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HomeMy WebLinkAboutMP22-100 . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook, N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.ryebrook.org TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Michael J. Izzo Stephanie J. Fischer David M.Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE .August 1,2022 Lori Sontag 191 Ivy Holl Crescent Rye Brook,New York 10573 Re: 191 Ivy Hill Crescent, Rye Brook,New York 10573 Parcel ID#: 129.76-1-22 As per the Certification letter from Northeast Environmental Inc.dated July 11,2022,the removal of an under- ground oil tank and installation of a new above-ground oil tank under Mechanical Permit #22-100 issued on 6/21/2022 has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to QyE BRCb,, w � F 0 1982 BUILDING DEPARTMENT /ASSISTANT UILDING INSPECTOR BUILDING INSPECTOR VILLAGE OF RYE BROOK ODE ENFORCEMENT OFFICER 938 KING STREET . RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS. 1 '\ ` -jj 0-) 1 ' ` -7 I '( ) 1"-12, 'z I i o0 a,-\\ PERMIT# ISSUED: SECT: / BLOCK: LOT: LOCATION: OCCUPA ❑ VIOLATION NOTED THE WORK IS... ❑ ACC ED ElECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE j o ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION J /� tC ❑ NATURAL GAS G( C'i, (�vo\ �� O l ❑ L.P. GAS /JNl� J 5 \Vj\Q J� �D C-4'- �eq c_ t n v4 Y Q FUEL TANK elf ❑ FIRE SPRINKLER Q% \ r.11Q C,YS �cN___. y-j. c UGC ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER In w A\ - I V` s e : O O `n : N w N 6. ONO a aZ fl M CA ,.i 0 O 0 c n 1400 © 79 OA O d Q v ° 22 1 ry V J N W E-i '�►Zo ' Q W, otz �v Sao e�a CN V CYd ° WV ONO �IMi 141 40, a w x � � b L,«� _J I BUIQVEBR MENT J L VILOOK SUN 2 1 2022 938 KING ,NY 10573 E_-(914}939-5801VILLAGE OF :AYE BROOK BU11 7�;Nr� PE P M t,!E(,,,pT — -- A lication 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#: /tPJOO Approval Date: JUN 201 Permit Fee: $ L/ Approval Signature: iAl V Other: Disapproved: (fees are non-refundable) RE UIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1.Application Completed by Bonded, Licensed Contractor. 2. Your contractor's valid proof of liability insurance.(Village of Rye Brook must be listed as certificate holder) 3.Your contractor's valid proof of workers compensation insurance. (Form#C 105.2 or Form#U26.3 /or NY State Workers Compensation Waiver) 4. Fee per Tank: Removal,Abandonment,or Installation: $185.00 per Tank. 5. Dig Safely New York#(dial 811): 0(0Ila.- 601 59 tt 6. Inspection by Building Department for removal/abandonment and/or installation. 7. Submit all Manifests&Reports(after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. Application dated, 0"7-2022 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 Removal 0 Abandonment'Above GroundZ�Buried in Ground 1. Address: 191 Ivy Hill Crescent SBL: 129.76-1-22 zone: PUD 2. Property Owner&Address: Lori Sontag 191 Ivy Hill Crescent Rye Brook NY 10573 Phone#: 516-526-7049 Cell#: email: leisenbe76@yahoo.eom 3. Contractor&Address: Northeast Environmental Inc 225 Valley Place Mamaroneck NY 10543 Phone#: 914-777-1930 Cell#: email; DMONACO@NEENVIRO.COM 4. Applicant: Northeast Environmental Inc 225 Valley Place Mamaroneck NY 10543 Phone#: 914-777-1930 Cell#: email: DMONACO@NEENVIRO.COM 5. Indicate Fuel Type: Fuel Oil L.P.Gas( )•GasolineD Other( ): 6. Number and Capacity of each Tank: Removal of a 300-gallon UST and install a 275-gallon AST 7. Exact Location(s)of each Tank: Removal of a 300-gallon UST and install a 275-gallon AST in rear storage shed t 6/112020 STATE OF WriW %'Q COUNTY OF ) as: LW Sontag 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 xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx for the legal owner and is duly authorized to make and file this application.(indicate architect,contractor,agent,attorney,ctcJ 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. Swots to befo a me this ZSworn to before me this ! 7 day f u 20 0�-� day of v"`L 20 L 2— Signature of Property Own ature of Applicant t _L y' 90Y) Dwayne Monaco Q6in�W�diG,of Property Own Print Name of Applicant N6KKi MADERA Notary Public State of NewYo o ry Public Ramon NOTARYPUBM Registrati ,t esttC 381 unr Qualified in es cFF�iester County CtNINEC ICUr Commission Expires July 23,20� MY COMMISSION EXPIRES NOVEMBM 3 This application must be properly completed in its entirety and must include the notarized signature(s) of:he 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. z 611/2020 CD 00 ',1- Q) V) 0 4--J 4-J ru 2! C) a! E 0- M (0 73 : , -L 3) , 4-- > Q) U u 0 Q) 4--J -0 ru ILL ru a) tw 0 0 �4 4-1 (N Ln c ru t 1; Ln Q) r rH L > M 1--13 1 c 0 4y W o ro a) (U 4-J 0 x _0 Q) P4 m c x Q) CD 7 r7 CL U �J4 • a c A a-c 0 0 m 4 2 4-j a 0 ru x X 4-J X X (1) 4- LLJ L/-) �: L/) Ln 4--J k4- c 4--J 4-j 0 4-j _0 0 _0 Q) (1) CL .0 4--j C_- Q) L/) V) C) 4--J (a) o Z3 u c Q) C) 0 n U U CU ru cu ru m L cz un u PL U 0 E un cc 4--j cr- (U u I.- LIJ 0 Ln on E -0 0) 4--J 0 u :3 a) (U un u M u C%4 un i3 u 4-, Ln Oc n E 4.-Jm _0 U-1 Ln4--j ucn 4--J (U +-j u Ln 4- 0 Ln n m m a) C: C: E 0 4-j Q) un Q) 0 0 -0 0 :D u rn 0 u 0 u u (a) u 4- (1) , +- m D L5 =3 C: 0- u (1) 4- E 0 Ln O 0 0 0 0 4-# �n D u a) - LUI E Ln ti) — 4- -&- M -:5 4-� _::�/ r- CD m .4- m Ln x 0 4-J - 4-j u c 0 M 4-J 0 0 Ln ru QJ m - r- -0 0 E -co) Ul u tw E a) E (1) -0 u > 0) E 4-- C) (a) m U CD- a) ;7 CD C— (U 0 -0 4-j 0 CD- a) Ln -- - Q) = c- o Ln L/) Ul) E Cr) uo L/) 0 4-, —E —4 cu 0 0 4- (1) 0 4--J >E u >, cn W 0 4--J u U 0 > C) (1) Ln .0 u LU Q) 4- LLI D Q) on u -0 C) M " 1 -0 -6— E cu 0 0 7D lb- Q) :D rn U > 0 a) (u un o u Q) Ln +-j Ln 0 C: 0 4- > a) E 40- 0 0 U C 0 4--1 0 C) 0 0 (U CT) 4--J m c M C: m E -� E -C Q. - Ln X 4--J 0 C: un 0 0 CLO 0- 0 4 4- > uo m a) 5 V) I -0 c- 0 . .. .. .c %..- =3 c M — > u a) -0 > Q) m — E Ll) Ll) Ln M U > Ln -0 c o 4-� > 0 m u > > o Cl) LE 0 E I.- 0 14-- Ll: (3) v ern u CD V) (1) u .7 4-j A (3) C) j0 > > 0 Er--I of ru u u 0 CU LL- D CD- 0 0 L) _0 4-a U 00 0 4-J CL) cc 0 < 40 F L NORTHEAST H LEC E, ; �" . . . .ENVIR0NMENTAL1tC. �� I 225 Valley Place J U L 2 7 2022 1 Mamaroneck•NlewYork 10543 VILLAGE OF RYE BRGOh Phone:(914)777-1930 BUILDING DEPARTMENT Fax:1914)777-1928 "EPARMENT-----T July 11, 2022 Michael Izzo - Code Enforcement Officer Village of Rye Brook 938 King Street Rye Brook, New York 10573 RE: 191 Ivy Hill Crescent Permit No. MP 22-100 Dear Mr. Izzo: This letter is to inform you that the work at the above referenced site is complete. WORK COMPLETED: Excavated, cut, cleaned, and disposed of one (1) 300- gallon UST and its associated piping. Once the tank was removed, one (1) composite CP-51 soil sample was extracted from the excavation; then backfilled to a rough grade. This sample was then brought to a NYS certified laboratory and analyzed according to DEC protocol. The analytical results are attached and shown to be within NYS DEC guidance. NE Installed one (1) 275-Gallon ROTH AST in the shed. DATE COMPLETED: July 11, 2022 Enclosed, please find copies of all paperwork requested by your office. NE's work was performed with its best present judgment and level of effort consistent with professional standards and in compliance with all applicable Federal, State, and Local ordinances and regulations. ease feel free to contact me at (914) 777-1930 with any questions or )Dwyne . , . Monaco Haz-Mat Spill Response• Soil Remediation• Mold Remediation • Transporting• Tanks Installed/Removed www.northeastenvironmental.com O N N t W 441 Qi W A A A . �J Ln y `� ' M � 4 � 'arc a •� � ., � Mai " � '' � i ••�`� � "'�0 0 , W E 1.4 O ^ ob00 0 Olt cn tN o8a �.b4) ( Z o � � )zo W H x. � oC � o o ° •�„� .� �C3 P. H � �y a .a E u O x � .. a " .. � �i �' V NORTHEAST ENVIRONMENTAL,INC. NYS DEC #3A-500 225 Valley Place EPA #NYR-000083766 Mamaroneck, NY 10543 CT HW #763 Manifest Number 1-877-574-TANK (8265) • Fax 914-777-1928 www-..northeastteenvironmental.com 9075 NAME: OY1T 1�CS1 ae�C� DATE: , `J'��� P a GENERATOR/LOCATION BILL TO(IF DIFFERENT FROM LOCATION) NAME r y NAME 1 F. M3," INFORMA7gWATTENTTON LINE ETAONBRE &FORM1111IT9111411IIIIIINTENFION LINE .fi WIN �•�. Ri00WFln�i7A f'ft.�.. ,..�.'i�4 ADD ADDRESS ss,W. .. .v;;; CITY STATE ZIP CRY STATE ZIP F : - (9v/.lC/•'.�i..5� .{.-, F' v .../ G A,C2 � y T. �,W.R. P UMBER PURCHASE ORDER PHONE NUMBER PURCHASE ORDER NUMBER . TIME IN TIME OUT DRIVERS SECTIONSERVICE WASTE CODE DESCRIPTION DRUMS GALLONS UNIT PRICE PRICE TAX LINE TOTAL 1993 USED OIL REMOVAL 1993 OILY WATER DISPOSAL 1325 SLUDGE DISPOSAL 1203 GASOLINEIWATER DRUM DISPOSAL(NON-HAZ) DRUM DISPOSAL IHAZ) TANK CLEANING VACUUM SERVICE TRUCK HOURLY RATE TRANSPORTATION Terms-Net CONDITIONALLY TOTAL 15 Days EXEMPT SMALL QUANTITY GENERATOR CHARGE MY ACCOUNT FOR THIS GENERATOR WARRANTS AND REPRESENTS THAT THE MATERIALS CERTIFICATION TRANSACTION UNLESS OTHERWISE PROVIDED NORTHEAST ENVIRONMENTAL HEREUNDER HAVE NOT INDICATED IN THE PAYMENT N. BEEN MIXED,COMBINED OR OTHERWISE BLENDED IN ANY certify that this generator INVOICED REFLECTING CHANNGESGES TO QUANTITY WITH MATERIALS CONTAINING POLYCHLORINATED generates less than 100 kilograms CUSTOMER ARE SUBJECT TO AN of hazardous waste r month,as INTEREST RATE OF THE LESSER OF 1-1/2%PER HA (PCB)OR ANY OTHER MATERIAL DEFINED AS MONTH 18% I HAZARDOUSRDOUS WASTE UNDER APPLICABLE LAWS,INCLUDING BUT defined In 40 C.F.R. 81 and does PER ANNUM)OR THE MAXIMUM RATE ALLOWED BY LAW ON ANY NOT LIMITED TO 40 CFR PART 281 GENERATOR AGREES TO not accumulale more Ilan 1,000 INVOICES TFIATARE NOT PAID WITHIN 15 DAYS.IN THE EVENT OF INDEMNIFY AND HOLD NORTHEAST ENVIRONMENTAL HARMLESS kilograms of such waste during DEFAULT NORTHEAST ENVIRONMENTAL INC.SHALL BE ENTITLED FOR ANY DAMAGES,COSTS,ATTORNEY'S FEES,ETC.ARISING the mcnth. TO RECGVER COSTS OF COLLECTION,INCLUDING REASONABLE OUT OF OR IN ANY WAY RELATED TO A BREACH OF THE ABOVE ATTORNEY'S FEES.INITIAL WARRANTY BY THE GENERATOR. Generator certifies that the waste Is ❑ used oil GENERATOR'S SIGNAI URE PAYMENT S SECTION Doily water ❑ other NON CONDITIONALLY CASH❑ _ TOTAL RECEIVED DE6CRMT10N EXEMPT LARGE ate« Inaccordance the N.J.A.C.7:26.12.1atseq.NorlhesslEnvironmentel QUANTITY GENERATOR I I-)`me has the required permits to accept the above described waste. CERTIFICATION In accordance with NJAC7;26.6,76.40 CFR PART 279,Northeast ntal has nol*Z I1S Ef A of It ed oil management actWes. PArNT NAME TITLE Dexsil CDT Test Resuits P AME 1304ATURE GATE GENERATOR/CUSTOMER PPM _ ____ ~-� - UATE �� .1 URE NORTHEAST ENVIRONMENTAL REPRESENTATIVE i PAYMENT RECEIPT Pascap Co, Inc. 4250 Boston Road Bronx, NY 10475 (718)325-7200 (914)725-3300 FACILITY ID NO. 7003010 SCP NYC DCA License#0437164-0764024 Roceipt: 1350709 Date: 07/14/2022 Customer: 1242 Time: 09:00 NORTHEAST ENVIRONMENTAL 225 Valley Place MAMARONECK, NY 10543 Ticket: 3161321 Weigh in: 07/14/2022 08:52 ` operator: 9 Weigh Out: 07/14/2022 08:57 Commodity Gross Tare Net Price TOTAL$ Steel To Torch 10500 9280 1220 4.250/CW ------ ------------- .......... ---..... ..-............-._........I...... ............. Ticket Total #of Tickets: 1 Total Paid Paid by EZCash Rounded to nearest $1.00 THERE IS TO BE NO PROCESSING OR CLEANING OF: MATERIALS ON PASCAP PROPERTY NO EXCEPTIONS. VIOLATORS RISK BEING BANNED.FROM THE YARD BY MANAGEMENT Technical Report prepared for: Northeast Environmental Inc. 225 Valley Place Mamaroneck NY, 10543 Attention: Mr. Dwayne Monaco Report Date: 07/18/2022 Client Project ID: Sontag 191 Ivy Hill Crescent, Rye Brook, NY York Project (SDG) No.: 22GO513 AC 2 CT Cert.No.PH-0723 New Jersey Ccrt.No.CT005 and NY037 New York Cert.Nos.10854 and 12058 PA Cert.No.6B-04440 B 120 RESEARCH DRIVE STRATFORD,CT 06615 le 132.02 89th AVE NLIE RICHMOND HILL,NY 11418 www.YORKLAB.com (203)325-1371 FAX(203)357-0166 CllentServices@yorktab.com Page 1 of 9 Report Date: 07/18/2022 Client Project ID: Sontag 191 Ivy Hill Crescent, Rye Brook, NY York Project(SDG) No.: 22GO513 Northeast Environmental Inc. 225 Valley Place Mamaroneck NY, 10543 Attention: Mr. Dwayne Monaco Purpose and Results This report contains the analytical data for the sample(s) identified on the attached chain-of-custody received in our laboratory on July 13,2022 and listed below. The project was identified as your project: Sontag 191 Ivy IIill Crescent,Rye Brook,NY. The analyses were conducted utilizing appropriate EPA, Standard Methods, and ASTM methods as detailed in the data summary tables. All samples were received in proper condition meeting tite customary acceptance requirements for environmental samples except those indicated under the Sample and Analysis Qualifiers section of this report. All analyses met the method and laboratory standard operating procedure requirements except as indicated by any data flags,the meaning of which are explained in the Sample and Data Qualifiers Relating to This Work Order section of this report and case narrative if applicable. The results of the analyses, which are all reported oil dry weight basis (soils) unless otherwise noted, are detailed in the following pages. Please contact Client Services at 203.325.1371 with any questions regarding this report. York Sample ID Client Sample ID Matrix Date Collected Date Received 22C0513-01 Excavation Soil 07/11/2022 07/13/2022 General Notes for York Project (SDG)No.: 22GO513 1. The RLs and MDLs (Reporting Limit and Method Detection Limit respectively) reported are adjusted for any dilution necessary due to the levels of target and/or non-target analyses and matrix interference. The RL(REPORTING LIMM is based upon the lowest standard utilized for the calibration where applicable. 2. Samples are retained for a period of thirty days after submittal of report,unless other arrangements are made. 3. York's liability for the above data is limited to the dollar value paid to York for the referenced project. 4. This report shall not be reproduced without the written approval of York Analytical Laboratories,Inc. 5. All analyses conducted met method or Laboratory SOP requirements. See the Sample and Data Qualifiers Section for further information. 6. Il is noted that no analyses reported herein were subcontracted to another laboratory,unless noted in the report. 7. This report reflects results that relate only to the samples submitted on the attached chain-of-custody form(s) received by York. 8. Analyses conducted at York Analytical Laboratories, Inc. Stratford, CT are indicated by NY Cert. No. 10854; those conducted at York Analytical Laboratories,Inc..,,,Richmond Hill,NY are indicated by NY Cert.No. 12058. Approved By: (S �" Date: 07/18/2022 Cassie L.Mosher Laboratory Manager Page 2 of 9 Sample Information Client Sample ID: Excavation Pork Sample ID: 22GO513-01 York Project(SDG)No. Client Proiect ID Matrix Collection Daterrime Date Received 22GO513 Sontag 191 Ivy Hill Crescent,Rye Brook,NY Soil July 11,2022 3:00 put 07/13/2022 Volatile Oreanics,CP-51(formerly STAIRS)List Loe-in Notes: VOA-CONT Snn1D1e Notes: Sample P,,Wd by Method:EPA 5035A Rcponcdto Date7l'ime Datemine CAS No. Parameter Result Flag Units LOD/AIDL LOQ Dilution Reference Method Prepared Analyzed Analyst 95-63-6 1,2,4-Trinxahylbcnzcnc ND ugykg dry 2.9 5.9 1 EPAS260C 07114/2022WOO 07i)4/202212:09 FTR Cenifxaliom: C.D0H,NELAC-NY10854,NELAC-NY12059MI)EPPADEP 108.67.3 1,3,5-TrinlcthylbenzCnc ND ug/kg dry 2.9 5.9 1 EPA 8260C 0h W202209:OD 07114202212:09 FTR C•<nifx.6- CT❑OH,NELAC NY10854,NELAC-NY12039.NJDEP,PADEP 71-43.2 Benzene ND ugtkg dty 2.9 5.9 1 EPA 8260C 07/142D2209:00 OUW202212:09 FTR Cmfxatitxn: CTDOH,NELAC-NY10854,NELAC-NY12058,NJDEP,PADEP IOD-41-i Ethyl Benzene ND ugAg dry 2.9 5.9 1 EPA 8260C 07/142D2209:50 07/141202212:09 FTR Cmifcmions: CTDOH,NELAC-NY10854,NELAC-NY12058,N1DEP,PADEP 98,82.8 Isopropylbenzene ND ugykg dry 2.9 5.9 1 EPA 8260C D7/14(202209:00 071141202212:09 FTR C'<nifxatims: CTD0)1,NELAC-NY10854,NELAC-NY12059,NJDEPPA13E1` 1634-044 Methyl tert-butyl ether(MTBE) ND ugykg dry 2.9 5.9 1 EPA 8260C 07114/202209:00 07/W202212:09 FTR Cmifi cons: CTDOH,NELAC-NY10854,NELAC-NY 12058,NJDEP,PADEP 91-20-3 Naphthalene ND uglkg dry 2.9 12 1 EPA 8260C OA14/202209:00 07114202212:09 FTR Certifxatims: NELAC-KYIOW,NELAC.NY12058,NJDEP,PADEP 104-51.8 n-Butylbenzene ND ugAgdry 2.9 5.9 1 EPA8260C 07/141202209.00 07)J4202Z12:09 FTR Ccrtifxations: CTT3OH,NEL AC-NY 10354,NELAC-NY 12058,NJDEP,PADEP 103-65-1 n-Propylbcnzene ND uS/kg dry 2.9 5.9 1 EPA 8260C O7JI4/202209:OD 07114202212:09 FTR C'enifxatiom: C71301 I,NELAC-NY 10954,NELAC-NY 12058NJDEI',PADEP 95-47-6 o-Xylcue ND ug(kg dry 2.9 5.9 1 EPA 8260C 07114202209:00 07/14/202212:09 FTR CmiEcatiom. CTDOI I,NELAC-NY IORS4NELAC-NY I2059,PADEP 179601-23-1 p-£m-Xylenes ND ugA:g dry 2.9 5.9 1 EPA 8260C 07/14202209:00 07/14202212.09 FTR Ceniflcwimr CTDOH,NELAC.NY10854,NELAC-YYI2058,PADEP 99-87-6 p-15opropyltoluene ND ug/kg dry 2.9 5.9 1 EPA 8260C 01/14202209:00 071141202212-09 FTR Cmifxatiam: CMOH,NELAC-14y10854,NELAC-NY12058,N)DEP,PADEP 135-98-8 sec-Bulylbenwie ND ugykg dry 2.9 5.9 1 EPA8260C 07/142D2209:00 071142012)2:09 FTR Crnia:uiom: CTI)OD,NF.LAC-NY103S4,NELAC-NY12058N1DEP,PAL)U 98-06.6 lerl-Butylbenzcne ND ugykg dry 2.9 5.9 1 EPA8260C 07/14202209:00 07114202212:09 FTR Cenifxmiom: (71>01 I,NELAC-NY 10854,NEL AC-N Y1 205&,NJ DEPPADEP 108-88-3 Toluene ND ugykg dry 2.9 5.9 1 EPA 8260C 07/142.02209:00 07114202212:09 Hit Ccnifxatims: L7DOJJ,NELAC-NYID854,NELAC-NY12058,NIDEPPADEP 1330-20-7 Xylcnes,Total ND ugykg dry 2.9 5.9 1 EPA 8260C 071142OZ209:00 07/142022 12:09 FTR Ccnifxw:ms: CTIXkt,NELAC.NYIM4,NELAC-NY12058NIDF.P Surrogate Recoveries Result Acceptance Range 17060.07.0 Sunogtne:SURR: 124"ii 77-125 1,2-Dlchlomellume-d4 2037.26.5 Sunngale.'SURR:To6tene-d8 94.1% 85-120 120 RESEARCH DRIVE STRATFORD,CT 06615 a 132-02 89th AVENUE RICHMOND HILL,NY 11418 vA•Av.YORKLAB.com (203)325-1371 FAX(203)357-0166 CllentSer -s Page 3 of 9 ;`. Sample Information Client Sample ID: Excavation York Sample ID: 22C0513-01 York Project(SDG)No. Client Project ID Matrix Collection paten ime Date Received 22GO513 Sontag 191 Ivy Hill Crescent,Rye Brook,NY Soil July If.2022 3:00 pin 0 7/1 31202 2 Volatile Oreanics,CP-51(formerly STARS)List I.og-in Notes: VOA-CONT Sample Notes: Sample Prepared by h1yhod.EPA 5035A Roponcd to Datemitie DaklTnte CAS No. Parameter Result Flag Units LOWAIDL LOQ Dilution Referencelllethod Prepared Analyzed Analyst 460-00.4 Surrogate:SURR: 91.0% 76-130 p-DramoJlumpbenrene Semi-Volatiles,CP-51(formerly STARS)List Lae-in Notes: VOA-CONT Sample Notes: Sample Prepared by Nlethod:EPA 3550C RcMted1. Date/rime Daterl'ime CAS No. Parameter Resull Flag Units Limn L 1.oQ Dilution Reference method Prepared Analyzed Analyst 83,32-9 Accnaphthenc ND ;gkg dry 48 96 2 tPA 82701) 07/14/202209,27 0711W02200:25 Kit Cmf o— CTDOH,NELAC-NY10854,N)DEPPADEP 208-96-8 Acenaphthylow ND ;gKg dry 48 96 2 LPA 8270D 07114/202208:27 07iW202200:25 Kit Cenifatiom: C L)OH,NELAC-NY1D354,NJDEPPADEP 120-12-7 Anthmccne ND uykg dry 48 96 2 EPA 8270D 07/14r202203:27 07/I(,1202200:25 KH Ccnificatims: C1DO11,NELAC-NYID8S4,NJDEPPADEP 56-55.3 Benzo(a)anthracenc ND ugAg dry 48 96 2 EPA 8270D 07114/202208:27 07)16/20220025 Kit CertiP.rations: CfD010ELAC-NY10854,N11)EPPA1)EP 50-32-8 Bcnzo(a)pyrcnc ND ughgd y 48 96 2 EPA 82701) 07114202208:27 07116/202200.25 KII C mif ati—: CI'D014NELAC.NY10354,N)DEPPADEP 205.99.2 B enzo(b)Iluoranthcnc ND ug Lg dry 48 96 2 EPA 82701) 07/14r202209:27 07116IM2200:25 Kit Ccnir.miom: C7D0H,NELAC-NY10854,NJDEPPADEP 191-24.2 Bcnzo(g,h,i)perylcnc ND ugAg dry 48 96 2 EPA 8270D 07/14002208:27 07;161202200:25 Kit Cmifadons: ('rDO11,NELAC-NY 10854,NJDEP,1'ADEP 207-08-9 Benzo(k)fluornnthene ND ug/kg dry 48 96 2 EPA 827DU 07/14,2022 D8:27 07116202200:25 Kit Cenifkationf: CrDOH,NELAC-NY 10854,N1DEP,PADEP 218411-9 Chrysene ND ugAgdry 48 96 2 EPA 8270D 07/14/202208:27 07116/202200:25 Kit C'crt&3tioas: (-MlI,NELAC-NY10854,NJDEP,PADEP 53-70.3 Dibcnzo(a,h)anthraccnc ND ug,kg dry 48 96 2 EPA 82701) 07/14rW209:27 07/16R0-72 D0:25 Kit C,Wfi artoas: CJD0H,NELAC-NY10354,NJDEP,PADFP 20644.0 Fluoranlhenc ND ugAg dry 48 % 2 EPA82701) 0711 41202 2 09:27 07/16202200:25 Kit Ccnrkmionr: CIDOH,NELAC-NY 10854,NJDEPPADEP 86.73-7 Fluorenc ND upvkg dry 48 95 2 EPA 8270D 07/141202208:27 0711 N202200:25 Kit Cenirimtioaa: NELAC-NY10854.NJDEP,PADE1• 193-39.5 Indcno(1,2,3-cd)pyrene ND upakg dry 48 96 2 EPA 8270D 07/14r202209:27 07116/202200:25 Kit Cenirkatiom: CTU011,NELAC.NYID854,N11)EPPADFP 91.20.3 Naphihalcnc ND ug/kg dry 48 96 2 EPA 8270D 07/141202203:27 071161202200:25 Kll Certifications: CTDOII,NEI.AC-NY10854,NJDEPPADEP 85.01-8 Phenanthmne ND ug/kg dry 48 96 2 EPA 9270D 07/141202203:27 07/16402200:25 Kit Certificadom: CTDOIINELAC-NY10354,N1DEPP,%DEP 129000 Pyrenc ND ugAg dry 48 96 2 EPA 92700 07/141202208:27 0711N202200.25 Kll C,rt&.6— CfDOII,NELA('-NY1o854N1DE1SPADEP 120 RESEARCH DRIVE STRATFORD,CT 06615 ■ 132-02 891h AVENUE RICHMOND HILL,NY 11418 mmYORKLAB.con) (203)325-1371 FAX(203)357.0166 ClienlServices Page 4 of 9 1 Sample Information Client Sample ID: Excavation York Sample ID: 22GO513-01 York Project(SI)G)No. Client Project ID Matrix Collection Date(I'im@ Date Received 22GO513 Sontag 191 Ivy Hill Crescent,Rye Brook,NY Soil July 11,2022 3:00 pm 07/13/2022 Semi-Volatlies,CP-51(formerly STARS)List Lou-in Notes: von-CONT Sample Notes: Sample Prcpared by Mrthod EPA 3tS0C Repottad to Dateffimc Date/1'Ime CAS No. Parameter Result Flag Units LOWNIDL LOQ Dilution Reference Method Prepared Analyzed Analyst Surrogate Recoveries Result Acceptance Range 4165 60-0 Snrrognre'SURR:N11robemene-A5 40.9% 22-108 321.60.8 Surrogate:SURR:2-Fluorohiphenyl 33.4% 21-113 1718-51-0 Surrogate.SURR:Terpheny1414 41.9% 24-116 To(al Solids Lou-in Notes: VOA-CONT Sample Notes: Sample Prepared by Method:Y Solids Prep RelKrxdn Dalc/Plme Dale/rime CAS No. Parameter Result Flag Units LOQ Dilution Reference Afethod Prepared Analyzed Analyst solids '%Solids 85.6 a 0.100 1 SM 25400 0711&202207:25 07n9R022 11:50 VR C'cnifiwatiom: CTOOR 120 RESEARCH DRIVE STRATFORD,CT 06615 M 132-02 89th AVENUE RICHMOND HILL,NY 11418 vAvw.YORKLAB.com (203)325.1371 FAX(203)357-0166 ClientServlces Page 5 of 9 I Volatile Analysis Sample Containers Lob ID Client Sample ID Volatile Sample Container 22GO513-0I Excavation 2 oz.WN4 Clear Glass Cool to 4°C 120 RESEARCH DRIVE STRATFORD.CT 06615 ■ 132-02 891h AVENUE RICHMOND HILL,NY 11418 %mv.YORKLAB.com (203)325-1371 FAX(203)357-0166 CliemS-1— Page 6 of 9 1 ' Sample and Data Qualifiers Relating to This Work Orcler VOA-CONT Non-Compliant-the container(s)provided by the client for soil volatiles do not meet the requirements of EPA SNV846-5035A. Results reported below 200 ug/kg may be biased low due to samples not being collected according to EPA SNV846 5035A requirements. QL-02 This LCS analyte is outside Laboratory Recovery limits due the analyte behavior using the referenced method. 'file reference method has certain limitations with respect to analytes of this nature. Definitions and Other Explanations • Analytc is not certified or the state of the samples origination does not offer certification for the Analytc. ND NOT DETECTED-the analyte is not detected at The Reported to level(LOQ(RL or LOD/MDL) RL REPORTING LIMIT-the minimum reportable value based upon the lowest point in the analyte calibration curve. LOQ L[MIT OF QUANTITATION-the minimum concentration of a target analyte that can be reported within a specified degree of confidence. This is the lowest point in an analyte calibration curve that has been subjected to all steps critic processing/analysis and verified to meet deftmed criteria.This is based upon current NELACIINI Standards and applies to all nnalyscs. LOD LIMIT OF DETECTION-a verified estimate of the minimum concentration of a substance in a given matrix that an analytical process can reliably detect. This is based upon NELAC 2009 Standards and applies to all analyses conducted under the auspices of EPA SW•846. MDL METHOD DETECTION LIMIT- a statistically derived estimate of the minimum amount of a substance an analytical system can reliably detect with a 99% confidence that the concentration of the substance is greater than zero. This is based upon 40 CFR Part 136 Appendix B and applies only to EPA 600 and 200 series methods. Reported to This indicates that the data for a particular analysis is reported to either the LOD/MDL,or the LOQ/RL. In cases where the"Reported to"is located above the LOD/MDL,any value between this and the LOQ represents an estimated value which is"J"flagged accordingly.This applies to volatile and semi-volatile target compounds only. NR Nor reported RPD Relative Percent Difference Wet The data has been reported on an as-received(wet weight)basis Low Bias Low Bias flag indicates that the recovery of the Ragged analyte is below the laboratory or regulatory lower control limit. The data user should take note that this analyte may be biased low but should evaluate multiple lines or evidence including the LCS and site-specific MS/MSD data to draw bias conclusions. In cases where no site-specific MS/MSD was requested,only the LCS data can be used to evaluate such bias. High Bias I figh Bias flag indicates that the recovery of the flagged analyle is above the laboratory or regulatory tipper control limit. The data riser should take note that this analyte may be biased high but should evaluate multiple lines of evidence including the LCS and site-specific MS/MSD data to draw bias conclusions. In cases where no site-specific MSMSD was requested,only the LCS data can be used to evaluate such bias. Non-Die Nou-dir.flag(Nott-Directional Bias)indicates that the Relative Percent Difference(RPD)(a measure of precision)among the MS and MSD data is outside the laboratory or regulatory control limit. This alerts the data user where the MS and MSD are from site-specific samples that the RPD is high due to either non homogeneous distribution of target analyte between the MSMSD or indicates poor reproducibility for other reasons. if P.PA SW-846 method 8270 is included herein it is noted that the target compound N-nitrosodiphenylantitic(NDPA)decomposes in the gas chromatographic inlet and cannot be separated from diphcnylaminc(DPA). These results could actually represent 100%DPA,100%,NDPA or some combination of the two. For this reason,York reports the combined result for u-nitrosodiphenylarninc and diphenylamine for either of these compounds as a combined concentration as Diphcnylamine. If Total PCDs are detected and the target aroclors reported arc"Not detected", the Total PCB value is reported due to the presence of either or both Anclors 1262 and 1268 which are non-target aroclors for softie regulatory lists. 2-ehlorocthylvinyl other readily breaks down under acidic conditions. Samples that arc acid preserved,including standards will exhibit breakdown.The data user should take note. Certification for pH is no longer ofiercd by NYDOH ELAP. Semi-Volatile and Volatile analyses arc reported down to the LOD/MDL,with values between the LODMDI,and the LOQ being"J"nagged as estimated results. 120 RESEARCH DRIVE STRATFORD,CT 06615 Y 132.02 89th AVENUE RICHMOND HILL,NY 11418 www.YORKLAB.coni (203)325-1371 FAX(203)357-0166 ClientServlces page 7 of 9 For analyses by EPA SW-846-8270D,the Limit of Quantitation(I.OQ)reported for bcnzidinc is baud upon the lowest standard used for calibration and is not a verified LOQ due to this compound's propensity for oxidative losses during extraction/conceniration procedures and non-reproducible chromatographic performance. 120 RESEARCH DRIVE STRATFORD,CT 06615 ■ 132-02 89tt1 AVENUE RICHMOND HILL,NY 11418 tvww.YORKLAB.com (203)325.1371 FAX(203)357.0166 CltentServices Page 8 of 9 e' a a:O X :. m C 'C ui JIB Rd1 �? n ruoQ � _ � ' LL CL a 0. 00.m.. a j W 'n A p., a o E E L U v w u p A a h ° E E G araFc Q � of Ot'7av o ~v ------- --- ------------- 41 Qj 'o L _ �• 0 C O q 0 r m rY Q y•�\Q � z z x a E W N U W r- o s5a E� El N Uz d N E ^ ram zj0 fi M E Oda c S Oit R a a a (V O ui.;+ 00 Q rj m a ii _ `r, oo-w V •Lin`1`- r_ _�c.°_c, ,v i �l O cE } y Q. F o _ r.. G cc m V-) O Uo y yy = a ca Cal z g cr I '_ .frcr L, r o C c 0 ° �. �� �— y of a 1 1cr J ^ a a I F a v .r tu e n �i E i v aftft LJL t O N L E o • E N a� m h v ccpp o v In C . fi 3 to N 3 FF UJ a U i(1 N 5 � H (] m l In Q } y N I O b _ N C o o S O L CI- c rt O C (v bQ 7 O W n• U M y Z7 0 �Q Z o o o p a Q a' o to E d 3 °1 U' °1 a O �+ a a U c Z N rnf y 5 W cn '�° s - € � € g •` b � U Page 9 of 9 t-QyE BR(�k, IW Gly`4. a V V i44 yyy J � BUILDING DEPARTMENT ❑ UILDINGINSPECTOR 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: 1 \ ` C DATE: PERMIT#' ISSUED: "`` SECT: ,d1 BLOCK: 1 LOT: � LOCATION: � '�-G.� 12f�"\�l`V�� ✓✓ OCCUPAN ❑ VIOLATION NO•rr:D THE WORK IS... ❑ ACC ED 0 ECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING \ (�,� b ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION n�,e- a 1 ❑ NATURAL GAS 1 ' "���� Q� l� ��DV�` �Q� r� ❑ L.P. GAS 6V0 V l S; 1(Z `j CG�i L� �QN`Z .BUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL 2 �C'\ (-kNQj-.O ❑ OTHER uj} V �� eS DATE(MM/DD/YYYY) AC OR" CERTIFICATE OF LIABILITY INSURANCE os/o2/zozz`,� 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 have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER CONTACT Ashlea Tarkazikis NAME: PF Northeast Brokerage Inc PHONE (845)223-8107 FAX (845)227-8816 A/C No xt: A/C No 1035 Route 82 E-MAIL atarkazikis@pfnortheast.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC M Hopewell Junction NY 12533 INSURER A: Great Divide Insurance Company INSURED INSURER B: Key Risk Insurance Company Northeast Environmental,Inc. INSURER C: 225 Valley Place INSURER D: INSURER E: Mamaroneck NY 10543 INSURER F: COVERAGES CERTIFICATE NUMBER: CL226213817 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. INSR ADDLISUOR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVO POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE F x_]OCCUR PREMISES Ea occurrence $ 100,000 X Contractual Liability MED EXP(Any meperson) $ 25,000 A ECP01530828-20 06/11/2022 06/11/2023 -PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER. GENERAL AGGREGATE $ 2,000,000 JECT LO PRODUCTS-COMP/OPAGG $POLICY ❑PRO 2,000,000 OTHER Professional Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea a.dent ANYAUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED BAP1530830 06/11/2022 06/11/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident $ X UMBRELLA LIAR I—[OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE FFX1530829-20 06/11/2022 06/11/2023 AGGREGATE $ 5,000,000 DED RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Provided It Is required by written contract,the following are named as additional insured as respects general liability with regard to work being performed by the insured under form ECP 1245 08116:Village of Rye Brook CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 OL&.AU-0 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE In.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured (914)777-1930 Northeast Environmental Inc 225 Valley Place lc.NYS Unemployment Insurance Employer Mamaroneck,NY 10543 Registration Number of Insured Work Location of Insured (Only required if coverage is Id.Federal Employer Identification Number of Insured specifically limited to certain locations in New York State, i.e., a or Social Security Number Wrap-Up Policy) 133965670 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) American Fire&Casualty Co. Village of Rye Brook 3b.Policy Number of entity listed in box"la" 938 King Street XWA57980680 Rye Brook, NY 10573 3c. Policy effective period _6/29/21 to 6/29/22 3d. The Proprietor,Partners or Executive Officers are included. (Only check box if all partners/officers included) X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "Y' insures the business referenced above in box "la" for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"T'. The Insurance Carrier will also notify the above certificate holder within 10 days IF policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Joseph W.Pires (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 6/21/22 (Signature) (Date) Title: President—PF Northeast Brokerage Inc. Telephone Number of authorized representative or licensed agent of insurance carrier: (845)223-8107 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2(9-07) www.wcb.state.ny.us STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia. Legal Name& Address of Insured(Use street address only) lb. Business Telephone Number of Insured (914)777-1930 Northeast Environmental Inc 225 Valley Place Ic. NYS Unemployment Insurance Employer Mamaroneck,NY 10543 Registration Number of Insured Work Location of Insured (Only required if coverage is Id. Federal Employer Identification Number of Insured specifically limited to certain locations in New York State, i.e., a or Social Security Number Wrap-Up Policy) 133965670 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) American Fire&Casualty Co. Village of Rye Brook 3b. Policy Number of entity listed in box"1a" 938 King Street XWA57980680 Rye Brook,NY 10573 3c. Policy effective period _6/29/22 to 6/29/23 3d. The Proprietor,Partners or Executive Officers are included. (Only check box if all partners/officers included) X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "T' insures the business referenced above in box "la" for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"T'. The Insurance Carrier will also notify the above certificate holder within l0 days IFa policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured.from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c", whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,1 certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Joseph W. Pires (Print name of authorized representative or licensed agent of insurance carrier) 1 w/-w Approved by: 1 6/2/22 (Signature) (Date) Title: President—PF Northeast Brokerage Inc. Telephone Number of authorized representative or licensed agent of insurance carrier: (845)223-8107 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2(9-07) www.wcb.state.ny.us Laura Petersen From: Mike Izzo Sent: Friday,June 17, 2022 1:23 PM To: Laura Petersen; Steven Fews;Tara Orlando Subject: FW: Message from UDig NY From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Friday, June 17, 2022 1:23:10 PM (UTC-05:00) Eastern Time (US & Canada) To: Mike Izzo Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 06/17/2022 13:21 To: VIL RYE BROOK PRIMARY Transmitted: 06/17/2022 13:23 00005 Ticket: 06172-001-534-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 191 To: Name: IVY HILL CRES Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: FRONT OF PROEPRTY BOTH SIDES AND REAR NearSt: IVY HILL LN & ARBOR DR Means of Excavation: HAND TOOLS Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: OIL TANK REMOVAL Estimated Work Complete Date: 06/22/2022 Depth of excavation: 30 FEET Site dimensions: Length 25 FEET Width 25 FEET Start Date and Time: 06/22/2022 07:00 Must Start By: 07/07/2022 ------------------------------------------------------------------------------ Contact Name: NIKKI BARNABA Company: NORTHEAST ENVIRONMENTAL INC Addrl: 225 VALLEY PL Addr2 City: MAMARONECK State: NY Zip: 10543 Phone: 914-777-1930 Fax: Email: nmadera@neenviro.com Field Contact: NIKKI BARNABA Alt Phone: 914-777-1930 Email: nmadera@neenviro.com 1 Working for: LORI SONTAG ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA/ WSCHSTR CONED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 2 Laura Petersen From: Mike Izzo Sent: Friday,July 1, 2022 11:25 AM To: Laura Petersen; Steven Fews;Tara Orlando Subject: FW: Message from UDig NY From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Friday, July 1, 2022 11:24:38 AM (UTC-05:00) Eastern Time (US & Canada) To: Mike Izzo Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 07/01/2022 11:23 To: VIL RYE BROOK PRIMARY Transmitted: 07/01/2022 11:24 00006 Ticket: 07012-000-991-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr- From: 191 To: Name: IVY HILL CRES Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: REAR OF PROPERTY, RIGHT SIDE OF PROPERTY AS FACING, LEFT SIDE OF PROPERTY AS FACING NearSt: IVY HILL LN Means of Excavation: BACKHOE Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: U Work Type: OIL TANK REMOVAL Estimated Work Complete Date: 07/13/2022 Depth of excavation: 25 Site dimensions: Length 25 Width 25 Start Date and Time: 07/07/2022 07:00 Must Start By: 07/21/2022 ------------------------------------------------------------------------------ Contact Name: KRISTINA FEIGHAN Company: NORTHEAST ENVIRONMENTAL INC Addrl: 225 VALLEY PL Addr2 City: MAMARONECK State: NY Zip: 10543 Phone: 917-777-1930 Fax: Email: kfeighan@neenviro.com Field Contact: KRISTINA FEIGHAN Alt Phone: 917-777-1930 Email: kfeighan@neenviro.com 1 Working for: HOMEOWNER ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA / WSCHSTR CONED NYSDOT TFC POKPSE SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 2