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HomeMy WebLinkAboutMP23-155 QyE BR � . 19 � pig VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J.Bradbury www.ryebrookny.gov TRUSTEES BUILDING&FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M.Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE August 11,2025 Arbors Homeowners Association 1731/2 Ivy Hill Crescent Rye Brook,New York 10573 Re: 173 1/2 Ivy Hill Crescent,Rye Brook,New York 10573 Parcel ID#: 129.76-1-1 As per the Certification letter from Enviroshield Inc.dated December 13,2023,the removal of an underground oil tank under Mechanical Permit#23-155 issued on 10/18/2023 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to BUILDING DEPARTMENT D ItV A.wmSTAM DITUMMG INSIM(MOR VILLAGE OF RYF, BROOK 13 Com ENFORCIUM(MV 01,111Clin 938 King SITect-Rye.Brook,NY '10573 (91.4)939-0t"lflwx.(914)939-5801 -- - - -- -- -- - - - IT - - - -- - -- - - - - - - - - - - - - INSPECTIONR.L.'r-al ADDRiss CL� DA:rF,:—I? NiRMIT# BLOCK:_-/ LOT: LocAviom OCCUPANCY: 0 Violation NoW UIE WORK is... P'*PASSED 11 FAILED /REINSPECTION 0 SIT(.+INSPECTION REQUIRED 11 FOOTING El FOOTING DkAmmat 0 FOUNDATION 0 UNI)ERGROUND PIUMIIY.N(. NMRS ON INSPECTION: 0 ROUGH PLUMBING 0 ItOUGH FRAMING 0 INSULATION 0 Naural Girlis 0 Ut Gam fir00i'tm - C4 1.0 I ir.'.t!A-NK 0 Fml, K SmKIN LjjiR, 0 FINAL PLUMBING 0 CRO-818 CONNECTION r I 0 J."INAJ., 0 ALL—_ Z-1c t -'SS u 0 Q Zm W Y J� �Q ��• +902 '�' BUILDING DEPARTMENT ❑BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑ VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 ❑ASSISTANT BUILDING INSPECTOR (914) 939-0668 FAx(914)939-5801 - - - - - - - - - - - --- - - - - - - - INSPECTION REPORT - - - - - - - - --- - - - - - - - - - - ADDRESS: DATE: PERMIT# ISSUED:^(1,i SECT: BLOCK: L LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMING NOTES ON INSPECTION: ❑ ROUGH PLUMING _ 0 ROUGH FRAMING 0 INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING cJ ❑ FINAL ❑ OTHER s : Ln M w M N N w v N � a Q C 00 A w O x a x Cf) ow v Z 0AOo ° s v� �1 C p W ON Ln Ir , 00 co C'7 w �, w a v o z Uz � b v � ° � A N U Wd oto' v v M zz .0 cu a a W w O � '^ o � ° a 0 ' U � o © Z z � ,� v PO i..� o O o � a vs y a. p M G7 W 0 A p �" . °' �"+ w H o o b xcn BUILD MENT p [ECEJWIE VIL E OFRY OOK 938 KING t" ET RI'E BR ,NY 10573 OCT 17 2023 -0 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Application for Permit to Remove, Abandon and/or Install Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT Approval Date: OCT 2023 Permit Fee: S Approval Signature: Other: Disapproved: fees arc non-reCundablc) 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: Remova , bandonment, r Installation: $185.00 per Tank. 5. Dig Safely New York# (dial 811): 3 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,Curb 3L- i t• Z�>7.3 ,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 M� I. Address: M 3 �z� `'`� "'tik Lca ,, 1 C14St.�iT SBL: 1Q%76-1-1 Zone: 2. Property Owner&Address: 'QsR amp S Phone#: "tl'� ' `'i39 - -`{ Cell#: email: 3. Contractor&Address: ;��2n�ti,1 Wit- `�jo {�yC�f=►tt Sr;rtTics���,eD lam. CYbblj Phone#: Cell#: email: ��� �n�':�`=S� •'� ,�'►'� 4. Applicant: nw bSk"LA-D �(' Phone#: °'�' 3�6 G6Lk`fi Cell#: email: LL) 't-b 5. Indicate Fuel Type: Fuel Oil(-)"- L.P. Gas( ) •Gasoline( )•Other( ): 6. Number and Capacity of each Tank: 3oo_ (oAAL_^ 7. Exact Location(s)of each Tank: t 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Dip.n i C I BQ r-,� ,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 A O h tart ;,:d,.n-� for the legal owner and is duly authorized to snake 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 01_4-obc r" day ofSt2 m h e to .20 day of 11 20 023 Signature of Property Owner Signature of Applicant f Prinq9lie of Pro pert O er Print ame of Applicant i Notary Publi Notes Public This application must be properly completed 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. DANIELLY NOVOLI-SANTOS Notary Public,State of Connecticut My Commission Expires May 27,2026 [AURA J DELUCA Notary Public-State of New York N0.01DE4998586 Qualified In Westchester County My Comm. Expires June 29, a A/12/2021 } v �� �JSoc,����^ � 1l1�., � �,� c��� - � 5 u -r�,� � a _ .�- � 5 5 5 __ ���" "� �1 �5��� �� � J � �� � P�� , G��-r� 1 ������� Clean, Preserve...Protect Environmentalecialists Specialists 5 1w�O December 13, 2023 Mr. Dominic Falcone Service Manager Westmore Fuel D S' 86 North Water Street Greenwich, CT 06830 `� � AUG - 8 2025 Subject: Tank Removal, November 28, 2023 Arbors Homeoxvners Association BUS AGE pF R-Y 173-t/2 Ivy Hill Lane SOLOING DEpARTP%00 Rye Brook, New York MENT Dear Mr. Falcone: On November 28, 2023, Enviroshield staff completed the removal of one underground 500-gallon fuel oil tank located at the subject property. The former location of the tank and progression of the tank removal process is shown in Site Photographs enclosed with this letter. Prior to the removal of the tank, all remaining liquid, sludge sediment and rinse water were pumped and cleaned from the tank for disposal by Enviroshield, Inc., a State of New York licensed waste transporter at Safety-Kleen Systems, Inc., 120 Forbes Avenue, New Haven, Connecticut. Attached is a copy of the waste transport bill of lading. The top of the tank was exposed using an excavator and enough soil was removed from the excavation to pull the tank from the ground. The tank was thoroughly inspected for rust, cracks, holes, or other physical characteristics,which could have been cause for a fuel release. No evidence of a fuel release was observed. Soil samples obtained from the tank grave were screened using the Photo Ionization Detector (PID); the results of the field screening indicated no evidence of a fuel release. A soil sample was collected from the bottom of the excavation, in the area presumed to be most impacted, and submitted to a Complete Environmental Testing (CET), a State of New York certified environmental laboratory for analysis by STARS 8260 and 8270. Consistent with New York State — Department of Environmental Conservation (NYS-DEC) requirements,these are the required analyses for oil tank removal in New York State. As indicated in the attached Complete Environmental Testing (CET) report #23K0771 (and the attached Table 1 — NYSDEC CP-51 Regulatory Comparison to Soil Sample Result) the reported results for the sample tested were all below the current NYS-DEC Guidance Values for the constituents tested. CT Home Improvement Contractor HIC.0582591 —Westchester Home Improvement License WC-27310-H14 250 Moffitt Street, Stratford, CT 06615 (203) 380-5644 FAX(203) 378-8736 www.enviroshield.com- info@enviroshield.com Page 2 of 2 December 13, 2023 Arbors Homeowners Association 173-1/2 Ivy Hill Crescent Rye Brook,New York The tank was transported, cleaned, and disposed of at P.C. Metals, Inc., 270 Central Avenue, Bridgeport, Connecticut in a manner consistent with industry standards and in compliance with all Local, State and Federal Codes and Regulations.The tank grave was backfilled and brought to grade. Based on visual observations, PID field screening and laboratory analysis, Enviroshield found no indication of the tank system's failure. If you have any questions concerning any of this work, please do not hesitate to contact me at your earliest convenience at (203) 380-5644. Sincerely, Enviroshield Inc. J= aL, Leonard Bochicchio Senior Project Manager Enclosures cc: Village of Rye Brook Building Department via email stevefews@rycbr000k.org Permit #MP23-155 Site Photographs Enviroshield 00Removal ArborsBrook, 'P • • 1 of • • of • • • 500-gallon tank.Visiblepipe. i Site Photographs Enviroshield 500-gallon Underground Tank Removal Arbors Homeowners Association, 173'/: Ivy Hill Crescent, Rye Brook, New York 10573 Jw- �7 a •�`�` Q�, Photo 2 of 5.Area above tank excavated and exposed. Site Photographs Enviroshield 500-gallon Underground Tank Removal Arbors Homeowners Association, 173% Ivy Hill Crescent, Rye Brook, New York 10573 _ t t, i '1 j 1 Photo 3 of 5.Tank grave. PhotographsSite Enviroshield 00Underground Arbors • . Brook, Photos 4 and 5.Tank has been removed;former tank grave area backfilled. n Clean, Preserve...Protect iw � Environmental Specialists 4 m ��-- BILL OF LADING DESCRIPTION: Check aciplicable waste ID: (NA1993) Fuel oil /diesel/waste oil — (UN1203) Gasoline (UN1223) Kerosene Off-Specification commercial chemical product fuel (applicable in CT only) _ Waste, NON-RCRA, Liquid, N.O.S. (Oil/Water mix) Non-Haz, None (applicable in NY State) Water only (no fuel waste). Date: / / 7(? Z Total Quantity: gallons � 1 f 1� Generator Name: LNfST rnl y6 Site Address: ' /" Al/ City: IL�r�f'G K- State: ) u Zip: Telephone: 3 - `E' �V W•O #: Generator/Agent for Signature: Transporter: Enviroshield, Inc., 250 Moffitt Street, Stratford, CT 06615 203-380-5644 Connecticut: CT-HW-495; New York: CT-095; Westchester County NY: WC-27310-H14; Connecticut H.I.C. 0582591 Driver Signature: Destination/Facility: Tradebe Treatment and Recycling of Bridgeport, 50 Cross Street, Bridgeport,CT 06610 X Safety-Kleen Systems, Inc., 120 Forbes Avenue, New Haven,CT 06512 Approval Code: (SEE BACK FOR HAZARD/SAFETY/RESPONSE DETAILS) FATemplatesMisc1801 of Lading Liquid.docx P.O. Box 1296. 250 Moffitt St., Stratford,CT 06615 (203)380-5644 (800)394-2268 FAX(203)378-8736 www enviroshield.com i-nhi@_-e.nviroshield.com Table 1—NYSDEC CP-51 Regulatory Comparison to Soil Sample Result Client: Enviroshield,Inc. Project: The Arbors,1731/2Ivy Hill,Crescent Rye Brook,NY Matrix: Soil Collect Date: 11/28/2023 Lab Number 23KO771-01 Sampled Name Tank Grave Sampled Date 11/28/2023 Parameter I-CASNumber I Value Qual EPA 8260C u d Meth -t-But l Ether(MTBE) 1634-04-4 NA <6.8 Benzene 71-43-2 60 <6.8 Toluene 108-88-3 700 <6.8 Ethylbenzene 100-41-4 1000 <6.8 m+p Xylenes XYLMP 260 <14 o-Xylene 95-47-6 260 <6.8 isopropylbenzene 98-82-8 2300 <6.8 n-Pro lbenzene 103-65-1 3900 <6.8 1,3,5-Trimethylbenzene 108-67-8 8400 <6.8 tert-Butylbenzene 98-06-6 5900 <6.8 1,2,4-Trimethylbenzene 95-63-6 3600 <6.8 sec-But lbenzene 135-98-8 11000 <6.8 4-Isopropyttoluene 99-87-6 10000 <6.8 n-Butylbenzene 104-51-8 12000 <6.8 Naphthalene 91-20-3 12000 <14 EPA&MD (uglkg d Acenaphthene 83-32-9 20000 <120 Acenaphthylene 208-96-8 100000 <120 Anthracene 120-12-7 100000 <120 Benzo a Anthracene 56-55-3 1000 160 Benzo(a)pyrene 50-32-8 1 1000 180 Benzo(b)fluoranthene 205-99-2 1000 220 Benzo ,h,i a lene 191-24-2 100000 <120 Benzo(k)fluoranthene 207-08-9 800 130 Chrysene 218-01-9 1000 210 _ Dibenz a,h anthracene 53-70-3 330 <120 Fluoranthene 206-44-0 100000 310 Fluorene 86-73-7 30000 <120 Indeno(1,2,3-cd)p rene 193-39-5 500 120 I Phenanthrene 85-01-8 100000 <120 rene 129-00-0 100000 280 Naphthalene 91-20-3 12000 <120 SM 2540 G % Percent Solids 7S NA 86 Notes: Report Generated on:12/12/2023 2:39:46 PM Qualifiers: Exceeds CP-51 Criteria= Reported present but not Exceeding CP-51 Criteria= 80 Lupes Drive Tel:(203)377-9984 Stratford,CT 06615 Fax:(203)377-9952 e-mail:cetlLcetlabs.com COMPII1f INVIPONMIN141 IISiING.ING Client: Mr. Richard Louis Enviroshield,Inc. P.O. Box 1296 Stratford,CT 06615 Analytical Report CET# 23KO771 1 ",Ntrttvettsnar 4tova-,os� . Report Date:December 12,2023 Project: The Arbors, 173 1/2 Ivy Hill,Crescent Rye Brook,NY PO Number:29895 ONO Connecticut Laboratory Certificate:PH 0116 New York NELAP Accreditation: 11982 Massachusetts Laboratory Certificate:M-CT903 Pennsylvania Laboratory Certificate:68-02927 Rhode Island Laboratory Certificate: 199 Page 1 of 11 CET#:23KO771 Project:The Arbors, 173 1/2 Ivy Hill,Crescent Rye Brook,NY SAMPLE SUMMARY The sample(s)were received at 1.2°C. This report contains analytical data associated with tbllowing samples only Sample ID Laboratory ID Matrix Collection Date/Time Receipt Date Tank Grave 23KO771-01 Soil 11/28/2023 11:00 11/29/2023 Analyte: Percent Solids ISM 2540 GI Analyst:DGG Matrix:Soil Datefrime Laboratory TD Client Sample TD Result RL Units Dilution Batch Prepared Analyzed Notes 23KO771-Ot Tank Grave 96 LO % 1 BK33022 11/30/2023 11/30/2023 14:10 Complete Environmental Testing,Inc. 80 Lapes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.ceilabs.com Page 2 of 11 CET#:23KO771 Project:The Arbors, 173 1/2 Ivy Hill,Crescent Rye Brook,NY Client Sample ID Tank Grave Lab ID: 23KO771-01 Semivolatile Organics Analyst:STP Method: EPA 8270D Matrix:Soil Result RL Date/Timc Analyte (ug/kg dry) (ug/kg dry) Dilution Prep Method Batch Prepared Analyzed Notes Naphthalene ND 120 1 EPA 3545A BL30615 12/06/2023 12/11/2023 17:19 Acenaphthylene ND 120 1 EPA3545A BL30615 12/06/2023 12/11/2023 17:19 Acenaphthene ND 120 1 F.PA 3545A BL30615 12/06/2023 12/11/2023 17:19 Fluorene ND 120 1 EPA 3545A B1.30615 12/06/2023 12/11/2023 17:19 Phenanthrene ND 120 1 EPA 3545A BL30615 12/06/2023 12/11/2023 17:19 Anthracene ND 120 1 EPA3545A BL30615 12/06/2023 12/11/2023 17:19 Fluoranthese 310 120 1 EPA 3545A BL30615 12/06/2023 12/11/2023 17:19 Pyrene 280 120 1 EPA 3 545 A 1300615 12/06/2023 12/11/2023 17:19 Benzo[alanthracene 160 120 1 EPA 3545A BL30615 12/06/2023 12/11/2023 17:19 Chrysene 210 120 1 EPA3545A BL30615 12/06/2023 12/11/2023 17:19 Benzolbinuoranthene 220 120 1 EPA3545A BL30615 12/06/2023 12/111202317:19 Benzo[kllluorantheoe 130 120 1 EPA 3 545 A BL30615 12/06/2023 12/11/2023 17:19 Benzo[alpyrene 180 120 1 EPA 3545A BL30615 12/06/2023 12/11/2023 17:19 lnden911,2,3-ed1Pyrene 120 120 1 EPA3545A BL30615 12/06/2023 12/11/2023 17:19 Dibenz[a,h]anthracene ND 120 1 EPA3545A BL30615 12/06/2023 12/111202317:19 Benzo[g,h,i]perylene ND 120 1 EPA3545A BL30615 12/06/2023 12/11/2023 17:19 Surrogate:Nitroben_ene-dS 51.3% 30-130 BL30615 12/06/2023 1211112023 17:79 Sunvgate.1-Fluumbiphenl 52.5% 30-130 BL30615 12/06/2023 1211112023 17:19 Surrogate. Terphenyl-d14 62 7% 30-130 BL30615 12/06/2023 1211112023 17:19 Volatile Organics Analyst:MJH Method: EPA 8260C Matrix: Soil Result RL Date[Time Analyte (ug/kg dry) (ug/kg dry) Dilution Prep Method Batch Prepared Analyzed Notes Methyl-t-Butyl Ether(MTBE) ND 6.8 2.35 EPA 5035A-L BL30134 12/01/2023 12/01/2023 21:37 Benzene ND 6.8 2.35 EPA5035A-L B1.30134 12/01/2023 12/01/2023 21:37 Toluene ND 6.8 2.35 EPA 5035A-L BL30134 12/01/2023 12/01/2023 21:37 Ethylbenzene ND 6.8 2.35 EPA 5035A-L BL30134 12/01/2023 12/01/2023 21:37 m+p Xylenes ND 14 2.35 EPA 5035A-L BL30134 12/01/2023 12/01/2023 21:37 o-Xylene ND 6.9 2.35 EPA5035A-L BL30134 12/01/2023 12/01/2023 21:37 lsopropylbenzene ND 6.8 2.35 EPA5035A-L BL30134 12/01/2023 12/01/2023 21:37 n-Propylbenzenc ND 6.8 2.35 EPA 5035A-L BL30134 12/01/2023 12/01/2023 21:37 13,5-Trimethylbenzene ND 6.8 2.35 EPA5035A-L BL30134 12/01/2023 12/011202321:37 '1 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•Nww.cetlabs.com Page 3 of 11 CET#:23K0771 Project:The Arbors, 173 1/2 Ivy Hill,Crescent Rye Brook,NY Client Sample ID Tank Grave Lab ID: 23KO771-01 Volatile Organics Analyst: MJH Method: EPA 8260C Matrix: Soil Result RL Date/Time Analyte (ug/kg dry) (ug/kg dry) Dilution Prep Method Batch Prepared Analyzed Notcs tert-Butylbenzene ND 6.8 2.35 EPA 5035A-L BL30134 12i01/2023 12i01/2023 21:37 1,2.4-Trimcthylbenzenc ND 6.8 2.35 EPA 5035A-L BL30134 12/01/2023 12/01/2023 21:37 sec-Burylbenzene ND 6.8 2.35 EPA 5035A-L BL30134 12/01/2023 12/01/2023 21:37 4-Isopropyltoluene ND 6.8 2.35 EPA5035A-L BL30134 12/01/2023 12/01/2023 21:37 n-Butytbenzene ND 6.8 2.35 EPA5035A-L BL30134 12/01/2023 12/01/2023 21:37 Naphthalene ND 14 2.35 EP.A 5035A-L BL30134 12/01/2023 12/01/2023 21:37 Surrogate:1,2-Dichloroethane-d4 80.7% 70-130 BL30134 12/01/2023 I210112023 Z1:37 Simogate:Toluene-d8 96.2% 70-I30 BL30134 12/0t/2023 1210112023 21:37 Surrogate:4-Bromofluorobenzene 106% 70-130 BL30134 12/01/2023 1210112023 21:37 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetiabs.com Page 4 of 11 CET#:23K0771 Project:The Arbors, 173 1/2 Ivy Hill,Crescent Rye Brook,NY QUALITY CONTROL SECTION Batch BL30134-EPA 8260C Result RL Spike Source %Rec RPD Analyte (ug!kg) (ug/kg) Level Result %Rec Limits RPD Limit Notes Blank(BL30134-BLKI) Prepared:12/1/2023 Analyzed:12/1/2023 Methyl-l-Butyl Ether(MTBE) ND 2.5 Benzene ND 2.5 Toluene ND 2.5 Ethylbenzenc ND 2.5 m+p Xylenes ND 5.0 o-Xylene ND 2.5 Isopropylbenzene ND 2.5 n-Propylbenzene ND 2.5 1,3,5-Trimethylbenzene ND 2.5 tcrt-Butylbenzene ND 2.5 1,2,4-Trimethylbenzene ND 2.5 sec-Butylbenzene ND 2.5 4-Isopropyltoluene ND 2.5 n-Butylbenzene ND 2.5 Naphthalene ND 5.0 Surrogate:1,2-Diehloroethane-d4 85.2 70-130 S+rmrgare:TJurne-JR 107 70-130 Surrogate:4-BmmoJluorobemene 103 70-130 LCS(BL30134-BSI) Prepared:12/1/2023 Analyzed: 12/112023 Methyl-t-Butyl Ether(MTBE) 40.5 2.5 50.000 81.0 70-130 Benzene 50.5 2.5 50.000 101 70-130 Toluene 48.2 2.5 50.000 96.3 70-130 Ethylbenzene 53.7 2.5 50.000 107 70-130 m+p Xylenes 105 5.0 100.000 105 70-130 o-Xylene 51.7 2.5 50.000 103 70-130 Isopropylbenzene 46.0 2.5 50.000 92.0 70-130 n-Propylbenzene 48.3 2.5 50.000 96.5 70-130 1,3,5-Trimethylbenzene 49.7 2.5 50.000 99.4 70-130 tert-Butylbenzene 48.4 2.5 50.000 96.8 70-130 1,2,4-Trimethylbenzene 47.8 2.5 50.000 95.7 70-130 sec-Butylbenzene 47.5 2.5 50.000 95.0 70-130 4-Isopropyltoluene 47.9 2.5 50.000 95.8 70-130 n-Butylbenzene 45.7 2.5 50.000 91.4 70-130 Naphthalene 57.6 5.0 50.000 115 70-130 Surrogare:l.7-Dirnlorvethane-d4 102 70-130 Sun»gate:Tolume-dR 90R 70-130 Surrogate:4-BromoJluorobenzene 85.1 70-130 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615-Tel:203-377-9994•Fax:203-377-9952•www.cetlabs.com Page 5 of 11 CET#:23KO771 Project:The Arbors, 173 1/2 Ivy Hill,Crescent Rye Brook,NY Batch B1.30615-EPA 8270D Result RL Spike Soul-cc %Rcc RPD Analyte (ug/kg) (ug/kg) Let,cl Result %Rcc Limits RPD Limit Notes Blank(BL30615-BLKI) Prepared:12/6/2023 Analyzed: 12/11/2023 Naphthalene ND 100 Acensphthylene ND 100 Acenaphthene ND 100 Fluorene ND 100 Phenanthrene ND 100 Anthracene ND 100 F'luoranthene ND 100 Pyrene ND 100 Benzo[a]anthraccnc ND t00 Chrysene ND 100 Benzo[blFluoranthene ND 100 Benzo[klfluoranthene Nv'D 100 Benzo[a]pyrene ND 100 ludeno[1,2.3-cd]pyrene ND 100 Dibcnz[a,h]anthraccnc ND 100 Benzo[g,hJ)perylene ND t00 Surrogate:Niuobenzenc-d5 68.9 30-130 Surrogate:2-Fluotobiphenyl 73.3 30-130 Snm,gate:Ter7,heay1-d14 58.3 30-130 LCS(BL30615-BS1) Prepared:12/6/2023 Analyzed: 12/11/2023 Naphthalene 2540 100 4,000.000 63.4 40-140 Accnaphthylcne 2640 100 4,000.000 66.1 40-140 Acenaphthene 2730 100 4,000.000 68.3 40-140 Fluorene 2820 100 4,000.000 70.5 40-140 Phenanthrene 2860 100 4,000.000 71.6 40-140 Anthracene 2910 100 4,000.000 72.6 40-140 Fluoranthene 2990 100 4.000.000 74.8 40-140 Pyrene 2990 100 4,000.000 74.7 40-140 Benzo[a]anthracene 2930 100 4,000.000 73.3 40-140 Chrysene 3020 100 4,000.000 75.4 40-140 Benzo[b]fluoranthene 2720 100 4,000.000 67.9 40-140 Benzo[k]fluoranthene 3130 100 4,000.000 79.2 40-140 Bcnzo[a]pyrene 2850 100 4,000.000 71.2 40-140 Indeno[1,2,3-cd]pyrene 2740 100 4,000.000 68.4 40-140 Dibenz[a,hlauthracene 2710 100 4,000.000 67.8 40-140 Benzo[g,h,i]perylene 2590 100 4,000.000 64.8 40-140 Surrogate:Nilrohewene-d5 75.9 30-130 Surrogme:2-Fluorohiphenyl 79.8 30-130 Surrogate:Terphem1414 68.9 3n-130 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetiabs.com Page 6 of 11 CE"r#:23K0771 Project:The Arbors,173 1/2 Ivy Hill,Crescent Rye Brook,NY SO Lupes Drive *ET Tel:(203)377-9984 Stratford,CT06615 COMP1111 iNVIRONMINiAI IISHNUNG Fax:(203)377-9952 email:cetI cetlabs.com Quality Control Definitions and Abbreviations Internal Standard(IS) An Analyte added to each sample or sample extract. An internal standard is used to monitor retention time,calculate relative response,and quantify analytes of interest. Surrogate Recovery The%recovery for non-target organic compounds that arc spiked into all samples. Used to determine method performance. Continuing Calibration An analytical standard analyzed with each set of samples to verify initial calibration of the system. Batch Samples that are analyzed together with the same method,sequence and lot of reagents within the same time period. ND Not detected at or above the specified reporting limit. RL RL is the limit of detection for an analyte after any adjustment made for dilution or percent moisture. Dilution Multiplier added to detection levels(MDL)and/or sample results due to interferences and/or high concentration of target compounds. Duplicate Result from the duplicate analysis of a sample. Result Amount of analyte found in a sample. Spike Level Amount of analyte added to a sample Matrix Spike Result Amount ofanalyte found including amount that was spiked. Matrix Spike Dup Amount of analyte found in duplicate spikes including amount that was spike. Matrix Spike%Recovery °/n Recovery of spiked amount in sample. Matrix Spike Dup%Recovery %Recovery of spiked duplicate amount in sample. RPD Relative percent difference between Matrix Spike and Matrix Spike Duplicate. Blank Method Blank that has been taken through all steps of the analysis. LCS%,Recovery Laboratory Control Sample percent recovery. The amount of analyte recovered from a fortified sample. Recovery Limits A range within which specified measurements results must fall to be compliant. CC Calibration Verification Flags: H- Recovery is above the control limits L- Recovery is below the control limits B- Compound detected in the Blank P- RPD of dual column results exceeds 40% #- Sample result too high for accurate spike recovery. Connecticut Laboratory Certification PI10116 New York N ELAP Accreditation 11982 Massachussets Laboratory Certification M-CT903 Rhode Island Certification 199 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetiabs.com Page 7 of 1171 CET#:23KO771 Project:The Arbors, 173 1/2 Ivy Hill,Crescent Rye Brook,NY All questions related to this report should be directed to David Ditta.Timothy Fusco,or Robert Blake at 203-377-9984. Sincerely. This technical report was reviewed by Robert Blake z4j A1014k fZ �1 (a T..' David Ditta Project Manager Laboratory Director This report shall not be reproduced except in full,without the written approval of the laboratory Report Comments: Sample Result Flags: E-The result is estimated,above the calibration range. H-The surrogate recovery is above the control limits. L-The surrogate recovery is below the control limits. B-The compound was detected in the laboratory blank. P-The Relative Percent Difference(RPD)of dual column analyses exceeds 40%. D-The RPD between the sample and the sample duplicate is high. Sample Homogeneity may be a problem. +- The Surrogate was diluted out. *Cl-The Continuing Calibration did not meet method specifications and was biased low for this analyte. increased uncertainty is associated with the reported value which is likely to be biased low. *C2-The Continuing Calibration did not meet method specifications and was biased high for this analyte. Increased uncertainty is associated with the reported value which is likely to be biased high. *F 1-The Laboratory Control Sample recovery is outside of control limits. Reported value for this analyte is likely to be biased on the low side. *F2-The Laboratory Control Sample recovery is outside of control limits. Reported value for this analyte is likely to be biased on the high side. *I-Analyte exceeds method limits from second source standard in Initial Calibration Verification(TCV). No directional bias. All results met standard operating procedures unless indicated by a data qualifier next to a sample result,or a narration in the QC report. For Percent Solids,if any of the following prep methods(3050B,3540C,3545A,3550C,5035 and 9013A)were used for samples pertaining to this report,the percent solids procedure is within that prep method. Complete Environmental Testing is only responsible for the certified testing and is not directly responsible for the integrity of the sample before laboratory receipt. ND is None Detected at or above the specified reporting limit Reporting Limit(RL)is the limit of detection for an analyte after any adjustment made for dilution or percent moisture. All analyses were performed in house unless a Reference Laboratory is listed. Samples will be disposed of 30 days after the report date. Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 8 of 11 CET#:23 K0771 Project:The Arbors.173 1/2 Ivy Hi]l,Crescent Rye Brook,NY CERTIFICATIONS Certified Analyses included in this Report Analyte Certifications EP4 8260C in Snil Methyl-i-Butyl Ether(MIKE) CT.NYTA Benzene CT,NY,PA Toluene CT.NY,PA Ethylbenzem CT.NY.PA m+p Xylenes CT,NY,PA o-Xylcnc CT,NY,PA fsopropylbenzene CT,NY,PA a-Propylbenzene CT.NY.PA 0,5-Trtmcthylbenzene CT,NY,PA ten-Butylbenzene CT,NY,PA 1,2.4-Trimethylbenzene CT.NY,PA scc-Butylbenzene CT,NY,PA 4-Isopropy ltoluenc CT,N Y,PA n-Butylbenzene CT.NY.PA Naphthalene CT.NY.PA EPA 8270D in Soil Naphthalene CT,NY,PA Acenaphthylcnc CT,NY,PA Acenaphthenc CT.NY.PA Fluorenc CT,NI,PA Phenanthrene CT,NY,PA Anthracene CT.NY.PA Fluoranthene CT,NY,PA Pyrene CT,NY,PA Benzo[a]anthracene CT.NY,PA Cluysene CT,NY,PA Bcnzo[blfluoranthcnc CT,NY,PA Benzo[klfluoranthenc CT.NY,PA Benzo[alpyrene CT.NY,PA I ndcno[1,2,3-cd]pyrcnc CT,N Y,PA Dibenz[a,hlanthracenc C'I'.NY,PA Benzo[g,h.ilperylcne CT.NY,PA SM 2540 G in Soil Percent Solids CT Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 9 of 11 CET#:23KO771 Project:The Arbors,173 1/2 Ivy Hill,Crescent Rye BTOOk,NY Complete Environmental Testing operates under the tbllowing certifications and accreditations Code Description Number Expires CT Connecticut Public Health PH0116 09/30/2024 NY New York Certification(NELAC) 11982 04/0112024 PA Pennsylvania DEP 68-02927 05/31/2024 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,Cf 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 10 of 11 N 31ON '1NOO d0 N 1V1O1 N O M v a ❑ LL c 21 c H U. ` c S � o ; ¢ 1 cm ❑ E O t) a in C O m a a E Q ¢ m m Y ¢ ❑ ❑ m c0 ? 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IP4 �. z O d 0- q a r � o [ 00 V J W ;:� '. 0. co u :: O O z V W Vr ^ O C p b a��i apiO4*4 ONO 94 H �1 N �•M A A z �W �z7 x .80 a pp U a W M V� M V � '� � Q � E cn � � a� O w ►.� U N 1.4 W a o a o a o .° � x =' b v tm W :' O a, o v H U 0 Z z U t c� 0C .� a.� T Y1 o u o b e -14 � r �� tl ED BUILDING DEPAR"I.1\IENT ECE V VILLAGE OF Rl'E•BRooK 938 KING S'i•Iti..Er Ri•E BROOK,Nl' 10573 OCT 17 2023 (91.4)93�-1►66K r P0068 VILLAGE OF RYE BROOK www.r v- BUILDING DEPARTMENT Application for Permit to Remove, Abandon and/or Install Fuel Storage Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY PERMIT r,: — 5 C► '02' �J Approval Date: O _ - Pcrmit Fee: S Approval Signature: _ _ - Other: Disapproved: (Ices are nun-rclundablc) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: I. Application Completed by Bondcd, 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 7# U26.3 /or NY State Workers Compensation Waiver) 4. Fcc per Tank: Retnov:t === r Installation: $185.00 per Tank. 5. Dig Safely New York#(dial 81 1): Ia 11,3 -Z o% - 3'31 - C e: 6. Inspection by Building Department for removal abandonment and/or installation. 7. Submit all Manilcsts& Reports(after work has been completed). 8.Certificate of Compliance will be provided when all requirements are fulfilled. ***}*#***k*#*#k*###tt**###*#*###t*#*##***##k*#*****##*#k##*****#**##kt***AA*#*#***#A**k****#****#***#* Application dated,OCe�3�z 11• Z�L3 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. ******AA**##*t**####A*#*************#*****#*#t}k* *****}}#}}#*k*******#**#**********#*#*#kt*******##A* Indicate Permit Type: Installation( )• Removal Abandonment( Above Ground ( )• Buried in Ground('< I. Address: -�+13 �z-5�+� L[s-t`t C1�St_�.T SBL: ,. Property Owner&Address: -�C3o-S ''^�- '`�^S �SSC:C %A' e ` Phone 4.. ""%"�. N39 - Cell#: email: 3. Contractor&Address: G,�,2oJti,� �r.t '�7o M•Lf-�s� Sr;TLtLT Tin-TEA l�r �bdlj Phone k: Cell r;: - ---- email: 5.��C Er�•�..51,..�..o ,t,�r 4. Applicant: �G�� '¢os�•``�_ti'� r Phone h: Cell N: - - email: 5. Indicate Fuel'I ype: Fuel Oil(-I"- L.P.Gas( )•Gasoline( )•Other( ): 6. Dumber and Capacity of each Tank: �joo- (o�U� v n D<u-�Co.�D'�a-•� 7. Exact Location fs)o each 'Tank: Q.Sh�' Nc,a& �`L 6\0ti AA_A- br 8/12."2021 QRC�j� W BUILDING DEPARTMENT /1S Bim.DINo INSPWMR VILLAGE OF RYE BROOK l o VIUAGE ENGNM 938 KING STREET RYE BROOK,NY 10573 ❑ASSISTANT BUimm INSPECTOR (914)939-0668 FAx(914)939-5801 - - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - -- - - - -- - - ADDRESS: 1 1c�s �T; 1 l� IZy PE mT# ISSUED: i�ECT' BLOCK: 14 LOCATION: �(� c01A 'l h<�AA "-i l c u, G� ( �ljJ t40 CUPANCY: !� 0 VIOLATION NOTED THE WORKIS... .,-d ACCEPTED ❑ REJECTED/REINSPECTION 0 SITE INSPECTION REQUIRED ❑ FOOTING 0 FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: 0 ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS 0 L.P.GAS ,CY'FUEL TANK 0 FNxE$PRWKLER ❑ FINAL PLumBiNG 0 FINAL o OTHER �gA T.., F �"�,,. 7'" ...,�,.;�y '���'a •? A ``:� ���� 1 � It :. � 1 /P�Pf►Pr� W. � 1P1t''��� `r�f• itt/fPIS ����t�ii�f/� �� �•P'�+ _ ♦ � / �i f�as)s y`°r=-L"if ►t .te3 :v a*�'.t i►ff y . .s f+fii_%tom. 1 t�►+�+iitI t €3`r\%1P►ii �ffi+li � 5�nth►yej t( w . . . .. . . . . . .. . .. .. . . . . . . c! Q. N v p IS. a O k ��• ma . LSD N ��pYi. h d .0 V � � � }tire ♦ 3 i in ° % = O V ^ L w o = � section K ; <Pw:»;t t c a Quo -Gy �r\ CJ u) O V O Q Qv LL Jr a, < O W 4 .� ✓G���p as �ye`v5, fi. 1 - fir ^ N 0 7- y rr. f d Lei / cl TZ " aLi C p C N cj w -.z s.f 11tfl �`� .° t-liil►4�ii�t1,' �'� Ir{ti�fl �°r�ss�tii L3< ?`�Z�;t!,i It , �s sa�:; Py- s. i.'►1 4� 4. at!n!► iiff+P{I� a% at�11a;a ?.g 'ij' ►1►Pji�+itt g "A Sr�uflfPiiP�i� 'i# kks �Iltt flll� z c,'� li/iP fli //t/ ifs t ��;. �A�• N � A4 s. *i,,+s �r'yf�A j tU�) �t�>� f • �t+l� F+' P1� �� �i' 'It)�P�Mf ��. �h.►P1PI�i1i' ��w;i�� \ --,may '�� 'rim' i�^ ,v �♦__ � v 4•:..1►\ cly>' �'� +;k ENVIINC-01 MTO ASE LI CERTIFICATE OF LIABILITY INSURANCE DATE 5120/2023-YYi 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 NAMEACT Mary Tomaselli Gowrie Group PHONE FAX 70 Essex Road (A/C.No.Ext): I (A/C,No): Westbrook,CT 06498 ADDRESS:mtoma-s-elli@risk-strategies.com omaselli@risk-strategies_com __INSLIRER(S)_AFFORDING COVERAGE NAIC0 INSURERA:NautilUS_Insurance Company __ 117370 INSURED INSURER a:Great Divide Insurance_Company _ 125224-_ Enviroshield Inc.and E.G.Kost Rental,LLC INSURER C: PO Box 1296 -- — 250 Moffitt Street INSURER D: _ Strafford,CT 06615 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDILU POLICY NUMBER POLIICY EFF ; POLK:Y EXP O A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR ECP01521982-23 1211/2022 112/1/2023 DAMAGE TO RENTED 100,000 _ R>zMISI;S((:�I_�unar{Pp S __ X Pollution Liability MED EXP An or1jpersort s 5,000 )X Professional P Professil Liab 1,000,000 ' ,�RSONAL b ADV WJURY_ S _ � -_--- -----GEN'L AGGREGATE LIMIT APPLIES PER: _GENERAL AGGREGATE S 2,000,000 i�POLICY 1 X J jpm U LOG I PRODUCTS-COMP/O AGG 2,000,000 OTHER' I INGLEUMIT _ 1,000,000 B AUTOMOBILE LIABILITY ANY AUTO �BAP1521979-23 12/1/2022 12/1/2023 @QpIly 9I,IURV-(Per rtaxl s -- ---�OWNED ONLY X AUTOSULED BODILY WJURY(Per_accWe__ S X�AU70S ONLY x.-. AUTo�.F �E.°aCClFkVi9DAMAGE X I MCS-90 En(n i A 'UMBRELLA LIAB X OCCUR EACH OCCURRENCE _ S 1,000,000 X:EXCESS LIM 1 CLAIMS-MADE IFFX 2036752 11 12/1/2022 12/1/2023 AGGREGATE $ _1'000'000 DED 1 X �RETENTIONS 10,000 B WORKERS COMPENSATION �( (PER OTH- AND EMPLOYERS'LIABILITY I�1 STATUN — �-R ANY PROPRIETOR/PARTNERIEXECUTIVE ("I WCA 1521960 22 12/1/2022 12l1l2023 '.�E.L EACH ACCIDENT S 1,000,000 OFFICER/M,.MBER EXCLUDED? u N/A 1,000,000 (Mandatory n NH) DISEASE-EA EMPLOYEE _ _ _ --. If yes,describe undar 1,000,000 I"611, T OF OPERATIONS below DIS •P ICY MIT S I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if mom space is required) Village of Rye Brook Is listed as Additional Insured for General Liability where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE _ Village of Rye Brook 938 King Street (. ok-NY 10573 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ,' ,r '� G� E ���� � � STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(Use street address only) lb. Business Telephone Number of Insured (203)394-2268 Enviroshield,Inc. Post Office Box 1296 1c. NYS Unemployment Insurance Employer Stratford,CT 06615 Registration Number of Insured Work Location of Insured(Only required ifcoverage is specifically Id.Federal Employer Identification Number of Insured limited to certain locations in New York State, i.e., a Wrap-Up or Social Security Number Policy) 060319014 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Commerce&Industry Insurance Company 3b.Policy Number of entity listed in box"la" WCA 1521980 22 Village of Rye Brook 938 King Street 3c. Policy effective period Rye Brook,NY 10573 12/1/22 to 12/1/23 3d. The Proprietor,Partners or Executive Officers are ■ included. (Only check box if all parincrs/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" 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"2". The Insurance Carrier will also notify the above certificate holder within 10 days IF a 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: Vincent M.Falcieno (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 12/5/2022 (Signature) (Dale) Title: Manasina Member Telephone Number of authorized representative or licensed agent of insurance carrier: (203)745-0078 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 Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department,board,commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits,shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however,shall be construed as creating any liability on the part of such state or municipal department,board,commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department,board,commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter,notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter. C-105.2(9-07)Reverse Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Thursday, November 9, 2023 11:41 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 11/09/2023 11:18 To: VIL RYE BROOK PRIMARY Transmitted: 11/09/2023 11:41 00003 Ticket: 11093-000-815-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 173 To: Name: IVY HILL IN-C`IP SC P r7� Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: DIGGING WILL OCCUR RIGHT OF THE CLUBHOUSE, PARTIALLY UNDER THE SIDEWALK NearSt: ARBOR DRIVE Means of Excavation: HAND TOOLS, EXCAVATOR, VAC TRUCK Blasting: N Site marked with white: Y Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: ABANDONMENT, DIGGING, EXCAVATION Estimated Work Complete Date: O1/01/2024 Depth of excavation: 10 Site dimensions: Length 10 Width 10 Start Date and Time: 11/15/2023 07:00 Must Start By: 11/30/2023 ------------------------------------------------------------------------------ Contact Name: LIZ OLAVARRIA Company: ENVIROSHIELD Addr1: PO BOX 1296 Addr2: City: STRATFORD State: CT Zip: 06615 Phone: 203-380-5644 Fax: Email: hz@enviroshield.com Field Contact: LENNY BOCHICCHIO Alt Phone: 800-394-2268 Email: len@enviroshield.com Working for: OWNERS OF PROPERTY ------------------------------------------------------------------------------ Comments: 173 1/2 IVY HILL LANE. ARBORS HOMEOWNER'S ASSOCIATION' CLUB HOUSE. : TANK IS NOT BEING REMOVED. DIGGING WILL OCCUR TO UNCOVER UNDERGROUND = TANK FOR ABANDONMENT. = Lookup Type: PARCEL ------------------------------------------------------------------------------ 1 Members: ALTICE USA BELL-VALHALLA / WSCHSTR CONED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR z Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Wednesday, October 11, 2023 12:21 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 10/11/2023 12:20 To: VIL RYE BROOK PRIMARY Transmitted: 10/11/2023 12:21 00005 Ticket: 10113-001-337-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 173 To: Name: IVY HILL LN Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: DIGGING WILL OCCUR RIGHT OF THE CLUBHOUSE, PARTIALLY UNDER THE SIDEWALK. NearSt: ARBOR DR & IVY HILL CRES Means of Excavation: EXCAVATOR, HAND TOOLS, VAC TRUCK Blasting: N Site marked with white: Y Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: ABANDONMENT, DIGGING Estimated Work Complete Date: 10/16/2023 Depth of excavation: 10 FEET Site dimensions: Length 10 FEET Width 10 FEET Start Date and Time: 10/16/2023 07:00 Must Start By: 10/30/2023 ------------------------------------------------------------------------------ Contact Name: LIZ OLAVARRIA Company: ENVIROSHIELD Addrl: PO BOX 1296 Addr2: City: STRATFORD State: CT Zip: 06615 Phone: 203-380-5644 Fax: Email: hz@enviroshield.com Field Contact: LENNY BOCHICCHIO Alt Phone: 800-394-2268 Email: len@enviroshield.com Working for: OWNERS OF PROPERTY ------------------------------------------------------------------------------ Comments: 173 1/2 IVY HILL LANE. ARBORS HOMEOWNER'S ASSOCIATION' CLUB HOUSE. TANK IS NOT BEING REMOVED. DIGGING WILL OCCUR TO UNCOVER UNDERGROUND TANK FOR ABANDONMENT. Lookup Type: MANUAL i