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HomeMy WebLinkAboutMP25-022 QyE BRn t tpCwa�o`w t vIVCr VMy� VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J. Bradbury www.iyebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R.Epstein Steven E. Fews David M.Heiser Donald T.Krom,Jr. Salvatore W.Morlino CERTIFICATE OF COMPLIANCE April 30,2025 Viktoriya Bogomolnaya 241 Tree Top Crescent Rye Brook,New York 10573 Re: 241 Tree Top Crescent,Rye Brook,New York 10573 Parcel I D#: 129.76-1-80 As per the Certification letter from Envirostar Innovative Corporation dated April 28,2025,the removal of an underground oil tank under Mechanical Permit #25-022 issued on 2/20/2025 has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to o � > �o BUILDING DEPARTMENT TMENT ❑BBUILDING INSPECTOR ,VASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : Z 7 / eFE 7-o P �JL.SEJ ca-A iT DATE: i JGG'as- PERMIT$ MP ��� -' 022 ISSUED: q?Q- bsECT:1��j BLOCK: � LOT: ��-� LOCATION: 4 - OCCUPANCY: ❑ VIOLATION NOTPJ) TI- E WORK IS... Lb' A-CCEPTED ❑ RLJti(-'TED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ TOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS Rem rl ' ► ��c) o ❑ L.P. GAS FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION _ � ❑ FINAL OTHER �l tl �E BR(�k, . 1982 BUILDING DEPARTMENT ❑BAjILDING 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 : '? Ll I DATE: ID".); PERMIT# f�`Q !-) 3 - O (. ISSUED: SECT:11_ 9.7(., BLOCK: LOT: L 0 LOCATION: nU�/` ^✓�C OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... FJ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION �Q . REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION �4 ❑ FINAL LA ❑ OTHER 71 2w /�q��!1 ;fir;. e, '' �µ l • �.. ---~ y '~ Y or se 16 _ s �► --� yk. if_ '�yl� � �; 1' y�, .ti.x r�,�'.ly. .. fly t��y. •">�+' t. �. •• \ }ry.. � ik. -ILA Ki i/ 1l . a a U i O, C, 1 4 fq Ln N C ° Q h===I N 0000rq W WWl o U zy y _ ^ W c`1 (� O O w y w C V op V CN ow 7 Ga rn Q x wa ` a 1 ( 1 p� Fa O till u W �J O 0-4 a w � z O 'n R. O a x z oa � Iba U U w V � G y p � a+ W w p o 0 0 �,� Y v fJr OO EsOw � •� V U O °' � o z F G p R pr o ti 04 a - �I � 0. � •� w x � � � a -o BUILD MENT VIL E oIa RY OOx R1 FEB 1 9 2025 938 KING ET RYE BRo , ,NY 1 Q573 ` `L'"4)939-0668 VILLAGE OF RYE BROOK XY • °v BUILDING DEPARTMENT Application for Permit to Remove or Abandon Fuel Storage Tank. (*Storage Tanks in excess of 1,100 gallons require registration with the County of Westchester) FOR OFFICE USE ONLY: PERMIT#: -1'� � 'C� Approval Date: FEB 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: 1. Application Completed by Bonded, Licensed Contractor. 2. Your contractor's valid proof of liability insurance. (Village of Rye Brook must be listed as certificate holder) 3. Your contractor's valid proof of workers compensation insurance. (Form#C 105.2 or Form #U26.3 /or NY State Workers Compensation Waiver) 4.Fee per Tank: Removal or Abandonment$185.00 per Tank, 5. Dig Safely New York# (dial 81 ]):©_2`2rz -COD 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, 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 Tvnt': Removal (J)•Abandonment ( )!Above Ground( )•Buried in Ground{✓) 1. Address: —1 I 4 SBL: c��i / — --�^ Zone: 2. Property Owner& Address: J l X' k� A%&Afl�I�, 2-9\ } V0R- (�I ce-( * Phone#: �1— ��fl" I#: email: .(—ro 3. Contractor& Address: Envirostar Innovation Corp., 50 Fields Lane, Brewster, NY 10509 Phone#: 845-279-9555 Cell#: email: info@tankremovalservices.com 4. Applicant: Envirostar Innovation Corp. Phone#: 845-279-9555 cell#: email: info@tankremovalservices.com 5. Indicate Fuel Type: Fuel Oil •L.P.Gas( )•Gasoline( )•Other( ): 6. Number and Capacity of each Tank: G QJIJI 7. Exact Location(s)of each Tank: Y,�Cor C Y-0 1 6/l/2024 STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: C1 WG�t1 ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of indjAdual signing as&c 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 C,3nlCY G�-C.trjX( 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 ofthe Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this -3 Sworn to before me this day of l n 20 J day of ,20 Si of Propedy Owner ` Signature of p icant , �lZC�1 19 e2-5,-, C� `` LJlrrrrrrrrr Y CA) r Nam�Property O O$` amgbf pl' t STATE I L O r' :'OFNER+YO , o A0 A No.O1ME6160063 ;NOTARY P[T$L1Q1Pubiic Qualified In Westchester County ? " �• commission Expires tenuity 29,202-7 D101637r279 .' This application;,Host be properly completed in its e �l� include the notarized signature(s) of the legal owner s of subjectproperty,g ( ) and the app scant 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. 2 3/21/19 O � Q O O � O O U — C L O O U � m C co O O O 0) — cv N O N � N � — � N c O O ML W Q� N� W N L.L O �.. ° z o °' O U 0- cc L 0O U z � O � p N Q 10� 0 Z LO L u co ^l O I W r L LOz > L z O E �O/ O I..L ENV1fK05Tf9f:K INNOVATION COR PORATION The name you trust for environmental needs SO Fields Line Phone: 845-279-9SSS Email: info@tankremovalservices.com Brevrster,NY 1OS09 Fax: US-279-0196 vivrw.tankremovalservices.com April 28. 2025 Village of Rye Brook Bldg. Dept. U E `v r-`� 938 King St.Rye Brook, NY 10573 APR 2 8 2025 RE: Permit#: MP 25-022 & MP 25-023 VILLAGE OF RYE BROOK 241 Treetop Crescent BUILDING DEPARTMENT Rye Brook. NY 10573 To Whom It May Concern: On March 17. 2025 Enyirostar Innovation Corp. removed(1) 550-gallon UST oil tank from the rear center of the property and installed (1) 275-gallon ROTH LoH Boy oil tank with weather cap and tie down kit on the left side of the patio on a concrete pad. at the above referenced location. Enyirostar cut man way into the top of the tank. disposed of the remaining liquids and tank bottoms. and hand cleaned inside tank %ails. 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 excavation. The tank was disposed of'. Enclosed. please find copies of the following documents: 1) Soil Sample Results 2) 'Dank Disposal Receipt 3) Liquid Disposal Manifest 4) Copy of Permits At this time, we ask the permit be closed. 1f you have any questions. please do not hesitate to contact us at 845-279-9555. Thank you. 1 Michelle Rezza � Enyirostar Innovation Corp. v: Bogomohul,va A4W PH0ENIX;z.Mo-;'a) EnvirimmiI ntai Laboratories. Inc. Friday, March 21, 2025 APR 2 8 2025 Attn: Greg DiNapoli VILLAGE OF RYE BROOK EnviroStar Innovation I BUILDING DEPARTMENT 50 Fields Lane ---- ---- - -- --- Brewster NY 10509 Project ID: BOGOMOLNAYA 241 TREETOP CRESCENT RYE BRK SDG ID: GCS82497 / Sample ID#s: CS82497 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, k D�, 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 PHOE VIX Environmental Laboratories, Inc. NY Al �isoi 587 East Middle Turnpike.P.O.Box 370,Manchester,CT 06045 Tel.(860)645-1102 Fax(860)645-0823 Sample Id Cross Reference March 21, 2025 SDG I.D.: GCS82497 Project ID: BOGOMOLNAYA 241 TREETOP CRESCENT RYE BRK Client Id Lab Id Matrix Col Date BASE CS82497 SOIL 03/17/25 0:00 Page 2 of 8 AdW. �C kN IIcCOg04 PHOENIX ��� ?� -- — e 4 Environmental Laboratories. Inc. � z 587 East Middle Turnpike.P O.Box 370.Manchester,CT 06045 NY#11301 Tel.(860)645-1102 Analysis Report FOR: Attn Greg DiNapoli EnviroStar Innovation March 21, 2025 50 Fields Lane Brewster NY 10509 Sample Information Custody Information Date Time Matrix: SOIL Collected by: 03/17/25 Location Code: ENVIROS Received by: CP 03/18/25 16:40 Rush Request: Standard Analyzed by: see "By"below P.O.#: Laboratory Data SDG ID: GCS82497 Phoenix ID: CS82497 Project ID: BOGOMOLNAYA 241 TREETOP CRESCENT RYE BRK Client ID: BASE R L/ Parameter Result PQL Units Dilution Date/Time By Reference Percent Solid 85 °, 0118/25 CV SW846-%Sold Extraction of NY ETPH Completed 03/19/25 H/O SW3546 TPH DRO (C10-C28) Diesel Range Organics(C10-C28) ND 290 mg/Kg 5 0120/25 JRB SW8015D DRO QA/QC Surrogates •COD(surr) 74 % 5 0312Q/25 JRB 50- 150% •Terphenyl(surr) 85 ors 5 03/20/25 JRB 50- 150% RUPQL=Reporting/Practical Quantitation Level(Equivalent to NELAC LOQ, Limit of Quantitatton) ND=Not Detected at RL.'PQL BRL=Below Reporting Level L=Biased Low QA/QC Surrogates:Surrogates are compounds(preceeded with a 01o)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 ex1.200. The contents of this report cannot be discussed with anyone other than the client listed above without their wntten consent. Phyllis hiller, Laboratory Director March 21,2025 Reviewed and Released by:Alejandro Paredes, Project Manager Ver 1 Haan;ni j W cC kN ACCO90 PHOENIX ' ..- Environmental Laboratories, Inc. 587 East Middle Turnpike. P.O Box 370. Manchester CT 06045 NY# 11301 Tel (860)645-1102 QA/QC Report March 21, 2025 QA/QC Data SDG I.D.: GCS82497 Blk LCS LCSD LCS MS MSD MS Rec RPD Parameter Blank RL % % RPD RPD Limits Limits QA/QC Batch 775341 (mg/Kg),QC Sample No:CS82805(CS82497) TPH by GC (Extractable Products) - Soil Ext.Petroleum HC ND 50 81 80 1.2 68 71 4.3 30-130 30 °/�COD(surr) 107 % 70 101 36.3 49 87 55.9 50-150 30 m %Terphenyl(surr) 97 % 89 89 00 66 79 17.9 50-150 30 Comment Additional surrogate criteria LCS acceptance range is 60-120%MS acceptance range 50-1509-o.The ETPHiDRO LCS has been normalized based on the alkane calibration. m=This parameter is outside laboratory MS/MSD specified recovery limits r=This parameter is outside laboratory RPD specified recovery limits 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 1. MS Dup Matrix Spike Duplicate NC No Criteria Phyllis hiller. Laboratory Director Intf Interference March 21. 2025 (ISO) Isotope Dilution Page 4 of 8 c V 1 _ - c a v Q � N a E a� � N 0 v — X (U (0 U N � U O cr y N U N C d :7 c Q E � o a c 0 c ) - o O O, 0 CD ti = N N V m N O ac s 0 0 d � n c Z a V w =`c_ X n m W $_ fV c x U a ` U U U m r< � U � C C � f0 � N C N O y m v 0 au O m „ a= na m E o` E o T° y a ,ica c o a� n a` f0 x w �.c E a E C N r 0 o O T O yN A O O� h U N �+ � u 0 O � N y y O N_ c L a N o )- Q 9 y L Z Z O 0 7 n u N m' m c D - v = x ° O n O c N E z L m o Q. Ea ACCoq PHOENIX --- - - _ : iris. 4 Environmental Laboratories, Inc. NY to 11301 587 East Middle Turnpike,P.O Box 370,Manchester,CT 06045 Tel.(860)645-1102 Fax(860)645-0823 Analysis Comments March 21. 2025 SDG I.D.: GCS82497 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 PHOEVIX Environmental Laboratories, Inc. z 587 Fact Middle Turnpike.P.O.Box 370.Manchester.CT 06045 NY# 11301 Tel.(860)645_1102 Fax(860)645-0823 NY Temperature Narration March 21,2025 SDC I.D.: GCS82497 The samples in this delivery group were received at 2.8°C. (Note acceptance criteria for relevant matrices is above freezing up to 6°C) Page 7 of 8 1 I m cr Ui a u a C w rZ b a z b J c z a+b bilS+6� aCOOCCDOC ❑ v°, c43Q7 h v 'OOd O N N �3�C a a � ��,q, `A, a ♦♦f � � 0 i Li � o Y - U � N d I U � Tic U I N W y n N U z EU pip o �i�U❑C N V o - m s B 0 a 2 c s Y c NeLU V Z a A rer ad• � 0 0 O � ? E Q �s LO m x b x _ 11 •D c J Z a E m Q E m c`0n p E LO art c ak a N W N < 're i C C U Q r p I. BASS & SON, INC. 9-11 Carleton Avenue Mount Vernon, NY 10550 Phone (914) 667-1442 • Fax (914) 667-9647 lbassandson(@aol corn CERTIFICATE OF DESTRUCTION Customer: ENVIROSTAR Location. 50 Fields Lane Brewster, NY 10509 Type: 7�j Date: 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. SIGNATURE K, J. Bass & Son, Inc. DATE: 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. SIGNATURE �\V` �j J. Bass 8 Son, Inc. DATE: L4 � �� NON-HAZARDOUS 1 Ge for D►lymber 1 2 Page 1 of 3.Emergency Response Phone C Waste Tntckirg Number WASTE MANIFEST — C -IL 5 G neratoes Name and Mailing A Generator's Site Address(if different than mailing address) I�l 1 ! `' Generator's Phone: �� 6.Transporter 1 Company Name l U.S.TPA ID Number 7 Transporter Company Name U.S.EPA ID Number B.Designated Faciltty Name and S0e Address lean Water of NY,INC I U.S.EPA ID Number °* 3249 Richmond Terrace Staten Island,NY 10303 3 718-918-4600 NY0000968545 Fa 's Phone' 9.Waste Sh,pping Name and Descnptron 10.Containers 11 Total 12 Unit No. Type Quantity WINol. OT-13� rT - : 2 2 3. 1. 4 13.Special Handling Instructions and Additional Information I: a It F" t r y3 14.GENERATOR'SrOFFEROR'S CERTIFICATION:I hereby declare that the contents of fha corwgrmrem are fully and accurately described above by the proper shpprng name,and are classified,packaged, j, marked and labeled/placarded,and are in as respects in proper condition for transport a000r6rg to appicable uttempgonal and I govern tal agulat ons. rG ;t201'sZJOffer0r's PnntedrT —'Sigpature I Dra� J 15.International Shipments - f- ❑Import to U.S. ❑Effort h U.S. Port of entry/exit u' = Transporter&grvature `ore orts on Date leaving U.S.: +, r¢ 16.Transporter Acknowledgment of R of Materials ' Tra rter 1 PrintedrTy/ped/�Name /�f� -- SignaW-- J� Z Transporter 2 Pnnled'Typed Name S ture Month Day Year y; cc I _ 17.Discrepancy �- 17a.Discrepancy Indication Space -- -- ❑Quantity, ❑Type ❑Resbue ❑Partial Rejection ❑Full Rejecton Manifest Reference_Numoer s` 17b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facilrty's Phone: W 17c.Signature of AItemate Facilely(or Generator)F Month Day Year Q Z ye,• C7 - i 2= -W 18 Desgnated Facility Owner or Opera r Certnccation of receipt of mategis covered by fhe mantles,except as noted n Item 17a Printed/Typed Name SWN if re Day r 169-BLS-C 6 10497(Rev.9/09) s;:r;iJS1 Vii I t= i= 1 ■I e 1 N � y . a � p .E E.. � ae � a � � ' • o c � ao IL O lT iil Z au H LnLn 0 CA .4 W N R j �J N �• y� u ;.Ly V 20 Z00 14 oc CN _ u u o Cr xPLO z Fry U. 4r. z a °c w o v L;6; U C 8 $ T a " ' Q•y O FCC Vl z c w Q z uQa O A 0 >4 12 x g ° �21 N _ a N N N \ W + N N � a O pot qd W a � A.rC� � � � ■ ` L1i a re) W N $ _ F ul) y � rv � C � o _ G „ U' o 0 t n � Q � N OG ►-j �1 �= Z a c z oE � � ups F ,� O W � • � x v W a O a w Ln S Ow 00 H S o s z a A . 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III Ii1.�M '� CL ,,;$.'/rlq`F .: � U -o co '�i�� O ryi: p U O_ U ��♦�1q3 U Vll �♦ I i i con H�• `ail �.. i— I +�•1 ! 1 1 -_ -air / •1 3:�ice. ,-x.:r r, r: :•sss. �mut\��-S� O _tllll'lll _ _ _, 'lll�ll!'-t• 1/�/�1�11 j�$S _J�/I//(�1�� :a '...lil//l//�l'..zt�ayggs 'i11/1/1�1i: '.? a 2 i�l'3$A� .ki 11/ ,, rA`��'"< . �� •',Jl�;?� .`-s 1 >a`Af �1��;,;+r,.SaAkk"rl., �11� .>:S7 Y6. ♦1 •WA�3"�.3 '�- ,Y•:. •1 1 ^i. /....A 1 M� Y iE JA t'l 11 1 g f�•{r�r �.j +k .^ - �s 1 ^ Ir Y Y 1 ^ < ,�Y+�:.. v3i. n'.L;3).•,_ u,ri• 1 r:6 \ ry'it :r+r 14 S;S,r�i � .:F j r 'hr!\Ul•: .AtyS�$ \ . .r+ � �l .rr:� w 1 M r�! y1-. t i `yl r ...s .yii V� ^ • ^ ,r`y ✓ ��\+ y V Ssr �\v: t�r f f(r.Ys - �o Y .. �v�t +^t{{/v� _ '§)��'Ft °.. _<�':� � ra�•`�� „�t�y�, ..�, y$�r�G �r��m<�zv.,, s�,,• ,�•�'(. v ��,�w��r•.�.: v �,�iac•<S'���� �'� •�W.4crrX:��r`' �. �.5,��>r ACCO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) llk. � 12/30/2024 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 Dominica Twitty _ The Allan Twitty Insurance Agency, LLC PHONE (845)278-6160 Fax ac No: (845)278 6537 P.O. Box 419 ADDRESS: dominica@atwlttyinsurance.com INSURERS AFFORDING COVERAGE NAIC N Patterson NY 12563 INSURERA: Benchmark Insurance Company 41394 INSURED INSURER B: Ohio Casualty Insurance Company 24074 Envirostar Innovation Corp INSURERC: 50 Fields Lane INSURERD: 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. INS— R - -- ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence 9AWGIE-TO RENTED $ 5U,000 X Professional Liability MED EXP(Any one person) $ 10,000 A X Contractors Pollution Liability MNGR-P-2001798 12/29/2024 12/29/2025 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PRO- JECT a LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Professional/Pollution l $ $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) b AUTOS ONLY AUTOS ( ) pli HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY per accident $ E UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A X EXCESS LIAB CLAIMS-MADE MNGR-X2000790 12/29/2024 12/29/2025 AGGREGATE $ 3,000,000 . DED I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ,ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ iOFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS Wow E.L.DISEASE-POLICY LIMIT $ Inland Marine Scheduled Equip I $250,748 B BMO 58 51 15 00 01/04/2025 01/04/2026 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached N more spice 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 N Y S ' F PO Box 66699,Albany,NY 12206 New York State Insurance Fund I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE """""" 823325897 Q . ALLAN TWITTY INSURANCE AGENCY PO BOX 419 ' PATTERSON NY 12563 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 CERTIFICATE NUMBER POLICY PERIOD DATE W 2549 055-8 940310 06/29/2024 TO 06/29/2025 07/01/2024 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://WWW.NYSIF.COM/CERT/ CERTVAL.ASP. THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO 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 DIRECTOR, I SURANCE FUND UNDERWRITING VALIDATION NUMBER: 891335243 IIII II �IltlI�IIIII10iu�ui0una0u CIli0�1 2 9 114 0 6 117]Jil11111I Form WC-CERT-NOPRINT Version 3(08/29/2019)[WC Policy-25490558] U-26.3 23 [00000000000129140617][0001-000025490558][x#W][16421-14][Cert_NoP{ERT_1][01-00001] Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Monday, March 3, 2025 11:54 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 03/03/2025 11:54 To: VIL RYE BROOK PRIMARY Transmitted: 03/03/2025 11:54 00002 Ticket: 03035-000-928-00 Type: Regular Previous Ticket: 02135-000-668-01 ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 241 To: Name: TREE TOP Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: REAR OF PROPERTY NearSt: ARBOR DR & BRUSH HOLLOW 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: 03/13/2025 Depth of excavation: Site dimensions: Start Date and Time: 03/13/2025 07:00 Must Start By: 03/27/2025 ------------------------------------------------------------------------------ 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: BOGOMOLNAYA ------------------------------------------------------------------------------ Comments: Lookup Type: MANUAL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA / WSCHSTR CONED NYSDOT TFC POKPSE SUEZ WTR WESTCHESTER TEN GAS-HDS VLY 1 Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Thursday, February 13, 2025 2:04 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 02/13/2025 14:04 To: VIL RYE BROOK PRIMARY Transmitted: 02/13/2025 14:04 00002 Ticket: 02135-000-668-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 241 To: Name: TREE TOP LN Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: REAR OF PROPERTY NearSt: ARBOR DR & BRUSH HOLLOW 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: 02/27/2025 Depth of excavation: Site dimensions: Start Date and Time: 02/27/2025 07:00 Must Start By: 03/13/2025 ------------------------------------------------------------------------------ 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: BOGOMOLNAYA ------------------------------------------------------------------------------ Comments: Lookup Type: MANUAL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA / WSCHSTR CONED NYSDOT TFC POKPSE SUEZ WTR WESTCHESTER TEN GAS-HDS VLY 1