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HomeMy WebLinkAboutMP24-101 DR �C4Cwv"°J V 19 W�•,�'� VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914)939-0668 Christopher J.Bradbury www.tyebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE August 26,2024 Paul Silver&Amy Silver Trustees of the Paul Silver and Amy Silver Joint Declaration of Trust 67 Rock Ridge Drive Rye Brook,New York 10573 Re: 67 Rock Ridge Drive, Rye Brook,New York 10573 Parcel ID#: 135.36-1-2 As per the Certification letter from Envirostar Innovative Corporation dated August 26,2024,the removal of an underground oil tank under Mechanical Perrot #24-101 issued on 8/6/2024 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to 6 BRC�� 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.orQ - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :�Z� OC DATE: PERMIT# 1` + y ISSUED: SECT: I3J-3(c BLOCK: LOT: LOCATION: _��� G�/� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑" ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION �- ❑ NATURAL GAS Ujjf I 1 ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ►� L ` '���! t ' ❑ CROSS CONNECTION 1`\ W 1. ❑ FINAL 1 1 C QL.�Q.�l e 4c-e c- ❑ OTHER a ■ = N N O a72 °° G0 x a� o ■ ■ Q\ x y� ty � WC4 a M P. OCA n z v a � Aoe0 � o � m H Ob�J F-j L F, Lin a � G n o Qv ,, ° = o N a. d v Q a. a Ln v cn VO oo zo a O W00 Q z o w V] H � zvva o A Q w z � W A o �' A c — V = E w U Q p+ 0.0 ¢ � ° 5 -a `° v _ w w z w z va ] � � o � -mac � t V o n Z; V H o � M y - 4 Q k, 0000 V V Q '.4 _ 0 � � �� p [ECCENIE BUILDING DEPARTMENT AU6 - 1 2024 VILLAGE OF RYE OROOK 938 KING STREET RYE BRbo-K,NY 10573 VILLAGE OF RYE BROOK (9114)939-0668 BUILDING DEPARTMENT www.ryebrookuy.pov Application for Permit to Remove or Abandon Fuel Storaze Tank (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) (/FOR OFFICE USE ONLY: PERMIT#: /r � —/© r (1 fi 424 _ Approval Date: AUG Permit Fee: $ Approval Signature: - Other: Disapproved: (fees are non-refundable) DO NOT START WORK 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 MINIMUM FEE OF$750.00 REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: I. 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 # C1052 or Form# U26.3 /or NY State Workers Compensation Waiver) 4. Fee per Tank: Removal or Abandonment $185.00 per Tank. 5. Dig Safely New York# (dial 81 1): 08014-000-927 6, Inspection by Building Department for removal or abandonment. 7. Submit all Manifests& Reports(after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulfilled. Application dated, 8/1/2024 ,is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove or abandon 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 or abandoned in conformance with all applicable Village,County,State&Federal laws,codes, rules and regulations. Indicate Permit Type: Removal(4•Abandonment ( )/Above Ground ( }•Buried in Ground (\X L Address: 67 Rock Ridge Drive SBL: 135.36-1-2 zone: R-10 2. Property Owner&Address: Paul Silver 67 Rock Ridge Drive, Rye Brook, NY 10573 Phone#: Cell#: 914-329-3110 email: asilverlady@aol.eom 3. Contractor&Address: Envirostar Innovation Corp 50 Fields Lane, Brewster, NY 10509 Phone#: 845-279-9555 Cell#: email: info@tankremovalservices.com 4. Applicant: Phone#: Cell#: email: 5. Indicate Fuel Type:Fuel Oil(y/•L.P.Gas I 1 •Gasoline( )•Other( ): 6. Number and Capacity of each Tank: 1 - 550 Gallon UST 7. Exact Location(s)of each Tank: Front Yard I 6/1/2024 �I �f F r 1F nrF:w•t•r)ttk.t t u �v rl c�F 11 FtiTt fig-�rt:tc t u: %._being duly st%t)m.deposes and states that he.she is the applicant abonc earned. �Mmt name nl ind�al s,�m ne�, rylor3�a� and turther states that(slhe is the legal o%tner of the property to tt hich this application pertains,or that I s)hc is the lc __ for the legal o%mur and is duly authorized to male and file this applicatttitn. �naiucc auclutn t,cormr-tw.agu-rn.all wm-t.ct.i That all statements contained herein are true ur the hest of his her kritm icdge and belief.anJ that any stork perlormed,ur t:u conducted at the abo%c captioned propem will he in LonlOrmance 1%ilh the dclails asset tbnh and comas W in this application and to am accompan%ing approted platy and spccifica6 m5,as gull at in accordatme%%iih the\e%% t ork State l nitorm Fire Prn enlion K Building Code.the Code of the V illage of Rse firtKtk and all Luther applicable lasts,ordinances anJ regulations. Shorn to before me this f St+stun to bc:tbre me this � --- Juti Si_nature o Propcm t hrre• Prt tt\ante of ProEk n ()ttricr I? of,�ppt�-art 1 i \o13r1 Public 1 11 twpll,t,I `oaan Pu hlic MANNA AtA,J(j41 WTI SrY�UUK-State of 10-Ylk, d�lL •..•. O-'•• MU.OIMADG05967 i l__ �A� '•,�j 1 wt�r1 riBnf orrtltirtt J is st•, irtit� Jed must includr the nut;g` of YOIt1('. i} i1r propc•rt-,. :rld ^,ht aPplic nt of record in the Spac S.�trM a 1ppii atitrrt rut p:ttp,rh c.Jmpjctud in its auiret% ar1d. it eat praprr'I} >i�ncd .hall he r..i4aot fir ' a st,itl anti vk ill rCtllrlled ro the applicant s anti,,,' ,'�t41/1NNIIIIN~, i r at».� �i a i,�s► ••y T, j ' ,x, ^'� -fir•,/�: � '�Jti�6• ,��J,.� , „�`� 7 `:. F`-1 '� ;} ,r Product# Capacity Model Gauge i Dimensions i Weight (US gal.) j thickness ! H W L i (lb.) 204201 P �" 275 vert. 12 44' 27' 60" !I 257 204701P 275 honz. 12 27- 44" 60' i 257 205201P ( 330 vert. i 12 44" 27' 72- 290 205701P j 330 horiz. j 12 27 44^ 72° 290 UL 142 also available(275 and 330 gal.) External finish:BEIGE polyurethane coating Warranty*: -- years Touch u�paint:PE0056C "BEIGE" KR0001 (repair kit) ���GARD Pr ct# Capacity ( Model i Gauge Dimensions Weight (US gal.) I thickness ! H W L (lb.) 244201 275 vert. 12 44' 27' 60" I 290 2 330 vert. 12 1 44" 27' 72' 334 External finish:BEIGE powder paint coating Warranty*: 25 years Touch up paint:PE0055C "BEIGE" ECOPLUS Product# ( Capacity Model Gauge Dimensions Weight (US gal.) thickness H W L (lb.) 244201P ( 275 vert. I 12 44" 27' 60' 295 245201P 330 vert. 12 44' 27' 72' 340 External finish:BEIGE polyurethane coating Warranty*: 30 years couch up paint:PE0056C "BEIGE" KR0001 (repair kit) 02• 02' 02" 02' - 12+ 12--12--,-12--- Technical specifications ------ • Steel ASTM A1011 H --------------- • Female threaded openings • Pressure tested at 5 to 7 PSIG • UL 80 and UL 142 listed •Operation at atmospheric pressure • I ' "Consult warranty documents for details c O ^ L Q Q E O L O O O E � O o O � 1n u1 V E O ° (� m E o CL d ti N r L _ U c!� o0 O C Cu W 0 CD >' LA ID z � °: U N (Y �° E L F, W W ��- c N (14 a- Q o $ 9 — Q oc c C/) v in ° v W N a- O cr- ° O x W � z I U I I Z O O > Q :IN o LL ru Z ' E c z O z a, N z LA a0 O i (II O m a O O L L a Ln "— O N � O O w E E O 0 EC EWE ENV 1 f� 0 5 Tf9 f� AI;G 2 6 2024 I �_ , INNOVATION C ORPORAT ION The Home you trust for environmental needs VILLAGE OF RYE BRGOKBUILDING DEPARTMENT 50 Fields Lane Phone: 845-279-9SSS Email: mfoCE tankremovalsennces.com Brewster,NY 10S09 Fax: 845-279-0196 wn na.tankremwalse.vices.com August 26. 2024 Village ol'Rye Brook Bldg. Dept. 938 King St. Rve Brook. NY 10573 RE: Permit #: MP 24-101 K MP 24-102 67 Rock Ridge Dr. Rye Brook. NY 10573 To Whom It May Concern: On August 16. 2024 Enyirostar Innovation Corp. removed (1) 550-gallon UST oil tank from the Mont left side ot'the property and installed (1) 275-gallon Double Bottom oil tank on the right side of the propem on a precast concrete pad. at the above referenced location. I nvirostar cut man %vay into the top of the tank. disposed of the remaining liquids and tank bottoms. and hand cleaned inside tank walls. The tank was removed from the ground and inspected for holes. No holes were found in the tank. A soil sample was drawn from the base of the excavatiein. The tank was disposed of. Enclosed. please find copies of the tollo�ying documents: 1) Soil Sample Results 2) Tank Disposal Receipt 3) Liquid Disposal Manifest 4) Copy ofPennits At this time. we ask the permit he closed. lfyou have any questions. please do not hesitate to contact us at 845-279-9555, -thank you. Michelle Rezza Frivirostar Innovation Corp. ( v: .Silver i PHOM-0-*n V-i, iTl ironnrental Laboratories, Inc. Monday, August 26, 2024 Attn: Greg DiNapoli EnviroStar Innovation 50 Fields Lane Brewster NY 10509 Project ID: SILVER 67 ROCK RIDGE DR RYE BROOK NY SDG ID: GCR44184 Sample ID#s: CR44184 This laboratory is in compliance with the NELAC requirements of procedures used except where indicated. This report contains results for the parameters tested, under the sampling conditions described on the Chain Of Custody, as received by the laboratory. This report is incomplete unless all pages indicated in the pagination at the bottom of the page are included. All soils, solids and sludges are reported on a dry weight basis unless otherwise noted in the sample comments. A scanned version of the COC form accompanies the analytical report and is an exact duplicate of the original. The contents of this report cannot be discussed with anyone other than the client listed above without their written consent. Sincerely yours, �� A�L Phyllis hiller Laboratory Director NJ Lab Registration #CT-003 NELAC -#NY11301 NY Lab Registration#11301 CT Lab Registration #PH-0618 PA Lab Registration #68-03530 MA Lab Registration #M-CT007 RI Lab Registration #63 ME Lab Registration#CT-007 VT Lab Registration #VT11301 NH Lab Registration #213693-A,B 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06040 Page 1 of 6 O\,ti0 `N h C C p 904� PHOEVIX U f U Environmental Laboratories, Inc. NY#11301 Z 587 East Middle Turnpike,P.O.9ox 370,Manchester,CT 06045 Tel.(860)645-1102 Fax(860)645-0823 Sample Id Cross Reference August 26, 2024 SDG I.D.: GCR44184 Project ID: SILVER 67 ROCK RIDGE DR RYE BROOK NY Client Id Lab Id Matrix BASE CR44184 SOIL Page 2 of 8 `N ACCOH PyI10F,WX*, -. �,�° ~� it Environmental Laboratories, Inc. _ 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 NY#11301 Tel.(860)645-1102 Fax(860)645-0823 Analysis Report FOR: Attn: Greg DiNapoli EnviroStar Innovation August 26, 2024 50 Fields Lane Brewster NY 10509 Sample Information Custody Information Date Time Matrix: SOIL Collected by: RUBIN 08/16/24 Location Code: ENVIROS Received by: B 08/19/24 16:35 Rush Request: Standard Analyzed by: see"By" below P.O.#: Laboratory Data SDG ID: GCR44184 Phoenix ID: CR44184 Project ID: SILVER 67 ROCK RIDGE DR RYE BROOK NY Client ID: BASE RU Parameter Result PQL Units Dilution Date/Time By Reference Percent Solid 84 % 08/19/24 CV SW846%Solid Extraction of NY ETPH Completed 08/19124 C/X SW3546 TPH DRO (C10-C281 Diesel Range Organics(C10-C28) ND 59 mg/Kg 1 08/20/24 JRB SW-846 8015 QA1QC Surrogates COD(surr) 73 % 1 08/20/24 JRB 50-150 •%Terphenyl(surr) 83 % 1 08/20/24 JRB 50-150% RL/PQL=Reporting/Practical Quantitation Level(Equivalent to NELAC LOQ,Limit of Quantitation) ND=Not Detected at RL/PQL BRL=Below Reporting Level L=Biased Low QA/QC Surrogates:Surrogates are compounds(preceeded with a%)added by the lab to determine analysis efficiency. Surrogate results(%)listed in the report are not"detected"compounds. Comments: The TPH(C10-C28)is quantitated using an alkane standard. All soils,solids and sludges are reported on a dry weight basis unless otherwise noted in the sample comments. If you are the client above and have any questions concerning this testing,please do not hesitate to contact Phoenix Client Services at ext.200. The contents of this report cannot be discussed with anyone other than the client listed above without their written consent. D Phyllis hiller,Laboratory Director August 26,2024 Reviewed and Released by.Phyllis Shiller,Laboratory Director Ver 1 Page 3 of 8 �N ACC0,9 PHOE �,y U U ` Environmental Laboratories, Inc. a 587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 NY#11301 Tel.(860)645-1102 QA/QC Report August 26, 2024 QA/QC Data SDG I.D.: GCR44184 Blk LCS LCSD LCS MS MSD MS Rec RPD Parameter Blank RL % % RPD % % RPD Limits Limits QA/QC Batch 745479(mg/Kg),QC Sample No:CR44184(CR44184) TPH by GC (Extractable Products) - Soil Ext.Petroleum HC NO 50 77 71 8.1 86 86 0.0 30.130 30 %COD(surr) 74 % 105 100 4.9 118 119 0.8 50-150 30 %Terphenyl(sun) 63 % 74 68 8.5 88 88 0.0 50-150 30 Comment: Additional surrogate criteria:LCS acceptance range is 60-120%MS acceptance range 50-150%.The ETPH/DRO LCS has been normalized based on the alkane calibration. If there are any questions regarding this data,please call Phoenix Client Services at extension 200. RPD-Relative Percent Difference LCS-Laboratory Control Sample LCSD-Laboratory Control Sample Duplicate MS-Matrix Spike Phyllis hiller, Laboratory Director MS Dup-Matrix Spike Duplicate Augu 26,2024 NC-No Criteria Intf-Interference Page 4 of 8 0 a a N N N T c Q m"y C L T J y d CJ U Q E N d C N N N 10 67 � y U C U x m a) ry U N � C U O rl U N G y (C 7 F CO T C O .= V _ C N N W � Q1 O Of 7 N td O T G N N c � cv a -a e z a o u w = rm W c� N d •ii LL % co +�+ a� ° Y U X U y� w 4 C y a E U c � m VI O Q) U Q C s n n m E o E ° o m D_ 'C CL N N C O 5 O 0 d c N O T Q 0 N c E a E cu O y N d c° o V T V N O U D� O 0 U N a) m N A C D Q L a N ° U N p N Q c 9 7 Z Z Q O 7 N N— N J O C Z O 'N Z O `0 oc 2 m U) a. ��O �p ACC0q�7 PHO "�_ U U ..n Environmental Laboratories, Inc. NY#11301 587 East Middle Tumpike,P.O.Box 370,Manchester,CT 06045 Tel.(860)645-1102 Fax(860)645-0823 Analysis Comments August 26, 2024 SDG I.D.: GCR44184 The following analysis comments are made regarding exceptions to criteria not already noted in the Analysis Report or QA/QC Report: None. Page 6 of 8 \�c OA A C C O'� PHOE VIX4 Environmental Laboratories, Inc. NY#11301 Z 587 East Middle Turnpike,P.O.Box 370.Manchester.CT 06045 Tel.(860)645-1102 Fax(860)645-0823 NY Temperature Narration August 26, 2024 SDG [.D.: GCR44184 The samples in this delivery group xverc received at 2.6�C. (Note acceptance criteria for relevant matrices is above freezing up to 6°C) Page 7 of 8 9� m I LO w O �' y> I CA .c a Io� L a 'a9, 1 'r+ �'rG •�AA•O. t LL V 2 W �j V a ul N c� N 'JS 1�c'� s Y LL a. lL 0- C wU z a z16, b o �rti o, b •' �I � a # /lmi ��� o�� LL w y c at �3 �� 00 $ 4 al❑❑❑ ❑ ❑ e C J O N 8 a B c U U Ui° m � 0 �� 3 E W 1 2IIJ❑❑ ❑ o OLL x of U m � o Ak 1. 10 o .V W co Lt1 Q U U Gn m e r pSd x i a m ¢ u d Z E �S } w w i Z ^ N � � y a OA p E U) ox � A vp � A Q ° z O c o c 0 m c ,p c J z CL E m !9 I E I e N y ! f N .�. a p LLa) U) El J o + I.E O f: W� tr) to C A A a s f7o .CL � a a a ,E, CL mm ° cn � S (nV) S 1. BASS & SON, INC. 9-11 Carleton Avenue Mount Vernon, NY 10550 Phone (914) 667-1442 • Fax (914) 667-9647 Lssandson[abaol.com CERTIFICATE OF DESTRUCTION Customer: ENVIROSTAR Location: 50 Fields Lane Brewster, NY 10509 T e: Date: C DISPOSITION TRANSPORTER COMPANY NAME AND ADDRESS: J. BASS & SON, INC. 9-11 CARLETON AVENUE MOUNT VERNON, NY 10550 I, THE UNDERSIGNED, CERTIFY THAT THE MATERIAL DESCRIBED ABOVE WILL ONLY BE DELIVERED TO A FACILITY FOR DEST TION. �, J. Bass & Son, Inc. DATE: "► SIGNATURE I i '11)� I, THE UNDERSIGNED, CERTIFY THAT THE MATERIAL WILL BE PROCESSED FOR REMELTING ONLY. THIS MATERIAL WIL NOT BE SOLD AS USABLE IN ANY SHAPE, FORM OR MANNER. NATURE �J J. Bass& Son, Inc. DATE: " SIG I I I NON-HAZAROOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waite Tra*ft Number WASTE MANIFEST _ 845-279.OM S.Generators Name and Mailing Address Generator s Site Address(ti different than mailing address) Generator's Phone: a�� 6.Transporter 1 Company Name U.S.EPA ID Number ENVIROSTAR INNOVATION CORP. NYMW121= 7.Transporter 2 Company Name U.S.EPA ID Number &.Qesigrated Facility Name and Site Address Clean Water of NY,jNkPA 10 Number 3249 Richmond Terrace Staten Island,NY 10303 Fad' s Phone: _. . 718-918-4600 Nymw 10.Cor>tainens 11.Total 12.Urnit 9.Waste Shipping Name and Desaiplion No. Type WAndtf' WI.NoI- -� W W 2. t7 3. 4. 13.Special Handing fnstnwiions and Additional Irdormatkm 14.GENERATORWOFFEROR'S CERTIFICATION:1 hereby declare that the contents of this consignment are fully and accurately described abA by the proper shipping name,and are classified,packaged. marked and labe"plararded.and are in all respects in proper condition for transport according to applicable international and nationI govemmen regulations. on rslOfterors PrintedTyped None/' Signature �rm y Year .� 15. I Shripments1:1F2- ❑Import to U.S. Export tr S. Port of entrylexA: Trdnsporter Sowure fore date leavm U.S.: Ir 16.Tran, t of Raceip Materiels Day ear I- Twj!!k4r 1 PrintaCyped Name S e 4 Transporter 2 PrinleVyped Name tore Month Day Yead 17.Discrepancy 17a.Drsaepar>cy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Marytesi Reform"Number: 17b.Alternate Facility(or Generator) U.S.EPA ID Number U rai Facility's Phan: W 17c.Signature of Akemate Facility(or Generates) Monts Day Year F- a z o a� w a 18.Designated Facility Owner or Operator:Certification of receipt of materials covered by the manifest except as noted in Item 17a Prxt Wyped Name Signature _ Month Day Year 169-BLS-C 6 10497(Rev.9/09) DESIGNATED FACILITY TO GENERATOR 8 v v o � ° w g a CO) _ W A,� tq. .a ,d �! 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III ♦"! � � � �', �-• w O ,o �- ��action � 9 � ,.�' /�1 � ; J }• �„ h � �` •yam ���.,�.._..., •..i.ay LL IW C- ,. > X O Z /- ." w ••' : �:�✓�: ¢ •3 � �'�:max ag Ike 00 .F ,• - 0 � is !_ •v � _ .:�'�'n � 4 tu CD / ry.� �,rA'I � C VJ � Imo-• l"' '�> �yy\ ASLO - �C �({dtts)�u.: .. :� �_`IIt4 ll'i*il:�_;.S.�,J�t+ff/ � :`f--'r�4+�_`t'' �: ! '=r'.•-'1 t ��i:,; 1 ..v nwy [�)1�1 �.- ., `�° t ►►11 �'i�g� k� 4i1/►it04� c� �ttt11., �'<�a`Iii.t���+,� �:sr {s1� t�li�'��6� A� f�/►1 i. � � 1 1 ;:; �A�� e� ;�bt`w�.,Ft: Q•ea � w�� aee� i�w�F§ .4••ea � w v a�i, t�rAs�,tr �C.�e�- A A •�'�:> eA A-gy? %7' o}�. .ylr''tr rvvy . e :\ r - ..ff+l .�v.�. �R•t �rtti�. �r r{y''� ,�v - ? ;�• s v � v a v s' v ', �:7�Swa}; .•Ip•✓�� x, -y'ky� �<'•'�' �- A`oRo� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YY1Y) 0110412024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME;_ Dominica Twitty The Allan Twitty Insurance Agency. LLC PHONE (845 278 FAx----_— - — P.O. Box 419 UVC,No Ex -6160 E-MAIL _(845)278-6_5.37 ADDRESS: dominicaQatwittyinsuranoe.com -- - - - - Patterson ----_ -�WRER(S)AFFORDING COVERAGE NAIC u NY 12563 - INSURED -------- ---- -- ----_ INSURER A_- AXIS SUfpIUS Insurance Co.nvirostar Innovation Corp _- INSURERe: Citadel Life&Health Insurance Company 71897 50 Fields Lane INSURERC: Ohio Casualty Insurance Company 24074 -- -- - INSURER D INSURER E: Brewster NY 10509 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 LTR TYPE OF INSURANCE AODL-SUBR - - POLICY EFF POLICY EXP -- -- POLICY NUMBER MMIDD X MMIDD LIMITS COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCGJR DA�tAGETDIiENTED _-_.- - X Professional Liability PREMISE$tEa_occurrenceL- _ $-50,000 ----- MED EXP(Any one person) $ 10,000 A X Contractors Pollution Liability — - -- — -- �y_-- EMP22003711-012 12/29/2023 12/29/2024_PERSONAL BADV INJURY _ S 1,000,000 GENT AGGREGATE LIMIT APPLIES PER -- ---X POLICY - JECT PRO- X LOC-- GENERAL AGGREGATE $ 2,000,00_0 ----- --- -OTHER -PRODUCTS-COMPIOP AGG $ 2.000,000 ---------------- - Professional/Pollution I $ S1.000.000 AUTOMOBILE LIABILITY COMBINED INGLE LIMIT ANY AUTO _.LE@_aca ern)_. _ $ 1,i)OO.p00 OWNED SCHEDULED BODILY INJURY(Per person) $ B X 73AP8006221 ---- ---""--- AUTOS ONLY AUTOS 03/05/2023 03/OS/2024 BODILY INJURY(Per acodeM) $ X HIRED v NON-OWNED DAMAGE ------- AUTOS ONLY /� AUTOS ONLY PROPE RTY 1Peracadentl----------..._ S - UMBRELLA LIAR X OCCUR $ - EACH OCCURRENCE S 1,000.000 A X EXCESS LIAB - CLAIMS-MADE EMX22001080-02 12129/2023 12/29/2024 _AGGREGATE $ 1,000.000 DED RETENTION WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY PER OTH- Y/N __STATUTE_ _ ER_ ANV PROPRIE70RlPARTNERlEXECUTIVE - --------- OFFICERIMEMBER EXCLUDED? ❑ N/A El EACH ACCIDENT j (Mandatory in NH) —- --- --------if yes describe under E L DISEASE-EA EMPLOYEE$ DESCRIPTION OF OPERATIONS below —" ------- E L DISEASE-POLICY LIMIT $ Inland Manne Scheduled Equip S250.748 C BMO 58 51 15 00 01/04/2024 01J04/2025 DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept. AUTHORIZED REPRESENTATIVE 938 King Street / Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NY S I F PO Box 66699 Albany,NY 12206 New York State Insurance Fund I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A A 823325897 ALLAN TWITTY INSURANCE AGENCY PO BOX 419 PATTERSON NY12563 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ENVIROSTAR INNOVATION CORP VILLAGE OF RYE BROOK 50 FIELDS LANE BUILDING DEPT. BREWSTER NY 10509 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER �CE�RTIFICA�TENUMBER POLICY PERIOD DATE W 2549 055 8 06/29/2024 TO 06/29I2025 107/01l2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO 2549 055-8, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS:l/W1NW.NYSIF.COM/CERT! CERTVAL.ASP. THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE SI GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION PRESIDENT GREGORY DINAPOLI ENVIROSTAR INNOVATION CORP(1 OF 1) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY NEW YORK STATE INSURANCE FUND VALIDATION NUMBER 891335243DIRECTOR,I(11"" 4 URANCE FUND UNDERWRITING . I„'r000000 0000�12�9140617 1111 Form WC-CERT•NOPRINT Veswn 310829/201'71(WC PoLcy-2S.I9(IS>81 23 I'-26.3 f000000000oo129140617110001 000025+9055e11sewgt6+21 ul(Ccn_nootEreT_iyol a000il Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Thursday, August 1, 2024 10:24 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 08/01/2024 10:24 To: VIL RYE BROOK PRIMARY Transmitted: 08/01/2024 10:24 00001 Ticket: 08014-000-927-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 67 To: Name: ROCK RIDGE DR Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: FRONT YARD NearSt: ACKER DR & JACQUELINE LN Means of Excavation: EXCAVATOR Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: U Work Type: OIL TANK REMOVAL Estimated Work Complete Date: 08/12/2024 Depth of excavation: 15 FEET Site dimensions: Length 15 FEET Width 15 FEET Start Date and Time: 08/12/2024 07:00 Must Start By: 08/26/2024 ------------------------------------------------------------------------------ Contact Name: ROBIN DINAPOLI Company: ENVIROSTAR CORP Addrl: 50 FIELDS LN Addr2: City: BREWSTER State: NY Zip: 10509 Phone: 845-279-9555 Fax: Email: info@tankremovalservices.com Field Contact: ROBIN DINAPOLI Alt Phone: 845-279-9555 Email: info@tankremovalservices.com Working for: SILVER ------------------------------------------------------------------------------ Comments: Lookup Type: MANUAL ------------------------------------------------------------------------------ Members: ALTICE USA CON-ED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR i