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0790 FALMOUTH ROAD/RTE 28 - HOSPITAL/NURSING HOMES
���� ��� ����f �-�?' � t °„ . _ s, e � , :.� u O it f CFGE x BOARD OF HEALTH . Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. arABLE. = F.P.(Thomas)Lee,. MAC ` Daniel Luczkow M.D. Alt. �a +aa�• .� 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 581 Issue Date: 01/01/2022 DBA: BROOKDALE - EMERITUS AT CAPE COD OWNER: BROOKDALE SENIOR LIVING INC. Location of Establishment: 790 FALMOUTH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 70 OutdoorSeating: 0 Total Seating: 70 FEES .,....,- FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: -•- -- -- MOBILE- FOOD: MOBILE- ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING; PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE i Restrictions: r _ O. Town of Barnstable Ear Office 21, Initials: 00 oa Inspectional Services , �.e�id atitt�a s .,, Public Health Division 2C - L Thomas McKean,Director 2(0!lain Street.11%anni ,Ni-%02601 x APPLICATION FOR PERMIT TO OPERATEA FOOD ESTABLISHMENT " D.ATY I %EW OW%ERSIIIP RENEW L.K %AOIF OF FOOD EST-ABLISNME 0. 0 ADDRESS OF FOOD FSTABLISH.'IENT: MAILING ADDRESS(IF DIFFERENT FRO.-VI ABOA'E): E-MAIL ADDRESS: p TELCPHONE NUIVIBER OF FOOD FST:ABLISH.%IENT: ) QO TOTAL NUMBER OF BATHROOAMS:�L1�00W AOCA , WELL WATER:VES_____NO ...(:•ANNII AL WATER AN ALVSIS REQUIRED) ANNUAL:- SEASONAL: DATES OF OPERATION:`.4-- NUtIVISER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING:; MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING.,MUST BE AlPRQVF B!"THE HEALTH OW,AND LICEN.SING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED:AT W AITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLIS14MENT: (PLEASE CHECK ALL THAT APPLI`BELOW) ®FOOD SERVICE _RETAIL FOOD-ONLV required for TCS foods(foods requiring refrigeratiouifreerer) _BED&BREAKFAST =CONTI:NENTAL BREAKFAST o; COTTAGE FOOD INDUSTRV_(forwer4 residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT 1IACHINES...(110NTHLV LAB ANALVSIS REQUIRED) ®CATERING..,(CATERING-,NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) ***SEASONAL.MOBILE&NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV FOR I-NSPECTION PR10R?O PERMIT BEING ISSLsFn PLEASE CALL 508462,!", 0. Wka 4to Fans FIODAPP 2010,d QWNER INFORNIATIO. : l ®® Q I l FULL NAME OF APPLICANT IL SOLE OWNER: YES!�NO OWNER PHONE# ADDRESS k Ll CORPOR.I'rE O*%-NER.- �O A CORPORATE ADDRESS: WCA+ 6 1 Wl `0 rwtd ' PERSON 1 CHs1RGE OF D,�t1,Y OPEQATION5: fl R CAII List(2)Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have i Certified Food Protection Manager PER SHIFT. "ATTACH COPIES OF CERTIFICATES"The Health Div.will NOT use past years' records.Vou must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date i.� nijr� r ,«��1� ifs(,, rC a ( lC'� ' , 2. -��C4.'E t �f_�L '�C:�F Z- v'•�.f I I {V�3 �jn� SIGNATURE OF APPLICAN DATE ***FOOD POLICY iNFORNIATION' SEASONAL FOOD SERVICE:All seasonal food cstablishmems.including mobile trucks must be inspected by the Health Div. Mdor to owWnr!! Please call Health Div,at 50S-F*624644 to schedule yo'w inspection. Pled call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen must be tested by a Scats:Certified lab prior to opening and monthly thereafter. %ith+sample results submitted to the Health Div. Failure to do so will result in the wspen:aon or revocation of your Frozen Dessert w Permit until the above term are met. CATERING POLICY: Anyone who caters within the Town of Banwable must notify thc.Town by fax or mail prior to catering event. You must complete a catering notice found at http:Jfaaa s .toaaoibarnstable.us�healthdfrisinntaaoticationx azn: OUTDOOR COOKING: Outdoor cookin&preparation.or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January Ist to Dec.314 each calendar year. IT IS POUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND RE®UIRED FEES BY DEC Ist. Q<'Ap he,"so Fo mi RMAPP PEVI-_'0t9.&- { Town of Barnstable BOARD OF HEALTH John T.Norman Board r of Health Donald A.Gaudagnoli,M.D. BARNSrABLE, � Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 581 Issue Date: 01/01/2021 DBA: BROOKDALE - EMERITUS AT CAPE COD OWNER: BROOKDALE SENIOR LIVING INC. Location of Establishment: 790 FALMOUTH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE/SENIOR Annual: YES Seasonal: IndoorSeating: 70 OutdoorSeating: 0 Total Seating: 70 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: CQA FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: �i rqw For Office Use Only: Initials: Town of Barnstable Date Paid�, $ �' BAMMBLE, ; Inspectional Services Public Health Division Check#00`I23 S ACED MAy A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE O NEW OWNERSHIP RENEWAL✓ NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: 21 D 914Q I-i�s ,R4 r MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: - gAuqj Ci TELEPHONE,NUMBER OF FOOD ESTABLISHMENT: �� TOTAL NUMBER OF BATHROOMS._I �- WELL WATER: YES NO�...(ANNUAL WATER ANA SIS REQUIRED) ANNUAL: 0 ` SEASONAL: DATES OF OPERATION: / / TO / t NUMBER'OF SEATS: INSIDE:'('*p '.OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QAApplication FormsTOODAPP 2020.doc e. OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER � ': YES/NO OWNER PHONE# lP — � ADDRESS l CORPORATE OWNER: CORPORATE ADDRESS: 4. PERSON IN CHARGE OF DAILY OPERATIONS: t� List(2) Certified Food Protection Managers AND at least(1) Allergen Awarenes ertified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date n� A0 � SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-8624644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec. 3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc f. Cj r pPt Town of Barnstable BOARD OF HEALTH t John T.Norman Board OI Health Donald A.Gaudagnoli,M.D. unNgMoLF. : PaulJ.Canniff,D,M.D. t9.MAM , 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food .Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A;a permit is hereby granted to: Permit No: 581 Issue Date: 12/10/2019 DBA; BROOKDALE - EMERITUS AT CAPE COD OWNER: BROOKDALE SENIOR LIVING INC. Location of Establishment: 790 FALMOUTH ROAD HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE/SENIOR Annual: YES Seasonal: IndoorSeating: 70 OutdoorSeating: 0 Total Seating: 70 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Cr'� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: For Office Use Onlyi Initials:C� �'THE'°' Town of Barnstable . q'^ Date Paid I lAmt Pd$ Inspectional Services � � n BAMSfABLE. �s J___ s639.9• ♦ f�•'4 �FDMAt� Public Health Division , r Thomas McKean,Director 2f O 01 a .200 Main Street,Hyannis,MA 02601 / Office: 508-862-4644 Fax: 508-790-6304 rAa ArPPLgI�CATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE �-1 \ NEW OWNERSHIP REN�EWAL '�(,_ NAME OF FOOD ESTABLISHMENT:1 � - C � ADDRESS OF FOOD ESTABLISHMENT:1 !b EUY. TT , gA d a� MAILING ADDRESS(IF DIFFERENT FROM FROM ABOVE()): E-MAIL ADDRESS: A- � 14,e rI l �'1 CJ r�U d(Ck l� L TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (561 TOTAL NUMBER OF BATHROOMS: . esIDevI_(-s b( lc WELL WATER:: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: A'A TOTAL: `a O-yyh r'lu I 101 k:�R2 .0m SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? iV IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE°DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) �CFOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO OWNER PHONE# ADDRESS CORPORATE OWNER: le. Sir, k-1 y, CORPORATE ADDRESS: Zem k l PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. �rek) �Pvedf 2. SIGNATURE OF APPLICANT DATE **FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div.. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div.,Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/heaIthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3 Vt each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:\Application FormsTOODAPP REV3-2019.doc CF TMET TOWN OF BARN.STABLE - HEALTH INSPECTOR•s Establishment Name: �"�� Date: 1 �7/) Page: of ry OFFICE HOURS PUBLIC HEALTH DIVISION . 8:00-9:30A.M. BARNSTABLE. i 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. �0 - HYANNIS,MA 02601 MON.-FRI. No Reference R-Red-Item . PLEASE PRINT CLEARLY - - 508-862-4644 - """'' FOOD ESTABLISHMENT INSPECTION REPORT Name Date,,, �� Tvpe of T of Inspection O er • o Address, �- ''y Risk ry Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: y Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector �nS Out: O Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ ( U Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or_ColorAdditives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling l 1 ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for,HSP - ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) t 3 �g Corrective Action Required: o ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating y within 90.days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today, .he items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more no violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F" 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 4 non-critical violations 9 if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation F is scored automatically if:, no hot 26.water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations less than 9 non-critical. If no water,sewage 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must s a an on o critical ga back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non critical violations=C. 29.Speci Requirements (590.009) y p - 30.Othe DATE OF RE-INSPECTION: Inspe s ure 31.D ster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y IN #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y - N �L t 13 ���S f• �G, Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 1 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-201.11 Separation-Storage* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protect ion* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 1B Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Chemical Stuffing Containing Fish,Meat,Poultry or 590.009 3-201.15 Molluscan Shellfish from NSSP Listed * (A)-(D) Violations of Section 590.009(A)-(D)in ca[er- Ratites-165'F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145`F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. radicsrho ld be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165'F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140'F* (Blue Items 23-30) 3-102.11 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* r 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140'F to 70'F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'17 to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41'F/45'F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. 1 Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF. rot TOWN OF BARNSTABLE HEAL?H-IrvsPecTOR s Establishment Name: Date: Page:.of v� q OFFICE HOURS BAR E.O1` PUBLIC 2 0 MAN STREET 3:30- DIVISION - - : 0 4:30 P.M.:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified a3q.` HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY prED MA'S° - 508-862-4644 .r FOOD ESTABLISHMENTANSP CT N REPORT Name Date yi2e of ns ection Routin Address Risk Fo Sery e- spe wn Level Pre s i n Telephone Residential Kitchen Dat Mobile Pre-op ation Owner, HACCP Y/N Temporary Sus Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspector Each violation checked requires n_explanation n the narrative p ge(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health,hazard and require immediate corrective Tobacco 590.009(F) Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12:Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities r EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures , ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved'Procedures/HACCP Plans ❑ 19.Hot and Cold Holding - / PROTECTION FROM CONTAMINATION ❑ 20.Time Asa Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) n ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP �- ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 1 �C ❑ 11.Good Hygienic Practices ❑ 22.Posting.of Consumer Advisories L / Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) 3 Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating I within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,t ite s ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other. checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3_non-critical violations. F=3 or more critical violations 9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation F is scored automatically if: no hot 26.water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 no critical iolations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 9' violation,4 to 8 non-critioal vl lation 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: I p Si n tur Prin 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's ignature Prin Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y_ . N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* S Cross-contamination LU Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 590.004(F) ( )OOther P 7-101.11 Identifying Information-Original Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to * 7-102.11 Common Name-Wwkiug Containers* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F* Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fruits and Vegetables Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* - 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* ff 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 163-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 11112001 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate Equipment cane 590.006(A) Bottled Drinking Water* Pathogens* Ef 3-401.11(A)(2) Comminuted Fish,Meats&Game 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Chemical* Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Mid Mushrooms Approved By -- 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 14Yr- kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal hoods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )�) 3-201.17 Game Animals* 11 Good Hygienic Practices 1 7 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* _ _ 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 3-101.11 Food Safe and Unadulterated* O g 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 1 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. /15�F THE rp `fir" .TOWN OF BARNSTABL - I EA TH INSPECTOR'S Establishment Name: Date:. '' of � . FICE HOURSLIC HEALTH Page: �- ARNSTARLE. ` PUB 0 MAN STREEETSION I` :30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Ve ified 3: 0- :30 P.M. v MAC. MON.-FRI. No Reference R-Red Item:. ; • ,. PEASE PRINT C cb .a3v .0 HYANNIS,MA02601 508-862-4644 y"' FOOD ESTABLISHMENT INSP CTION EPORT (�� U,_Opg/ y Name Date voe of 7Date: s ec ion p Address Risk ood Servi on Level s tiQ �. Telephone Residential Kitchen Mobile oOwner HACCP Y/N Temporary ess Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other InspectorLM ut: c� Each violation checked requires an explanation on=thenarrativ', page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ -� Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination"from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS' ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 77 ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE • TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating C ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control - ❑ 8.Separation/.Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTI"BL'E POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP i ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good.Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations -^ me> Critical(C)violations marked must be corrected immediately. (blue&red items) OI 1`g Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. - ❑ Voluntary.Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today ms checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency.Closure. ❑ Voluntary Disposal ❑ Other:. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4ncn-critical violations g if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=.F is scored automatically if: no hot 26.Water,.Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment iol operations. If C=2 critical violations and less than 9 non c itical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials. (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-c ca lations. If 1 critical refrigeration. Io a ,4 to 8 non-critical vio on - 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Insp re rint: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N P C's Ina re Poll Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted. - Y N Dumpster Screen? Y N Violations related to Foodborne Illness- Violations Related to Foodborne Illness Interventions '! Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* $ Cross-contamination14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12-- Additives Cooked and RTE Foods.* 19 _ PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties- 3-302.14 Protection fr6"m Unapproved Additives* Contamination from Raw Ingredients 1,5 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F)- EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * 2 590.003(C) - Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7'-10�2.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Se aration-Stora e* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An _ 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590 004 11 Variance Req uirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ •REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions--d g � ) Disposition of Adulterated or Contaminated - -- Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law*_ 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs*_ _ Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 1$ 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from-an Approved System*_ _ __ * gg Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e��"°e 1iirzoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* � Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11- Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical*.- . g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing * g' P mT3' Game and Wild Mushrooms Approved By- - - - * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Aries 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 _ Shellstock Identification Present* - -- 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* - 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23.30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands a - 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the $ Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 S Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* y Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. A0HEALTH INSPECTOR'S Establishment Name: Q29,0&6 DateTHE HEATOWN OFBARNSTABLE .. - -. • - -- age of ti OFFICE HOURS PUBLIC HEALTH DIVISION - r 8:00-9:30 A.M. ` BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS.. MON.-FRI. �p ,639•per• HYANNIS,MA 02601 No Reference R-Red.Item . _ PLEASE PRINT CLEARLY: - 508-862-4644 'FOM F OD ESTABLISHMENT INSPJJECTJON JRIEPORT .Name Da Tyne of Type of Inspection Operation(s) Routine Address Ris'rl Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an a lanation on.the narrative page(s)and a citation of specifi rovision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ IN Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned!Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.'Receiving/Condition ❑ 17.Reheating O ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP Q _s ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices, ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) ' Corrective Action Required: ❑ No ❑ es Non-critical(N)violations must be corrected immediately or Overall Rating f ' within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑-Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure-- El Voluntary Disposal ❑.Other:_ checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4npn-critical violations 9 • _ )( ) cited in this report may result in"suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical n. If no critical water,sewage back-up,infestatio of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must , 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8npn-critical violations. If 1 critical refrigeration. vio 29.Special Requirements (590.009) within 10 days of receipt of this order. I 4 to 8 n -critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspe r Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's i at re int: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N ` If i Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 _ PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties - 3-302.14 Protection from Unapproved Additi3es Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge[0 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 1-1 Variance Re uirements 590.003(G)- Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ . .. REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) - - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources _ 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.00.4(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.11-1- - Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* _ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* _ gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef°"9e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency r f Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or590.009(A)_(D)3-201.15 Molluscan Shellfish from NSSP Listed_ _ Chemical* g g Violations of Section 590.009(A)-(D)in cater- * -' - Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g. P tart 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12. Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11 A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )(b) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 - Receivirrg/Condition - 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3 402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-002.12 Records,Creation and Retention* Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. l9 r: Ca'•: �5 ,. �� �'I � aye o 5 �o t a � a �W'.WL.lky q .• ' E II �j �F j y :Sv�F S fit: .� _ - { 3 4 9 ..................... ...... 7� A S 1 CJit 2Frr Sri 2 44'F 601 . tirtai liar _ ST 51, 1 24t. 3 _ 2� . � 2 21 � ALv i 1 1E1t2 3C}F� 1° �624 VL'r 0> t1230 J "11ti 012 III l 82 4 R. ; 2 D{Sl1 � B21l R it3 RA GE1 , 3 - ... .. ., ..... < s , + •.... t 1 WNW }p 3 c t P d( , > s s , F i , < c , a Y • } South Coast _ IMPROVEMENT COMPANY' CONSTRUCTION RENO\/ATIONS 39 Foster Road . New Bedford MA 02740 � 518 984 . 7983 RENOVATIONS TO: Whitehall Estate M Q o Assisted Living Facility p o 0 790 Falmouth Road . Hyannis . MA . 02601-2397 U w Ux General Notes Reference Symbols Abbreviations Materials List of Drawings Z ' 1. ENE CdNPAC1.ENALL ORTAN R EMRED VENN"S PROP 10 STAFI -ram A--�� <, CS AI'chltec[ural ^J Z fF CpSTZUCnON. mw'^' ��^�� V ra " ��-� qn Lrya " � O y � O Z S <Ox5muC1NM E.I. I D"iN Ap PER-EES i[IXPAL.' @A �'•"O �-/ a.,.ew 7m"' �'jd� pg�L`�� •"^" �'"^ ° j-'^., AD OD W'hR STATE me LOCAL REGULATWS CODES ma OPpxANCES Q� 'd1'X.':h i t:PR$""'®' iw. SIP.somw••� 0 O14RNi ROpV P..w K/AEA 10 RF RENMIRD W U @YSIiO w�°99'' __ ffp!! .�,C "^"'.�$',� �•�:b O O NW4 D MR OF UNIT D 10 DE REND D } ALL EIxSTNG CONpTOxS anR pYENS(NS ON THE MB 5R APE i0 - .�}nm 'O�e e.w o� .. �''"' eo- ARI WINW4 a0'tW 6 uLRi C t0 ff 1rtxWATEO- \ ] BE MDNRED AS NECESSO,..RERATEO 10 NORH 1D RE PCRTORMED. /A=��'-_ �- q� �.o m�un tea �w N 2 NO.UN ER -UP DF Uxll E 10 RE RENOVAIEO /O N EMISTHG RFLO CBNDITgR DO NOT PERMIT MSTALLATON 0�TIE. ""mo-' Tp '-'� 6' b :Fweu DP , ;>>y�R�t E� OF N.S N R..flO 1 OF UNI1 F TO RE PENOVARD 0 {L NDPN IN.-A..NTN TR-RINGS mE SPEOFIGTIWS, {��,�.� L � ^'TwYO nm.o Gd'ta...n ti' � AR,A wp1IDu4&0'x-W p PESnBULF AFEA 10 BF REpOVATEO Im NOTIFY-ARCHITECT IMMEBITELY OF THE CONDITION N WESTMW, HC"' qa-�A i � -wa�u ��n O ® x NL R.OETNLS SxOMN.IRE INTENDED FOR EPEORC LOCATIONS mE COxp110Ni '•"^� BBI9.fJl' t_ r"s�� 3EY. Y�A wxOR uBOOT-E.S WY BE REDIIOED i0-T SWNAR CON 'I Ei:;'m� '�� � N '"•'� , aL� O mR-BE CCNSOETED 1.1 OF TIE-, w.R �..ak-d"`�' S DO NOT ECALE DRAmxGS. >..xo.v ` v RJ.� 'P' .n E.'•sT . �.. u"SGC°w• 'e�L'$f", •`GY'nYLul hw5'P I s...,u. _` /E R. COORDINATE-ATION wB SCE OF ALL R OPENINSE INTERIOR /R. }mom EMTENIOR BIT,Au TRADES PROR TO INE—AlIpa •,�.'.. 2 y''- ,�, ;,, R o, o aWl ,,...I _ L ., 1. NER IN TIAT D PIPTS TO fMBEODEO ITEMS RETE. RY IL iRAOCG � (' �^'� ff ro��..FmI ^ �Fu' p- �_ L` (-_7 AF[IN PRNR 10 POURING DF CONCRETE. 'nR'.'v, Ell'A.C' "'�"'A :r�i w L[A.� L� Egff] J 1 I R INDICTED UNLEBS OTHER"SE ON ONE DR—OS OR IN EPECRICATONS AS SEND'N I.C',AL--MAIERII%ETC. 'tlnr��- wu �'���,� O O FiRWp mC NSTALLATION OF SAYE AM A PART OF lxE COHGRACI NORM. �� '� - �.. ..G. w m mm.v ®pm ® Fb BgLp REFER TO STHUCNRN DRAwNOS FOR LOCATION,SIZING,anE CONNECTION ."uv. �"" =PL9b FXe4@1 e�al CIi° FoWFou'� ••°•" ua, u�yrun Pb P�IIb S BEINLS OF ALL SIRUCTIP.CONPONEN M U RNL Pul NOT JNITEO 1--- _�' q 0 Upl1 GUGE STEEL-NE.STEEL.CONEREIE.AND N000. N-1 q g� u ""a' '""�a. nE..TRIT I.M.-BF..1 oaxpnw IN WaSTDN. �' `� � �� �•"&"'"°"` ' �aA �'yo gygp .uy�Y�.".a_n 9g5 xI '9" 9�:� F4E Wll®ER �me1 FE f�lw`o7a �- SCI—Whltehell , L f�' 11 GEDDIO AS NOTED . ' O1.1L.O9 This Structure has an intended use of Assisted Living Private-Residential AQ.Q This Structure has an intended use of Assisted Living Private-Residential Unit B � NIC NIC H NIC Vestibule. NIC Area LIM C Z z ,�,I� "` � UnK F `v d Q PRIVACY 0 00 COURTYARD }U w ALL MRDSCAPEAND LANDSCAPE �./ it PRODUC1ENOw7BWtm BE UWALLED S7 OTHM F. a-pREwAwTRrA7m NAC.fN BN` Z w/MSUPPO ITWAXSRDP. W ZO POST PER SPEC. FORCON PO'lE , W, swxRwlm 0 C Unit E P"�'H 0 d i SEW ��0 C3 pry ❑Ra PAAy ❑romamp OVERALL . . •`"""°°' •� Existing Floor Plan FU Right Side Wing of Building S I-weA&INen Scale:1/8"=V-0" m M.GEDDIO ME AS NOTED 01.26.01 N9P4Qo0sri4 Rarme.eM N�MelbmnPll winALLAV^^+mtl9m&i0iNW0r A1 .0 r � � 0 O _ ® General Construction Notes&Specifications N.I.C.=NOT INCLUDED IN SCOPE OF WORK BY SOUTH COAST IMPROVEMENT 00, m ® ® 4 Location Ident6catlon Remarks IST FLR.,RIGHT WNG UNIT BLE 1 F-TYP REMOVE EXISTING KITCHEN CABINETRY BATHRM• IST FLR.,RIGHT WING UNIT B.CE 1 F-TYP DISCONNECT AND CAP ALL REMAINING WATER AND DRAIN LINES y IST FLR..RIGHT WING UNIT B.CE 1 F-TYP REMOVE EXISTING GPI CIRCUITS,REPLACE WITH STANDARD 120V CIRCUIT H ®® AT THE EXISTING CIRCUIT HEIGHT ON WALL LIVING AREA Si FLR.RIGHT WING UNIT B.CE 1 F-TYP REMOVE EXISTING FLOORING.IN KITCHEN AND BATHS Q REPLACE WITH OWNER SUPPLIED VINYL PLANK FLOORING PER SPEC LLL¢ 15T FLR..RIGHT WING UNIT B.CE 1 F-TYR REMOVE EXIST CARPET MATERIAL AND REPLACE ® WITH OWNER SUPPLIED CARPET IN REMAINING SPACES OF EACH UNIT r.p 1 N IST FLR,.RIGHT WING UNIT B.CE 1 F-TYP ALL WALLS,CEILINGS,MILLWORK,AND DOORS TO BE PAINTED PER SPEC I'^ -II II IST FLR..RIGHT WING UNIT B.CE 1 F-TYP INSTALL FACILITIES LOCK ON ELECTRICAL PANEL I r________It _----------DEMO EXISTING— I n IST FLR..RIGHT WING MAIN CORRIOORISJ REMOVE ALL EXISTING FLOORING,REPLACE WITH OWNER SUPPLIED CARPET =-=- n WALL AT KITCHEN �/Lr�- = -J - �L - IST FLR..RIGHT WING MAIN CORRIOORf51 REMOVE EXISTING VINYL BASE BOARD,REPLACE WTH OWNER SUPPLIED VINYL BASE BOARD �1 IST FLR..RIGHT WING MAIN CORRIOORISI ALL WALLS.CEILINGS,MILLWORK.AND DOORS TO BE PAINTED PER SPEC 00 RELOCATE EXISTING KITCHENETTE il t °i 120V CIRCUIT %Z �} i Z Ali Spedfications,Components,Processes,and Materials to comply with ALL Regional and State BuBding Codes d 0 Q ® O00 zZ Wo �W0 >> UNIT B 0.o Existing Floor Plan Right Side Wing of Building �Pn@dury oFa� .fo Pn1� Scale: 1/2" = 11-011 370 Sq.Ft. Living Space F '"'NISM CI-WhM1rhell M.GEDOIO AS NOTED 8N@T I� A2.0 General Construction Notes BSpecifications N.I.C.=NOT INCLUDED IN SCDPE OF WDRK ar SDIffN CDAST IMPRDVEMENT CD, �j ® 4 Locatwn Idenuf¢atlon Remarks .b LIVING AREA IST FLR..RIGHT WING UNIT .CE I P-TYP REMOVE EXISTING KITCHEN CABINETRY E] BED RM. IST FLR.,RIGHT WING " S.CE I F-TYP DISCONNECT AND CAP ALL REMAINING WATER AND DRAIN LINES iy ® ISi FLR.,RIGHT WING UNIT B.CS I F-TYP REMOVE EXISTING GFI CIRCUITS,REPLACE UTII STANDARD 120V CIRCUIT •h ®® AT THE EXISTING CIRCUIT HEIGHT ON WALL IST FLR..RIGHT WING UNIT B,CE I F-TYP REMOVE EXISTING FLOORING IN KITCHEN AND BATHS W ® ® REPLACE WITH OWNER SUPPLIED VINYL PLANK FLOORING PER SPEC g DEMO EXISTING 15T FLR..RIGHT WING UNIT B,CE I F-TYP REMOVE EXIST CARPET MATERIAL AND REPLACE WITH OWNER SUPPLIED CARPET IN REMAINING SPACES OF EACH UNIT UJALL AT KITCHEN IST FLR..RIGHT WING UNIT BCE I F-TYP ALL WALLS.CEILINGS,MILLWORK.AND DOORS TO BE PAINTED PER SPEC S 15T FLR..RIGHT WING UNIT B.CE I F-TYP INSTALL FACILITIES LOCK ON ELECTRICAL PANEL ,yQ O L'C1 RELOCATE EXISTING IST FLR..RIGHT WING MAIN CORRIDOR(S) REMOVE ALL EXISTING FLOORING,REPLACE WITH OWNER SUPPLIED CARPET 1 0 _ —I20V CIRCUIT 15T FLR..RIGHT WING MAIN CORRIDORS) REMOVE EXISTING VINYL.BASE BOARD.REPLACE WITH OWNER SUPPLIED VINYL BASE BOARD y{.yyj //// ———_______ IST FLR.:RIGHT WING MAIN CORRIDORISI ALL WALLS.CEILINGS,MILLWORK.AND DOORS TO BE PAINTED PER SPEC O r �Zz BATH R AO Specifications,Components,Processes,and Materials to comply with ALL Regional and State Budding Codea Q KITCHENETTE ®® _ , == z-o D: 0 08 V"Uj z ® F- ZZ------ W UNIT C 0.o Existing Floor Plan Right Side Wing of Building p w Fs P�iNb Scale: 1/2" = 1'-0" PLUENUU— w� 450 Sq.Ft. Living Space CI- M.GEDDIO AS NOTED 04.2G.09 r A2.1 I I BED RM. BED RM. ® General Construction Notes BLSpecifications N.I.C.=NOT INCLUDED IN SCOPE OF WORN BY SOUTH COAST IMPROVEMENT CO, +41^C! 4 Location Identlrmaaon Remarks IST FLR..RIGHT WING UNIT B.CE I F-TYP REMOVE EXISTING KITCHEN CABINETRY AT IST FLR..RIGHT WING UNIT B,CE I F-TYP DISCONNECT AND CAP ALL REMAINING WATER AND DRAIN LINES ® IST FLR..RIGHT IN, UNIT B,C,E I F-TYP REMOVE EXISTING GFI CIRCUITS,REPLACE WITH STANDARD I70V CIRCUIT �® THE EXISTING CIRCUIT HEIGHT ON WALL g Q IST FLR„RIGHT WING UNIT 8.CE I F-TYP REMOVE EXISTING FLOORING IN KITCHEN AND BATHS [ 0i REPLACE WITH OWNER SUPPLIED VINYL PLANK FLOORING PER SPEC ao ® IST FLR..RIGHT WING UNIT B.CE I F-TYP REMOVE EXIST CARPET MATERIAL AND REPLACE Ch 0 WITH OWNER.SUPPLIED CARPET IN REMAINING SPACES OF EACH UNIT ® IST FLR.,RIGHT WING UNIT B,CE 1 F-TYP ALL WALLS,CEILINGS,MILLWORK,AND DOORS TO BE PAINTED PER SPEC IST FLR_RIGHT WING UNIT B.CE I F-TYP I INSTALL FACILITIES LOCK ON ELECTRICAL PANEL n IST FLR.,RIGHT WING MAIN CORRIDOR(S) REMOVE ALL EXISTING FLOORING,REPLACE WITH OWNER SUPPLIED CARPET ATH RM. IST FLR..RIGHT WING MAIN CORRIDOR($, REMOVE EXISTING VINYL BASE BOARD.REPLACE WITH OWNER SUPPLIED VINYL BASE BOARD o IST FLR,RIGHT WING MAIN CORRIDOR(S) ALL WALLS,CEILINGS,MILLWORK.AND DOORS TO BE PAINTED PER SPEC W ®8 ------ �z h LIVING AREA ♦'Z Z I. ® Mao All Specifications,Components,Processes,and Materials to corn*Wdh ALL Regional and State Building Codes Q KITCHENETTE 0 00 ®; ® UW zZ - ® t�lw2 ® �w0 WU �0 0a? UNIT E u 0 Existing Floor Plan 13 P`lnlwy Right Side Wing of Building Scale: 1/2" = 1'-0" $O_Whnl 650 sq.ft. Living Space M.GEDDIO AS NOTED 04.26.04 A2.2 ® I General Construction otes&Specifications N.I.C.=NOT INCLUDED IN SCOPE OF WORK BY SOUTH COAST IMPROVEMENT CO, j4 Locaton Ident,flcaton Remarks LIVINGAREA ST FLR..RIGHT WING UNIT BCE I F-TYP REMOVE EXISTING KITCHEN CABINETRY 5.w!I IST FLR..RIGHT WING UNIT B.CE 1 F-TYP DISCONNECT AND CAP ALL REMAINING WATER AND DRAIN LINES V] ® BEDROOM ® IST FLR.,RIGHT WING UNIT BLE 1 F-TYP REMOVE EXISTING GFI CIRCUITS.REPLACE WITH STANDARD 120V CIRCUIT y AT THE EXISTING CIRCUIT HEIGHT ON WALL ISTRIGHT UNG UNIT B,CE 1 F-TYP REMOVE EXISTING FLOORING IN KITCHEN AND BATHS REPLACE WITH OWNER SUPPLIED VINYL PLANK FLOORING PER SPEC ® I5T FLR.,RIGHT WING UNIT B.CE I F-TYP REMOVE EXIST CARPET MATERIAL AND REPLACE WITH OWNER SUPPLIED CARPET IN REMAINING SPACES OF EACH UNIT IST FLR..RIGHT WING UNIT B,CE 1 F-TYP ALL WALLS,CEILINGS.MILLWORK,AND DOORS TO BE PAINTED PER SPEC C L IST FLR.,RIGHT WNG UNIT B.CE 1 F-TYP INSTALL FACILITIES LOCK ON ELECTRICAL PANEL DRYWALL Q A KITCHENETTE PATCH 1 57 FLR,RIGHT WING MAIN CORRIDOR(S) REMOVE ALL EXISTING FLOORING,REPLACE WITH OWNER SUPPLIED CARPET PAINT DOOR IST FLR..RIGHT WING MAIN CORRIDORfS) REMOVE EXISTING VINYL BASE BOARD,REPLACE WITH OWNER SUPPLIED VINYL BASE BOARD ® OPENING IST FLR..RIGHT WING MAIN CORROOR15) ALL WALLS,CEILINGS,MILLWORK,AND DOORS TO BE PAINTED PER SPEC �N ® z REMOVE EXISTING DOOR _ - ==1 I,® _ AND FRAME OPENING SHUT �''^J} N NEW .V)Z O LIGHT SWITCHES LIBRARY AN Specifications,ConWnerds,Processes,and Materials to comply with ALL Regional and State Building Codes 0 TO REMAIN __--_- —�— o12 0 ATH RM. t E REMOVE CLOSET UU W DRYWALL PATCH AND PAIN iY EFFECT AREAS - F. O PROVIDE NEW ® Z 2 ® 5/0 CASED OPENING 0 --- --- > 0 ox UNIT F 0 Existing Floor Plan o Right Side Wing of Building Scale: 1/2" = 1 r-0" N scl-wn�lsNan 620 Sq.Ft. Living Space M.GEDDIO AS NOTED ' 09.21.09 A2.3 �I TOWN OF BARNSTABLE LOCATION SEWAGE # -.Ll 73 VILLAGE )4'/4/kW. 4'/4/ W. S ASSESSOR'S MAP & LOT 27 1- DD 1. _ 747—gZDo INSTALLER'S NAME&PHONE NO. �,ICkf4k") S ;?4�20)J% Gr2r SEPTIC TANK CAPACITY 3C00 5AZt_.)v,) r7�Zs Ti2P LEACHING FACILITY: (type) �f A S�.0 i i7� 2��.►�Size) NO.OF BEDROOMS v O BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: y Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility AA4 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) I Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by =2Cr3c-LF. 4 Pr -� 2-0% 4 r'" EE2 PVC LEANOU TS, 3 FROM BLDG 4" PVC SEWER INV OUT=56.62 PVC W �z! ` 8" PVC SEWER INV OUT=56.62 6 FIRE SERVICE ROPOSED SMH1 i 50r :8". WITH GATE VALVE IM=61.5 'PVC ® 2.0% )INV IN=55.62 _ JV OUT=54.62 , 4" DOMESTIC SERVICE EE3 WITH GATE VALVE 108'•LF 8" PROF --PVC 0 2.1 _ . AMICANT MUST OBTAIN A SEWER No. - *'"""' CONNECTION PERMIT FROM THE Fee " ZNGINEERINO DXWOX MOM TO Entered in computer: THE COMMONW MASSACHUSETTS Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS ZippYication for Mi-4pozar *pgtem Construction Permit Application for a Permit to Construct()Q Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. q O F-L.•,�u l E( l�n/ f / L rLS t-�i� S iy r4t1�i� S VICs�4 G.L.C Assessor's Map/Parcel '5 ©os 0 _C Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 2NGH4/Z4) `5. 12.40n cj iv 40 265%'-?A7•v ST 0v •�-� X,04 !�14AIoLne_0 "A (S-L)5, Type of Building: Dwelling No.of Bedrooms Lot Size �C -04- ft. Garbage Grinder( ) Other Type of BuildingA%(S7)Ot I-10 ONo.of Persons Showers( ) Cafeteria( ) Other Fixtures 6 Z�A-s�� re 4A — 3 op O Co, A�_o u Design Flow 3 OV CD gallons per day. Calculated daily flow 2/ 24 J gallons. Plan Date 41I y t 4 P, Number of sheets Revision Date Title Size of Septic Tank 3 go12�ype of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by ' d ealth. Signed Date g Application Approved by Date '7� `,�- Application,Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by at ;7 1 /I/ ! has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. /v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS Miopo5al *p5tem Construction Permit Permission is hereby granted to Co ct Repair( ))U )A on( ) System located at `7 ;4 I- �7z;d S m ����1�,� I and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: Approved by ...; .. ♦ S-.// u.n .Y � - ��a":i0:M14e"r "nfigi - � ` � ,..... ... N .+ �y ...--- �'. Fee& _ THE COMMONWEALTH'OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Yes ZIPPYication for°3N.5pogal 6potem Construction Permit Application for a Permit to Construct OC)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Locatio Addre s or Lot No. f Owner's Name,Address and Tel.No. � t� 1- 4��ulr�lWJv/',r' erq 0,4(/��� S/. e�NCr4 G LC i Assessor'sMap/Pazceln (1 � 3-2 L Q� t S kt�Ltai��f}/ ,� lZrjl4 j Ins ler's Name,,4�ddress,an%gl. o. i� Designer's Name,Address and Tel.No. 2 S -i{-z.V ST, i34,D& • C-rf /�T L.4/1/T)L. I� S�('/� 1 Type of Building: Dwelling No.of Bedrooms y Lot Size g AC -sq- I" Garbage Grinder( ) Other Type of Bw lding/ /✓9a/GNo.of Persons —Showers( ) Cafeteria( ) Other Fixtures G �A S a= 7-�&4,0 o 9 o Design Flow — �� C Dgallons per day. Calculated daily flow 2/. J gallons. ;*. Plan,Date Number of sheets Revision Date ` Title, l Size of S'epCt'U-TMr— 3 GV a L C f&-7AZTWI`ype of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) i Date last inspected: Agreement: fi The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of'the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by ealth. (� ! Signed ' V V' date /2.5)96 Application Dpsao roved for the followin r f' � .' .3 . �- � � � Date Application pp g reasons r � _ Permit No. Date Issued- -—— — ———————— — —— —— —————————=— THE COMMONWEALTH OF MASSACHUSETTS ` y BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(' )Repaired ( )Upgraded( 9 ) Abandoned( )by at 7 /11J 4,17` 77? _ j /Yr` / has been constructed in-ac�coorr+dance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated"" "-� . Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. e. Date Inspector Via,#, N�; -- -- -- -- —•— ,—�"—� -- ... .. No. Fee'../ " THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION ', BARNSTAB,LE., MASSACHUSETTS migoal *pgtem Con4truction Permit -Permission is hereby ran to Co struct Y)Repair( U . e,- )A 01a don( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes;.pis/her duty to comply with,Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: r ._ Approved by - STANDARD NEENAH FOUNDRY CO. MANHOLE FRAME & COVER W/GASKET OR APPROVED EQUAL SET RIM EL AT FINISHED GRADE 4HACS .0 24" RISER 17'-0" 4" BAFFLETO FINISHED OPTIONALGRADE 6" DIA INLET " 2 MIN. 6'-0" T-0" T I 7'-0" 5'_1" 2'-6" 4'-2"UQUI 6' DIA. — LEVEL OUTLET 4'_ 6". 24" DIA. H - 20 COVERS »/'moo:$� �Q'o o j�, 6" ' PLAN VIEW 6 OF 1/2 TO 3/4 A CRUSHED STONE CROSS SECTION VIEW SPECIFICATIONS: CONCRETE MINIMUM STRENGTH - 5,000 P.S.I. 0 28 DAYS DESIGN LOADING - AASHTO HS20-44 STEEL REINFORCEMENT - ASTM A-615 GRADE 60, 1" MIN. COVER EARTH COVER - 0 TO 5 FEET CONSTRUCTION JOINT - SEALED WITH 1" DIA. BUTYL RUBBER OR EQUIVALENT WATER TABLE - MIN: 3.5 FEET BELOW TEES - SCHEDULE 40 PVC FINISH GRADE 3o000 GALLON y`REASE 'TRAP DETAIL NOTE: GREASE TRAP TO WITHSTAND (NOT TO SCALE) HEAVY DUTY H-20 LOADING. cnu�aRo - ROOM O ! T12 T14 ' cwwaRa / 5 WALK—IN FREEZER n 2 yM F OFiICE . h V6 h hr r 5 STORAGE WALK—IN ' � 5 COOLER 4 \ ,. ,. . •:fir h r hr�` + i / \ / 24 8 7 9 10 + PREP. AREA a 11 15 16 16 17 18 19 28 \ 12 . Y \ WASH / 13 , O ,COOKING .. . 7 . r° PICK-UP i 34i 33 32 WARE—WASH 37 + ;FMea. EXHAUST 41 " 42 ;FMea. SUPPLY. Is Vf k 58 j fi' / 51 52 50 " �L � . WAIT STATION : • a'y LEGEND CATY Q EE3 EMERGENCY EXIT # NOTES: F_� EXISTING CABLE TV SERVICE FOX 1. VERTICAL ELEVATIONS ARE BASED UPON NGVD. �0� PROPOSED LEACH PIT 2. EXISTING CONDITIONS AND TOPOGRAPHY ARE TAKEN FROM A PLAN BY �'�' EX1STl(`�IG GRANITE BOUND SET \ / El 25 PROPOSED PARKING SPACES TUNDRA/DEFEO, WAIT AND PARE, INC. FROM SEPTEMBER 1996. BUILDING LAYOUT IS TAKEN FROM PLANS FROM THE ARCHITECTURAL TEAM, INC. ,�S� i.H EXISTING SEWER MANHOLE 6) PROPOSED SEWER MANHOLE DATED NOVEMBER 8, 1996. PROPERTY LINES ARE FROM A PLAN PROPOSED DRAIN MANHOLE ENTITLED, "PLAN OF LAND IN HYANNIS, BARNSTABLE, MA BELONGING TO DI,,AH ® JOHN J. SHIELDS & WALCOTT AMES, JR.," DATED FEBUARY 2, 1965, BY o EXISTING DRA€N MANHOLE 0 PROPOSED CATCH BASIN NELSON BEARSE-RICHARD LAW, SURVEYORS, CENTERVILLE, MA, RECORDED IN PLAN BOOK 498, PAGE 124. EXISTING TELLPHONIE SERVE CE BOX PROPOSED HANDICAPPED RAMP 3. ELECTRIC, TELEPHONE, CABLE, AND FIRE ALARM SYSTEMS SHALL BE PROPOSED TREELINE UNDERGROUND. ALL UTILITY STRUCTURES SHALL BE PLACED IN ACCORDANCE �E%/,H 'EXISTING ELECTRIC MANHOLE WITH THE REQUIREMENTS OF THE APPLICABLE UTILITY COMPANIES AND THE 61 PROPOSED CONTOUR e TOWN OF BARNSTABLE FIRE AND PUBLIC WORKS DEPARTMENTS. SITE r EXISTING UTILITY POLE 62x60 62x4 PROPOSED SPOT GRADES CONTRACTOR IS RESPONSIBLE FOR SEWER, WATER, AND UTILITY SERVICES TO WITHIN 10 FEET OF THE BUILDING. _Y'° EXISTING WATER SHUTOFF E PROPOSED ELECTRIC, CABLE, 4. IT IS THE CONTRACTORS RESPONSIBILITY TO NOTIFY DIG SAFE, THE TC AND TELEPHONE SERVICES BARNSTABLE DPW, AND ALL UTILITY COMPANIES, A MINIMUM OF 72 EXISTING HYDRANT W-- PROPOSED WATER MAIN HOURS PRIOR TO CONSTRUCTION ACTIVITIES FOR LOCATION OF ALL UNDERGROUND UTILITIES AND UTILITY COMPANY AND DPW APPROVALS. G PROPOSED GAS SERVICE 5. CONTRACTOR IS RESPONSIBLE FOR MAINTAINING CONTINUOUS ACCESS EXISTING CATCH BAS!N \ TO ALL EXISTING DRIVEWAYS WITHIN THE LIMITS OF WORK AND FOR a-- LINE MAINTAINING A MINIMUM OF ONE OPEN LANE OF ACCESS DURING PROPOSED PVC DRAIN EXISTING TREELIKE FROM BUILDING DOWNSPOUTS I WORKING HOURS AND TWO WAY TRAFFIC AT ALL OTHER TIMES. CONTRACTOR IS RESPONSIBLE AND LIABLE FOR ALL THROUGH TRAFFIC i' DURING CONSTRUCTION. REFERENCE: MANUAL ON UNIFORM TRAFFIC I CONTROL DEVICES FOR STREETS AND HIGHWAYS. +II ,jG r 3,���� 6. ALL EXISTING UTILITIES, WATER, SEWER AND DRAINAGE SHOWN ARE - APPROXIMATE ONLY AND THE CONTRACTOR SHALL BE RESPONSIBLE FOR S'�y VERIFICATION OF ALL LOCATIONS AND RIM AND INVERT ELEVATIONS. PARCEL 6-1 1? W `� )O THE CONTRACTOR SHALL NOTIFY THE OWNER AND ENGINEER DIVERSIFIED FIN. r Q \ IMMEDIATELY IF ANY DISCREPANCIES ARE FOUND. THE UTILITY PARTNERS III PARCEL 4-4 INFORMATION SHOWN ON THIS PLAN IS APPROXIMATE ONLY, IS NOT LEON D. NARBONINE & WARRANTED BY THE OWNER AND ENGINEER TO BE CORRECT, NOR DOES cRrnRirk �. THQ,r!a!ER JR. \ THF' OWNFR AND FNGINFFR WARRANT THAT All HNDERGROUND UTILITIES ARE SHOWN. TRUST PARCEL 6-4 0 7. SLOPES ON ALL SEWERS AND CULVERTS ARE APPROXIMATE. CONTRACTOR TO HOLD INVERTS FOR CONSTRUCTION. i PARCEL 8. CONTRACTOR IS RESPONSIBLE FOR LOAMING (4" COMPACTED DEPTH) t LEON D. NARBONNE AND SEEDING ALL DISTURBED AREAS, OR PAVING TO MATCH EXISTING. EXISTING END OF WATER f TRUST PARCEL 2 NEW UTILITY POLE 9. ALL CONSTRUCTION SHALL CONFORM WITH THE TOWN OF BARNSTABLE DPW MAIN WITH BLOWOFF VALVE j \ AND THE PLANNING BOARD OF BARNSTABLE, MASSACHUSETTS, UNLESS ROBERT & SAMIRA H. BY COM ELECTRIC TIE-IN TO EXISTING SCHUMANN - _ OTHERWISE SPECIFIED OR CALLED OUT ON THE DRAWINGS. I MAIN WITH 8" PVC - _ - - `+� ' r-1hl 10. ALL EXISTING MANHOLE AND CATCH BASIN RIMS, GATE VALVE BOXES • Sipi - _ _ NEW ELECTRIC - - --� - _ 1 �' AND OTHER STRUCTURES WITHIN THE LIMIT OF WORK SHALL BE - PRIMARY PULL BOX SERVICE BY - - __ I ADJUSTED TO FINISHED GRADE. i' 466.13 BY COM ELECTRIC COM ELECTRIC _ GRAY AND ROSE COL-" FEED ___ PRIMARY PULL BOX CONCRETE PAVERS BY COM ELECTRIC I 11. GREASE TRAP SIZING: 90 DINING HALL SEATS x 15 GPD PER SEAT=1,350 GPD. REFER TO ARCHITECTURAL _ I 1,350 GPD x 200% = 2,700 GALLON GREASE TRAP REQUIRED. ONE 3,000 t PLANS FOR PATTERN -- - - ~ 1 GALLON GREASE TRAP SHALL BE PROVIDED. 3,000 GALLON �� 8" PVC WATER MAIN 12. FIELD TIES ARE TO BE TAKEN FOR ANY CONCRETE BOUNDS OR SURVEY GREASE TRAP `` TO WHITEHALL WAY - MONUMENTS TO BE REMOVED OR DISTURBED DURING CONSTRUCTION. RIM=62.0t �> _ - N 09'08'10" E - ; INV. IN.=56.27 $;�1 DISTURBED BOUNDS OR MONUMENTS SHALL BE RESET BY A PROFESSIONAL INV. OUT=56.02 > � I a LAND SURVEYOR AND CERTIFIED AS SUCH. 00 61x4 x 4 DIA, 6 DEEP LEACH PIT WITH I J > 13. ALL WATER PIPE AND APPURTENANCES SHALL CONFORM TO THE TOWN OF 22 LF 4" 2' STONE SURRO�IND (lYP) v BARNSTABLE FIRE, WATER AND PUBLIC WORKS DEPARTMENTS. ALL WATER RIM ELEVATION=61.8f i PVC ® 1.6% JOINTS, VALVES, HYDRANTS, AND ANGLES SHALL BE RESTRAINED WITH z Ox : . 12 PVC INV IN =57.8t r 6 62x2 m�,, 1 MECHANICAL JOINT RESTRAINTS BY MEGALUG, UNIFLANGE, OR APPROVED EQUAL. 61x3 ;; ;.r ! < \ i 14. THE SITE FALLS WITHIN FLOOD ZONE C, PER BARNSTABLE FIRM MAP 5 FOOT PRECAST CONCRETE 61 E ° PANEL 250001 0005 C LAST REVISED AUGUST 19 1985. PARCEL 232 60x4 CHILLER MANHOLE, SEE DRA V 4 15. ALL ROOF LEADERS SHALL BE ROUTED TO LEACH ITS WITH SCH 40 PVC PIPE. Ct7 + DONALD E. & MANHOLE DETAIL (SIMILAR) CJO 62 / PARCEL 1t ` \\ /^ REFER TO ARCHITECHTURAL PLANS FOR EXACT ROOF LEADER LOCATIONS. KARIN PIPATTI \ 16. ALL NEW ROADWAY CONSTRUCTION SHALL BE IN ACCORDANCE WITH 8"x8"x6" D.I. TEE 20 LF 4" AREA = 314,730f S.F. z' \ THE REQUIREMENTS OF THE BARNSTABLE DPW. 60x3 WITH GATE VALVE PVC ® 2.0% TC \ CP 7.23 A.C. \ \ 17. ALL EXISTING TOPSOIL SHALL BE STRIPPED, STOCKPILED AND RESPREAD 6 ( 12" PVC TO DRYWELL (TYP) ) AS REQUIRED BY LANDSCAPING PLAN. (2) 6 DIA. LEACH PITS, 10 DEEP - - j EE2 / ; 18. REFER TO LANDSCAPING AND IRRIGATION PLANS BY HOME PHILIE, INC., DATED W/ 4' STONE SURROUND 11-12-96 FOR LAYOUT AND SPECIFICATIONS FOR SITE LANDSCAPING AND PVC CLEANOUTS, �o RIM ELEVATIONS=60.2 3' FROM BLDG EE5 CONNECT ALL ROOF LEADERS WITH -� { �" UNDERGROUND IRRIGATION SYSTEM. INVERT IN=54.89 L - - - " , 8" SCH 40 PVC PIPE AND SCH 40 .� 19. REFER TO ELECTRICAL PLANS PROVIDED BY ARCHITECT FOR SPECIFICATIONS 4 PVC SEWER PVC APPURTENANCES TYP N. \�' . Cn AND DETAILS ON SITE LIGHTS AND ELECTRICAL LAYOUT. INVERT �E`QUALIZER)=54.79 • G INV OUT=56.62 � ( ) � " oz ; 8" PVC SEWER 62x6 20. REFER TO REPORT OF SUBSURFACE INVESTIGATIONS BY GEOTECHNICAL \ ' �� CONSULTANTS, INC., DATED 11-7-96 FOR SOILS AND GROUNDWATER INFORMA1 6 PVC W INV OUT=56.62 ON. \ J 59x5 21. ROUTE 28 CENTERLINE STA110NING IS APPROXIMATE AND WAS TAKEN FROM " 62x98 ;' I , ` J1 ROUTE 28 BARNSTABLE 1932 LAYOUT, SHEETS 11 AND 12 OF 14. 6 FIRE SERVICE 59x6 59x A,(' WITH GATE VALVE ~' I l \ �' 22. REFERENCE IS MADE TO MASSACHUSETTS HIGHWAY CURB CUT PERMIT PROPOSED SMH1 50 L 8" I f� NUMBER 5-25900, ISSUED ON SEPTENBER 10, 1997 FOR ACCESS TO ROUTE 28.12" 'HDPE EQUALIZER PIPE \ RIM=61.5 'PVC ® 2.0% I2)INV N OUT=54.62 4" DOMESTIC SERVICE EE3 7- WITH GATE VALVE EE4 N 1\33 LF 12" HDPE @ 1% 108 LF 8" PROPOSED ASSISTED PVC ® 2.1% LIVING FACILITy CATCH BASIN 1 �� - " TWO STORIES MH LP \ RELOCATE EXISTING UTILITY POLE PER PARCEL 233 ur : RIM=59.3 00 (2) 8 PVC CHILLER PIPES __ - - 1 INV. OUT=55.30 REFER TO PLUMBING PLANS FF EL. = 63.00 62x5 CB5 `RIM��8_7 le OF UTILITY COMPANIES JANUSZ & 6`L WEISIAWA MADEJ �� PROPOSED SMH2 INV. OUT=54.7 60x4 PROPOSED MAIN RIM=59.9 60 FIRE WATER ENTRANCE QEE7 INV.=52.35 \ - - - - CONNECTION fi2x9 n r t 0 LF 1 DPE ® 1% l EE1 J I CB6 RIM=58.7 /i �a 1- --- L PROPOSED WELL FOR I INV IN=54.50 LAWN & IRRIGATION �• .� 59 INV OUT=54.40 SYSTEM X _ 60 - T I 61 x9 61 ; 1 61 1 �/ / 90' BEND 1 F 12 ' 2% N t` I 24 LF 12" HDPE 0 1% CB4 RIM=61 55 7 L 0' MIN \ 1�2 INV. OUT=57.55 22 LF 12" `4� ' 61� HDPE ® 2% 61x8 \ \` I f 6 -.---PR_0P_OSED- - _ 62 62 ,y �, J YDRANT \ := PARCEL 234 1� 6� O� 810 CATCH BASIN 2 61 3 4' DIA. 'LEACH PIT, 6' ( EEO 1 �� DANIEL & CHERYI_ RIM=60.8 '� PAZZANESE W/ 2' §TONE SURROUND' " INV. OUT=56.60 / \ ,`r _ " ` 230 LF 8 � '� RIM ELEV=62.5 �, 4b. J \ / 63 12" HDPE)=54:16 \ PVC ® 1.0%- Q `. SITE BENCH MARK: ,, . INV IN - , 63 ( s .� I DATUM NGVD 1929 (M.S.L.) 6 DIA. LEACH PIT, 10 DEEP \ ® BM#1 2.5' BEND W/ 4' STONE SURROUND 'r \\ 1 f R.R SPIKE INPOLE #333/45 INV. OF 12 HDPE PIPE=57.00 CB3 RIM=61°55 63x5 / I I i ; NORTH SIDE OF RTE. 28 62x2 INV. OUT=57.21 62 ,- -- - ' % - � ,` ~� ELEV.=58.82 ( - - 6' DIA. LEACH PIT, 8' DEEP -- - - '""~ 8"x8%8" PVC TEE W/ 3' STONE SURROUND 1 ! \ ; ► PROPOSED 24' V DE GRAVEL WITH GATE VALVE _ \ 4Of HH EMEROENCY VEHICLE ACCESS INV. OF 12 HDPE PIPE=5�6.16 �i� ...- ��� v`_--'jam Jf_.�J*..r -=•�`:`._./`' f I � , � GV ' - A CP S'MI`i L IL - 1 lilt V. ----- -- r - - - - - -- - �--- - - CONSTRUCTION DRAWINGS � GRADING & UTILITY PLAN - _ - � _ 24 LF 8" - "�� _------- - --- S t�i H PROPOSED SMH3 PVC ® 2.0% _. - ---_ - _` --i__- `---- ----- S M H FOR (IN RIGHT OF WAY) EXISTING ELECTRIC MANHOLE __ - ------ RIM=62.7 TIE INTO EXISTING 12" SEWER MAIN AT AND WATER SHUT OFF SHALL BE If dl _y-g LO \< INV.=50.05 - - t _ CB WHITEHALL ESTATE PI'YI irti u ^3 APPROXIMATE INVERT OF 49.57 WITH ADJUSTED TO FINISH GRADE, _ yµs� -4J �6 SADDLE CONNECTION OR LOCATE EXISTING IF NECESSARY EXISTING CABLE TV AND TELEPHONE _Y ` �� \ HYANNIS MASSACHUSETTS PARCEL 167 WYE BRANCH FOR CONNECTION SERVICE PEDESTALS SHALL BE - - } GV OCTOBER 14, 1997 PARCEL 166 PLACED IN UNDERGROUND VAULTS _ , PARCEL 165 TIE-I TO EXISTING 8" PARCEL 164 PARCEL 163 `' EXISTING PREPARED FOR: PVC AIN WITH 8 x 8 D.I. PARCEL 162 HYDRANT PARCEL 161 TAPPI SLEEVE AND VALVE PARKSIDE SENIOR SERVICE- ,�« 13 RIVERSIDE ROAD, SUITE 201 ll � it WESTON, MASSACHUSETTS 02193k' !I 'IU _ ® Designed by SCALE: Shee cin C DESIGN ENGINEERS, INC. (Drawn by : SCALE 1" = 30' 2 4 Checked by : 0 15 30 45 2 ML 4-10-98 PER ARCHITECT J08 NUMBER P.O. BOX 1051 , Sandwich, MA 02563 (508) 888 - 9282 Field survey chk. by : 1 K - 7-9 PER ARCHITECT Approved by : NO. BY DATE REVISION 1543.0