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HomeMy WebLinkAboutMP24-119 �yE BR(iv� �s VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914)939-0668 Christopher J.Bradbury xv%v%v.ryebrookny.gov TRUSTEES BUILDING&FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE December 3,2024 Joseph D'Ambrosio&Pamela D'Ambrosio 34 Talcott Road Rye Brook,New York 10573 Re: 34 Talcott Road, Rye Brook,New York 10573 Parcel ID#: 135.50-1-6 As per the Certification letter from Northeast Environmental Inc. dated October 9, 2024, the removal of an underground oil tank under Mechanical Permit #24-119 issued on 9/19/2024 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to _ o- _ s !l N N C� ;? y ■ rq NCs W �� • a [., ~ Y Q 0-4 O 0-4 W - TO z w y QJ ` ■ O O O W y M M w c o72W FI L v y 1r z � ro � .� W O w A w U v C� w0045 d " c Q to d w rU- 5 "1 0 Z) V O x � C v z g4 U � o v w ., O v V ^ O c~n W [ C Z H 0` w Q FBI U � U q z z M A z C � o ' F O cu _ _ cif -�3 BUILDING DEPARTMENT " VILLAGE OF RYE BROOK RrSEP 938 KING STREET RYE BRWY( ,NY 10573 �/ EC (914j 939-066$-Jj w,".rti��il rooku .goy 7 2024 BROOKA lication for Pearmit to Remove or Abandon Fuel(*Storage Tanks in excess of 1,100 gallons require registration with the CounTMEN7 FOR OFFICE USE ONLY: PFR\11T Approval Date: SEP 1 9 2n& Permit Fee: S Approval Signature: Other: Disapproved: (fees are non-refundable) ####rY*+k�rxxxxxxx*xxxxxxxxx+xxxxxxxxxxxxxx++xxxxxxxx+*+++xxxxxx++++*+++#+*#++#xxxxxxxxxxxxxxx+x##+x++xxxx 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: 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#U263/or NY State Workers Compensation Waiver) 4.Fee per Tank: Removal or Abandonment $185.0) per an 5, Dig Safely New York# (dial 81 1): yq IN M- Q5 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, 0&3vm4 ,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 TVDC: Removal Abandonment Above Ground Buried in Ground 1. Address: 34 TALCOTT ROAD SBL: 135.50-1-6 Zone. R-12 2. Property Owner&Address: PAMELA D'AMBROSIO 34 TALCOTT RD RYEBROOK NY 10573 Phone#: 914-636-0022 Cep#: 914-522-9214 email: PAM.BUDDYAMBROSIO@GMAIL.COM 3. Contractor&Address: Northeast Environmental Inc. 225 Valley pl Mamaroneck NY 10543 Phone#: 914-777-1930 Cell#: email: dmonaco@neenviro.com 4. Applicant: Dwayne Monaco for Northeast Environmental Inc. Phone#:914-777-1930 Cell#: email: dmonaco@neenviro.com 5. Indicate Fuel Type:Fuel Oil L.P.Gas( )-Gasoline[a Other( ): 6. number and Capacity of each Tank: REMOVAL OF A 550-GALLON UST 7. Exact Location(s)of each Tank: FRONT YARD UNDERGROUND i 6/1/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: DWAYNE MONACO ,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 Tank Removal/Abandonment Contractor for the legal owner and is duly authorized to make and file this application. 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 { day of S Q.,�-� ,20 0N 14 day of "+J 7 ,20 Signature of Property Owner U turc of Applicant to,r-fl s p AYNE MO ACO Print Name of of Property Owner Print Nam of ppi' a Notary Public o.aryry u ic,State of New KAT'HLEEN registration No.OIBA6171381 Y Notar KI�LINGBACIt Qualified in Westchester County auaiift4 in. W Public State of New York Commission Expires July 23,2W estc This appl' mtrev usilf PIF4t �41gd in its entirety and must include the notarized signature, , � �t�a l ar ih, if6- Iyroperty, and the applicant of record in the spaces provided. Any application not properly comp e led in its entirety and/or not property signed shall be deemed null and void and will be returned to the applicant. 2 6/1/2024 rANORTHEAST ENVIRONMENTALNC. 225\alley Place Mamaroneck b New York 10543 Phone:)914)777-1930 Fax:(914)777-1928 October 9, 2024 N O V , 2 Steven Fews - Code Enforcement Officer Village of Rye Brook 938 King Street Rye Brook, New York 10573 RE: 34 Talcott Road Permit#: MP 24-119 and MP 24-120 Dear Inspector Fews: This letter is to inform you that the work at the above referenced site is complete. WORK COMPLETED: Excavated, cut, cleaned, and properly disposed of one (1) 550- gallon UST and its associated piping. Once the tank was removed, one (1) composite CP-51 soil sample was extracted from the excavation; it was then backfilled to a rough grade. This sample was sent to a NYS certified laboratory and analyzed according to DEC protocol. The analytical results are attached and shown to be within NYS DEC guidance. NE Installed one (1) 275-Gallon ROTH double wall AST on a concrete pad with a rainshield in the rear of the residence. DATE COMPLETED: October 9, 2024 Enclosed, please find copies of all paperwork requested by your office. NE's work was performed with its best present judgment and level of effort consistent with professional standards and in compliance with all applicable Federal, State, and Local ordinances and regulations. P ease feel free to contact me at(914) 777-1930 with any questions or concerns. Sincere , Dw yne J. Monaco c. Enc. Haz-Mat Spill Response ■ Soil Remedialion • Transporting ■ Tanks Installed/Removed www.northeastenvironmental.cam BUILDINC; DETAR')'MLNT VILI.Mme Oh RYI'vAROOK 938 KINGS'r1i,f:E,r 1tVF.BRooK,NY 10573 (914)939-0668 wwy►,r\rbrool:n\.�n� SEP 17 2024 Application for Permit to Remove or Abandon Fuel SVIL 10F.RkE BROOK (*Storage'Tanks in excess of 1,100 gallons require registration with the County o cs c tcti RTMENT HW (►I I It'I t!Y. t►N1 1 14-R4\11T WP )Y— // 17 Approval Dale: _ SEP 1_-9-ZQ Permit FCC: Approval Signature: ` _- -^ Other: Disapproved: _-- (acc,aye nun-raftmdable► *AA*ir**A*Ai:.i*kAY:Ah*#*i.;:i:**R':A*Ah#*i#'h f;kA;-k 4,t*R*A*kAA*f:Akw**f:Al.A*****kAi;#****A At, hA#*hA###iih#h#*«*AA**i#* DO N01 S I AR I \\URk or( (t\ti 1 Rl.( 1 14P, ! \1 IL A PE WM11 HAS KEE\ I�tiU};U K1' 1 ilt: IN!11.111\(: IN'SPVC"I OR.'THE.ADNIINIti FRA fl\'I. EF1- I OR \\t►I(K PROGRE."ED OR COMPLETED\\'TI NClUT A PER A11 f IS 1 M.011,110:"I'OT. L( Os t_(tf c ONSUR .'MINUIU,\1 FEE_W $750.04) 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 Ryc(book must be listed as certificate holder) 3.Your contractor's valid proof of workers compensation insurance. (form II C 105.2 or Form II U26.3/or NY Slate Workers Compensation Waiver) 4. Fee per Tank: Removal or Abandonment I 5. Dig Safely New York ii (cii.il xl 1): Q - %25 0. Inspection by Building Department for removal or abandonment. 7. Submit all Manifests& Reports(aQer work has been completed). 8.Cerliticate ol'C:ontpliance will be provided when all requirements are luffilled. Application dated, 08IM24 _ ,is Iterob),made to lite Building:Inspector of the Village of Ityc Brook For a permit to remove or abandon a Fucl 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 K Federal laws,codex, rules and regulations. Indicate Permit 'I'yl►e: Removal Ahandonmen(D Above Ground buried In GroundD 1. Address: 34 TALCOTT ROAD _ -_ _Sill.: 135.50-1-6 _Zone: R-12 2. Property Owner&Address: PAMELA D'AMBROSIO 34 TALCOTT RD RYEBROOK NY 10573 I'I►one A.- 914-636-0022 Cell 0: 914-522-9214 c►►►ail: PAM.BUDDYAMBROSIOQGMAIL.COM 3. Contractor&Address: Northeast Environmental Inc.225 Valley pl Mamaroneck NY 10543 Phoa►e 11: 914-777-1930 Cell 0: emaii: dmonaco@neenviro.eom 4 Applicant: Dwayne Monaco for Northeast Environmental Inc. Phone n:914-777-1930 Cell n: __ email: dmonaco a neenviro.com 5. Indicate fuel'Type: Fuel Oil�-I.T.Gas( )-Oasolinc0.Other( ). 6. Number and Capacity of each Tank: REMOVAL OF A 550-GALLON UST - 7. Exact Location(s)of each Tank: FRONT YARD UNDERGROUND t 611/2024 BUILDING 69PARTMENT R `" v E VILLAGE OF RYc',RKOOK SEP 17 2024 938 Klnc S-rltua-Rn BR60k,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK %m-A.r�ehrookn♦.um BUILDING DEPARTMENT Application for Permit to Install Fuel Storaee Tank (*Storage'Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOK OFFICE USl. ()NI Y: cc � Approval Date: SEP 1 202 Permit Fcc:S -- Ahhrovat Signature: I)isapploved: (fees ary non-rcfund.11A ) Ix) v(rr STA10 WORK dot,CONti7 K1't UMN I v'11L ♦ IT1011T a ♦s 13t't'v ISSI F'p tt� '1 lit Bt�lt u1vt; I:\til'h'c FOR.l tih::♦1)�1tylSl RA'11♦'h: h'h:I hUK N'OItK Plt/)(:Kt(tiSF:u OK ('O�1PI,h:I h:n��I I I101rl' ,♦ Ph:KMI'1' IS 1-'� UI� 1'IIF;'1O'I':♦1.(()S•I'O1 ('U1\11'Rl�t"T11)V ♦1'Il'It ♦ ♦111\'1♦tl`il hFH. t►F t7511,/N) REQUIREMENTS FOI(RELEASE OF PE14MIT& CERTIFICATE OF COA11'1,1.%NC•;: 1.Application Completed by Bonded, Licensed Contractor. 2. Your contractor's valid prool'of liability insurance.(Village of Ryc Brook must be listed us certificate holder) 3. Your contractor's valid proof of workers compensation insurance. (Form N C105.2 or form tT U26.3/or NY State Workers Compensalion Waiver) 4. I-ce per Tank: Installation: 1185.00 lu•r 1 ,ii ,. 5. Dig Safely New York ll(dial S 1 1): _ 6. Inspection by Building Department for installation. 7. Submit all Manifests& Reports(if applicable,tiller work has been comple(ed). 8.Certificate of Compliance will be provided when all requirements are rulfilled. Application dated, 0913a2024 ,is hereby made to the Building Inspector ofthe Village of I(ye Brook for a permit to install it Fuel Tank as heroin described.The applicant and propciiy oN mer,by signing this ducument agree that tic subject Net tank(s) will be installed in conformance with all applicable Village,County,State& Federal laws.codes,rules and regulations. Imdieate Permit'Cvoe: AboveGroundW1 Buried in (;round !. Address: 34 TALCOTT ROAD -- _ 'BL: 135.50-1-6 zi,11e; R-12 2. Property Owner& Address: PAMELA D'AMBROSIO 34 TALCOTT RD RYEBROOK NY 10573 I'I1onc ll: 914.636.0022 ('ell#: 914-522-9214 email: PAM.BUDDYAMBROSIO®GMAIL.COM 3. Contractor&Address: Northeast Environmental Inc 225 Valley Ill ,Mamaroneck NY 10543 Phone P: 914-777-1930 Cell It: email: dnlonaco o neenvirocom a. Applicant: Dwayne Monaco for Northeast Environmental Inc. Phone tt: 914-777-1930 _Cell H: cnuiil: dmonaco@neenvirocom 5• Indicate Fuel,rype: Fuel Oil f L.P.Gas( )-GasolinO Other( ):_ 6. number and Cispach),ofeaci,Tank: ONE (1) 275 DOUBLE WALLED AST S op- SC ( Q" �a US S o c Q ,-<R 7. Exact Location(s)ofcach'rank: EXTERIOR RIGHT HAND SIDE OF RESIDENCE t 6/t/2U24 NORTHEAST ENVIRONMENTAL, INC. NYS DEC #3A-500 25TH ANNIVERSARY EPA #NYR-000083766 225 Valley Place Mamaroneck, NY 10543 CT-HW #763 Manifest Number 1-877-574-TANK(8265) • Fax 914-777-1928 9 518 1 www.northeastenvironmental.com NAME: .J 1yYV-%)CV05% 0 DATE: GENERATOR/LOCATION BILL TO(IF DIFFERENT FROM LOCATION) NAME NAME INFORMATION/ATTENTION LINE ETA ONSITE INFORMATION/ATTENTION LINE ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE NUMBER PURCHASE ORDER NUMBER PHONE NUMBER PURCHASE ORDER NUMBER TIME IN TIME OUT DRIVERS SERVICE SECTION WASTE CODE DESCRIPTION DRUMS GALLONS UNIT PRICE PRICE TAX LINE TOTAL 1993 USED OIL REMOVAL 1993 OILY WATER DISPOSAL ? e5 1325 SLUDGE DISPOSAL 1203 GASOLINEIWATER DRUM DISPOSAL(NON•HAZ) DRUM DISPOSAL(HAZ) TANK CLEANING VACUUM SERVICE TRUCK HOURLY RATE TRANSPORTATION Terms-Net CONDITIONALLY 15 Days EXEMPT SMALL TOTAL QUANTITY GENERATOR CHARGE MY ACCOUNT FOR THIS GENERATOR WARRANTS AND REPRESENTS THAT THE CERTIFICATION TRANSACTION UNLESS OTHERWISE MATERIALS PROVIDED NORTHEAST ENVIRONMENTAL INDICATED IN THE PAYMENT SECTION. HEREUNDER HAVE NOT BEEN MIXED, COMBINED OR 1 certify that this generator INVOICED REFLECTING CHANGES OTHERWISE BLENDED IN ANY QUANTITY WITH MATERIALS generates less than 100 kilograms TO CUSTOMER ARE SUBJECT TO AN CONTAINING POLYCHLORINATED BIPHENYLF (PCB) OR ANY of hazardous waste per month, INTEREST RATE OF THE LESSER OF 1.1l2% PER MONTH (18% OTHER MATERIAL DEFINED AS HAZARDOUS WASTE UNDER as defined in 40 C.F.R.281,and PER ANNUM)OR THE MAXIMUM RATE ALLOWED BY LAW ON ANY APPLICABLE LAWS, INCLUDING BUT NOT LIMITED TO 40 CFRINVOICES THAT ARE NOT PAID WITHIN 15 DAYS.IN THE EVENT OF PART 261 GENERATOR AGREES TO INDEMNIFY AND HOLD does not accumulate more than DEFAULT,NORTHEAST ENVIRONMENTAL INC.SHALL BE ENTITLED NORTHEA§T ENVIRONMENTAL HARMLESS FOR ANY DAMAGES 1,000 kilograms of such waste TO RECOVER COSTS OF COLLECTION,INCLUDING REASONABLE COSTS ATTORNEY'S FEES, ETC.ARISING OU7 OF OR IN AN during the month. ATTORNEY'S FEES.INITIAL WAY RELATED TO A BREACH OF THE ABOVE WARRANTY BY THE GENERATOR. Generator certifies that the waste Is O used oil GENERATOR'S SIGNATURE PAYMENT LJ olly water F1 Other NON CONDITIONALLY CASH U TOTAL RECEIVED DESCRIPTION EXEMPT LARGE CHICK In accordance the N.J.A.C.7:26.12.1 at seq.Northeast Environmental QUANTITY GENERATOR r"`'0En has the required permits to accept the above described waste. CERTIFICATION In accordance with NJAC7;20.0, 76 40 CFR PART 279. Northeast Environmental ties noeflad the US EPA of It's used oil management activities. PRINT NAME TITLE Dexall CDT �QS6►~ 6' Test Results PRINT NAME SIGNATURE DATE �Q./6 GENERATOR/CUSTOMER PPAI MATUIT�-'� '6A E NORTHEAST ENVIRONMENTAL REPRESENTATIVE 1 i i q PAYMENT RECEIPT R Pascap Co, Inc. 4250 Boston Road Bronx, NY 10475' Ij 111 (718)325-7200 (914)725-3300 FACILITY ID NO. 7003010 SCP NYC DCA License#0437184-0764024 i R ucel pt: 1489703 Date: 10/10/2024 Custoinor: 1242 Time: 08:50 N-DRl'HEAST ENVIRONMENTAL 11 225 Valley Place I MAMARONECK, NY 10543 i Ticket: 3410130 Weigh In: 10/10/2024 08:41 Operator: 9 Weigh Out: 10/10/2024 08:49 CommoBity Orosa Tare Net Price TOTAL$ #i I11•epared 11620 11080 640 8.600/CW I ...............-•--•--.................................................................. Ticket Total 1 �ft of Tickets: 1 Total Paid Pa Id by EZCash Rour,de(i to nearest $1. 00 THERE IS'TO BE NO PROCESSING OR CLEANING 01" MATERIALS ON PASCAP PROPERT)' *:) EXCEPTIONS. VIOLATORS RISK BEING Rlh.NNED FROM THE YARD BY MANAGEMENT 1 ' Technical Report prepared for: Northeast Environmental Inc. 225 Valley Place Mamaroneck NY, 10543 Attention: Mr. Dwayne Monaco Report Date: 10/21/2024 Client Project ID: DAMBROSIO 34 TALCOTT RD RYE BROOK NY York Project (SDG) No.: 24JO862 Stratford,CT Laboratory IDs: @� Richmond Hill,NY Laboratory IDs: NY:10854,NJ:CT005,PA:68-0440,CT:1`11.0723 ' NY:12058,NJ:NY037,CT:PH-0721,NH:2097, EPA:NY01600 120 RESEARCH DRIVE STRATFORD,CT 06615 q 132.02 80th AVENUE RICHMOND HILL,NY 11418 ww,nv.YORKLAB.com (203)325-1371 FAX(203)351-0166 ClienlSorvices®yorklab.com Page 1 of 8 Report Date: 10/21/2024 Client Project ID: DAMBROSIO 34 TALCOTT RD RYE BROOK NY York Project (SDG) No.: 24JO862 Northeast Environmental Inc. 225 Valley Place Mamaroneck NY, 10543 Attention: Mr. Dwayne Monaco Purpose and Results This report contains the analytical data for the sample(s) identified on the attached chain-of-custody received in our laboratory on October 11, 2024 and listed below. The project was identified as your project: DAMBROSIO 34 TALCOTT RD RYE BROOK NY. The analyses were conducted utilizing appropriate EPA, Standard Methods, and ASTM methods as detailed in the data summary tables. All samples were received in proper condition meeting the customary acceptance requirements for environmental samples except those indicated under the Sample and Analysis Qualifiers section of this report. All analyses met the method and laboratory standard operating procedure requirements except as indicated by any data flags, the meaning of which are explained in the Sample and Data Qualifiers Relating to This Work Order section of this report and case narrative if applicable. The results of the analyses, which are all reported on dry weight basis (soils) unless otherwise noted, are detailed in the following pages. Please contact Client Services at 203.325.1371 with any questions regarding this report. York Sample ID Client Sample ID Matrix Date Collected Date Received 24JO862-01 EXCAVATION Soil 10/10/2024 10/11/2024 General Notes for York Project (SDG)No.: 24JO862 1, The RLs and MDLs (Reporting Limit and Method Detection Limit respectively) reported are adjusted for any dilution necessary due to the levels of target and/or non-target anolytes and matrix interference. The RL(REPORTING LIM1T1 is based upon the lowest standard utilized for the calibration where applicable. 2. Samples are retained for a period of thirty days after submittal of report,unless other arrangements are made. 3. York's liability for the above data is limited to the dollar value paid to York for lite referenced project. 4. This report sliall not be reproduced without the written approval of York Analytical Laboratories,Inc. 5. All analyses conducted met method or Laboratory SOP requirements.See the Sample and Data Qualifiers Section for further information. 6. It is noted that no analyses reported herein were subcontracted to another laboratory,unless noted in the report. 7. This report reflects results that relate only to the samples submitted on the attached chain-of-custody form(s) received by York. 8. Analyses conducted at York Analytical Laboratories, Inc. Stratford, CT are indicated by NY Cert. No. 10854, NJ Cert No. CT005, PA Cert No. 68-04440, CT Cert No. PH-0723; those conducted at York Analytical Laboratories, Inc., Richmond Hill, NY are indicated by NY Cert.No. 12058,NJ Cert No.NY037,CT Cert No.PH-0721,NH Cert No.2097,EPA Cert No.NY01600. Approved By: g�L f w Date: 10/21/2024 Cassie L.Mosher Laboratory Manager Page 2 of 8 Sample Information Client Sample Ill: EXCAVATION York Sample ID: 24J0862-01 York Project(SDO)No. Client Proiect 10 Matrix Collection Date/fimc Dale Received 24JO862 DAMBROS10 34 TALCOTT RD RYE BROOK NY Soil October 10,2024 12:00 am 10/11/2024 Volatile Ortranics,CP-51(formerly STARS)List Lop-in Notes: Swule Notes-, Switpic Prepared by Method:EPA 5035A Rqw u-4 to Datelfime Date/Time, CAS No. Parameter Result Flag Units 1.013hIDL LOQ Dilution Rererence Method Prepared Analyzed Analyst 95.63.6 1,2,4-Trimethylben7.ene ND ug/kgdry 2.1 4.3 1 EPA8260D INIM202419:38 10/16/202400:01 SCB Certification: L=11-PH-0723,NP,I,AC.NY10854,NELAC-NY12038,NJDEP.CT 108-67.9 1,3,5-Trimcthylbenzene ND ug/kgdry 2.1 4.3 1 EPA82601) 10/1.9202418:39 10/1600240001 SCB Certifintit CFDOH-PII-0723.NEt.AC-NY108S4,NELAC.NY12058,NJDEP-Cr 11.43-2 Benzene ND uSA-Z dry 2.1 4.3 1 EPA 8260D 10115R024 19:38 10/162024 00:01 SCB Coliftcatloaa: CFDOII-Pit-0723,NELAC-NY10854,NELAC-NY12058,NJDEP-CI 100-41.4 Ethyl Benzene ND ug/kgdry 2.1 4.3 1 EPA9260D 101151202418:38 10/1N20240011 SCB CMiOcaliwm CIDOlf-PH-0723,NELAC-NY10854,NELAC-NY12058,NJ13EP-CT 98.82-8 lsopropyibenzene ND ug/kgdry 2.1 4.3 1 EPA9260D 10115n02418:39 10✓16/202400:01 SCB Ceaifiationr. C=11-PII-0723,NELAC-NY10854,NELAC-NYI2058,NJDEP-CT 1634.04.4 Meihyl tert-butyl ether(MTBE) ND ug/kgdry 2.1 4.3 1 EPA8260D 10/15/20241838 10116R0240001 SCB Certification: CFDOII-PII-0723,NliLAC-NYI0854,NELAC-NY12058,NJDEP-CI 91.20.3 Naphthalene ND ug/kgdry 2.1 8.5 1 EPA9260D I0/151202418:39 10/16/20240001 SCB Cenifkatiom: NELAC-NYt08S4,NELAC-NY1205kNJDEP-CT005,PADEP-U44 104-51-8 n•Butylbenzene ND ug/kgdry 2.1 4.3 1 EPA9260D 10/IM02419:39 10/161202400:01 SCB Cenifimtio : CFDOII-Pil-0723,NELAC.NY10854,NELAC-NYI20S8,N1DEP-CJ I03.63-1 n-Propylbcnzcne ND ttg/kgdry 2.1 4.1 1 EPA82601) 10/15130241938 1NI6120240001 SCB Certifleaootu: Cn)OII-PII-0723,NELAC-NY111854,NELAC-NY12059,NJDBP.CT 9S47.6 o-Xylene ND ug/kgdry 23 4.3 1 EPA9260D 10/15RO2418:38 t0/16/202400:01 SCB CMI(leatimc Cf130H-PII-0723,NELAC-NYl0154,NELAC-NV12058,PADEP-68 179601.23.1 p.&m-Xylenes ND ugJkgdry 2.1 4.3 1 EPA8260D 101157202418:38 10/16/202400:01 SCB Ce"1lk-atiww CrWRI-PII-0723,14ELAC-14YI0954,NELAC-NYI20S8.PADEP-68 99.87.6 p-150propylloluene ND ug/kgdry 2.1 4.3 1 EPA8260D 10/13/202418:38 10/16✓J02400:01 SCB Cenffimiau: CTDOII-PII-0723,NEI.AC-NY10854,NELAC.NY12038,N1DEP- T 133-98.8 sec-Bulyibenzene ND ug/kgdry 2.1 4.3 1 EPA8260D 10115/20241939 10/16/202400:01 SCB Cenlfleadon: CIDOII-Pit-0723,NELAC-NYI0854,NELAC-NY12058.NJDE1'-CT 99-06.6 ten-Butylbenzene ND ugAgdry 2.1 4.3 I [IPA8260D 10/13/20241838 10/I002400.01 SCB Cenifiadon: CMII-PH-0723,NELAC-NYI0854,NBLAC.NY12058,NJOEP-CT 108-99.3 Toluene ND ug/kgdry 2.1 4.3 1 EPA8260D 10/15=418J8 10116/202400:01 SCB Cenifcatimm CMII-PH-0723,NELAC.NY10854,NEt.AC-NY]2058,NJDEP.Ci 1330.20.7 Xylcnm Total ND ug/kgdry 23 4.3 1 EPA3260D 1011&702418:38 10/16/202400M SCB CemirteadcaL* CIDOIJ-PJi-0723,NELAC-NYt0854,NELAC-NY1205&NJDEI'-CI Surrogate Recoveries Result Acceptance Range 17060-07-0 Surtvgare:SURR: 100% 77-125 1,2-Dlch/oroelhane-W 2037.26.5 Surrogate:SURR:Tvhterte-A8 103% 85-120 120 RESEARCH DRIVE STRATFORD.CT 06615 • 132-02 891h AVENUE RICHMOND HILL,NY 11418 www.YORKLAB.com (203)326.1371 FAX(203)357.0166 CllentServicea Page 3 of 8 Sample Information Client Sample ID: EXCAVATION York Samole ID: 24JO862-01 York Project(SD(A No. Client Project ID matrix Collection Datc/rime Date Received 24JO862 DAMBROSIO 34 TALCOTT RD RYE BROOK NY Soil October 10,2024 12:00 and 10/11/2024 Volatile Orltanics,CP-51 (formerly SPARS)List Loe-in Notes: Sample Notes: Sa tplo Prepared by Method:EPA 5035A Reponcdto Daterl'ime Daterrime CAS No. Parumeler Result Flag Unlls LODAIDI. LDQ Dilution Reference Method Prepared Analyzed Analyst 460.00.4 Surrogate:SURR: 113: 76-130 p-DromoJluorobenzene Semi-Volatiles,CP-51 (formerly STARS)List I,oe-in Notes: Sample Notes: Samplc Prepared by Method:EPA 3550C RZ ncdto Daterrime Daterrime CAS No. Parameter Result Flag Units I-OD/14DI, LDQ Dilution Reference Method Prepared Analyzed Analyst RZ-32.9 Acenaphthene 68 1 u$kg dry 46 91 2 EPA 8270E INI6f202409.07 101IR202410.50 SS Ccniftcations: C1700I1.I111-0723,NELAC-NY 1 1)854,NJDEP-Cl 003,PADEP-69-04 208-96.8 Accnaphthy1cnc ND ug6:gdry 46 91 2 EPA 8270E IW16(202409.07 10/18/2024IO:50 SS Ccnifiwtions CMot I-PI1-0723,NELAC-NY I0854,N)DEP.CT005,PA DE P-68-04r 120-12-7 Anthracene 130 ug/kg dry 46 91 2 EPA8270E 10116202409.07 1(VIR1202410:50 SS Cmincalions: Cn)0I I-PI I-0723,NELAC-NY 10854,1,11DEP-C-17005,PA DEI1b8.04 56-55-3 Renzo(a)anth race ne 460 ugft dry 46 91 2 EPA 8270E 10116202409.07 10118202410:50 SS Cenificati— LTDOI ITII-0723,NL•I.AC-NY 10854,NJDEI'-Cl'005,PA DE P68.04 50-32-8 Benzo(n)pyrene 490 ug/kgdry 46 91 2 EPA 8270E lU116/202409.07 1YI9202410:50 SS Cmirrc-atiom: CfDOI LPI1-0723,NELAC-N Y 10834,NJDEPLT005,PA DEP68-04 205-99.2 Benzo(b)nuoranthene 420 uglgdry 46 91 2 EPA8270P. ININ2024D9.07 I(VI8202410:50 SS Certifiwtiom: Cn>D31-I'll-0723,NELAC-NY 10854,N)DEPLI'003,11A DEP-68-W 191.24.2 Benzo(g,h,l)perylene 370 u&'kg dry 46 91 2 EPAS270E 10+I6/202409.07 IO/t R1202410:50 SS Crttirrcatlonc C WII-PIF0723,NELAC-NY10854,N1DEP-CTOOS,PADEP68-04 207-08-9 Benzo(k)Uuoranthene 450 upfkgdry 46 91 2 EPA8270E I01I6202409.07 10/19/202410:50 SS Cenifieations: CIUOII.I'H-0723,NEI.AC-NY10854,NJDEP-Cl'005,PADEP-68-W 218-01-9 Chrysene 490 ugAg dry 46 91 2 EPA8270E 10116202409:07 ICIIPJ202410:50 SS Ccnificatiom: CTD011-1111-0723,NELAC-NY10854,NJDEP-CI005,1'ADEI'68.04 53.70.3 Dlbenzo(a,h)anlh race ne 86 J ugJkgdry 46 91 2 EPA 8270E 10/I6/202409:07 10/19/202410:30 SS Ccnifications: C73)OII•Pi1-0723,NELAC-NYI0854,NJDEI'-CT005,PADF;P6R-04 20644.0 Fluoranthene 970 uWkgdy 46 91 2 EPA 8270E I0716t202409.07 IOIIR202410:50 SS Cenirtatiom: C-Mil-PH-0723,NELAC.NY10854,N1DEVL' S,1'ADEI'68-04 86.73.7 Pluorcnc ND ug/k8dry 46 91 2 EPA 8270E 10II6/202409.07 10118202410:50 SS Ccnifteatiom: NELAC.NY10854,N1DEP-CM5,1-ADEI'•6804440 193-39-5 Indcno(1,2,3-cd)pyrene 370 ug)kgdry 46 91 2 EVA8270E 1WI61202409.07 IOJIR202410:50 SS Ccri fcatiom: CTMII-1'1-0723,NELAC-NY10854,N)DEP-Ct005,14WEP-68A4 91.20.3 Naplllholene ND uglkg dry 46 91 2 El'A8270E I0116/202409.07 INI8202410:50 SS Cenifiraiims: Crl)011-11H-0721,NEI-AC.NY10854,NJDEI'-CrOO5,PADE1'-6R•04c flS 01-X 11ticnanlhrene 590 ug/kg dry 46 91 2 EPA 8270E 101IN202409.07 INI R202410:50 SS Certirtcatiuns Cn)011-1'11.0723,NI:LAC.NYIORS4,NIDEP-Cf-005,1'ADEI'-68.04 129.00.0 Pyrene 980 ug9:g dty 46 91 2 EPA 8270E I 071N202409.07 104W202410:50 SS CcnificalimK Cn7U11 P11-0723,NELAC-NY10854,N)DI!P-CT005,PAI5EP68-04 Surrogate Recorerles Result Acceptance Range 4165.60.0 Surrogate:SURR:Nirrr)benzeitc-r15 29.2% 22 JIM 120 RESEARCH DRIVE STRATFORD,CT 06615 0 132.02 891h AVENUE RICHMOND HILL,NY 11418 www.YORKLAH.com (203)325.1371 FAX(203)357-0166 CliuntServicos Page 4 of 8 1 Sample Information Client Sample ID: EXCAVATION York Sample ID: 24JO862-01 York Project(SDO)No. Client Proicct 1D Matrix Collection DatcfFime Date Received 24JO862 DAMBROSIO 34 TALCOTT RD RYE BROOK NY Soil October 10,2024 12:00 am 10/11/2024 Serni-Volatiles.CP-51(formerly STARS)List Loe-In Notes: Sample Notes: Sample Prepared by Method:EPA 3550C Re vdMto Date/Tinte DatefTime CAS No. Parameter Result Flag Units WWb1DL LOQ Dilution Reference Method Prepared Analyzed Analyst 321.60-9 Surrogate:SURR:2-rinorohiphenyl 53.0% 21-113 171"1-0 Surrogate:SURR:Terphenyl-dM 64.7% 24-116 Total Solids Lot<-In Notes: Sample Notes: Sample Prepared by Method:%Solids Prcp Reponedro Dalemme Datemme CAS No. Paranteler Result Flag Units LOQ Dilution Reference Method Prepared Analyzed Analyst solids '%Solids 89.9 i• 0.100 1 Sla 254OG 10/16J2024 os:S4 10/16r=4 14:13 SMht Ceniriadlons: CTD016411-0721 120 RESEARCH DRIVE STRATFORD,CT 06616 ■ 132-02 89th AVENUE RICHMOND HILL,NY 11418 www.YORKLAB.com (203)325-1371 FAX(203)357-0188 CllentServices Page 5 Of 8 1 Volatile Analysis Sample Containers Lab ID Client Sample ID Volatile Sample Container 24JO862-01 EXCAVArION 2 oz.Glass Cool to 4°C 120 RESEARCH DRIVE STRATFORD,CT 06615 ■ 132.02 89th AVENUE RICHMOND HILL,NY 11418 www.YORKLA8.com (203)326.1371 FAX(203)357-0166 CllentServices Page 6 of 8 YORK Sample and Data Qualifiers Relating to This Work Order i Defected below the Reporting Limit but greater(Iran or equal to the Method Detection Limit(MDULOD)or in the case of a TIC, the result is an estimated concentration. Definitions and Other Explanations Analyle is not certified or the state of the samples origination does not offer certification for the Analyle. ND NOT DETECTED-the analyte is not detected at the Reported to level(LOQ/RL or LOD/MDI.) RL RLWORTING LIMIT-the minimum reportable value based upon the lowest point in the analyte calibration curve. LOQ LIMIT OF QUANTITATION-the minimum coacentmtion of a larger analyze that can be reported within a specified degree of confidence. This is the lowest point in an analyze calibration curve that has been subjected to all steps of the proccssing/analysis and verified to meet defined criteria.This is based upon current NELAC/fNI Standards and applies to all analyses. 1.01) LIMIT OF DETECTION-a verified estimate of the minimum concentration of a substance in a given matrix that an analytical process can reliably detect. This is based upon NELAC 2009 Standards and applies to all analyses conducted under the auspices of CPA SW-846. MDL METHOD DETECTION LIMIT- a statistically derived estimate of the minimum amount of a substance an analytical system can reliably detect with a 99%confidence that tine concentration of the substance is greater than zero. This is based upon 40 CFR fart 136 Appendix B and applies only to EPA 600 and 200 series methods. Reported to This indicates that the data for a particular analysis is reported to either the L0D/MDL,or the LOQ/RL. In cases where the"Reported to"is located above the I.OD/MDL,any value between this and the LOQ represents an estimated value which is 'T'flagged accordingly.This applies to volatile and semi-volatile target compounds only. NR Not reported RPD Relative Percent Difference Wet The data has been reported on an as-received(wet weight)basis Low Bias Low Bias Flag indicates that the recovery of the flagged analyte is below the laboratory or regulatory lower control limit, The data user should take note that this analyte may be biased low but should evaluate multiple lines of evidence including the LCS and site-specific MS/MSD data to draw bias conclusions. In cases where no site-specific MS/MSD was requested,only the LCS data can be used to evaluate such bias. High Bias High Bias flag indicates that the recovery of the flagged analyte is above the laboratory or regulatory upper control limit. 'Ilse data user should take note that this analyte may be biased high but should evaluate multiple lines ofevidence including the LCS and site-specific MS/MSD data to draw bias conclusions. In cases where no site-specific MS/MSD was requested,only the LCS(lain can be used to evaluate such bias. Non-Dir. Non-dir.flag(Non-Directional Bias)indicates that the Relative Percent Difference(RPD)(a nneasure of precision)among the MS and NISD data is outside the laboratory or regulatory control limit. This alerts the data user where the MS and MSD are from site-specific samples that the RPD is high due to either non-hontogcncous distribution of target analyte between the MS/MSD or indicates poor reproducibility for other reasons. If EPA SW-846 method 9270 is included herein it is noted that the target compound N-nitrosodiphenylamine(NDPA)decomposes in the gas chromatographic inlet and cannot be separated from diphenylamine(I)PA). These results could actually represent 100%DPA,100%NDPA or some combination of the two. For this reason,York reports the combined result for n-nitrosodiphcnytamine and diphenylamine for either of these compounds as a combined concentration as Dipincnylaoinc. If Total PCBs are detected and the larger aroclors reported arc"Not detected", the Total PCB value is reported due to the presence oreither or both Aroclors 1262 and 1268 which arc non-largcl aroclom for some regulatory lists. 2-cldorocthylvinyl elhcr readily breaks down under acidic conditions. Samples that arc acid preserved,including standards will exhibit breakdown.The darn user should take note. Certification for pH is no longer offered by NYDOH FLAP. Scnti-Volatile and Volatile analyses are reported down to the LOD/MDL,with values between the LOD/MDI,and the LOQ being T'flagged its estimated results. For analyses by EPA SW-846-82701),the Limit of Qusnlltation(LOQ)reported for benzidine is based upon the lowest standard used for calibration and is not a verified LOQ due to this compou nd's propensity for oxidative losses during extrnction/conccrntration procedures and non-reproducible cluomatogruphic performance. 120 RESEARCH DRIVE STRATFORD,CT 06615 M 132.02 891h AVENUE RICHMOND HILL,NY 11418 svww.YORKLAB.com (203)325.1371 FAX(203)357.0166 CIIenlServices Page 7 of 8 s U I Q Iola f2 CL o Q P N 0 'Q a �° � Q a a � axb o' er o rn C cL 3aQ� wb � rVbaN ? ��` VO v N d r3Ua- � N a !r2tj oG C. tO E C E F(. 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O v .p O a 4 0 0 'ar g a oro � YI O M N < N xx n d ti^�1 �v p C k UI 4 C 4) O O 's r o c �4'O C E 0 Z {\ •�A ri Z w co 0 0 O c: O C 'fi V1 W \ N 4- tV p +.. o 41 Q W C m E ?, O U -0 e =O z rn Yt U E W E IX Lij a x a V cn U) a ti u w a h Page 8 of 8 �yE BR(�jk F, • 1982 BUILDING DEPARTMENT ❑ZLDING INSPECTOR ISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - -- -- -- - ADDRESS : `1 TA L C.7 t ) n d DATE: 10- % - Z O L q PERMIT# ISSUED: ZI SECT: /35"S-b BLOCK: LOT: LOCATION: R. L�'A OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... Q- ACCEPTEDr 1 ElREJECTED/ REINSPECTION ❑ SITE INSPECTION �I�YZ �l REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION _ 1 ❑ NATURAL GAS k ' )y ✓C� �'�"� ❑ L:P. GAS C FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING '' {� ❑ CROSS CONNECTION ❑ FINAL I ✓e Pot ❑ OTHER r sty jh Ali „ f III I` I s i I rf�* 1 1 1 � 'i f (• ,� 1 I . , 07 13 F/. 'qr, t 1 y 1 .f. � �rf ... �•- � <I r , } t S y Jr^h � }h� r�' -�y �.F®—„1 .3+7�' .,•Veyy.J /'l, i'a +fZY k,yl r4 Aj`. j �a " `'%(`'r 1>>, ' y� i 1'`�SS, y-T• .`�`r IN- R l � •o r 1' 4 1 k M r !tiyti - ♦ ,.� ....u�k� �i`,k .h}LL`.� ;; \t b' ;� TS6"� �i�. I�.Et," �r✓!i•�I���jam` /`1�,�+C ^ �r �I� 1,`,��4.�,��„•: ' -1 1 - .�y�'� IL Aw `awl,/v,� -a t DATE(M MIDDIYYYY) ACORL® CERTIFICATE OF LIABILITY INSURANCE 05/31/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Ashlea Tarkazikis NAME: PF Northeast Brokerage Inc PHONE (845)223-8107 FAX (845)227-8816 AIC No xt AIC No 1035 Route 82 E-MAIL atarkazikis@pfnortheast.com ADDRESS: INSURERS)AFFORDING COVERAGE NAIC 0 Hopewell Junction NY 12533 INSURER A: Great Divide Insurance Company INSURED INSURER B: Key Risk Insurance Company Northeast Environmental,Inc. INSURER C: 225 Valley Place INSURER D: INSURER E: Mamaroneck NY 10543 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2453115862 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 CONTRACTOR 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 ADDLISU13RI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MMIDDIYYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx_]OCCUR PREMISES Ea occurrence $ 100,000 X Contractual Liability MED EXP(Any one arson $ 25,000 A ECP01530828-24 06/11/2024 06/11/2025 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO PRODUCTS-COMP/OP AGG $ JECT ❑LDC 2,000,000 OTHER Professional Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED BAP1530830 06/11/2024 06/11/2025 BODILY INJURY(Per accident) $ AUTOS ONLY R AUTOS HIRED NON-OWNED PROPERTY DAMAGEAUTOS ONLY AUTOS ONLY Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE FFX1530829-24 06/11/2024 06/11/2025 AGGREGATE $ 5,000,000 DIED I X RETENTION $ 10,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is listed as additonal insured with regard to general liability coverage as per written contract.Coverage is primary and non-contributory. Waiver of subrogation applies,as per written contract.No labor law exclusion applies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 0JAUVN-_ � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured (914)777-1930 Northeast Environmental Inc 225 Valley Place lc.NYS Unemployment Insurance Employer Mamaroneck,NY 10543 Registration Number of Insured Work Location of Insured (Only required if coverage is 1d. Federal Employer Identification Number of Insured specifically limited to certain locations in New York State, i.e., a or Social Security Number Wrap-Up Policy) 133965670 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) American Fire&Casualty Co. Village of Rye Brook 3b.Policy Number of entity listed in box"Ia" 938 King Street XWA57980680 Rye Brook, NY 10573 3c. Policy effective period _6/29/24 to 6/29/25 3d. The Proprietor,Partners or Executive Officers are included. (Only check box if all partners/officers included) X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "T' insures the business referenced above in box "l a" 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 notes the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c", whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder kith a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Joseph W.Pires (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 6/2/24 (Signature) (Date) Title: President—PF Northeast Brokerage Inc. Telephone Number of authorized representative or licensed agent of insurance carrier: (845)223-8107 Please Note. Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2(9-07) www.wcb.state.ny.us Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Friday, September 13, 2024 12:12 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 09/13/2024 12:12 To: VIL RYE BROOK PRIMARY Transmitted: 09/13/2024 12:12 00008 Ticket: 09134-001-125-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 34 To: Name: TALCOTT RD Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: FRONT OF PROPERTY BOTH SIDES NearSt: BONWIT RD & MOHEGAN LN Means of Excavation: BACKHOE Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: OIL TANK REMOVAL Estimated Work Complete Date: 09/18/2024 Depth of excavation: 30 FEET Site dimensions: Length 25 FEET Width 25 FEET Start Date and Time: 09/18/2024 07:00 Must Start By: 10/02/2024 ------------------------------------------------------------------------------ Contact Name: NIKKI BARNABA Company: NORTHEAST ENVIRONMENTAL INC Addrl: 225 VALLEY PL Addr2: City: MAMARONECK State: NY Zip: 10543 Phone: 914-777-1930 Fax: Email: nmadera@neenviro.com Field Contact: NIKKI BARNABA Alt Phone: 914-777-1930 Email: nmadera@neenviro.com Working for: PAMELA D'AMBROSIO ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA/WSCHSTR CON-ED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR i Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Thursday, October 3, 2024 2:13 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 10/03/2024 14:13 To: VIL RYE BROOK PRIMARY Transmitted: 10/03/2024 14:13 00004 Ticket: 10034-001-649-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 34 To: Name: TALCOTT RD Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: FRONT OF PROPERTY BOTH SIDES NearSt: BONWIT RD & MOHEGAN LN Means of Excavation: BACKHOE Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: OIL TANK REMOVAL Estimated Work Complete Date: 10/08/2024 Depth of excavation: 30 FEET Site dimensions: Length 25 FEET Width 25 FEET Start Date and Time: 10/08/2024 07:00 Must Start By: 10/23/2024 ------------------------------------------------------------------------------ Contact Name: NIKKI BARNABA Company: NORTHEAST ENVIRONMENTAL INC Addr1: 225 VALLEY PL Addr2: City: MAMARONECK State: NY Zip: 10543 Phone: 914-777-1930 Fax: Email: nmadera@neenviro.com Field Contact: NIKKI BARNABA Alt Phone: 914-777-1930 Email: nmadera@neenviro.com Working for: PAM D'AMBROSIO ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA / WSCHSTR CONED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 1 ^ }, O O O 0 p — O - �-� p c� O c� _ _ _ m +-+ c6 — L' (DC C o O O T o cn Q o M = o c = a� (DQ O con c o O p = M o D M N = U m m _0 c� C� — Q CCmm p > m 6 O Q p � m c p(D CO Q U C •� (6 L- (� -0 O C 4-- O O CU cn C ---, � U z O C U o c o ,_, C .N U c� O p (n O f- C O CU O O C W C C Q N cn C �. 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