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HomeMy WebLinkAboutMP24-017 DRn O` yC V, la V WJ. �IGG �tCCt.°taJJ� G CCU.(Go t JJ 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 April 10,2024 Anthony Bueti&Anne Bued 26 Bishop Drive North Rye Brook,New York 10573 Re: 26 Bishop Drive North, Rye Brook,New York 10573 Parcel ID#: 130.69-1-10 As per the Certification letter from Enviroshield Inc. dated April 4, 2024, the removal of an underground oil tank under Mechanical Permit#24-017 issued on 2/16/2024 has been satisfactorily completed. Sincerely, Steven E. Fews Building& Fire Inspector /to �yE BR(��• 198,2. cu � -c BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street• Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: 2 s� O Z�e I ✓Ci AJ JQ DATE: / 0 L PERMIT# L~' O 1 -7 ISSUED:2-16-Z SECT: 10-6 BLOCK: LOT: U LOCATION: f' T r--L()J � (-4 G`'t J . OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION L ❑ Natural Gas e JL C o S w-e Pe ❑ L.P. Gas ❑ FUEL TANK , ,/ ❑ FIRE SPRINKLER ( ( l�l�0 2 /C ❑ FINAL PLUMBING ❑ CROSS CONNECTION J ❑ FINAL ❑ OTHER QyE BRC�k. Fb 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR (ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street • Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : b ���O 1 LJIP 1 ✓C� /�J�e i DATE: PERMIT# / `/ �� O / ISSUED: -�-jj!� SECT: I U &'i BLOCK: LOT: LOCATION: f—C� �7 ��Ll�^.� 7' y(/"� `� OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION / ❑ Natural Gas Cr�' ' '�2 �� 0 4 o ❑ L.P. GasFUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING L L E�A , ' c-- ❑ CROSS CONNECTION ❑ FINAL IP e 1 ✓P ^ Losq"o I , " ❑ OTHER Y �� *,'w`I ,, e �'��1 it 1.1 •y 1 i 1 ��� tea' �"�+.��� '�' -� �• . _ lb ,• Y4 �� Pl` - i PA t` r- ry' t � , � e � s a a = Lin 0 _ NC N W `� s y ° N N O a F, = GL' a O ■ 06 6-4 ■ � ,� a c o 1-0o v� W a0 A a w O = pp �"■'1 Os r T ~ A o y Q o r-I p o a rot a I� ,_y ■ a rT, ��J a O L o Ln CA '"'' z00 o g O U q U R 0 a �j i"� ■ 0 O W u4 -t cn 'd � z 05 � 'r1 � � � A W �a � . U � ■ o 05 o v Ga ■ ao a ° 14 9• ° fly V W � � Hy a v a G3 x V U 't o ? 0v ❑Q ° F U W o o zOn bB d 0 LeiC ' w v l a M—I III���III (Z, Oo O O -n •U3 P4 �..� '�' W. u d ." a a N W z H a o � O � U dab _ ■ BUILDS _15) MENT VIL '' E OF RYi oOK FEB - 9 2024 DD 938 KING ET RYE BR ,NY 10573 -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 Countyof Westchester)] FOR OFFICE USE ONLY: PERMIT#: O/ / FEB I ,Q Approval Date: Permit Fee: S Approval Signature: Other: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION C NTIL A PERMIT IIAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT 1S 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 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: emoval bandonment, or Installation: $185.00 per Tank. 5.Dig Safely New York#(dial 811): 0'-*A-a-1'* - bw� 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, ���"y n-ZnZ`r ,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. *ww**w*wwww*w********w***wwwwwwwwwwwwwwwwwww*wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww**www****w*wwww**wwwwww* Indicate Permit Type: Installation t Removal(-l'IAbandonment( )/Above Ground ( )• Buried in Ground 1. Address: �_ '`s*mot' c.)-(- 1`4�"zr'-` SBL: l U Zone: -IS 2. Property Owner&Address: ('OR 4::�-4" "t 1 ti`r, Phone#: Cell #: � ` 3 `�` ��� I email: 3. Contractor& Address: °��" `-'c --a5'. n"'K�Cr Phone#: a�'� �' 2_)I"`'`l Cell#: email: �'F° L '`�`'� `''� �� 4. Applicant: q_,.,S„.y�1„tu, rSr� Phone#: `��3 -6%'' - !�-`k`k Cell#: email: 5. Indicate Fuel Type: Fuel Oil(-I'•L.P.Gas( ) •Gasoline( )•Other( ): 6. Number and Capacity of each Tank: C1pk1-•, L1n0E2�1r,� 7. Exact Location(s)of each Tank: i 10/30/2023 STATE 0 NEW YORK1�, COUNTY OF WESTCHESTER ) as: 1—cr o ✓h I G Yl ,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 ts�yrr-o 5 h I e J'l,I n G 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 Y� Sworn to before me this day of 20 day of r1-4, ,24 oL y Signature of Proper w Signature of Applicant I 'k�1 � P �i L -0 e,o G�► I c c h I o Print Name f rop net Print Name of Applicant MICHAEL ESQUIVEL '1� Notary Nblic Notary Public-state of New York Notary Public No.OlES6442359 Quaiified in Westchester County My Commission Expires Oct 11,2026 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. �s DANIELLY hlOV01.J-r3ANTOS I k`try Publlc,Stater: ;:a3 ctiCut lViy Cumrris ��tt Explrts May 27,2026 2 10/30/2023 . ��,.., .. .�..,.�,....,_..__.__._. .._..�._._...._...._,_.�....w ...._,...�._..w.�_.._.....,�._._W...�.., �_..._._.._.._ 1 �` , t � 1 s � L7- V f((1jJ� _fib i � � .l r 5 �1�.Q t�l ��`' aa�s�� �� � �, ���a,�� �=��� p Clean, Preserve...Protect �►�'�` Environmental Specialists April 4, 2024 Mr. Dominic Falcone D CIE � V LE Service Manager Westmore Fuel FR - 4 2024 3D 86 North Water Street Greenwich, CT 06830 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Subject: Tank Removal, March 28,202 T Bueti Residence 26 Bishop Drive North Rye Brook, New York Dear Mr. Falcone: On March 28, 2024, Enviroshield staff completed the removal of one underground 550-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 requited analyses for oil tank removal in New York State. As indicated in the attached Complete Environmental Testing (CET) report #24C0966, the reported results for the sample tested are below the laboratory detection limit for all the constituents tested; no-petroleum was detected within the sample. 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 April 4,2024 Bueti Residence 26 Bishop Drive North 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.Attached is disposal ticket#555180. 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, Enviroshicld Inc. 9- 0_u"_.Y Leonard Bochicchio Senior Project Manager Enclosures cc: Village of Rye Brook Building Department via email 1petersen f n-ebrook.orty, Permit #MP 24-017 Site Photographs Enviroshield 550-gallon Underground Tank Removal Residence,26 Bishop Drive North, Rye Brook, New York � r r�. ram, T �r L- - r - J �y Photo 1 of 2. Underground Tank exposed and removed. �� Site Photographs Enviroshield 550-gallon Underground Tank Removal Residence,26 Bishop Drive North, Rye Brook, New York r. ......................... y-4;• a - L t _ N r' `�T l■l�■ l f •• Photo 2 of 2.Tank grave backfilled and restored. 011 4 i Clean, Preserve...Protect Environmental Specialists T / / BILL OF LADING DESCRIPTION: Check applicable 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: Total Quantity: 1 5 gallons Generator Name: wPS� �� S"O Site Address: City: \`yl ` State: Zip: Telephone: Qz✓^ 53 M� W.O#: n Generator/Agent for Signature: Transporter: Enviroshield, Inc.,250 Moffitt Street, Stratford,CT 06615 03-380-5644 Connecticut: CT-HW-095; New York: CT-095; Westc ter ounty NY: WC-27310-H14; Connecticut H.I.C. 0682591 Driver Signature: Destination/Facility: Tradebe Treatment and Recycling of Bridgeport, 50 Cross Street, Bridgeport,CT 06610 Safety-Kleen Systems, Inc., 120 Forbes Avenue, New Haven,CT 06512 Tradebe Treatment and Recycling Northeast, 136 Gracey Avenue,Meriden,CT 06451 Approval Code: (SEE BACK FOR HAZARD/SAFETY/RESPONSE DETAILS) F1TemplatesNiscOill 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 infoRenviroshield.com 80 Lupes Drive Tel:(203)377-9984 Stratford,CT 06615V" Fax:(203)377-9952 e-mail:cetl@cetlabs.com COMpt I lI I NVIRONMINIAI IISIINO,I NG Client: Mr.Richard Louis Enviroshield,Inc. P.O.Box 1296 Stratford,CT 06615 Analytical Report CET# 24CO966 1 `4 Report Date:April 03,2024 Project:Bueti Residence,26 Bishop Dr N,Rye Brook,NY PO Number: 31343 Connecticut Laboratory Certificate:PH 0116 New York NELAP Accreditation: 11982 Massachusetts Laboratory Certificate:M-CT903 Pennsylvania Laboratory Certificate:68-02927 Rhode[stand Laboratory Certificate: 199 Page 1 of 11 CET#:24CO966 Project:Bueti Residence,26 Bishop Dr N,Rye Brook,NY SAMPLE SUMMARY The sample(s)were received at 2.0°C. This report contains analytical data associated with following samples only. Sample ID Laboratory ID Matrix Collection Date/Time Receipt Date Tank Grave 24CO966-01 Soil 3/28/2024 14:00 03/29/2024 Analyte: Percent Solids (SM 2540 G] Analyst:DGG Matrix: Soil Daterrune Laboratory 1D Client Sample ID Result RL Units Dilution Batch Prepared Analyzed Notes 24CO966-01 Tank Grave 84 1.0 •o I BD40260 04/022024 04/03/2024 09:22 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 066I5•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 2 of 11 CET N:24C0966 Project:Bueti Residence,26 Bishop Dr N,Rye Brook,NY Client Sample ID Tank Grave Lab iD:24CO966-01 Semivolatile Organics Analyst:TWIT Method: EPA 8270D Matrix: Soil Result RL Date/Time Analyte (ug/kg dry) (u.-/kg dry) Dilution Prep Method Batch Prepared Analyzed Notes Naphthalene ND 120 1 EPA 3545A BD40102 04/01/2024 04/02/2024 18:47 Acenaphthylene ND 120 1 EPA 3545A BD40102 04/01/2024 04/02/2024 18:47 Acenaphthene ND 120 1 EPA 3545A BD40102 04/O1/2024 04/02/2024 18:47 Fluorene ND 120 1 EPA3545A BD40102 04/01/2024 04/02/2024 18:47 Phenanthrene ND 120 1 EPA3545A BD40102 04/01/2024 04/02/2024 18:47 Anthracene ND 120 1 EPA3545A BD40102 04/01,2024 04/02/2024 18:47 Fluoranthene ND 120 1 EPA 3545A BD40102 04/O1/2024 04/02/2024 18:47 Pyrcnc ND 120 1 EPA3545A BD40102 04/01/2024 04/021202418:47 Benzo[alanthracene ND 120 1 EPA3545A BD40102 04/01/2024 04/02/2024 18:47 Chrysene ND 120 l EPA 3545A BD40102 04/O1/2024 04/02/2024 18:47 Benzo[b]tluoranthene ND 120 1 EPA 3545A BD40102 04/O1/2024 04/02/2024 18:47 Bcnzo[k]fluoranthcne ND 120 1 EPA3545A BD40102 04/O1/2024 04/02/2024 18:47 Benzo[a]pyrene ND 120 1 EPA 3545A BD40102 04/01/2024 04/02/2024 18:47 lndeno[1,7.,3-ed]pyrene ND 120 1 EPA3545A BD40102 04/O1/2024 04/02/2024 18:47 Dibenz[a,h]anthracene ND 120 1 EPA 3545A BD40102 04/O1/2024 04/02/2024 18:47 Bcnzo[g,h,i]perylcnc ND 120 1 EPA3545A BD40102 04/01/2024 04/02/2024 18:47 Surrogate:Nitrobenzene-d5 42.2% 30-130 BD40102 04/01/2024 0410212024 18:47 Surrogate:2-Fluorobiphenyl 51.3% 30-130 BD40102 04/01/2024 0410212024 18:47 Surrogate:Terphenv1-d14 62.5% 30-130 BD40102 04/O1/2024 0410212024 18:47 Volatile Organics Analyst: MR Method: EPA 8260C Matrix: Soil Result RL Date/Timc Analyte (ug/kg dry) (ug/kg dry) Dilution Prep Method Batch Prepared Analyzed Notes Methyl-t-Butyl Ether(MTBE) ND 5.5 1.85 EPA 5035A-L BD40241 04/02/2024 04/02/2024 13:59 Benzene ND 5.5 1.85 EPA 5035A-L BD40241 04/02/2024 04/02/2024 13:59 Toluene ND 5.5 1.85 EPA 5035A-L BD40241 04/02/2024 04/02/2024 13:59 Ethylbenzene ND 5.5 1.85 EPA 5035A-L 13D40241 04/02/2024 04/02/2024 13:59 m+p Xylenes ND 11 1.85 1:PA 5035A-L 13D40241 04/02/2024 04/02/2024 13:59 o-Xylene ND 5.5 1.85 EPA 5035A-L 13D40241 04/02/2024 04/02/2024 13:59 Isopropylbenzene ND 5.5 1.85 EPA 5035A-L BD40241 04/02/2024 04/02/2024 13:59 n-Propylbcnzcnc ND 5.5 1.85 EPA 5035A-L BD40241 04/02/2024 04/02/2024 13:59 1,3,5-Trimcthylbeazene ND 5.5 1.85 EPA 5035A-L BD40241 04/02/2024 04/02/2024 13:59 tert-Butylbenzene ND 5.5 1.85 EPA 5035A-L BD40241 04/02/2024 04/02/2024 13:59 1,2,4-Trimethylbenzenc ND 5.5 1.85 EPA 5035A-L BD40241 04/02i2024 04/02/2024 13:59 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615-Tel:203-377-9984•Fax:203-377-9952-www.ectlabs.com Page 3 of 11 CET 0:24CO966 Project:Bueti Residence,26 Bishop Dr N,Rye Brook,NY Client Sample ID Tank Grave Lab iD:24CO966-01 Volatile Organics Analyst:MH Method:EPA 8260C Matrix: Soil Result RL Date/Time Analyte (ug/kkg dry) (ug/kg dry) Dilution Prep Method Batch Prcpared Analyzed Notes sec-Burylbenzene ND 5.5 1.85 EPA 5035A-L BD40241 04/02/2024 04/02/2024 13:59 4-lsopropyltoluene ND 5.5 1.85 EPA 5035A-L BD40241 04/02/2024 04/02/2024 13:59 n-Butylbenzene ND 5.5 1.85 EPA 5035A-L 131340241 04/02/2024 04/02/2024 13:59 Naphthalene ND 11 1.95 EPA 5035A-L BD40241 04/02/2024 04/02/2024 13:59 Surrogate:1,1-Dichlomethane-d4 110% 70-130 BD40241 04/02/2024 0410212024/3:59 Surrogate:Tolaene-dg 101% 70-130 BD40241 04/02/2024 0410212024 13:59 Surrogate:4-Biamulluorubetttene 94.0% 70-130 BD40241 04/02/2024 0410212024 13:59 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984-Fax:203-377-9952•www.ectlabs.com Page 4 of 11 CET#:24CO966 Project:Bueti Residence,26 Bishop Dr N,Rye Brook,NY QUALITY CONTROL SECTION Batch BD40102-EPA 8270D Result RL Spike Source %Rec RPD Analyte (ug/kg) (ug/kg) Level Result %Rec Limits RPD Limit Notes Blank(BD40102-BLKI) Prepared:4/l/2024 Analyzed:4/2/2024 Naphthalene ND 100 Accnaphthylcnc ND 100 Acenaphthene ND 100 Fluorene ND 100 Phenanthrene ND 100 Anthracene ND 100 Fluoranthene ND 100 Pyrene ND 100 Benzo[a]anthracene ND 100 Chrysene ND 100 Benzo[b]fluoranthenc ND 100 Beazo[k]fluoranthene ND 100 Benzo[a]pyrene ND 100 Indeno[1,2,3-cd]pyrene ND 100 Dibenz[a,b]anthracene ND 100 Beazo[g,h,i]perylene ND 100 Surmgute:Nimbemene-d5 627 30-130 Surrogate.1-Fluorobiphet{vl 73.8 30-130 Surrogate:Terphenyl-d14 90.5 30-130 LCS(BD40102-BSI) Prepared:4/l/2024 Analyzed:4/2/2024 Naphthalene 1820 100 4,000.000 45.4 40-140 Acenaphthylene 1920 100 4,000.000 48.0 40-140 Acenaphthene 2100 100 4,000.000 52.5 40-140 Fluorene 2150 100 4,000.000 53.7 40-140 Phenanthrene 2270 100 4,000.000 56.7 40-140 Anthracenc 2220 100 4,000.000 55.5 40-140 Fluoranthene 2350 100 4,000.000 58.8 40-140 Pyrene 2310 100 4,000.000 57.9 40-140 Benzo[a]anthracene 2290 100 4,000.000 57.2 40-140 Chrysene 2210 100 4,000.000 55.3 40-140 Benzo[b]fluoranthene 2190 l00 4,000.000 54.7 40-140 Bcnzo[k]fluoranthcnc 2440 100 4,000.000 61.0 40-140 Benzo[a]pyrene 2270 100 4,000.000 56.6 40-140 Indeno[1,2,3-cd]pyrene 2440 100 4,000.000 61.0 40-140 Dibenz[a,h]anthracene 2350 100 4,000,000 58.8 40-140 Benzo[g,h,i]perylene 2520 100 4,000.000 63.0 40-140 Surrogate:Nitrobenzene-d5 539 30-130 Surrogate:1-Fitunwhiphenr! 613 30-130 Surrogate:Terpheny1414 772 30-130 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615-Tel:203-377-9984-Fax:203-377-9952-www.cetlabs.com Page 5 of 11 CET 11:24CO966 Project:Bueti Residence,26 Bishop Dr N,Rye Brook,NY Batch BD40241-EPA 8260C Result RL Spike Source %Rec RPD Analyte (ug/kg) (ug/kg) Level Result %Rec Limits RPD Limit Notes Blank(BD40241-BLKI) Prepared:4/2/2024 Analyzed:4/2/2024 Mcthyl-t-Butyl Ether(MTBE) ND 2.5 Benzene ND 2.5 Toluene ND 2.5 Ethylbenzene ND 2.5 m+p Xylenes ND 5.0 o-Xylene ND 2.5 Isopropylbcnzcne ND 2.5 n-Propylbenzene ND 2.5 1,3,5-Trimethylbenzene ND 2.5 tent-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 Sum,gute:1.2-Diehkmwthane-d4 105 70 130 Surrogate:Toluene-dB 102 70.130 Surrogate:4-Bronio/hrorobenzene 101 70-130 LCS(BD40241-BSI) Prepared:4/2/2024 Analyzed:4/2/2024 Methyl-t-Butyl Ether(MTBE) 49.0 2.5 50.000 98.0 70-130 Benzene 52.6 2.5 50.000 105 70-130 Toluene 49.3 2.5 50.000 98.7 70-130 Ethylbenzene 57.3 2.5 50.000 115 70-130 m+p Xylenes 101 5.0 100.000 101 70-130 o-Xylene 51.1 2.5 50.000 102 70-130 Isopropylbenzene 51.3 2.5 50.000 103 70-130 n-Propylbenzene 56.0 2.5 50.000 112 70-130 1,3,5-Trimethylbenzene 53.8 2.5 50.000 108 70-130 tent-Butylbenzene 52.4 2.5 50.000 105 70-130 1,2,4-Trimethylbenzene 55.8 2.5 50.000 112 70-130 scc-Butylbcnzcnc 54.1 2.5 50.000 108 70-130 4-Isopropyltoluene 52.7 2.5 50.000 105 70-130 n-Butylbenzene 62.3 2.5 50.000 125 70-130 Naphthalene 61.5 5.0 50.000 123 70-130 Surrogate:1,2-Dtchhrroerhane-d4 104 70-130 Surrogate:Tolueue-d3 997 70-130 Surrogate:4-Bromofluorobenzene 94.1 70-130 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•TO:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 6 of 11 CET#:24CO966 Project:Bueti Residence,26 Bishop Dr N,Rye Brook,NY 80 Lupes Drive *FT Tel:(203)377-9984 Stratford,CT 06615 COMRIII INVIROWINIAI HS11NC,X, Fax:(203)377-9952 email:cetl@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 are 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 of analyte found including amount that was spiked. Matrix Spike Dup Amount of analyte found in duplicate spikes including amount that was spike. Matrix Spike%Recovery %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% Y Sample result too high for accurate spike recovery. Connecticut Laboratory Certification PHO116 New York NELAP Accreditation 11982 Massachussets Laboratory Certification M-CT903 Rhode Island Certification 199 Pennsylvania NELAP Accreditation 68-02927 Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615-Tel:203-377-9984-Fax:203-377-9952-wwnv.cetlabs.com Page 7 of 11 CET#:24CO966 Project:Bueti Residence,26 Bishop Dr N,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 Timothy Fusco n 0. C' 010t— 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. *Fl-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(ICV). 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 Lopes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 8 of 17,71 CET#:24C0966 Project:Bueti Residence,26 Bishop Dr N,Rye Brook,NY CERTIFICATIONS Certified Analyses included In this Report Analyle Certificalions EPA 8260C in Soil Mcthyl-t-Butyl Ether(MTBE) CT,NY,PA Benzene CT,NY,PA Toluene CT,NY.PA Elhvihenzene CT,NY,PA m+p Xylenes CT,NY,PA o-Xylene CT.NYPA Isopropylbenzene CT,NY,PA n-Propylbenzene CT,NY,PA 1,3,5-Trimethylben7ene CT,NY,PA terl-Burylbenzeoc CT,NY,PA 1,2,4-Trimethylbenzene CT,NY,PA sec-Burylbenzene CT,NY,PA 4-Isopropyltoluene CT.NY.PA n-Butylbenzene CT,NY,PA Naphthalcnc CT,NY,PA EPA 8270D In Soil Naphthalene CT.NY,PA Acemphlbylene CT,NY,PA Accnaphthcne CT,NY,PA Fluorene CT.NY,PA Phenanduene CT,NY,PA Anthraccne CT,NY,PA Fluuranthene CT,NY,PA Pyrene CT,NYTA Benzo[a]anthracene CT,NY,PA Chrysene CT.NY,PA Benzo[b]fluoranthene CT.NY,PA Benzo[k]fluoranlhcoc CT,NYPA Bcnzo[a]pyrcne CT,NY,PA Indeno[12,3-cd]pyrene CT.NY,PA Dibenz[a,h]anthracene CT,NY,PA Benzo(g,h.i]perylcne CT,NY,PA SM 1540 G in Soil Percent Solids CT Complete Environmental Testing,Inc. 80 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•wm-w.cetlabs.com Page 9 of 11 CET N:24CO966 Project:Bueti Residence,26 Bishop Dr N,Rye Brook,NY Complete Environmental Testing operates under the following certifications and accreditations: Code Description Number Expires CT Connecticut PublicHealtb PHO116 09/302024 NY Ncw York Ccrtification(NELAC) 11982 04/012024 PA Pennsylvania DEP 68-02927 05/31/2024 Complete Environmental Testing,Inc. 30 Lupes Drive,Stratford,CT 06615•Tel:203-377-9984•Fax:203-377-9952•www.cetlabs.com Page 10 of 11 #MON '1Noo do#1V101 y O m V _ N H 4 Q) CDAj) M c ¢ ❑ rn o d t, ❑ < E o 0 3 0 y O ❑ c N c N a a. a a� v E cr a: m co MQ M ❑ O CO is y F Nd w a a 7 U U d Vv1 v o o z a v ❑au�a� � �wx� m o 4) ui PenlOsslQ o a o z 0) O d101 m ` a- a U n V O.a v ti o E 7 a E ❑ b �CL, FQ- O ` d330104L q Q N m v fl°d Aluoi)d EL N O ❑ CIL U) o > 0 o a COddoa 9 _ S t sGPIOIQ]QH w o / � a a N T V sePiollsed n W p p m ` ct3O LL 3stl❑ XOS❑ s90d L g Z U cc w O HVd/sVNd OLZB � m ICA isri 10 DIN Z Hd1310 o � X m o Cc cu Q suabO19H 09Z9 m o n a C = so IewaV 09ZB 0 •n o o aO m $ $ m d � V isn io o9z9 Z * o U o ¢ H fC w p J :— ...WePuais m C c ApQ oMl m A¢Q PON `v W � .AaQ eweg M d O En W ggr�� ccRggR}} a' m_0 x � d3�d3c5 p1_c w O.- It E r6+ V w m m m gp V W vaEE c m E w w _ cu rn rn $ E c� w iu i a U LU )co o v 0 Q c N N W z d m .Q)� O : w w w J3 Q F lL o toCD �~0 Qo m w o ` CJo ° zn q (j� �. a cc � � _� a T v m z o M a C U a10 N to cc% o 0)uj 7 y 0 �ov nv ja F'— o w w aai E a) mIt W E m : Z c Q 0 y O c v� F° a O W Z 2 2 2 n m o e O O O w w � o o Z o c p � Coco a U W Q 2 V U Q U fu a V Q • N 11111111111111111111111 SCALE PURCHASE TICKET P.C. Metals, Inc. 270 Central Avenue Bridgeport, CT 06607 203-367-9328 Ticket: 555180 Weigh In: 03/29/2024 14:42 Customer: 1034 Weigh Out: 03/29/2024 14:46 ENVIRO SHIELD Bridgeport,CT RED DUMPTRUCK Commodity Gross Tare Net Price TOTAL$ Light Iron 11840 10480 1360 /GT ............................................... -_...................._..... ..._.......__... Buyer: 0 1 hereby certify that I have the right to possess and sell this scrap. This is a Bill of Sale to the above described scrap. I hereby acknowledge payment in full. Customer Signature Please do not lose this ticket. Ticket required for payment. !-i w H O N N ti N N N 6 m a N N F O 1.1 " vi U y Cl) U - 1 Vl c� W w .n v " v a W oo W A4 O `a C lu w = � �A �t7 W O 0 o cn c o v° 0 T °' v' ~y • Q C v a s v Oo z h� 00 C� z M W U v a a `" o6=1 en U Uz � �V A C7 W a W za oA M w U 0o a 8 � v u cv U W O H a � x o C2 cn L� A� A: W E A L 6 = x ��.• 5z Z M � . hh y 4- 0-1 a ' p v C �r ,r Z o c n ag�i 1 1=1W O F0+ 0 a, u u U a , � � � r.w CD Z LI V V o OC) H N -cc C V V ED BUILDINaDEJPARTINIENT `='E N VILLA(E OF Ri'L: BROOK FEB - 9 2024 938 KING S77i1?ET RYE Bw6K, Nl' 10573 (A I )t `�f)6K VILLAGE OF RYE BROOK ivww.ry rook:ort' f 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) FEB 1 FOR OFFICE USE ONLY: PERMIT #: � / ��—O/ 7 � / f ,Q Approval Date: Permit Fee:S /85'/ 6 Approval Signature: Other: Disapproved: (fees are non-rcfundabtc) DO NOT START NVORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A.**1ININIUM FEE OF S750 Olt 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 #C105 2 or Form U26.3 /or NY State Workers Compensation Waiver) 4. Fec per Tank: cmoval bandonmcnt,or Installation: S I X5.00 per Tank. 5.Dig Safcly New York# (dial 81 1): - ow - Sc\-\ 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, 3�� tl•Z�Z`r ,is hereby made to the Building Inspector or the Village of Rye Brook for a permit to remove,abandon,and/or install n 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 t '-Removal(v • Abandonment( )/Above Ground ( )•Buried in Ground(✓{ 1. Address: r � �'s4,�p�t�,;t �''�� SBL: / o,62--1-/ U Zone: 2. Property Owner&Address: Phone It: �^ Cell 3. Contractor& Address: �•,rL.oS�.�"•o�0-''� •-XSo ry,-- 4;Cy 5T2SS'r S�f`r,�c.,r+A ll� . Dbbtj Phonc h: ��3 3� �b`t`1 Cell N: email: 'F' (` CCs•,rr,.st,.`1o,(p'r. d. Applicant: �,S„�e�1.s '�,c -- `D.5 - (.a tz-.,6-6rs- Phonc k: r�.�3 3g� �}.`r`it Cell r:: email: -�'��C' �is`'Loyh„ao.G��r1 5. Indicate Fuel Type: Fuel Oil(-• L.P.Gas( )•Gasoline( )•Other( ): 6. number and Capacity ol'cach Tank 7. Exact Location(s)of each Tank. �'c._ '�'�.slr` 15 l�clsa v �>rt" pG -1't+�. J�f�J`t t:Jt�-►I . I 10/30t2O23 ED BUILDING.DEPARTMENT C E 0 v VILLAGE OF RI'E',EIROOK FEB - 9 2024 938 KING STET RYE BROX,NV 10573 (414) -0668: VILLAGE OF RIPE BROOK www.ryacook.,ure 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 4: `- / � � D/ 7 FEB Approval Date: _ Permit Fee: S Approval Signature: - Other: Disapproved: (fees are non-relundable) *#A######A#########**##*##*##**###*##**#### ###*#A##A###**#***#*#a1#AA#**#*#*#####*#*##*#*##f**#**##A** DO NOT START WORK or CONSTRUCTION t'NTIL A PERMIT HAS BEEN ISSUED B1'Tl1E BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WIT1101.1T A PERMIT IS 12%OF TIIE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF S750.00 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#C105.2 or Form a#U26.3/or NY State Workers Compensation Waiver) 4. Fee per Tank: cmoval bandonmcnt,or Installation: S 185.00 per Tank. 5.Dig Safely New York#(dial 81 1): Oa o„} - M4,, - 3`C1 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. ##*#a###aaa#####a#a#####a**a##a######A*##########*##*##aA##A#############*#**########*#♦*#######**#### Application dated, rl ZA2`r ,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 t Removal(✓f•Abandonment( )/Above Ground ( )•Buried in Ground(✓� 1. Address: �S W 2 �' � SBL: 13Qi 0 Zone: 2. Property Owner&Address: �R �^ `-1 17vti-T; Phone k: Cell k: yt`t ' 3'�`k- �50 email: 3. Contractor&Address: `n°S�"``'�—�-"x � n"(�. ��4 S'7`s� ,aA Ek•• Db6t j Phone h: a�3 3� �1�ty Cell#: email: -�F° @ �"sh.slo, 4. Applicant: ���J1•• 'Sr,< �7� tzt'� 9' �s�-T. �Tr�TrK� Cam. l�lt.�j Phonc A: 395�1 -54+ `< Cell#: email: ___ �°� �n��toyti.� •�"n 5. Indicate Fuel Typc: Fuel Oil(-f•L.P.Gas( )•Gasoline( )•Other( ): 6. Number and Capacity of each Tank: 7. Exact Location(s)of each Tank: 10 3012023 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Lcn o _h . G being duly sworn,deposes and states that he/she is the applicant above named, (pnni 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 isty,-c,S h I e -k, Ind- 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 Yf Swum to before me this U day of_ t,G� .20 day of Feb ruCa r vy ,20�_ Signature of Proper w ignature of Applicant �w �L-) Ley) �'CliIcckI Print Natne f rop ner Print Name of Applicant MICHAELESQUIVEL Notary blic Notary Public-state of New York Nota Public No.01ES6442359 Quaafi^d in Westchester County My Commission Expires Oct 11.2026 cr+armcrmiw--� This application must be properly completed in its entirety and must include the notarized sigttature(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 110VOI.t SANTOS )(tdru Public,State r -Lirnecticut hly Cumrr.i ;%n Expir6,May 27,2026 2 10/30/2023 / � 'S+,.i,^`^`7"-,� • � ,A,, ,.a�,__ ...��'A�A �,?�''` >�� A .Q.�• �-•�'QA'y1�"^'se'�+'-- .+G A .�.._ �{^�`5����i�.M'•'���^{.:��A � � .. t> � •.:ip •p .in r! 3 `J� O � - + '• S ;F��r�+I.n� O 7�+2'�L�' ,r'� O h"'Y: f`Q� 0 =s i �� •; b v �" YG1, v � ,G4 '++ to 1 a�v �.>'+Z.�`v v��!,� v �:,�+;11,��j' •r v l'� ,C o litr ��1 ` iil*r a iRv I�'1�/�/�I1 I{)~ f,{I�I�{/ f' v • II•I�1•; `f'`xv5 ' � �� 'il)ll�l{I ! Ili' R1�•�{f 'fs It 1111 1 �Ih11f11'/ Fs 'Ih/lll'P Sl4s lll�l{ ,�, 1 saw. .:�.s "�:4'Ikl' v,-`' :�•:1l111'ir��,;11i!1�Y=t<�'-s;�` /ld ys��u; ..v;.d1�/114 -.,r i..,,!t ;s �'t�1f11':-�r� -t .�• / S •,Aj 06 �• : R v M V 41, <O) � `�\ ..r���:�. �i y •ICI � V CSC � !� :''+` � w ~ 8 ¢ a o LI' elf u 0 ate �e5 Ln N cn o ca CL si w cl � a�i ai vVi v V (•� ,. •�, a ; «O)1b.-i� 11 N C%n �1.r i.-1 I�1'�'�s's >•,���;. ;. . -a. s.. . . . . . . . . fTw . . . . .•' '„T �- <(s>•)!�\ �zs y �f-fl►1 y�� 1 /Illy fl Il 1.,���s.,; �;I/�/Iyf-�Mi . •<< ,�,aa"� ydi/ih>+ I�Ic ��(y 1� �k•}� �y�A/h ►�il l . � /1 l (��f{IiI 1�-`yp "s�, i�� ,.,.J +;F,,��.••,h � �� +.r. ��� �ii1� �' ./� •� Ni�,�,!'� ���. �t�. �i��ref r _ h\ 6 MOP", :FfO rlrr�l)>' d 7,G�r,ivS ;Q n✓%}Yir�Sti ` O a f O 4 ENVIINC-01 TLIVERNOCHE ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYYY) 12/512023 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(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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(ss). PRODUCER ` I_N coAMACT_Vincent Falcigno _._. . PHO cowrie Group i(A/C..No,Exq: (AAlxc.No): 70 Essex Road - - Westbrook,CT 06498 l DA vfalcign�risk-strategies.com IN9URER(3LAFFORDING COVERA-GC -__.__ NAIL! INSURER A:Nautilus Insurance Company- 17370 INSURED INSURERa:Great Divide Insurance Company 25224 Enviroshield Inc.and E.G.Kost Rental,LLC INSURER c PO Box 1296 — 250 Moffitt Street INSURER o: Stratford,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 ADDL SUER: POLICY NUMBER POLICY EFF MMIDpNyffl PO Y EXPT LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENC 1,000'000 CLAIMS-MADE X OCCUR IECP01521982-24 12/1/2023 1211/2024 DAMAGE TO RENTED a 100,000 M D EXP — one-.Penon 5,000 PERSONAL d ADVJ JIL RY _ __ 1'000,000 GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGAAT�_ _ 21000,000 1 POLICY 7 JP& LOC PR UCTS-COMP/QPAGG 2,000,000 OTHER. I - --- - COMBINED SINGLE LIMIT1,000,000 B AUTOMOBILE LIABILITY 8_BCClddnl)___ S ._._.__-- ANYAUTO BAP1521979-24 12/1/2023 12/1/2024 g _yK-9R,OWNED I pegga I AUTOS ONLY X 'AUTOSULED BQDILY WJURY(Por,at:ckleM)rS X H RED X '..NU%0V NE PROPERTY DAMAGE __.ALTOS ONLY I._..;AUTOS ONL� _tr_'4rlCCWgniL______-_j_S _ X MCS-90 End'1 Is A UMBRELLA LV1B X OCCUR EACH OCCURRENCE is 1,000,000 X EXCESSLIAe CLAIMS-\1ADE FFX203675212 12/1/2023 12/1/2024 rAOGREGATE ¢ 1,000,000 F.E. X RETENTIONS 10,000 I is B WORKERS COMPENSATION X�1P Q 9 AND EMPLOYERS'LIABILITY - E � YIN IWCA 1521980 23 12/ /202312l/2024 ¢---- _ 1,000.000 �F} yHAC IANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A OFFICE MNI ER EXCLUDED? 1,000,000 (MandatRry9nNH) _I Q,LDISEASE-EA_EM.P�.QY _ If yes,descnbe under 1,000,000 DESCRPTION OF OPERATIONS below E.L.OtSEASE•POLICY LINK DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more spat.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 i, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE__ Village of Rye Brook 938 King Street ye Brook.NY_10573 ACORD 25 _—_-- -- - -- - -.--- -- — - -- (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. 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 (203)394-2268 Enviroshield,Inc. Post Office Box 1296 lc.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"1a" WCA 1521980 23 Village of Rye Brook 938 King Street 3c. Policy effective period Rye Brook,NY 10573 12/1/23 to 12/1/24 3d. The Proprietor,Partners or Executive Officers arc ■ included. (Only check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "T' insures the business referenced above in box "la" for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"T'. The Insurance Carrier will also notify the above certificate holder within 10 days IFa 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 maybe 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 dale 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.Falcigno (Print name of authorized representative or licensed agent of insurance carrier) Approved by: yG�t-��% 12/15/2023 (Signature) (Date) Title: Managing 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 Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Tuesday, March 19, 2024 9:01 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 03/19/2024 09:01 To: VIL RYE BROOK PRIMARY Transmitted: 03/19/2024 09:01 00002 Ticket: 03194-000-562-00 Type Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 26 To: Name: BISHOP DR N Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: TANK IS LOCATED LEFT OF THE DRIVE WAY; LEFT FRONT CORNER OF THE HOUSE NearSt: KING ST & RT 120A Means of Excavation: EXCAVATOR Blasting: N Site marked with white: Y Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: TANK REMOVAL Estimated Work Complete Date: 03/22/2024 Depth of excavation: 12 FEET Site dimensions: Length 12 FEET Width 12 FEET Start Date and Time: 03/22/2024 07:00 Must Start By: 04/05/2024 ------------------------------------------------------------------------------ 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: WESTMORE FUEL ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA/ WSCHSTR = CON-ED MCI SUEZ WTR WESTCHESTER VIL RYE BROOK 1 WESTCHESTER CTY SWR z Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Wednesday, February 7, 2024 9:34 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 02/07/2024 09:28 To: VIL RYE BROOK PRIMARY Transmitted: 02/07/2024 09:33 00001 Ticket: 02074-000-397-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 26 To: Name: BISHOP DR N Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: TANK LOCATED LEFT OF THE DRIVEWAY; LEFT FRONT CORNER OF THE HOUSE. NearSt: KING ST & RT 120A Means of Excavation: EXCAVATOR Blasting: N Site marked with white: Y Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: TANK REMOVAL Estimated Work Complete Date: 03/12/2024 Depth of excavation: 12 FEET Site dimensions: Length 12 FEET Width 12 FEET Start Date and Time: 02/12/2024 07:00 Must Start By: 02/27/2024 ------------------------------------------------------------------------------ Contact Name: LIZ OLAVARRIA Company: ENVIROSHIELD Addrl: PO BOX 1296 Addr2: City: STRATFORD State: CT Zip: 06615 Phone: 203-380-5644 Fax: Email: liz@enviroshield.com Field Contact: LENNY BOCHICCHIO Alt Phone: 800-394-2268 Email: len@enviroshield.com Working for: WESTMORE FUEL ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA/ WSCHSTR CONED MCI SUEZ WTR WESTCHESTER VIL RYE BROOK 1