HomeMy WebLinkAboutMP25-101 t�
19
VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914) 939-0668 Christopher J.Bradbury
www.ryebrookny.gov
TRUSTEES BUILDING& FIRE INSPECTOR
Susan R. Epstein Steven E. Fews
David M. Heiser
Donald T.Krom,Jr.
Salvatore W. Morlino
CERTIFICATE OF COMPLIANCE
July 29,2025
Anders Papritz&Paula Papritz
227 Tree Top Crescent
Rye Brook,New York 10573
Re: 227 Tree Top Crescent, Rye Brook,New York 10573
Parcel ID#: 129.76-1-55
As per the Certification letter from Innov8tive Environmental Services Inc. dated July 21,2025, the removal
of an underground oil tank under Mechanical Permit #25-101 issued on 7/1/2025 has been satisfactorily
completed.
Sincerely,
Steven E. Fews
Building&Fire Inspector
/to
QyE BRC�k,
O� tim
• 1982 BUILDING DEPARTMENT
VAs
rILD1NG INSPECTOR
sISI'AN'I'BUILDING INSPECTOR VILLAGE OT RYE BROOK
❑CODE ENFORCEMENT ODUICER 938 King Street . Rye Brook, NY 10573
(914) 939-0668 FAx (914) 939-5801
www ryebrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADDRESS : 2 2 7 1 rer- Op . DATE: -) - 2! - ZO&S-
PERMIT# I• , 10 ` ISSUED: SECT: /29 7G BLOCK: I LOT:
LOCATION: OCCUPANCY:
❑ Violation Noted THE WORK IS... ASSED ❑ FAILED REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION 1 n
❑ Natural Gas foo
❑ L.P. Gas
,8- FUEL TANK
❑ FIRE SPRINKLER W e- CRC'_ e- -Ae
❑ FINAL PLUMBING �_ r •
❑ CROSS CONNECTION 2,0
❑ FINAL pn �+ ,1
❑ OTHER M L) V t,L W M P U, CL �• f'V
1989'. 'BUILD'tN'G .'I)'E.-I-)A.It'r'MENT
❑PRIMING INSPItc-ro.m
VtLlL,.A.GV 0F .'RY)F, BitoOK
CI"MMi P'NPORCEMUNT OFFICER 938 KING;S'AlUKET * .'Ryli BROOK,NY 10573
(914) 939-0668]SAX (914)939-5801
-wwwj-ysAw(to,k om
- -- - -- - - - - - - -- - - - - - - INSPECTIONS REPORT - - - - - - - - - - -- - - - - - - - -
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: OCCUPANCY:UPANCY:
❑ 11
VIOI-Al'JON NO-rim U.11 wolui-is... AciarrmLILCrlD/RE INSPECTION
S11%INSPECYVION RLQVIRED
1:1 VOO'YING
13 't"00-YING DRAINAGE
11 UOUNDATIOTq
13 UNDIRUGRou-NI) 'N(')'.*I'].,'.S(IN INSPECTION:
0 Roma.) p1jimitim.
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BUILll1NG DEPARTMENT
VIL R6E OF RYE BROOK
938 KING i-REET RYE BR00x,NY 10573 JuN 302025
(914)939-0668 VILLAGE OF RYE BROOK
y:rvebrook.or( BUILDING DEPARTMENT
��;,-
Application for Permit to Remove or Abandon Fuel Storage Tank
(*Storage Tanks in excess of I,100 gallons require registration with the County of Westchester)
FOR OFFICE USE ONLY: PERMIT#:
Approval Date: jut2 Permit Fee: $ 'mob
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS REF,\' ISSi lED BY THE. BUILDING
INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR( ()MP ETED WITHOUT A PERMIT Is
12%OF THE'TOTAL COST OF CONSTRUCTION WITH AM I\111 l Ni FEE OF S750.00
REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE:
1. Application Completed by Bonded, Licensed Contractor.
2. Your contractor's valid proof of liability insurance. (Village of Rye Brook must be listed as certificate holder)
3, Your contractor's valid proof of workers compensation insurance.
(Form# 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 811):_ ( ZqS —(`L^b �(
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 pen-nit 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•Abandonment( )/Above Ground( )• Buried in Ground
I. Address: 227 Treetop Crescent SBL: 129.76-1-55 Zone: U�
2. Property Owner&Address: Paula and Anders Papritz
Phone#: 914-565-9753 Cell #: email: anders.t-papritz@gmail.com
3. Contractor&Address: Innov8tive Environmental Services 392 Columbus Ave Valhalla, NY 10595
Phone#: 914-449-6608 Cell#: email: service@innov8enviro.com
4. Applicant: Innov8tive Environmental Services 392 Columbus Ave Valhalla, NY 10595
Phone#: 914-449-6608 Cell#: email: service@innov8enviro.com
5. Indicate Fuel Type:Fuel Oil( )•L.P.Gas( )•Gasoline( )•Other( ):
6. Number and Capacity of each Tank: Removal of(1) 300 Gal Underground Storage Tank
7. Exact Location(s)of each Tank: From the rear of the property
t
2/21/2024
ST TF OF NFW YO ,COT TNTY OF WESTCHESTER ) as:
being duly sworn,deposes and states that he/she is the applicant above Warned,
(print name of individual signing as the a plicant)
and-further tates dipt(s)he is the legal owner of the property towhich this application pertains,or that(s)he is the
r�(� fb for the legal owner and is duly authorized to make and file this
application.(indicate architect,contractor,agent,attorney,etc.)
That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use
conducted at the above captioned property will be in conformance with the details as set forth and contained in this
application and in any accompanying approved plans and specifications,as well as in accordance with the New York State
Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances
and regulations.
Sworn t before me this Sworn to before me this
day of ,20 _ da of >2070 -
Signature of Property Owner Signature of Applicant
Anders Papritz Donald of
:0tar4o"traiMEVIN
t t me of Property Owner t Name of Applicant
NORINE MBYIIR
LNo Public,Stets of N&btaky ublic
Notary Public,State of New YorkG ic.No.01 ME61308M
Lic.No.01 ME6130833 fied in Westchester CouQualified in Westchester County, ssion E*rss JuN 25,2()
Commission Expires July 25,20 -
is app ica ton mustl5e properly completed in its entirety and must include the notarized
signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces
provided. Any application not properly completed in its entirety and/or not properly signed shall be
deemed null and void and will be returned to the applicant.
2
2/21/2024
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6
INNOVt TIVE
ENVIRONMENTAL SERVICES INC .
July 21, 2025
Village of Rye Brook Building Department
938 King Street
Rye Brook, NY 10573 D �� I� ��/1
DD
RE: Andres Papritz JUL 2 8 2025
227 Treetop Cres
Rye Brook NY
MP-25-101/MP-25-103 VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
To Whom It May Concern,
This letter is regarding the work performed at 227 Treetop Cres, Rye Brook. Innov8tive
Environmental Services(IES)was contracted by Andres Papritz to remove a 300 Gal Underground
Storage Tank(UST)from the rear of the property and install (1) 275 (AST)on the rear left side of
property.
IES removed the tank on July 17, 2025. IES pumped 23 gallons of waste oil and sludge out of the
tank.A liquid waste manifest is attached for your viewing.The UST was then cut and cleaned in
accordance with DEC regulations.The tank was found to be free of any breaches or contaminants.
An inspection was performed by the Village of Rye Brook building inspector,where it was
determined that the scope of work was completed in accordance with the current regulations.The tank
was then removed from the premises and recycled at Brookfield Resource Management, NY. A scrap
tank ticket is attached for your viewing.
At this time, IES is requesting closure of permit#MP-25-101/MP 25-103. Please advise if any
additional information is required.
Thank you,
Donnie Feeney
Innov8tive Environmental Services
Innov8tive Environmental Services Inc.
392 Columbus Avenue, Valhalla NY 10595
serviced—innov8enviro.com 1 (914) 449-6608
www.innov8enviro.com
EC ENE
Jul 2 8 2025
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
PAYMENT RECEIPT
Brookfield Resource Management
100 Lamont Street
Elmsford, NY 10523
914-592-5250
Receipt:1935639 Date:7/17/2025
Customer:69802 Time:3 59 45 AM
INNOVATIVE ENVIRONMENT AL
392 COLUMBUS AVE
VALHALLA, NY 10595
ID Number
Ticket:2002244 Weigh In:7/17/2025 3:4931 AM
Operator:Rotny C Weigh Out:7/17/2025 3.t)9.4:)AM
Commodity Gross Tare Net Price TOTAL$
Tanks 14 540 12 400 2.140 22300/CW 47 72
Ticket Total: 47.72
No.of Tickets:1 EZCash Paid: S48.00
Payment Melhod:EZCasi1 Round Amt: $0 28
Total Paid: $48.
For current pricing,hours and
contact information check us out
on the web
@brookfieldeciap.com
Join Brookfield Scrap on
Facebook @webuyscrap
NON-HAZARDOUS WASTE MANIFE V
Please rent or type (Form designed for use on elite(12 pitch)typewriter)
T) IE C [E � IE Rn
NON-HAZARDOUS 1.Generator's US EPA ID No. A-inbs l �] lul '"
WASTE MANIFEST
Uj
3.Generator's Name and Mailing Address
ZZ
rill 1 8 RE OF RYE BReeK
4.Generator's Phone BUILDING DEPARTMENT
5 Transporter 1 Company Name US EPA ID Num ber A.Slate Transporter's ID
Innov8tive Environmental Services N Y R 0 0 0 2 3 9 2 1 0 B Transporter 1 Phone 914-449-6608
7.Transporter 2 Company Name US EPA ID Nummer C.Slate Transporter ID
D.Transporter 2 Phone
9,Designated Facility Name and Site Address 1p US EPA ID Number E.Slate Facility s ID
Clean Water of New York N Y 0 0 0 0 9 6 8 5 4 5
3249 Richmond Terrace
F Facility's Phone
Staten Island, NY 718-981-4600
11.WASTE DESCRIPTION 12. Containers 13. 14,
Total Unit
No Type Quantity WLNol
a.
Non RCRA, Non DOT liquid (Oily Water) T T 2-3 Gallon
G
E
N
E
R
A
T
O
W R
QAdditional Descriptions for Materials Listed Above H Handling Codes for Wastes Listed Above
N
M
A�
5 Special Handling Instructions and Additional Information
Z
Z
1e,GENERATOR:fS CERTIFICATION:I hereby certify that the contents of this shipment are fitllyy and accurately described and are in all respects
in proper condition for transport The materials described on this manifest are not subject to lederal hazardous waste regulations
Date
Typed Nama. .ri1g11ghlre Month Day year
1 /
zb�LL
T Y ransparler 1 Acknowledgement of Receipt Matan Is Dale
R
A f'nniedlTyped Name SlgnaWre Month Day Y.",N
S
Qlit Transporter 2 Acknowledgement of Receipt of Malunali. Onto
TPonted/Typed Name Signature Month Day Year
E
R
19.Discrepancy Indication Space
F
A
C
20 Facility Owner or Operator.Certiticalion of receipt of the waste malonala covered by this nuinlfesi.excepFris noted in item 19
L
Date
T I'mntad/Typed Name Signslurs Month Day year
Y
Copyright 0 2006.ShlpMate.Inc 40.All Rights Rewrved (310)370.30M www.shipmete con,
PHOENIT��: .
I nvirua rental laboratories. Inc.
Friday, July 25, 2025
Attn: Donnie Feeney
Innov8tive Environmental Services JUL 2 8 2025
392 Columbus Ave
Valhalla NY 10595 VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
Project ID: 227 TREETOP CRESENT
SDG ID: GCT81409
Sample ID#s: CT81409
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,
UL
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 10
Q\��0 \N ACCOHpq� r
PHOEVIX!"�'�'
e
Environmental Laboratories, Inc. ` F NY# 11301
587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045
Tel (860)645-1102 Fax(860)645-0823
Sample Id Cross Reference
July 25, 2025
SDG I.D.: GCT81409
Project ID: 227 TREETOP CRESENT
Client Id _ Lab Id Matrix Col Date
ITANK BOTTOM I CT81409 i SOIL 07/17/25 14:30
R [Ec [E �Y[E
JUL 2 8 2125
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
Page 2 of 10
D EC OVE
0 �N ACCO 0
5 PHOENIX `. � o•��' � 4y�
JUL 2 8 202 P
U
VILLAGE OF RYE BROOK Environmental Laboratories, Inc. i
BUILDING DEPARTMENT 7 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 NY# 11301
Tel.(860)645-1102
Analysis Report FOR: Attn: Donnie Feeney
Innov8tive Environmental Services
July 25, 2025 392 Columbus Ave
Valhalla NY 10595
Sample Information Custody Information Date Time
Matrix: SOIL Collected by: 07/17/25 14:30
Location Code: INNOVAT Received by: B 07/21/25 18:00
Rush Request: 5 Day Analyzed by: see"By"below
P.O.#: Laboratory Data SDG ID: GCT81409
Phoenix ID: CT81409
Project ID: 227 TREETOP CRESENT
Client ID: TANK BOTTOM
RL/
Parameter Result PQL Units Dilution Date/Time By Reference
Percent Solid 86 % 07/21/25 CV SW846-%Solid
Soil Extraction for SVGA PAH Completed 07/24/25 DS/DS SW3546
Volatiles- STARS/CP-51
1,2,4-Trimethylbenzene ND 0.63 ug/Kg 1 07/22/25 JLI SW8260D
1,3,5-Trimethylbenzene ND 0.63 ug/Kg 1 07/22/25 JLI SW8260D
Benzene ND 1.3 ug/Kg 1 07/22/25 Al SW8260D
Ethylbenzene ND 1.3 ug/Kg 1 07/22/25 Al SW8260D
I sop ropy lbenzene ND 0.63 ug/Kg 1 07/22/25 JLI SW8260D
m&p-Xylene ND 1.3 ug/Kg 1 07/22/25 JLI SW8260D
Methyl t-Butyl Ether(MTBE) ND 0.63 ug/Kg 1 07/22/25 JLI SW8260D
Naphthalene ND 0.63 ug/Kg 1 07/22/25 JLI SW8260D
n-Butylbenzene ND 0.63 ug/Kg 1 07/22/25 JLI SW8260D
n-Propylbenzene ND 0.63 ug/Kg 1 07/22/25 JLI SW8260D
o-Xylene ND 1.3 ug/Kg 1 07/22/25 JLI SW8260D
p-Isopropyltoluene ND 0.63 ug/Kg 1 07/22/25 JLI SW8260D
sec-Butylbenzene ND 0.63 ug/Kg 1 07/22/25 JLI SW8260D
tert-Butylbenzene ND 0.63 ug/Kg 1 07/22/25 JLI SW8260D
Toluene ND 1.3 ug/Kg 1 07/22/25 JLI SW8260D
Total Xylenes ND 1.3 ug/Kg 1 07/22/25 JLI SW8260D
QA/QC Surrogates
% 1,2-Dichlorobenzene-d4 95 % 1 07/22/25 JLI 70- 130%
%Bromofluorobenzene 98 % 1 07/22/25 JLI 70-130%
%Dibromofluoromethane 114 % 1 07/22/25 JLI 70-130%
%Toluene-d8 97 % 1 07/22/25 JLI 70-130%
Ver 1
Page 3 of 10
Project ID: 227 TREETOP CRESENT Phoenix I.D.: CT81409
Client ID: TANK BOTTOM
RL/
Parameter Result PQL Units Dilution Date/Time By Reference
Sem ivolatiles-STARS/CP-51
Acenaphthene ND 260 ug/Kg 1 07/24/25 MR SW8270E
Acenaphthylene ND 260 ug/Kg 1 07/24/25 MR SW8270E
Anthracene ND 260 ug/Kg 1 07/24/25 MR SW8270E
Benz(a)anthracene ND 260 ug/Kg 1 07/24/25 MR SW8270E
Benzo(a)pyrene ND 260 ug/Kg 1 07/24/25 MR SW8270E
Benzo(b)fluoranthene ND 260 ug/Kg 1 07/24/25 MR SW8270E
Benzo(ghi)perylene ND 260 ug/Kg 1 07/24/25 MR SW8270E
Benzo(k)fluoranthene ND 260 ug/Kg 1 07/24/25 MR SW8270E
Chrysene ND 260 ug/Kg 1 07/24/25 MR SW8270E
Dibenz(a,h)anthracene ND 260 ug/Kg 1 07/24/25 MR SW8270E
Fluoranthene ND 260 ug/Kg 1 07/24/25 MR SW8270E
Fluorene ND 260 ug/Kg 1 07/24/25 MR SW8270E
Indeno(1,2,3-cd)pyrene ND 260 ug/Kg 1 07/24/25 MR SW8270E
Naphthalene ND 260 ug/Kg 1 07/24/25 MR SW8270E
Phenanthrene ND 260 ug/Kg 1 07/24/25 MR SW8270E
Pyrene ND 260 ug/Kg 1 07/24/25 MR SW8270E
QA/QC Surrogates
%2-Fluorobiphenyl 76 % 1 07/24/25 MR 30-130%
%Nitrobenzene-d5 73 % 1 07/24/25 MR 30-130%
%Terphenyl-d14 85 % 1 07/24/25 MR 30-130%
RUPQL=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:
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.
Phyllis hiller,Laboratory Director
Is*
July 25, 2025
Reviewed and Released by:Anil Makol,Project Manager
Ver 1
Page 4 of 10
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n out `saiaojeaoge-j Ie}uawuoalnu3 MOONS BA J �O 3J`d"M
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QA/QC Data SDG I.D.: GCT81409
Blk LCS LCSD LCS MS MSD MS Rec RPD
Parameter Blank RL % % RPD % % RPD Limits Limits
Comment:
Additional 8260 criteria: 10%of LCS/LCSD compounds can be outside of acceptance criteria as long as recovery is 40-160%.
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 AOL MS - Matrix Spike MS Dup - Matrix Spike Duplicate
NC - No Criteria Phy1, 2025
iller, Laboratory Director
July
Intf - Interference
(ISO) - Isotope Dilution
JUL 2 8 2125 DD
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
Page 6 of 10
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Environmental Laboratories, Inc. nela. .C' '
587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 NY# 11301
Tel.(860)645-1102 Fax(860)645-0823
Analysis Comments
July 25, 2025 SDG I.D.: GCT81409
The following analysis comments are made regarding exceptions to criteria not already noted in the Analysis Report or
QA/QC Report: None.
D IE C [E O M F 3D
JUL 2 8 2025
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
Page 8 of 10
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Environmental Laboratories, Inc. a
587 East Middle Turnpike,P.O.Box 370,Manchester,CT 06045 NY# 11301
Tel.(860)645-1102 Fax(860)645-0823
NY Temperature Narration
July 25,2025
SDG I.D.: GCT81409
The samples in this delivery group were received at I.M.
(Note acceptance criteria for relevant matrices is above freezing up to 6°C)
DD
JUL 2 8 2125
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
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AC"Ra CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDD/YYYV)
�i 2'1912025
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 EVlta Grande
Mt Pleasant Capacity PHONE FAX
P O Box 1689 1A.C.No.
Etai) 9142057682 t :914-205-7682
EMAIL
Pearl River NY 10965 ADDREss. Evita.Grande__Qmtpcap com
INSURE •AFFORDING COVF RAGE _ NAIC•
- INSURER A Century SUfeJJ�Company _ _ 36951
INSURED INSURER B.Sele ive Way Insurance Co any 26301
Innov8tive Environmental Services Inc. -- — -
392 Columbus Ave INSURERC:
Valhalla NY 10595 INSURER D
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER:284037213 REVISION NUMBER:
HIS IS TO CERTIFY THAT IHE 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 AWL TYPE OF INSURANCE POLICY EFF POLICY EXP -
LTR POLICY NUMBER DIYYYYI LB/MS
A X COMMERCIAL GENERAL LIABILITY CCP1289339 2/14rA26 I 2114rJ= MaCg
_ EACH OCCURRENCE $1.000.000
CLAIMS-MADE �X_ OCCUR PREMISES Occu"On $100,000
_.
MED EXP(Any one parson) $5.000
PERSONAL A AOV INJURY $1.000.000
GENL AGGREGATE LIMIT APPLIES PER. GENERK AGGREGATE $3.000.000
X POLICY❑JE T u LOC PRODUCTS-COMPlOPAGG 53.000.000
OTHER
B AUTOMOBILE LIABILn-V S264364200 1/15/2025 1'15/2026 COMBINED SINGLE LIMITS 1.000.000
-- Ea awwnt1 -- '------ -
ANY AUl O BODILY INJURY(Pw parson) S
OWNED -SCHEDULED
X - BODILY INJURY(Par atxtden0l S
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X HIRED ~X NON-OWNED I PROPERTY E DAMA
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X UkUMI LA LIAB ! X_ OCCUR CCP1269340 2/14/2025 2/14/2026 EACH OCCURRENCE _54 000 000
EXCESS LIAR CLAIMS-MADE a AGGREGATE 54 000 000
r---
DED RETENTION S
WORKERS COMPENSATION SIR E ER-
AND EMPLOYE RS'LIABILITY YIN _ __--
ANY11111111I110R:PAR TNERIEXECUTIVE ❑ E.L.EACH ACCIDENT S
OFFICER MEMBEREXCLUDED? NIA' -(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S
II Yes describe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S
I. P-Aubor.Ltabdny CCP1289339 2114f2025 2/14/2026 Each claim 2 000 000
P•ofessional ab,lity Aggregate 2 000 000
L,md 1 OOO 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule.may be attached it more spats is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Village of Rye Brook
938 King Street
Rye Brook NY 10573 AUTHORIZED REPRESENTATIVE
L r^�C I eUOrra
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
NYSIF
New York State Insurance F-10 PO Box 66699,Albany NY 12206
1 nysif.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED)
0
^^ ^ ^ ^ ^ 824703808
MT PLEASANT CAPACITY AGENCY
1 BLUE HILL PLAZA STE 1689 ` F
PEARL RIVER NY 10965
SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
INNOV8TIVE ENVIRONMENTAL VILLAGE OF RYE BROOK
SERVICES INC 938 KING STREET
392 COLUMBUS AVENUE RYE BROOK NY 10573
VALHALLA NY 10595
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
VV2455 047-7 51245 10/02/2024 TO 10/02/2025 10/2/2024
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2455 047-7, 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
DONALD FEENEY
VICE PRESIDENT
FRANK MORACO
INNOVBTIVE ENVIRONMENTAL SERVICES
20F2
THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT
OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN
WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE
EVENT THAT PRIOR TO THE DATE OF THE ACCIDENT THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN
CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED
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 SUR NCE FUND
T �V
DIRECTOR,INSURANCE FUND UNDERWRITING
VALIDATION NUMBER 676702696
U-26.3
Laura Petersen
From: UDig NY Exactix <tickets@exactix.udigny.org>
Sent: Tuesday, July 8, 2025 2:10 PM
To: Steven Fews
Subject: Message from UDig NY
****REGULAR****
DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 07/08/2025 14:09
To: VIL RYE BROOK PRIMARY Transmitted: 07/08/2025 14:09 00001
Ticket: 07085-002-099-00 Type: Regular Previous Ticket: 06245-000-956-00
------------------------------------------------------------------------------
State: NY County: WESTCHESTER Place: RYE BROOK
Addr: From: 227 To: Name: TREETOP CRES
Cross: From: To: Name:
Offset:
------------------------------------------------------------------------------
Locate: ENTIRE PROPERTY
NearSt: TREE TOP CRES
Means of Excavation: EXCAVATOR 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: 07/11/2025 Depth of excavation:
Site dimensions:
Start Date and Time: 07/11/2025 07:00
Must Start By: 07/25/2025
------------------------------------------------------------------------------
Contact Name: NORINE MEYER
Company: INNOVBTIVE ENVIRONMENTAL SERVICES
Addrl: 392 COLUMBUS AVE Addr2:
City: VALHALLA State: NY Zip: 10595
Phone: 914-449-6608 Fax:
Email: service@innov8enviro.com
Field Contact: NORINE MEYER
Alt Phone: 914-449-6608 Email: service@innov8enviro.com
Working for: HOMEOWNER
------------------------------------------------------------------------------
Comments: Lookup Type: ADDRESS
------------------------------------------------------------------------------
Members: ALTICE USA BELL-VALHALLA / WSCHSTR
CONED SUEZ WTR WESTCHESTER
TEN GAS-HDS VLY VIL RYE BROOK
i
Laura Petersen
From: UDig NY Exactix <tickets@exactix.udigny.org>
Sent: Tuesday,June 24, 2025 10:50 AM
To: Steven Fews
Subject: Message from UDig NY
****REGULAR****
DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 06/24/2025 10:49
To: VIL RYE BROOK PRIMARY Transmitted: 06/24/2025 10:49 00002
Ticket: 06245-000-956-00 Type: Regular Previous Ticket:
------------------------------------------------------------------------------
State: NY County: WESTCHESTER Place: RYE BROOK
Addr: From: 227 To: Name: TREETOP CRES
Cross: From: To: Name:
Offset:
------------------------------------------------------------------------------
Locate: ENTIRE PROPERTY
NearSt: TREE TOP CRES
Means of Excavation: EXCAVATOR 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: 06/27/2025 Depth of excavation:
Site dimensions=
Start Date and Time: 06/27/2025 07:00
Must Start By: 07/14/2025
------------------------------------------------------------------------------
Contact Name: NORINE MEYER
Company: INNOVBTIVE ENVIRONMENTAL SERVICES
Addr1= 392 COLUMBUS AVE Addr2:
City: VALHALLA State: NY Zip: 10595
Phone: 914-449-6608 Fax:
Email: service@innov8enviro.com
Field Contact: NORINE MEYER
Alt Phone: 914-449-6608 Email: service@innov8enviro.com
Working for: HOMEOWNER
------------------------------------------------------------------------------
Comments: Lookup Type: ADDRESS
------------------------------------------------------------------------------
Members: ALTICE USA BELL-VALHALLA / WSCHSTR
CONED SUEZ WTR WESTCHESTER
TEN GAS-HDS VLY VIL RYE BROOK
i