner_; _;: --- -� H � � A pplic ary ublic _..._ ^" , ,A# lic O r'i( my COMMISSiLiy L;: ►��13f a v This application m st b entirety affi must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. 12/18/15 AFO DPS Detailed Removal/Install Drawing: (Please draw all utilities if known) Lj i — r i II �1 � � R �- .- n Tara Orlando From: O'Dee,John (DEC) <john.odee@dec.ny.gov> Sent: Monday,March 13,2023 11:50 AIb1 To: Tara Orlando Subject: RE:42 Hillandale Road,Rye Brook,NY DEC#1608612 Attachments: 1608612 Spill Form.pdf;Report.ER.1608612.2017-10-16.Taylord.pdf Hello Tara, I have attached a copy of the Spill Report Form, and I am also attaching a copy of the closure report I received from Taylord Environmental.There were some complications in getting this one closed out, if you have any questions about please feel free to contact me. But I was satisfied the remediation was completed satisfactorily. John O'Dee Environmental Engineering Technician 3 New York State Department of Environmental Conservation 21 South Putt Corners Road,New Paltz,NY 12561 P: 845-256-38761 iohn.odee@dec.ny.gov o RK Department of Alm TATE Environmental `/ Conservation NYSDEC 24 HR SPILL HOTLINE: 1-800-457-7362 From:Tara Orlando<torlando@ryebrook.org> Sent: Monday, March 13, 2023 8:40 AM To:O'Dee,John (DEC)<john.odee@dec.ny.gov> Subject:42 Hillandale Road, Rye Brook, NY DEC#1608612 Good morning, Would you have the closure documents for the above spill? Tara Tara A OrCando Planning Board& Zoning Board of Appeals Secretary `Village of Rye Brook 938 Xing Street Rye Brook, New York i o573 Office (914) 939-0668 1 D EC OY[E D [MAR 13E VILLAGE OF RYE BROOK BUILDING DEPARTMENT NATIONAL ENVIRONMENTAL SPECIALISTS,INC. 26 BROADWAY HAWrNORNE,NEW YORK 10532 (914)741-5472 Mr.John O'Dee October 16,2017 New York State Department of Environmental Conservation Bureau of Spill Prevention and Response 100 Hillside Ave Suite 1 W White Plains,NY 10603 Re: Lukse Residence 42 Hillandale Rd. Rye Brook,New York Spill#1608612 Mr. O'Dee, The purpose of this letter is to summarize the underground storage tank (UST) removal and soil remediation, performed by National Environmental Specialists, Inc. (NES) at the above referenced site,as well as provide all pertinent information required by your office. On December 8, 2016, NES removed one (1) 550-gallon UST from the above listed site. The 550-gallon UST was used to store#2 fuel oil. The UST was cut, cleaned, removed and properly disposed of according to New York State Department of Environmental Conservation(NYSDEC) Regulations 613.9 (B). All residual product and sludge was solidified with oil absorbent, removed from the tank,and properly disposed of as solid waste. During the removal activities,NES found holes in the UST. Apparently the holes allowed fuel oil into the subsurface, thereby, impacting tank-grave soils. NES elected to remediate the site by excavation and ex-situ reclamation of impacted soil. The remedial action included the removal of accessible petroleum contaminated soils from the tank grave. The soil remediation preformed by NES generated 136.88 tons of petroleum-contaminated soils. Fuel oil impacted soils could not be safely removed from the south side of the tank grave, below the house foundation (see included site sketch). Petroleum contaminated soils removed during the remedial action were properly disposed of at Soil Safe. Soil disposal manifests are included for your review. Following the remedial action,NES collected five composite soil samples from the sidewalls and bottom of the excavation. The soil samples were collected from areas of the tank grave that exhibited the highest PID readings. The soil samples were collected into laboratory clean glassware, maintained at four degrees Celsius, and delivered to Phoenix Environmental Laboratories. The soil samples were analyzed by EPA Methods 8260 and 8270. Laboratory analysis of the post-excavation soil samples showed concentrations of target analytes that were below the NYSDEC Guidance Values(CP-51), except the south side of the tank grave. See Table 1 for a summary of the laboratory data. Nsd=9 8W ==W Spit,ftm 26&mft D Inftrm,New Ywk 10532 101D NO Twk Fu 191411414310 NATIONAL ENVIRONMENTAL SPECIALISTS,INC. 25 BROADWAY HAWTHORNE.NEW YORK 10532 (914)741-5472 The "Post-Ex South" soil sample represents fuel oil impacted soils that could not be safely removed by excavation. Copies of the laboratory analysis are included for your review. NES,on behalf of the Lukse Residence,requests closure of the NYSDEC Spill Case number 1608612. Said request is based on the remediation preformed,laboratory data presented,and the utilization of municipal potable water. It is the opinion of NES that target analytes that exceed the NYSDEC CP-51 SCO will be effectively remediated by natural attenuation. This report has been prepared for the use of the NYSDEC,the Lukse Residence, and the Town of Rye Brook. Reasonable due diligence was exercised by the staff of National Environmental Specialists, Inc. in conducting the research and investigation necessary for the development of this report. The conclusions provided by NES in this report are based solely on the information reported in this document. Results of future subsurface investigations may result in a modification of the conclusions stated above. The conclusions presented herein are based upon the current regulatory climate and may require revision if future regulatory changes occur. This investigation and preparation of this report has been conducted in accordance with generally accepted practices. No other warranty,expressed or implied,is made. If you have any questions regarding this report,please contact Scott Taylor at(914)741-5472. Sincerely, Scott Taylor Senior Environmental Scientist National Environmental Specialists,Inc. CC: Lukse Residence Town of Rye Brook W=9hWmv=WSPeddlftl@L 260 @do ll NtwIMn a low TNt 10532 (IM MEt Ttet Fn(IN]1414310 HILLANDALE ROAD 0 m v 550-gal UST C3 House (42 Hillandale Rd.) Figure 1 : 42 Hillandale Road Tank Location Rye Brook, NY 10573 11+AYLARD Diagram 0 25 ENVIRONMENT Tavlord Environment,Inc. Source: NYS Clearinghouse 2016 Aerial Photo 101 Scale in Feet P.o.Bo,e,a Site Sketch, 5/12/17 Wingdale NY,2594 (914)4;9-9740 Scale: As shown I Date: 07/23/17 National Environmetal Specialists, Inc. Table 1 Soil Sample Summary Lukse Res.-42 Hillandale Rd,Rye Brook,New York Collected May 15,2017 Concentration Given in Parts Per Billion Volatile r an c om oun s Post-Ex NorthPost- os - x South Post-Ex.East Post-Ex Bottom Comp.West 1,2,4-Trimeth lbenzene 15 13,000 37.............. ................2..............................ND 3,600....... ................. . ........... 1,3,5-Trimeth !benzene ND 5,400 12 ND.. ND .......................8,400....... ...................................... . . . ............. ................D.............. . .............. Benzene ND ND ND ND ND 6.. ................ ................2 .............. ....................D.............. . ................ .................. ........... Eth !benzene ND ..... .......... ..............ND ND ND 1,000 ...................................... . .............. .................................... .................. Iso ro Ibenzene ND 840 ND ND.............................ND 2,300....... .................. .................... .................. MTBE ND ND.............. � ND������������ � ND ND 930 ...................................... .................................. .................................. ................................................................................................ Naphthalene 220 .....9:900 ............110 .............�:� ............................................................. ................. . ............... . ............... . ................ n-Bu !benzene ND 2,300 8.4 .............ND .............ND_...................12,000...... ...................................... .................................. .................................. . .................. n-Pro lbenzene ................ND ...........1.:500 :� .N� ND 3,900....... ................ . . ........... . .............. . .................. .................. o-Xylene ND ND ND ND ND NA ...................................... .................................. .................................. ................................................................................................ -8 m X !ones N�................ .............:800........... ..............N�.............. ..............N�.............................ND NA ........................................... Iso ro Itoluene ND 1:400 5.4 ND ND 10,000 ............... ......... . .............. .................. sec-Bu lbenzene ND 2 200 5 8 ND ND 11,000................ ......... ................................ . .................. U............... tort-Bu !benzene ND ....ND.............. ..............ND ND.............................N� ........7 00 .................. ......... ................ .................... .................. .......... Toluene ................ND ND ... ..............N�.............. ..............N�.............................N�........................700 1................ ............ X lone Mixed ND 1 800 ND ND ND 260 Semi-Volatile Organic Compounds SP-51 Acenaphthene ND 490 ND ND ND 20,000 Anthracene ND ............490 .............N� .............N� .............No.....................100.000..... ...................................... . ............... . ................ . .................. Benzo a anthracene ND ND ND ND .ND 1,00.0 .................. .................................. . Nb............... U............... Benzo a one .ND ............N� .............N� .............ND .............N� ......1,000........ .................... . .............. . ................ . . ....... ................. Benno fluoranthene ND ND ND ND....... _ ND .. 000...................... . .D.............. ................D.............. . ..... .......................0.............. Benno i lone No N� No N� ND 100,000..... ................ . .........I...... . ................ . ........................ .. Benno k fluoranthene ND ND ND ND ND 800................ ....................D......... ........ . .............. .................. ......... C sene ND .ND ND ND N�......................1...... ..... .... .... 000 ...................... . .D......... N................. ..............N................... Dibenzo a h anthracene ND ND ND No. N� 330......... ................. . .D.............. ................D.............. . ................. ................. Fluoranthene ND ND ND ND ND 100,000...................................... ............................. ................. ....... Fluorene No 2,700 No No ND 100,000..... .................. . . ........ .............. . U............... .................. Indeno 1,2,3-cd ene .ND ND............. ..............ND ND ........... ND ........500......... .................. ..................... .............. .................................... .................. Naphthalene ................N�................ ...........5:300........... ..............N�.............. ..............N�.............................N�.....................12,000...... Phenanthrene ND................ ...........4:400 ND.............. ..............N�.............................N�....................100,000..... one ND 630 ND ND ND 100,000 Note: Soil Analytes are compared to CP-51,Potable Groundwater Analytes are Compared to TOGS 1.1.1 1)Concentrations in Bold Exceed NYSDEC Guidance Values 2) ND= None Detect 3 NA = Not Analyzed i N(WYORK Dayarlmcrqu' Y,.NYSDEC SPILL REPORT FORM 1 "'�'" - Ernirunrntal � '":rr. °1 I EMkorwnenlal `v.. Con[Mvalon 1F.. GOM1Mrv.Nion DEC REGION: 3 SPILL NUMBER: 1608612 SPILL NAME: LUKSE - UST DEC LEAD: JBODEE CALLER NAME: ELIZABETH RIVARD NOTIFIER'S NAME: CLR'S AGENCY: NAT ENVIRO SPECIALIST NOTIFIER'S AGENCY: CALLER'S PHONE:(914)741-5472 NOTIFIER'S PHONE: SPILL DATE: 12/08/2016 SPILL TIME: 11:40 am DISPATCHER: CALL RECEIVED DATE: 12/08/2016 RECEIVED TIME: 12:24 pm JJCLARK SPILL LOCATION PLACE: LUKSE - UST COUNTY: Westchester STREET: 42 HILLANDALE RD TOWN/CITY: Rye COMMUNITY: RYE BROOK CONTACT: STEVEN LUKSE RESIDENCE CONTACT PHONE: (914) 939-7251 CONT. FACTOR: Equipment Failure SPILL REPORTED BY: Other FACILITY TYPE: Private Dwelling WATERBODY: CALLER REMARKS: tank removal MATERIAL CLASS SPILLED RECOVERED RESOURCES AFFECTED #2 fuel oil Petroleum Soil, GW, POTENTIAL SPILLERS COMPANY ADDRESS CONTACT Stephen Lukse 42 Hillandale Rd RYE BROOK NY Stephen Lukse (914) 939-7251 Tank No. Tank Size Material Cause Source Test Method Leak Rate Gross Failure UST 550 #2 fuel oil (on-site c Unknown Tank NN DEC REMARKS: 12/8/16: t/c with Elizabeth at National Enviro: #2 fuel, heavy contamination, gw present in excavation. Could not dig through contamination with site equipment. Public Water. Freshwater wetland about 150-200 feet down gradient of home. cj 12/05/2018: Message sent to NES requesting additional information on the status.jod 2/26/21: Message sent to Scott Taylor requesting that he check his records for any sample results or a closure report. jod 5/03/21: In late February Scott Taylor responded: "I have all the information for the closure report, however, I do not have the disposal manifests, or the actual laboratory reports. I did not collect a groundwater sample out there." After that I spoke with Jeneen Cianflone, formerly of NES who stated she would try and get into her old office to see if she could find the file. Created On: 12/08/2016 Date Printed: 3/13/2023 Last Updated: 05/14/2021 1 4E1Y'/OtM Dey.IrtMen/u' N �.- Enriurnrxntul NYSDEC SPILL REPORT FORM Consrnr.Nion CgIMNtNt101t DEC REGION: 3 SPILL NUMBER: 1608612 SPILL NAME: LUKSE - UST DEC LEAD: JBODEE I sent a message today requesting that both Scott and Jeneen submit the information they do have to DEC.jod 5/06/21: Scott Taylor reports he found the cover letter from this closure report in his files. He does not have the analytics or disposal receipts, but he will forward what he has to DEC. jod 5/14/2021: National Environmental Specialists removed the leaking UST and disposed of 136.88 tons of petroleum contaminated soil. According to the report from Taylord Environmental, some residual contamination in excess of CP-51 Guidance levels could not be excavated due to structural/safety concerns. Report entered in DecDocs database. Based upon information provided, no further action required at this time. jod PIN T 8t A COST CENTER CLASS: C3 CLOSE DATE: 05/13/2021 Created On: 12/08/2016 Date Printed: 3/13/2023 Last Updated: 05/14/2021 2 NE'WYORK Department of STATE Of OPPORTUNITY Environmental Conservation Spill Incidents Database Search Details Spill Record Administrative Information DEC Region: 3 Spill Number: 1608612 Spill Date/Time Spill Date: 12/08/2016 Spill Time: 11:40:00 AM Call Received Date: 12/08/2016 Call Received Time: 12:24:00 PM Location Spill Name: LUKSE - UST Address: 42 HILLANDALE RD City: RYE BROOK County: Westchester Spill Description Material Spilled Amount Spilled Resource Affected #2 fuel oil UNKNOWN Soil , Groundwater Cause: Equipment Failure Source: Private Dwelling Waterbody: Record Close Date Spill Closed: 05/13/2021 "Date Spill Closed" means the date the spill case was closed by the case manager in the Department of Environmental Conservation (the Department). The spill case was closed because either; a) the records and data submitted indicate that the necessary cleanup and removal actions have been completed and no further remedial activities are necessary, or b) the case was closed for administrative reasons (e.g., multiple reports of a single spill consolidated into a single spill number). The Department however reserves the right to require additional remedial work in relation to the spill, if in the future it determines that further action is necessary. If you have questions about this reported incident, please contact the Regional Office where the incident occurred. Return To Results Refine This Search C1P' T ff.Il c.nr)► �:.�•y_t_ 1 :'- .iToz°.F'_k �'_:t+°3.4. i`,• iJCX947:�kS•YNT'•"7Kfs'�3(�7CR F a CIM � r fs, N A I Cd i + o R � f Ocj }i V y COrA c� CN aV ••ii ;L}•I ��� 11^^�11 � � Q C) x _► 4`o�cctie4 � CA uj Z Q. O m f O to !-- c, o `.. ► J N C► 't] z = b > " Q CO o o en. � ' N C ti N - W � 0 > {•' y V 0 ul �.l�y►� v tes�ftl xr�0..Y' i _.. -rily ,•y,r' k -.S� , .: t"'�•• ;l.i�t "y,.; Aw ACC) CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD YYYV) 1 1/8/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT NAME: ____ _ _ Miller&Miller Insurance Agency Inc _ 741-6400 720 Commerce Street EMAIL ac,Ne):914-741-6407 Thornwood NY 10594 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# _ INSURER AiltQn Specialty Ins Co 13551 INSURED NATI-10 INSURER B: T P _ National Environmental Specialist Inc INSURERC: 26 Broadway INSURER 0: Hawthorne NY 10532 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1741703167 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRT TYPE OF INSURANCE ADDL':SUB POLICY EFF POLICY EXP LIMITS LTR IN SR POLICY NUMBER MM/DD MMIDD/YYYY A GENERAL LIABILITY AHSECC10628-00 7/16/2016 7/16/2017 EACH OCCURRENCE $3,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $50,000 CLAIMS-MADE FX-1 OCCUR MED EXP(Any one person) $10,000 X Deductible$10000 PERSONAL&ADV INJURY $3,000,000 X Contractual Liab GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 POLICY PRO- LOC Pollution $ AUTOMOBILE LIABILITY Ea accident I ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per acc dent E U MBRELLA LIABH OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEC RETENTION$ $ 'WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS EEL---- ANY PROPRIETORIPARTNER/EXE I—ANY E.L,EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Contractors Pollution AHSECC10597-00 7/16/2016 7/16/2017 Each Occurrence $3.000,000 General Aggregate $3,000,000 j Deductible $10,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) *Policies shown are subject to terms, conditions, exclusions, sublimits and deductibles not listed on this certificate. We recommend that requests for policy copies be directed to the Named Insured shown above.* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook NY 10573 AUTHORIZED ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD a New York State Insurance Fund Workers'Compensation& Disahilitp Beneflih Specialists Since 1914 199 CHURCH STREET,NEW YORK,N.Y.10007-1100 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A^A^^^ 133668662 LEVITT-FUIRST ASSOCIATES LTD 520 WHITE PLAINS ROAD,2ND FL _ TARRYTOWN NY 10591 ❑ ■ Scan to Validate POLICYHOLDER CERTIFICATE HOLDER NATIONAL ENVIRONMENTAL SPECIALISTS VILLAGE OF RYE BROOK INC T/A NES 938 KING STREET 26 BROADWAY RYE BROOK NY 10573 HAWTHORNE NY 10532 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G1340187-2 814667 06/29/2016 TO 06/29/2017 11/7/2016 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1340187-2. COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. THIS POLICY IS CANCELLED EFFECTIVE 11/13/2016. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 812746111 U-26.3 11/ , /16 1-J : 20 =w 3154372621, 01/01 ****REGULAR**** DIG REQUEST from DSNY for: VIL RYE BROOK Taken: 11/08/2016 10 : 08 To: VIL RYE BROOK PRIMARY Transmitted: 11/08/2016 10 :26 00004 Ticket: 11086-040-032-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK /V Addr: From: 42 To: Name : HILLANDALE RID Cross : From: To: Name : Offset: ------------------------------------------------------------------------------ Locate: LOCATE ENTIRE FRONT OF PROPERTY TO THE HOUSE AS FACING FROM THE STREET NearSt: LOCK LN AND KING ST Means of Excavation: BACKHOE Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: U Work Type: REMOVE U/G OIL/STORAGE TANK Duration: 2 DAYS Depth of excavation: Site dimensions : Length 6 FEET Width 4 FEET Start Date and Time: 11/22/2016 08 : 00 Must Start By: 12/07/2016 ------------------------------------------------------------------------------ Contact Name: ELIZABETH RIVARD Company: NATIONAL ENVIROMENTAL SPECIALISTS Addrl : 26 BROADWAY Addr2 : City: HAWTHORNE State: NY Zip: 10532 Phone: 914-741-5472 Fax: 914-741-6310 Email : TANKREMOVALS@OPTONLINE .NET Field Contact: JENEEN CIANSLONE Alt Phone: 914-741-5472 Working for: PROPERTY OWNER ------------------------------------------------------------------------------ Comments : DEPTH OF EXCAVATION UNKNOWN : Lookup Type: PARCEL ------------------------------------------------------------------------------ Members : CBLVSN HUDSON VLY CON-ED SUEZ WTR WESTCHESTER TEN GAS-HDS VLY SELL-VALHALLA / HDSN VLY SELL-VALHALLA / WSCHSTR VIL RYE BROOK WESTCHESTER COUNTY / SEW 11/28/16 08 : 47 AM 313427262i, 01/01 ****REGULAR**** DIG REQUEST from DSNY for: VIL RYE BROOM Taken: 11/28/2016 08 :30 To: VIL RYE BROOM PRIMARY Transmitted: 11/28/2016 08 : 47 00001 Ticket: 11286-134-020-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOM /V Addr: From: 42 To: Name: HILLANDALE RD Cross : From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: LOCATE ENTIRE FRONT OF PROPERTY TO THE HOUSE AS FACING FROM THE STREET NearSt: LOCM LN AND MING ST Means of Excavation: BACKHOE Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: U Work Type: REMOVE U/G OIL/STORAGE TANM Duration: 2 DAYS Depth of excavation: Site dimensions : Length 6 FEET Width 4 FEET Start Date and Time: 12/08/2016 07 : 00 Must Start By: 12/22/2016 ------------------------------------------------------------------------------ Contact Name: ELIZABETH RIVARD Company: NATIONAL ENVIROMENTAL SPECIALISTS Addrl : 26 BROADWAY Addr2 : City: HAWTHORNE State: NY Zip: 10532 Phone: 914-741-5472 Fax: 914-741-6310 Email : TANMREMOVALS@OPTONLINE .NET Field Contact: JENEEN CIANSLONE Alt Phone: 914-741-5472 Working for: PROPERTY OWNER ------------------------------------------------------------------------------ Comments : DEPTH OF EXCAVATION UNKNOWN CALLER IS REQUESTING ALL UTILITIES PLEASE RE-MARM (caller ticket) Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: CBLVSN HUDSON VLY CON-ED SUEZ WTR WESTCHESTER TEN GAS-HDS VLY BELL-VALHALLA / HDSN VLY BELL-VALHALLA / WSCHSTR VIL RYE BROOM WESTCHESTER COUNTY / SEW