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MP23-039
�E J L(C V G 7, 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 Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE June 2,2023 306 Fayette Avenue Realty Inc 566 Westchester Avenue Rye Brook,New York 10573 Re: 566 Westchester Avenue,Rye Brook,New York 10573 Parcel ID#: 135.83-1-55 As per the Certification letter from Northeast Environmental Inc dated May 9,2023,the removal of an under- ground oil tank and installation of a new above-ground oil tank under Mechanical Permit #23-039 issued on 4/4/2023 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to s s 6 V A o _ M _ M c = Z w a (� N N Q~Gt , a y 0-0 CAo-�r c7 Q H a z by ow�1 0 aNd t9i a "d CA W cn o o W ZUall w F Q 7 M M ~' any Z n y I•� 0-4 or oo V �c a a, cn i--. M••r7 W y a � N O..r d W W � 8 .°a � m c CN ouZi v � a • v `+ �O" � zac " vggv � �.J u M '"1' M 0 8 QR:00 � bb v Cn Lti O W 9 C z O O a Q H Z � m O U ( i o p A z A arA � �. vQ E� U a Q o � o � l a P, p rff.,�W BUIL DEPARTMENT VIL of RYEOOK APR - 3 2023 938 KING ET RYE BROOK,NY 10573 (914)9 39-5801 VILLAGE OF RYE BROOK i Z BUILDING DEPARTMENT Avolication 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#: /#�3— ® , Approval Date: Permit Fee: $ 0— AL Approval Signature: Al Other: Disapproved: 1114 (fees are non-refundable) REQUIREMENTS 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. S. Dig Safely New York#(dial 811): 6331 �- CEO 1-S 4 7 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, 03-27-2023 ,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 Abandonment Above Ground Buried in Ground 1. Address: 566 WESTCHESTER AVE SBL: 135.83-1-55 Zone: R2-F 2. Property Owner&Address: 306 FAYETTE AVE. REALTY INC. Phone#: 914-935-3950 Cell#: 203-482-2996 email: CARMINEDOMINICUS@GMAIL.COM 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 Oilw}L.P.Gas( )•Gasolin Other( ): Capacity P 6. Number and Ca i of each .•Tank: REMOVAL OF A -GALLON NO.2 OIL UST INSTALL ONE (1)275-GALLON AST 7. Exact Location(s)of each Tank: UST IS LOCATED IN FRONT YARD, AST TO BE INSTALLED IN BASEMENT t 6/1/2020 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: DWAYNE MONACO FOR NORTHEAST ENVIRONMENTAL,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 CONTRACTOR. 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 Sworn to before me this 7- 7 day of ,20 � day of ter, ,20� Signature of Property Owner Si t e of Applicant 7H, 0 ,q S /'Y)/LO D AYNE MONACO Print Name of Property Owner Print Name ofApplic NiKKi MADE Noc Notary Public,State of ublic Registration No.01BA 1 t AAAPY.IANE 'DE FIORE QL13Ued in Westchester COLmry N�ytApy pUbl_IL'. Stale of New Yurk Commission Expires July 23,20.2 �;�;IFihU�574 i Ustel Goenty This apUlmmt��i►l� mu;t l,c po �rl}�d in its entirety and 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. MARYJANE DE FIORE NOTARY PURLIG, State of New Yurk No. 01 DE4604574 Qualified in Westchester 'ot nt' y, � Commission Expires `2.�/ 2 6/1/2020 QyE BRC�� '9n2 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 - - - - - - - - - - - - --- - - - - - 1 ADDRESS : �'/ _�-� 1 1— . DATE: 3, PERMIT# ISSUED: �'1'l `� SECT: 5 BLOCK: 1 LOT: - . LOCATION: �� OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ D PAS / ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION �} ❑ Natural Gas C� SS2S� ❑ L.P. Gas 12 FUEL TANK`'Z ❑ FIRE SPRINKLER ❑ FINAL PLUMBING t c 4 ❑ CROSS CONNECTION � }� \'y C `' y�A ❑ FINAL ❑ OTHER 1 11 8 (2 LocaUona-Top And Front) Tank Serial Number Data Label 7 6 Rost, O 3'-88' -S& 1 5 it 3 " Roth Industries DWT 1000L 9 4 Legend Specifications 1. Tank Side 6. Warning Label Height-61" 10 2. Tank Base 7. Serial Number Width -28" 3. Tank End 8. UL Number Length-43" 4.Tank Top 9. Serial Number Weight- 167 Lb. 5. Handle 10. Leak Indicator Capacity-275 Gal. e 11. Connections Molded Into Inner Outer Tank Capacity- 110%of Inner Tank Tank- Proprietary Piping Accessories Outer Tank- 19 GA. Galvanized Steel For Either 2" NPT Black Iron Pipe or Inner Tank-3/16"Thick High Density Polyethylene 3/8" & 1/2" Copper Tubing Used NORTHEAST D ECEHE D .0, ENV,R0NMENTALNC. JUN - 12023 225 Valley Place Nbmarawk•New York 10543 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Phone:(9141777-1930 Fax:(914)777-1928 May 9, 2023 Michael Izzo - Code Enforcement Officer Village of Rye Brook 938 King Street Rye Brook, New York 10573 RE: 566 Westchester Avenue Permit#: MP 23-039 Dear Mr. Fews: 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) 550- gallon UST and associated piping. Once the tank was removed, one (1)composite CP-51 soil sample was extracted from the excavation; it was then backfilled to a rough grade. This sample was sent 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 double wall AST in the basement location. DATE COMPLETED: May 8, 2023 i I 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. Please feel free to contact me at(914) 777-1930 with any questions or concerns. Since ly, D ayne J. Monaco C.C. Enc. Hoz-Mat Spill Response• Soil Remediation• Mold Remediation• Transporting• Tanks Installed/Removed www.northeastenvironmental.com BUILDING DEPARTMENT V11A,AGE OF RYF. BROOK APR - 3 2023 938 KING S,nu*.F r RYE BROOK,NY 10573 (914)939-0668 FAX(914)939-5801 VILLAGE OF RYE BROOK �����►.r�cln ool.. �t'L BUILnING UEI ARTMENT 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 WWestch�e`s�ter) Approval Date: APR 0 11171 Permit Fee:S )•/�✓�'�� Approval Signature: Other: t• �. Disapproved: I lees me ixa►-tellmdabk-) }#A***#A*AAA#*AAA#AAA*#*}}A##}**A#AA*}k##}*#**}A#}}**A#}}*#*A#A}*#A##A**#*#*#*#*A#A*}A}*#}}#}A#AA**}#A# REOUIREMENTS 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 #CI 05.2 or Form I/ U26.3 /or NY State Workers Compensation Waiver) 4. Fee per Tank: Removal,Abandonment,or Installation: . I'll , S. Dig Safely New York# ( I ;): (333 V3- dOI-Sy 7 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 lidfilled. Application dated, 03-27-2ma 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 Mel tank(s)will he removed,abandoned and/or installed in conformance with all applicable Village,County,State& Federal laws,codes,rules and regulations. AAAAAAA##AAA*AAAiA#AAAAA*#AAAAAA#**#*A#***A**A*A*A*#*AAA**#A***AAAAAA****#AA#*A#**A#A*AA*AAA#AAAAAAAA# Indicate Permit Tyne: Installation RemovalW1 AbandonmentD Above Ground Buried in Ground I. Address: 566 WESTCHESTER AVE _S131,: 135.83-1-55 Zone: R2-F 2. Property Owner&Address: 306 FAYETTE AVE. REALTY INC. Phone ll: 914-935-3950 Cell#: 203482-2996 email: CARMINEDOMINICUS@GMAIL.COM 3. Contractor& Address. Northeast Environmental Inc 225 Valley Place Mamaroneck_NY 10543 Phone I): 914-777-1930 Cell#: email: DMONACOONFENVIRO.COM 4. Applicant: Northeast Environmental Inc 225 Valley_Place Mamaroneck NY 10543 Phonc I): 914-777-1930 Cell#:_ _ _ _ _ email: DMONACO@NEFNVIRO.COM 5. Indicate Fuel Type: Fuel Oilwl L.P.Gas( )•Gasolin Other( ): REMOVAL OF Q-GALLON NO.2 OIL UST 6. Number and Capacity ofeach'I'ank. _ __ - - - -_- INSTALL ONE (1)275-GALLON AST 7. Iixact Location(s)ol'cach Tank: UST IS LOCATED IN FRONT YARD, AST TO BE INSTALLED IN BASEMENT � t I 6/1/2020 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.northeastenvironmental.co1m 9161 NAME: FQ�e-4P— A\Ie. ? e-e-qt 4 _ DATE: T GENERATOR/LOCATION BILL TO(IF DIFFERENT FROM LOCATION) NAME NAME INFORMATION'ATTENTION LINE ETA ONSITE INFORMATIONIATTENTION LINE ADDRESS ADDRESS �/ CITY c� STA E ZIP CITY STATE ZIP Pf ONE MBER �R-C�HAS ORDER MBER PHONE NUMBER PURCHASE ORDER NUMBER TIME IN TIME OUT-JV` 3 C DRIVER • SECTIONSERVICE WASTE CODE DESCRIPTION DRUMS GALLONS UNIT PRICE PRICE TAX LINE TOTAL 1993 USED OIL REMOVAL 1993 OILY WATER DISPOSAL 1325 SLUDGE DISPOSAL 1203 GASOLINE(WATER DRUM DISPOSAL(NON-HAZ) DRUM DISPOSAL(HAZ) TANK CLEANING VACUUM SERVICE TRUCK HOURLY RATE TRANSPORTATION Terms-Net CONDITIONALLY TOTAL 15 Days EXEMPT SMALL QUANTITY GENERATOR CHARGE lAV ACCOUNT FOR THIS GENERATOR WARRANTS AND REPRESENTS THAT THE MATERIALS CERTIFICATION TRANSACTION UNLESS FOR PROVIDED NORTHEAST ENVIRONMENTAL HEREUNDER HAVE NOT INDICATED IN THE PAYMENT SECTION. BEEN MIXED,COMBINED OR OTHERWISE BLENDED IN ANY I certify that Ibis Generator INVOICED REFLECTING CHANGES TO QUANTITY WITH MATERIALS CONTAINING POLYCHLORINATED Oeneraleslessthan 1.0kilograms CUSTOMER ARE SUBJECT TO AN BIPHENYLF (PCB)OR ANY OTHER MATERIAL DEFINED AS of hazardous waste per month,as INTEREST RATE OF THE LESSER OF 1-1r2%PER MONTH(18 HAZARDOUS WASTE UNDER APPLICABLE I-AWS.INCLUDING BUT defiled in 40 C.F.R.261.and does PER ANNUM)OR THE MAXIMUM RATE ALLOWED BY LAW ON ANY NOT LIMITED TO 40 CFR PART 261,GENERATOR AGREES TO not accumulate more than 1.000 INVOICES THAT ARE 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 month. TO RECOVER COSTS OF COL I ECTION,INCLUDING REASONABLE OUT OF OR IN ANY WAY RELATED TO A BREACH OF THE ABOVE ATTORNEYS FEES.INITIAL WARRANTY BY THE GENERATOR. Generator certifies that the wasto is �� used oil GENERATOR'S SIGNATURE PAYMENT RECEIVED SECTION I oily water i II Other NON CONDITIONALLY CASH F TOTAL RECEIVED DESCRIPTON EXEMPT LARGE In accordance the N.J.A.C.7:26 12.1 at seq.Northeast Environmental QUANTITY GENERATOR has the required permits to accept the above described waste. CERTIFICATION In accordance wilh NJAC7:26-6, 76. 40 CFR PART 279,Northeast [n6ionmenlal has notified the US EPA of it's used oil management activities. PRINT NAME TITLE Dexsil CDT Test Results PRINT NAME SIGNATURE DATE GENE RATORrCUSTOMER ppkI SIGNATURE DATE NORTHEAST ENVIRONMENTAL REPRESENTATIVE i PAYMENT RECEIPT Pascap Co, Inc. a 4250 Boston Road Bronx, NY 10475 (718)325-7200 (914)725-3300 FACILITY ID NO.7003010 SCP NYC DCA License#0437184-0764024 Receipt: 1399950 Date: 05/08/2023 Cust:otniw 1242 Time: 14:43 NORTHEAST ENVIRONMENTAL 225 Valley Place MAMARONECK, NY 10543 .Ticket: 3249028 Weigh In: 05/08/2023 14:35 Operator: 9 Weigh Out: 05/08/2023 14:40 Commodity Gross Tare Net Price TOTAL$ #1 Unprep Steel 10420 9680 740 8.600tCW Ticket Total tt(sf 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 i Technical Report prepared for: Northeast Environmental Inc. 225 Valley Place Mamaroneck NY, 10543 j Attention: Mr. Dwayne Monaco Report Date: 05/18/2023 Client Project ID: 306 Fayette Ave Realty, 566 Westchester Ave, NY York Project (SDG) No.: 23E0582 P- a CT Ccrt.No.PH-0723 Ncw Jcrsey Ccrt.No.CT005 and NY037 New York Cert.Nos.10854 and 12058 PA Cert.No.68-04440 6 120 RESEARCH DRIVE STRATFORD,CT 06615 0 132-02 891hAVENUE RICHMOND HILL,NY 11418 mv%y.YORKLAB.com (203)325-1371 FAX(203)357-0166 ClientServices@yorklab.com Page 1 of 8 Report Date: 05/18/2023 Client Project ID: 306 Fayette Ave Realty, 566 Westchester Ave, NY York Project (SDG)No.: 23EO582 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 May 10, 2023 and listed below. The project was identified as your project: 306 Payette Ave Realty, 566 Westchester Ave, 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 the customary acceptance requirements for environmental samples except those indicated under the Sample and Analysis Qualifiers section of this report. All analyses met time method and laboratory standard operating procedure requirements except as indicated b an data flags, Y rY P g P 9 P Y Y &S> 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 on 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 23EO582-01 Excavation Soil 05/09/2023 05/10/2023 General Notes for York Project (SDG) No.: 23EO582 ( 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 analytes and matrix interference. The RL(REPORTING LIMITI 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. It 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, Cf 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: DL "'y r" Date: 05/18/2023 Cassie L.Mosher Laboratory Manager r • Page 2 of 8 0, ` 1 RK Sample Information Client Sample ID: Lwavatiott fork Sample 11): 23EO582-01 York Project(SUG)No. Client Projccl ID Matrix Collection Dateffin)c Date Received 23EO582 306 Fayette Ave Realty,566 Westchester Ave,NY Soil May 9,2023 3:00 pm 05/10/2023 Volatile Orennics,CP-51(formerly STARS)List Loe-in Notes: Sample Notes:VOA-CONT Sampla Prepared by Method:FTA 5035A arponedto Daterl-ime Date/Time CAS No. Parameter Result Flag Units LOD/N11)L LOQ Dilution Reference Method Prepared Analyzed Analyst 95-63.6 1,2,4-Trimethylbenzenc ND ug/kg dry 2.8 5.7 1 EPA 8260C 05/12R02309:00 051IN02314:38 [)SIT Ccrtifiatiom: Cl-D011-PII-0723,NELAC-NY10854,NELAC-NY12058,NJDEP,PA1 108.67.8 1,3,5-Trimcthylbenzcne ND ug/kgdry 2.8 5.7 1 EPA 9260C 03/1 2/202 1 09.00 (15112J202114:18 UNIT C'cnifiauom: CTI)OH-PH-0723,NELAC-NY10854,NELAC-NYI 2058,NJ1)EP,PA1 71-43.2 Benzene ND ugA&dy 2.8 5.7 1 EPA 8260C 05112f202309:00 05/I2f202314:38 UNIT Cenificatia : CTDOII.PII-0723,NELAC-NY10854,NELAC-NY)2058,N1DEP,PA1 10041-4 Ethyl Benzene ND ugAg dry 2.8 5.7 1 EPA 9260C 05/121202)Q9:00 05112/202314:39 HNIT Cmin-iom: (7130H-PH-0723,NELAC-NY;0354,NELAC-NY12058,N1DE1•,PAI 98-87-8 Isopropylbenzene ND ug/kgdry 2.8 5.7 1 EPA 8260C 05/12/202309:00 051121202314:38 UNIT C'cnificaliom. CTDOH-PH-0723,NFLAC-NY10854,NELAC NYI2058,NJDEP,PA1 1634-044 Methyl lert-butyl ethcr(MTBE•) ND up/kg dty 2.8 57 1 EPA 8260C 05/12/202309:DO 05i12/202314:38 BNtT Cmirtatiom: CTDO31-P1t-0723,NELAC-NY10854,NELAC.NY1205gN1DEP,PA1 91-20-3 Naphthalene ND ug/kgdry 2.8 H I EPA 8260C 05/121202309:00 05112/202114:38 Bid Ccaffi atiom: NELAC-NY10854,NELAC-NY12058,NJDEP,PAOEP 104-51-8 n-Butylbenzene ND uykg dry 2.9 5.7 1 EPA 8260C 0RIW02109:00 0511N202314:39 UNIT Ccnificatiom: CT130I1 P11-0723,NELAC-NYI0854,NELAC-NY)2059,N1DEP,PkI 103-65-1 n-Propylbenzene ND ug/kgdry 2.9 5.7 1 EPA 8260C 05112f202109.00 OV121202)1448 BNIT Ccnikatic> CTDOH-1111-0723,NELAC44Y10854MELAC-NY1205g,N)DEP,PA1 95-47-6 o-Xylcnc ND ug/kg dry 2.8 5.7 1 EPA 9260C 05112120I309:00 05J121202114:18 UNIT Ccnifications: CTDOII.Pll•0723,NELAC--NYIO$54,NELAC-NY12058,PADEP 179601.23.1 p-&m-Xylencs ND ugAg dry 2.8 5.7 1 EPA 8260C 05/I21202309:00 0S/12J2a1314:38 UNIT Ccr irkatiom: CTDOII-Pil-0723,NELAC-NY10854,NELAC-NYI 2056,PADEP I 99.87-6 p-lsopropylloluenc ND ugNg dry 2.8 5.7 1 EPA8260C 05112/2023 D9:00 05/12/202314:39 BNIT Cmiaariom: CTDOII-PII-0723,NELAC.NY10854NF:LAC-NYI 2058,NIDEP.PA) 135-98-8 scc-Bulyibenzene ND ug/kg dry 2.8 5.7 1 EPA 8260C OV 1 27202 3 09:00 OVIM02314:38 UNIT Cenifiatiom: CTD011-1'11.0723,NE LAC-NY 1(854NEL AC-NY 12D58,N)DEP,PA1 99.06-6 lclt-Butylbcnzene ND ug/kg thy 2.8 5.7 1 EPA 826DC 05112/2023 D9:00 091V202314:38 UNIT 1I1I1I Ccnificatiom: CTDOII-19I-0723,NELAC-NY10854,NELAC-NY[2059,NJDEP,PA3 1 108-88-3 Toluene ND ug/kg dry 2.8 5.7 1 EPA 8260C OV12/202309,00 09121202314:38 MIT Cmific.iom: CfDOiI-PIL0723,14ELAC NYI0954,NELAC•NY1205kNJDEP,PAI 1330.20.7 Xylcucs,Total ND ugAs dry 2.8 5.7 1 EPA 8260C 0 511 272 0 2 1 D9.00 0511 MINI 14:38 HSIT Ccni6catiom: CTDOII-Pil-0723,NELAC.NY10854,NELAC--NY12039N)DEP Surrogate Recoveries Result Acceptance Range 17060-07-0 Surrogate:SURR: 93.1% 77-125 1,2-Dichlornethane-d4 2037-26.5 Surrogate:SURR:7blaene-d8 105% 85-120 120 RESEARCH DRIVE STRATFORD,CT 06615 ■ 132-02 891h AVENUE RICHMOND HILL,NY 11418 ivww.YORKLAB.com (203)325-1371 FAX(203)357-0166 ClieniServices Page 3 of 8 Sample Information Client Sample ID: Excavation fork Sample ID: 23EO582-01 York Project(SDG)No. Client Project ID Matrix Collection Date'Time bate Received 23EO582 306 Fayette Ave Realty,566 1Vestchesicr Ave,NY Soil May 9,2023 3:00 pal 05/10/2023 Volatile Organics,CP-51(formeriv STARS)List Log-in Votes: Sample Notes:VOA-CONT Sample Prcpar-d by h1tthod:EPA 5035A Rcponcdm Datefilnle imerrime CAS No. Parameter Result Flag Units LODTIDI, LOQ Dilution Rercrence Method Prepared Analyzed Analyst 460-004 Surrogate:SURR: 105 V. 76-130 p-UromoJluorobenzene Semi-VOIAtileS,CP-51(formerly STARS)List Log-in Notes: Sample Notes: Sample Prepared by.kWhod:EPA 3530C aepw�dro Da(errime Datefl'Ime CAS No. Parnmeter Result Flag Units LOD/5ID1, LOQ Dilution Reference Method Prepared Analyzed Analyst 83-32-9 Acenaphthcnc ND ug/kg dry 47 94 2 EPA 8270D 05/172D2309:33 05/18202311:06 Kit Ccnificuions: CTDOII-PiI-0723,NELAC-NY 10854,NJDEPPADEP 208-%-8 Acenaphlhylene ND uVlgdry 47 94 2 EPA 8270D D5117/202309:33 05/1820231)306 Kit Cenifiwtlom: CTDOH-Pli-0723,NFJ.AC-NY10854,N1UEPFADEP 120-12-7 Anthracene ND ug/kg dry 47 94 2 EPA 9270D 05/172D2309:33 051191202311.06 Kit C,nifintions CTUGH-PH-0723,NELAC-NY10854,N1DEP,PADEP 56.55.3 Benzo(n)anthraccne ND ug/kg dry 47 94 2 EPA 8270D MlU202309:33 09182023 I I% Kit Cenif iiom: CTD011-PII-0723,NELAC-NY10854,NJDEP,PADEP j 30-32-8 Benzo(n)pyrcnc ND ug/kg dry 47 94 2 EPA 9270D 05/17202309:33 05/1 g202311:06 Kit I CmtN.lioro: CTD01I-PH-0723,NELAC-NY10354,NJDEPPAUEI' i 205-99-2 Bcnzo(b)0uoran1hcne ND ugAg dry 47 94 2 EPA 8270D 05/17JN2309:33 W191202311:06 Kit Cmr-6— C7UGH.PII.0723,NELAC-NY10854N1DEPPADEP I 19144-2 Bcn2o(g,h,i)peryIcnc ND ug/kg dry 47 94 2 EPA 8270D 05/171202309:33 OVIN202311,06 Kit Ceniacafiom: CTWII.Pii-0723,NELAC--NY10854,NJDEPPADEP 107.08.9 Bcnzo(k)Ouoranthenc ND ug'k8 dry 47 94 2 EPA 8270D 091712023 09:33 05/1K202311:06 Kit Cenir—Ti— CTDO114PI1-0723,NELAC-NYtOS.54,NJDEPPADEP 21MI.9 Chrysene ND ug'kg dry 47 94 2 EPA 8270D 05/171202309:31 OVI14102311:06 Kit Certifications: (TD0II-Pll-0723,NELAC-NY 10854NJDEPPAUEP 53.70-3 Dibenzo(a,h)anthrecene ND ug/kg dry 47 94 2 EPA 8270D 0511 71202 3 09.33 0511FJ102311.06 Kit CcniOcmiom: CTDOH-Pit-0723,NELAC-NYI0354,NJDEPPADEP 206.44.0 Fluoranthene ND ug/kg dry 47 94 2 EPA 8270D 0511 7202 3 09:33 05118202311:06 Kit Ccrtifica5om: C7U0H-PII-072J,NF.LAC-NY 10854N1DEPPADEP W73-7 Fluorme ND ,g/kg dry 47 94 2 EPA 8270D 0511 7202 3 09:33 05118202311:06 Kit Certifications: NELAC-NY10854,NJDEIJ'AUFP 193-39-5 Indcnc(1,2,3-cd)pyrcnc ND ug/kg dry 47 94 2 EPA 8270D 05/17202309:13 051191202111:06 Kit t CnIi!karioru: (TW11-P)I-07I3,NF.I.AC-NY1 D854,N1UE1',PADEP 91-20.3 Nnphthalcne ND ug/kg dry 47 94 2 EPA 8270D 05117/202309:33 05/IN2D2311:06 Kit Ccrtif—tiau CTDOH.PII.0723,Nr1AC-.LAC 85-01-8 Phcnanthrme ND ug/kg dry 47 94 2 EPA 8270D 05M 7/202309:33 D5/I8202311:06 Kit C'enificmiom C7fU011.PI60723,NELAC-NY10854,NJDEPPADEP 129-00-0 Pyrene ND utAt;dry 47 94 2 EPA 82700 05/17/202309:33 09I9/202111:06 Kit Ccnificmfau: CTDOII-PII-0723,NELAC-NY10954,NJDEPPADEI' 120 RESEARCH DRIVE STRATFORD.CT 06615 ■ 132-02 89th AVENUE RICHMOND HILL,NY 11418 vAnv.YORKLAB.com (203)325-1371 FAX(203)357-0166 ClientServlces Page 4 Of 8 Sample Information Client Sample Ill: Excavation York Sample ID: 23EO582-01 York Project(SDG)No. Client Project ID Matrix Collection Dutefl-ime Date Received 23EO582 306 Fayette Ave Really,566 Westchester Ave,NY Soil Mny 9,2023 3:00 pin 05/10t2023 Semi-Volatiles,CP-51 (formerly STARS)List Lop-in Notes: Sample Notes: Sample Prepared by Alethod:EPA 3550C It"nd ro Datefrinic Datell-ime CAS No. Parameter Result Flag Units LODA101, LOQ Dilution Reference Method Prepared Analyzed Analyst Surrogate Recoveries Result Acceptance Range 4165-60.0 Surrogole:SURR:Nirrvben.ene-d5 39.4% 22-108 321-60.3 Surrogole:SURR:2-Fluorobiphenyl 58.9% 21-113 171&51.0 Surrogate:SURR:Terpheny1414 66.4 4b 14-116 Total Solids Log-in Notes: Sample Notes: Sample Prepared by hicibod:%Solids Prep Repomd ro Date/nme Datefrime CAS No. Parameter Result Flag knits LOQ Dilution Reference Dlethod Prepared Analyzed Analyst wlids •%Solids 88.1 R 0.100 1 Shl 2540G 05A5/202310:40 05115/202315:19 sgs Ccnikoxiom: MD011-1,II-0723 i f i 1 I t 120 RESEARCH DRIVE STRATFORD,CT 06615 0 132-02 89th AVENUE RICHMOND HILL,NY 11418 w%vw.YORKLAl3.com (203)325.1371 FAX(203)357-0166 ClientServices Page 5 of 8 I Volatile Analysis SanlPle Containers Lab ID Client Sample ID Volatile Sample Container 23EO582-01 Excavation 2 oz.WM Clear Glass Cool to 4°C I 120 RESEARCH DRIVE STRATFORD,CT 06615 M 132-02 89lhAVENUE RICHMOND HILL,NY 11418 %mmYORKLAR.com (203)325-1371 FAX(203)357-0166 ClienlServices Page 6 of 8 1 Sample and Data Qualifiers Relating to This Work Order VOA-CONT Non-Compliant-the container(s)provided by the client for soil vo)atiles do not meet the requirements of EPA S\V846-5035A. Results reported below 200 uglkg may be biased low due to samples not being collected according to EPA SW846 5035A requirements. Definitions and Other Explanations ' Analytc is not certified or the stoic of iltc samples origination does not offer certification for the Analyte. 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 analyze calibration curve. LOQ LIMIT 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 of the proccssing/analysis and verified to meet defined criteria.This is based upon current NELAC/TN1 Standards and applies to all analyses. LOD LIMIT OF DETECTION-a verified estimate ofthc minimum concentration of a substance in a given matrix that an analytical process can reliably detest. This is based upon NELAC 20D9 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 Band 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 LODfMDL,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 estinimcd value which is "1"flagged accordingly.This applies to volatile and semi-volatile target compounds only. NR Not reported RPD Relative Percent Difference Wet The data has been reported on an as-received(wet weight)basis I Low Bias Low Bias Rag indicates that the recovery of the[lagged analyte is below the laboratory or regulatory lower control limit. The data user should take note i that this analyte may he biased low 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 MS/MSD was requested,only the LCS data can be used to evaluate such bias. I High Bias High Bias flag indicates that the recovery of the flagged analyte is above the laboratory or regulatory upper control limit. The data user should take note that this analyte may be biased high but should evaluate multiple lines of evidence including the LCS and site-specific MS/hISD data to draw bias conclusions. In cases where no site-specific MSlMSU was requested,only the LCS data can be used to evaluate such bias. Non-Dir. Non-dir.flag(Non-Directional Bias)indicates that the Relative Percent Din'crence(RPD)(a measure of precision)among the MS and MSD darn 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 MS/MSD or indicates poor reproducibility for other reasons. If EPA SW-846 method 8270 is included herein it is noted that the target compound N-nilrosodiphcnylaminc(NDPA)decomposes in the gas chromatographic inlet and cannot be separated from diphcnylamine(DPA). These results could actually represent 1001/9 DPA,10D'✓NDPA or some combination of the two. For this reason,York reports the combined result for n-nitrosodiphcnylamine and diphenylarnine for either of these compounds as a combined concentration as Diphenylamine. If rural PCBs are detected and the target aroelors reported are"Not detected", the Total PCB value is reported due to the presence of either or both Aroalors 1262 and 1268 which are non-target aroclors for some regulatory lists. 2-chloroethylvinyl ether readily breaks dosvm under acidic conditions. Samples that are acid preserved,including standards will exhibit breakdown.The data user should take note. Certification for pH is no longer offered by NYDOH FLAP. Semi-Volatile and Volatile analyses are reported down to the LOD/MDL,with values between the LOD/MDL and the LOQ being"1"Bagged as estimated results. For analyses by EPA SW-846-8270D,the Limit of Quantization(LOQ)reported for benzidinc is based upon the lowest standard used for calibration and is not a verified LOQ due to this compound's propensity for oxidative losses during eximetion/concentration procedures and non-reproducible chromatographic performance. 120 RESEARCH DRIVE STRATFORD,CT 06615 ® 132.02 89th AVENUE RICHMOND HILL,NY 11418 vvvnv.YORKLAB.com (203)325-1371 FAX(203)357-0166 ClientServlces(Page 7 of 8 YORK ANALYTICAL LASCRATCOICS Page of 0 RCBLARCHRCH Da. Field Chain-of-Custody Record 1 2 97RATFORO.CT 06615 >7 . � (2031 325-1371 NOTE.York's Std.Terms&Conditions arc listed on the back side of this document. York Project No. FA%(203)357.01 66 This document serves as your written authorization to York to proceed with the analyses requested and your siparure binds you to York's Std.Terms&Conditions. YOUR Information Report To: Invoice To: YOUR Project ID Turn-Around Time Report Type company Northeast Environmental Company: Same company: Same 306 Fayette Ave Realty RUSH.Same Day Summary Report X 225 Valley Place 566 Westchester Ave RUSH-Next Day r� Summary w Rt/QA sw— y Address Address: Address: Rye Brook NY I__.1 CT RCP Package Mamaroneck NY 10543 Purchase Order No. RUSH-Two Day CTRCP DQA/DUE Pkg ?her,Vo. 914-777-1930 Phone Vo. Phone No. RUSH-Three Day NY ASP A Package Contact Person Dwayne Monaoo Atre rion NJ : Attention: 3473-23C RUSH-Four Day I7 ASP a Package —' DEP Red.Deliv. E-\1a7 Address: Dmonaco@neenviro.com FrStail Address E•�4ail Address: Samples from:CT_NY X NJ Standard(5-7 Days)�; E7,,&Lmic Data ndivrraMrs(EDD) Print Clearly and Legibly. All Information must be complete. Volatiles ml-val tnrrcR Mew Afisc ot� Fia List muse Simple Excel v a y f p 8260 fun ncs 8270 a 25 8082PCB RCRAS TPH GRO Pri.Poll. Corrm%ity NYSDEC EQuIS Samples will NOT be logged in and the turn-around time 624 Site Spec. STARS list 8081 Pest PP13 lia TPH DRO TCL Q8►;<s Reattisity EQuIS(std) clock will not begin until any questions by York are resolved STARS list Nassau Co. MOnly 815lHerb TAL CT ETPH TaL� lgnitabtlity EZ-EDD(EQuls) BTEX Suffolk Co. acids Only Cr RCP CTIS list NY 310.13 Full TCLP Rash Pont NJDEP SRP HazSitc EDD Matrix Codes MIME Ketones PAH list App.IX TAG,I Iiq TPH 1664 Fun,ipp.DC SicacAml. GIS/KEY(std) S- soil T'CLHt Oqp=3►s TAGA4list Site Spec, NJDEPIist AirTO14A Pzt36NR=w Httomalis Other Other-specifF•(od,etc) TAGM list TCLP list CT RCP list SPIPor7ay Taal Air TO15 PatrXGais&r TUX York Regulatory Comparison Samples Collected/Authorized By(Signature) V/W- wastewater CTRCPlkt 5242 TCLlist TCLP Pest Dissolved Air STARS Psr�W-- sn1b. GW- groundwater Arom.on 5022 NJDEP list Herb SP1ParTW Air Excel Spreadsheet ry Ps�3 Acluetu:Tm Cart a<ao the albwmlt Rem<tease fa ml Sergio DW- drinkingwater Halog.only NJDEP list ,Apr IX Chlordane lat$;Ltlfth AirTICs MCOD.7W Name(printed) Air-A•ambictu air App,IX list SPLPcrTCLP TCLP BNA 608 Pest TST13eku• NtsClute NYSCEDoa, Mxsms Air-SV-soil vapor 902 18if Helium TAMIr Sample Identification Dateffime Sampled Sample Matrix Choose Analyses Needed from the Menu Above and Enter Below Gontaincr Dcscri tin s Excavation 05-08-2023 S CP-51 8260 and 8270 2oz.and 4oz.glass jars Presen•fltion 4°(��e h'rozcn HCl McOH FI NUt HrSO Na0H Comments CheckthoeeA tie ble ZnAc Ascorbic Acid Other Temperature Special N Instructianc -•'V/-` •{,1,Q�/ il?pZ� 9;30 on Receipt to (DD Fieldrdlnrod 7j Safn les elinquis �d y Dat lme Samples ived /,, n Datie i ne Co Lab m Filter CG S �3 tS: 'v.�5`� �iP�/ '��C ° Samples Relinquished By Dateffime SanplesRe wed in LAB by Date/Time m J Y rec_DR 19812 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: `' DATE: PERMIT#1 ISSUED: SECT: BLOCK: 1 LOT: LOCATION: �' C � 7 1 , / OCCUPA14cy: _ i ❑ Violation Noted THE WORK IS... [I PAS D ❑ FA ED REINSPECTION ❑ SITE INSPECTION `' I ��� ' � ) -, REQUIRED ❑ FOOTING � ❑ FOOTING DRAINAGE 'J�SV V\ ���. �� Cl•,, 1Cv�� C� ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas � � �C-U •— Zf1� \cJ - ❑ L.P.Gas (( 1 El FUEL TANK(?- ❑ FIRE SPRINKLER ❑ FINAL PLUMBING \ ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER I i I ACo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ll%. � 1 06/02/2022 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 Ext: A/C No 1035 Route 82 ADDRESS: atarkazikis@pfnortheast.com INSURER(S)AFFORDING COVERAGE NAIC N Hopewell Junction NY 12533 INSURERA: 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 THATTHE 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 AUUL1SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx_]OCCUR PREMISES Eaoccurrence $ 100,000 Contractual Liability 25,000 MED EXP An one person) $ A ECP01530828-20 06/11/2022 06/11/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2.000,000 JECT LOC PRODUCTS-COMP/OPAGG $POLICY PRO 2,000,000 OTHER: Professional Liability $ 1,000.000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO _ BODILY INJURY(Per person) $ B OWNED X SCHEDULED BAP1530830 06/11/2022 06/11/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY AUTOS ONLY Per acc dent $ a X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE FFX1530829-20 06/11/2022 06/11/2023 AGGREGATE $ 5.000.000 DED I X1 RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? El ]/A (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 08/16: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 dL'&kxuo _ —1 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(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 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 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"Ia" 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 "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 117 a 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,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: 6/2/22 (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: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Monday, April 24, 2023 12:11 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 04/24/2023 12:10 To: VIL RYE BROOK PRIMARY Transmitted: 04/24/2023 12:11 00001 Ticket: 04243-001-963-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 566 To: Name: WESTCHESTER AVE Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: FRONT OF PROPERTY BOTH SIDES NearSt: DIVISION ST & N RIDGE ST Means of Excavation: BACKHOE 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: 04/27/2023 Depth of excavation: 30 FEET Site dimensions: Length 25 FEET Width 25 FEET Start Date and Time: 04/27/2023 07:00 Must Start By: 05/11/2023 ------------------------------------------------------------------------------ Contact Name: NIKKI BARNABA Company: NORTHEAST ENVIRONMENTAL INC Addr1: 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 Working for: 306 FAYETTE AVENUE REALTY ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA AT&T BELL-VALHALLA / WSCHSTR CONED FIRSTLIGHT FIBER LEVEL 3 COMMUN MCI SUEZ WTR WESTCHESTER i Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Friday, March 31, 2023 2:36 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 03/31/2023 14:36 To: VIL RYE BROOK PRIMARY Transmitted: 03/31/2023 14:36 00007 Ticket: 03313-001-547-OO Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 566 To: Name: WESTCHESTER AVE Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: FRONT OF PROPERTY BOTH SIDES NearSt: DIVISION ST & N RIDGE ST Means of Excavation: BACKHOE 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: 04/05/2023 Depth of excavation: 30 FEET Site dimensions: Length 25 FEET Width 25 FEET Start Date and Time: 04/05/2023 07:00 Must Start By: 04/19/2023 ------------------------------------------------------------------------------ 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 Working for: 306 FAYETTE AVENUE REALTY ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA AT&T BELL-VALHALLA/ WSCHSTR CONED FIRSTLIGHT FIBER LEVEL 3 COMMUN MCI SUEZ WTR WESTCHESTER i D (� § Removal of one (1) 550-gallon No.2 oil UST l� D File permits and notify agencies of intent and scheduling of UST removal. =- 3 �o> 3' Contact "Call Before You Dig", one call utility mark out one week prior to breaking PERMIT# GARAGE ground. Two days prior to breaking ground, a field inspection will be made to SOLI#� 3J ' b � identify any marked underground utilities that may infringe on the excavation VILLAGE OF RYE BROOK area. Mobilize equipment on site and set up perimeter of work area with proper BUILDING DEPARTMENT_j PAT!—XT AP j 2�23 cautionary devices to ensure public safety while work is being conducted. The UST will be excavated and cleared of overburdens. All piping (i.e. vent, fill, BUILDING viva Rye Brook,NY suction and return, etc.) will be flushed leading back to the UST. Piping will then be disassociated from the UST and either removed if accessible or capped subsurface. The UST will then be properly vented and metered with a Lower Explosive (LEL) meter. Once proper LEL is achieved, the tank will then be cut opened, cleaned of all its contents and deemed gas free. The tank contents will be transported to a permitted disposal facility. Extend the excavation to at least (2) feet around the perimeter of the UST to allow sufficient clearance for removal. Remove UST from excavation and dispose of offsite at a metal recycling facility. Inspect UST excavation for release of petroleum using visual and/or Photo FILE COPY ionization Detection meter (PID) methodology. If contaminated soil is present, the client and proper agencies (i.e. NYS DEC, WCHD, etc.) will be immediately No. 566 notified. Petroleum contaminated soils will be properly excavated and staged on poly sheeting in preparation for disposal. If no contaminated soil is present, the excavation will be backfilled with clean fill and raked to a rough grade. All proper documentation of the tank removal(s) will be provided to the client and local governing agencies. Installation of one(1)275-gallon#2 fuel AST in the basement of the Residence The basement will be surveyed for the proper placement of the AST. Installers will keep in mind the required distance from any open flame. Utilization of 2" OIL FIRED FURNACE schedule 40 steel pipe with NPT fittings for the vent and fill pipe. Vent and fill to be piped to the exterior of the structure with weather tight terminations. Exterior $, vent and fill pipe terminations will be at least two (2) feet away from any openings. _IV An audible vent overfill alarm will be installed at the tank. '/2" coated copper tubing AST 14 will be used to feed fuel oil to the burner with the required in line safety valves. Any foundation penetrations will be repaired in a manor to prevent ground/surface 4, water from entering building. *GENERALIZED SITE SKETCH; Contractor: NOT TO SCALE Northeast Environmental Inc. 225 Valley Place Site: Mamaroneck NY 10543 306 Fayette Ave Realty (914) 777-1930 566 Westchester Ave WC License No. WC-14361-1-103 WESTCHESTER AVE Rye Brook NY 10573 NYSDEC License No.3A-500