HomeMy WebLinkAbout0812 MAIN STREET (OST.) - Health 812 Main Street
Osterville
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Commonwealth of Massachusetts _
Title 5 Official Inspection.,Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
812 Main Street - -
Property Address
812 Corporation
Owner Owner's Name
information is Osterville MA 02655 April 18, 2015 _
required for every p
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in.any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information 67
?0
on the computer,
use only the tab 1. Inspector: . \
key to move your
cursor-do not Kevin J. Sullivan
use the return key. Name of Inspector
Ready Rooter, Inc.
� Company Name
P.O. Box 371
Company Address
Sandwich - MA 02563
Cityrrown State Zip Code
508-888-6055 Sl 13517
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
Needs Further Evaluation by the Local Approving Authority
April 21, 2015
lnspectoes19igKatu4z Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30-days_of completing this inspection. If,the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perf711,
the f ture under
the same or different conditions of use.
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4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
812 Main Street
Property Address
812 Corporation
Owner Owner's Name
information is Osterville MA 02655 April 18, 2015
required for every p
page. Cityrrown State 'Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" ection need to be
replaced or repaired. The system, upon completion of the replaceme or repair, as approved by,
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the Ilowing statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septi ank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or k failure is imminent. System will pass
inspection if the existing tank is replaced with a compl i g septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is ructurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less t 20 years old is available.
❑ Y ❑ N ❑ ND(Ex ain below):
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 812 Main Street
Property Address
812 Corporation
Owner Owner's Name
information is Osterville MA 02655 April 18 2015
required for every P ,
page. City/Town State Zip Code Date of Inspection .
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distrib ion box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution ox. System will
pass inspection if(with approval of Board of.Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND( plain below):
❑ ` obstruction is removed ❑ Y ❑ N, ❑ N (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ND(Explain below):
❑ The system required pumping more than 4 times a ear due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of th oard of Health): y
❑ broken pipe(s)are replaced ❑ Y ❑, N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
C) F/, eq
luation is R uired by the Board of Health:
❑ Cexist which equire further evaluation by the Board of Health in order to determine if
this failing protect public health, safety or the environment. f
1will ss unless Board of Health determines in accordance with 310 CMR
1 )t t the system is not functioning in a manner which will protect public health,
st environment:❑ spool or privy is within 50 feet of a surface water
❑ spool or privy is within 60 feet of.a bordering vegetated wetland or a salt marsh
Commonwealth of Massachusetts
Title 5 Official inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�M 812 Main Street
Property Address
812 Corporation
Owner Owner's Name
information is Osterville MA 02655'- April 18 2015
required for every p ,
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health(and Public Water Supplier, i ny)
determines that the system is functioning in a manner that protects the lic health,
safety and environment: w
❑ The system has a septic tank and soil absorption system (SAS nd the SAS is within
100 feet of a surface water supply or tributary to a surface water su y.
❑ The system has a septic tank and SAS and the SAS is ' in a Zone 1 of a public water
supply.
❑ The system has aseptic tank and,SAS and the S is within 50 feet of a private water
supply well. >-
❑ The system has aseptic tank and SAS and the SAS ' less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance- r
This system passes if the well water an is, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and t presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that n other failure criteria are triggered.A copy of the analysis must
be attached to this form..
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool -
Discharge or ponding of effluent to the surface of the ground or surface waters
® due to an overloaded or clogged SAS or cesspool
El ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool t
El ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than %day flow
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 812 Main Street
Property Address
812 Corporation
Owner Owner's Name
information is Osterville a MA 02655 April 18, 2015
required for every P
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
{
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s):Number of times pumped:.
❑ ® Any portion of the SAS;cesspool or privy is below high ground water elevation.
El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water'supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1,of a public well..
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A c f
0 o the analysis
99 PY Y
and chain of custody must be attached to this form.]
The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system,must se e a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of a following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a rface drinking water supply
❑ 'El ' 'the system is within 200 feet a tributary to a surface drinking water supply
❑ ❑ the system is located in itrogen sensitive area(Interim Wellhead:Protection
Area—IWPA)or a ma ed Zone II of a public water supply well
If you have answered"yes"to any ques. n in Section E the system is considered a significant threat,
or answered"yes" in Section D abov he large system has failed. The owner or operator of any large
system considered a significant th at under Section E or failed under Section D shall upgrade the
system in accordance with 31 MR 15.304. The system owner should contact the appropriate
regional office of the Depart ent.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,
M , 812 Main Street .
Property Address
812 Corporation
Owner Owner's Name
information is Osterville MA 02655 A nl 18, 2015
required for every P
page. City/Town State. Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
® ❑ . Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
i
® ❑ -Has the system.received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of
❑ ® this inspection?
❑NIR ® Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components,excluding the SAS, located on site?'
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum? }
® ❑. Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
❑ INR .® Existing information. For example, a plan at the Board of Health.
® El approximation
in the field (if any of the failure criteria related to Part C is at issue
approximation of distance.is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): ber of bedrooms(actual):
DESIGN flow based on 310 CMR 15.2)(for mple: 110 gpd x#of bedrooms):
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 812 Main Street
Property Address
812 Corporation
Owner Owner's Name
information is Osterville MA 02655 A riI 18 2015 -
required for every � p
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
r
Number of current residents:.
Does residence have a garbage grinder? ❑ Yes ❑ .No
Is laundry on a separate sewage system? [if yes sepa to inspection required] ❑ Yes ❑ No
Laundry system inspected? ❑ Yes ❑ No
Seasonal,use? ❑ .Yes ❑ No
Water meter readings, if available(las years usage(gpd)):
Detail:
Sump pump? ❑ Yes ® No
'Last date of occupancy: April 18, 2015Date
CommerciaUlndustrial Flow Conditions:
Commercial Offices
Type of Establishment:
Design flow(based on 310 CMR 15.203): 464 Gallons per day
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.): 6,183sq ft/1000 X 75ga1 per 1000
Grease trap present? ❑ Yes ® No
Industrial waste holding tank present? ❑ Yes ® No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No
Water meter readings, if available: 2013=315 GPD 2014=381 GPD
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M , t 812 Main Street
Property Address
812 Corporation
Owner Owner's Name
information is Osterville MA 02655 April 18, 2015
required for every P
page. Cityrrown State Zip Code Date of Inspection
D. System Information (coot.)
Last date of occupancy/use:. April 18, 2015
Date
Other(describe below):
General Information
Pumping Records:
Source of information: Ready Rooter Pumped September 29, 2014
Was system pumped as part of the inspection? ❑ Yes No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool ,
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
s
❑ Tight tank. Attach a copy of the DEP approval:
❑ Other(describe):
Commonwealth of Massachusetts
Title 5 Official Inspection Form,
.
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
e ,
�M 812 Main Street _
Property Address ,
812 Corporation '
Owner Owner's Name
information is Osterville MA 02655 April 18, 2015
required for every P
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
Building was built in 1988. Sytem appears,to be original system.,No information is available on
system at Barnstable Board of Health.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
2'
Depth below grade: feet
Material of construction:
❑cast iron ®40'PVC ❑ other(explain):
Distance from private water supply well or suction line: N/A
' feet '
Comments(on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade: �2 '
t5
Material of construction:
® concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is.metal, list age:
years'
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No `
Dimensions: 10.5'x 6'x 4.25'2000 Gallons
Sludge depth:
- 1
, t r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
812 Main Street I: i
Property Address
812 Corporation
Owner Owner's Name
information is Osterville MA 02655 April 18, 2015
required for every _ p
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle NA
Scum thickness
Distance from top of scum to top of outlet tee or baffle NA'
Distance from bottom of scum to bottom of outlet tee or baffle NA
• How �
Tape measure and dip tube.
o ere dimensions determined.
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.): -
Inlet manhole cover to grade in parking lot. Outlet under asphalt. H-20 tank with PVC inlet and oulet
baffles.
Grease Trap(locate on site plan):,
F
Depth below grade: feet
.
Material of construction:
❑ concrete .0-metal ❑ fiberglas :. ❑ polyethylene ❑ other(explain):
Dimensions: "
Scum thickness
Distance from top of scum to to f outlet tee or baffle
Distance from bottom of s m to bottom of outlet tee or baffle
Date of last pumpin ' Date
,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 812 Main Street
Property Address
812 Corporation
Owner Owner's Name
information is Osterville MA 02655 A nl 18, 2015
required for every P
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structu I integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) ovate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
4
Dimensions:
Capacity:
• gallons ,
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level.' Alarm in working order: ❑,Yes ❑ No
Date of last pumping:. Date
Comments(condition alarm and float switches, etc.):
`Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
f
Commonwealth of Massachusetts r
Title 5 Official Inspection Form ,
Subsurface Sewage Disposal System Form'-Not for Voluntary Assessments
M '( 812 Main Street
Property Address
812 Corporation
Owner Owner's Name
information is Osterville MA 02655. A nl 18 2015
required for every p
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0,,
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Concrete H-20 D-Box with one inlet and two outlets.D-Box had no sign of high water staining
manhole cover to grade in parking lot.
Pump Chamber(locate on site plan):
Pumps in working order: Zmpsand
❑ No
Alarms in working order: ❑ No
Comments(note condition of pump chamber, cs, etc.):
Soil Absorption System(SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
,M 812 Main Street
Property Address
812 Corporation
Owner Owner's Name
information is Osterville MA 02655 April 18, 2015
required for every P
page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits ' number: , (2)1000 gallon H-
20 leach pits
❑' leaching chambers number:
❑ leaching galleries number:
❑ Aeaching trenches number, length:
❑ leaching.fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
One leach pit is empty and one leach pit has 28"from water level to invert with no high water staining. :
Manhole covers to grade in parking lot.
Cesspools (cesspool must be pumped as part of inspection)(locate on a plan): .
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater ow ❑ Yes ❑ No
Commonwealth of Massachusetts
Title 5 Official Inspection Form ' .
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 812 Main Street
Property Address
812 Corporation
Owner Owner's Name
information is Osterv'ille MA 02655_ A nl 18 2015
required for every P ,
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, conditi of vegetation,
etc.):
•
Privy(locate on site plan):
Materials of construction:
Dimensions '
Depth of solids
Comments(note condition of soil, sign/ofdraulic failure, level of ponding, condition of vegetation,
etc.):
y
2•
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
812 Main Street
Property Address
812 Corporation
Owner Owner's Name
information is Osterville MA -02655 A nl 18 2015
required for every p
page. Cityrrown State Zip Code Date of Inspection
D. System Information (con't.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,including ties to
at least two permanent reference landmarks orbenchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
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Commonwealth of Massachusetts'
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments
812 Main Street
Property Address
812 Corporation
Owner Owner's Name
information is Osterville MA 02655 A riI 18 2015
required for every P >
page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: `91
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
-❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
Checked with local excavators, installers-(attach documentation) ;
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Base of empty leah pit 7'from grade. Hand augered 2'through base of empty pit to 9' no ground
water present. Property to the east is 10' below parking lot grade with conventional septic system.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
a Commonwealth of Massachusetts
Title 5 Official In Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
812 Main Street
Property Address
812 Corporation_
Owner Owner's Name
information is Osterville MA ' 02655 April 18 2015
required for every p
page. CityrFown State. Zip Code Date of Inspection
E. Report Completeness Checklist
®, Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
3y+ '
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
yY 812 Main Street
Property Address
812 Corporation
Owner Owner's Name
information is
required for every Osterville MA 02655 April 18, 2015.
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
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F d l D Page: of
�nr�rq TOWN OF BARNSTABLE HEALTH INSPECTOR'S pre-11141ICt Establishment Name: oo Date: D
OFFICE HOURS: �
Si PUBLIC HEALTH DIVISION 8a00-9:30 A.M. ,a.•i
200 MAIN STREET ` 3:30. 4:30 P.M. Item Code C-Critical Item
MON.-FRL DESCRIPTION OF VIOLATION/PLAN,OF CORRECTION Date Verified
i639 �� HYANNIS,MA02601 sob-662-4644 No. Reference R-Red Item
p PLEASE INTCLEARLY�.
Date/o Type of Inspection w Type o _ #
Operation(s) Routine Re-inspection
i Y
Add r ��� Ris `Food Service
d0 " / 7�CGTf�G�
Le Retail Previous Inspection 0 :3 [firQ a ld
Tele hone D Residential Kitchen Date:
Mobile Pre-operation
Owner " HACCP YIN Suspect,Illness
Temporary
Caterer General Complaint
Person in Charge (P Time HACCP
In:t ,
Bed& Breakfast ther ' r^ j
Inspector v; S n Out: - u
Each violation check ed"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 Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective. 590.009(E) ❑ 590.009(F) ❑
Action as determined by the Board of Health. i
FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands '
❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 11 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
115. 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
❑ B. Separation/SegregatioNProtecbon
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) i
❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21• Food and Food Preparation for HSP
❑ 10. Proper Adequate Handwashing -
❑ 11"Good Hygienic Practices CONSUMER ADVISORY
Violations Related to Good Retail Practices(Blue Items) ❑ 22: Posting-of Consumer.Advisories - -
Critical(C)violations marked must be corrected immediately. Non- Total Number of Critical Violations -
critical(N)violations must be corrected immediately or (blue&red items)
within 90 days as determined by the Board of Health. -�
C .N Overall Rating
23.Management and Personnel (F�2>(5so.003) Official Order for Correction: Based on an inspection today,the items Corrective Action Required:. ❑ No ❑ Yes
24.Food and Food Protection (FC 3)(5so.0o4) checked indicate violations of 105 CMR 590.000/federal Food Code.
25.Equipment and Utensils (Fc-4)(590.005) This report,when signed below by a Board of Health member or its ❑Voluntary Compliance ElEmployee Restriction/Exclusion ❑Re-inspection Scheduled ❑ 'Emergency Susperision
agent constitutes an order of the Board of Health. Failure to correct
26.Water, Plumbing and Waste (FC-5)(590.006) violations cited in this report may result in sus-pension or revocation of ❑Embargo ❑ Emergency Closure ❑Voluntary Disposal ❑ Other:
27. Physical Facility (FC-6)(590.007) the food establishment permit and ces-sation of food establishment
28. Poisonous.or Toxic Materials (FC-7)(590.006) operations. If aggrieved by this order,you have a right to a hearing. A= Zero critical violations and no more than 3 non-critical violations. F= 3 or more critical violations. If no critical violations observed,
29.Special Requirements (590.009) Your request must be in writing and submitted to the Board of Health at B= One critical violation and less than 4 non-critical violations. 9 or more non-critical violations=F.
30. Other the above address within 10 days of receipt of this order. If no critical violations observed,4 to 6 non-critical violations= B. Seriously Critical Violation=F is scored automatically if no hot water,
31. Dumpster screened from public view DATE OF RE-INSPECTION: C= 2 critical violations and less than 4 non-critical. If no critical violations sewage back-up, infestation of rodents or insects, lack of refrigeration, or•
Permit Posted? obsery on-critic violations=C. no PIC or alternate PIC present.
r� Y N Grease Trap Previous Pumping Date Grease Rendered. Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N Inspector' Sig r Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
PIC's Signature Print:
( Dumpster Screen? Y N
`"�� ""'w.c.`lK�'.r�\.,,�t'``.�*'=�.a•�:-,..a.�.•.�:.�+�€.�`7,�-w: _� .. � _l_„� .. �_. .,-r- -....a-- �. *'--Ul 4 -w.��--��+.- vim..='+"�.-.-.-.
Violations Related to Foodbome Illness
Interventions and Risk Factors(Red Items 1-22) rs501.14(C) fWs Received at Temperatures
Violations Related to ome Illness Interventions and Risk
PROTECTION FROM CONTAMINATION Facto (Red Items 1-22)22) (Cont.).((Coot According to Law Cooled to). 41°F/45°F Within 4 Hours.'
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
1 590.003 A Assi ent of Responsibility* 3-302.11(AX 1) Raw Animal Foods Separated from
PROTECTION FROM CHEMICALS 3-501.1 S Cooling Methods for PHFs
590.003 B Demonstration of Knowledge* Cooked and RTE Foods' 14 Food or Color Additives 19 PHF Hot and Cold Holding
2-103.1 l Person in charge-duties Contamination from Raw Ingredients 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below
3-302-11(Ax2) Raw Animal Foods Separated from Each 3-302.14 Protection from Unapproved Additives* 590.004(F) 410/45°F*
EMPLOYEE HEALTH Other* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above
2 590.003(C) Responsibility of the person in charge to Contamination from the Environment 7-101.1 1 Identifying Information-Original 140'F.
require reporting by food employees and 3-302.1 (A) Food Protection' Containers* 3-501.16(A) Roasts Held at or above 130°F.• y
applicants* t 3-302.15 Washing Fruits and Vegetables 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control w.q.;
590.003(F) Responsibility Of Food Employee Or An 3-304.11 Food Contact with Equipment and 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control*
Applicant To Report To The Person In Utensils* 7-202.1 1 Restriction-Presence and Use* 590.004(11) Variance Requirement
Charge* Contamination from the Consumer 7-202.12 Conditions of Use*
590.003 G Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food' 7-203.1 1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
3 590.003D Exclusions and Restrictions* Disposition of Adulterated or Contaminated 7-204.11 Sanitizers,Criteria-Chemicals• POPULAT IONS(HSP)
590.00 Removal of Exclusions and Restrictions Food 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.1 I(A) Unpasteurized Pre-packaged Juices and
3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels*
FOOD FROM APPROVED SOURCE Food* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use.of Pasteurized Eggs*
q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.1 1 Restricted Use Pesticides,Criteria* 3-801.1 1(D) Raw or Partially Cooked Animal Food and
590. A-B Com liance with Food Law* 4-501.1 I 1 Manual Warewashing-Hot Water 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.*
3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-801.1 1(C) Unopened Food Package Not Re-served.
3-201.13 Fluid Milk and Milk Products' 4-501.112 Mechanical Warewashing-Hot Water Monitoring* .
3-202.13 Shell Eggs* Sanit nation Temperatures* CONSUMER ADVISORY
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, TIME/TEMPERATURE CONTROLS 22 3-603.1 1 Consumer Advisory Posted for Consumption of
* concentration and hardness.* Animal Foods That are Raw,Undercooked or
3-202.16 Ice Made From Potable Water 16 Proper Cooking Temperatures for
4-i01.11(A) Equipment Food Contact Surfaces and PHFs Not Otherwise Processed to Eliminate
S-]01.11 Water from an Approved System* Utensils Clean' en n;K,nrrpo,
590. A Bottled Water' 3-401.11A(1)(2) Eggs- 155'F 15 Sec. Pathogens.*
* 4-602-11 Cleaning Frequency of Equipment Food- 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
590. Water Meets Standards in 310 CUR 22.0 Eggs-Immediate Service 145°F I Ssec•
Contact Surfaces and Utensils*
Sheiyrsh and Fish From an Approved Source 3-401.1 I(A)(2) Comminuted Fish,Meats&Gamc
4-702.11 Frequency ofSanitization of Utensils and * SPECIAL REQUIREMENTS
3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Animals- I55°F I5 sec.
Shellfish' 3-401.11 B 1 2 * 590.009(A)-(D) Violations of Section 590.009(A)-(D)in t
4-703.1 1 Methods of Sanitization-Hot Water and ( )( )O Pork and Beef Roast-130°P 121 min
3-201.15 Molluscan Shellfish Dorn NSSP Listed Chemical* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. catering,mobile food,temporary and
Sources' « residential kitchen operations should be
Game and Md Mushrooms Approved h 10 Proper,Adequate Handwat hittg
PWo y 2-301.11 Clean Condition-Hands and Arms* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHI's, debited under the appropriate sections
R ula A * Stuffing Containing Fish,Meat, above if related to foodborne illness
3-202.18 Shellstock Identification Present' 2-301.12 Cl Procedure g g * interventions and risk factors. Other
590. C m Wild Mushrooms* 2-301.14 When to Wash* Poultry or Ratites-I65°F 15-sec.
3-201.17 Game Animals* 11 Good Hygienic Practices 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail
5 ReceivinglCondition 2401.11 Eating,Drinking or Using Tobacco* 145°F* practices should be debited under#29-
3-202.11 PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and 3-401.12 Raw Animal Foods Cooked in a Special Requirements.
3-202.15 Package Integrity* Mouth* Microwave 165°F
3-101.11 Food Safe and Unadulterated' 3-301.12 Prevent Contamination When T « 3-401.1 1(A)(1)(b) All Other PHFs-145°F 15 sec.• VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
12 Prevention of Contamination from Hands 17 Reheating for Hot Holding (Blue Items 23-30)
6 Tagsstock Identification
Shea ion* g g Critical and non-crilical violations,which do not relate to the
3-202.18 Shellstock Identification' 590.004(E) Preventing Contamination from 3-403.1 I(A)&(D) PHFs 16S°F IS sec.'
Em to ees' foodborne illness interventions and risk factors listed above,can be
3-203.12 Shellstock Identification Maintained. 3-403.11(B) Microwave-165°F 2 Minute Standing
13 Handwash Facilities * found in the following sections of the Food Code and 105 CMR
Tags/fteeords:Fish Products Time 590.000.
Conveniently Located and Accessible
3�02.11 Parasite Destruction• 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000
3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 140°F* 23. Management and Personnel- FC-2 .003
5-204.11 Location and Placement' 9
590. J Labeling of Ingredients' 3-403.1 I(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004
Conformance with Approved Procedures 5-205.11 Aecessibilit ,Operation and Maintenance Roasts* 25. Equipment and Utensils FC-4 .005
MACCP Plans Supplied with Soap and Hand Drying 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006
3-502.11 Specialized ProcessingMethods* Devices 3-501.14 A 27. Physical Facility FC-6 .007
( ) Cooling Cooked PHPs from 140°F to
3-502.12 Reduced oxygenpackaging,criteria* 6-301.11 Handwashin Cleanser,Availability 70°F Within 2 Hours and From 70°F 28 Poisonous or Toxic Materials FC-7 .008
8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Provision 29,to 41°F/451F Within 4 Hours.* Spheral Requirements .009
3-501.14(B) Cooling PHFs Made From Ambient ss Ko°w to-:.aK
Temperature Ingredients to 41°F/45°F
Within 4 Hours*
t
•Denotes critical¢crn 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. �
i�
HEALTH INSPECTOR'S /
TOWN OF BARNSTABLE OFFICE HOURS: Establishment Na e\ 1 �e yvd C r a,a,a<�f Date:, z��/l 0 Page: of
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
s 200 MAIN STREET 3:30-4:30 P.M.
'""Ne1A MON.-FRI. Item Code C-Critical Item
DESCRIPTION OF`VIOLATION/PLAN OF CORRECTION Date Verified
s61 ',y� HYANNIS,MA02601 508-862-4644 N0. Reference R-Red Item PLEA SEPRINTCLEARLY
{{}} �- Date / Type'of Type of Inspection i
j Name 1'r`fA17,Pr s'Fu.df l0/�/�r��
Operation(s)
Routine �.
J Ris k e-inspection- R I ,
t )) J( / 1
Address A^ n CGt r �% Food Service Previous Inspection s° �a c . Y t. . fl�J lv/++
Level} Retail ,
Telephone 1A ! -7 '1 � Residential Kitchen Dater
g Y Mobile Pre-operation Y �) +.J I•v» Y 31 rrO Cn / :l�n, v A ;//'
Owner ��/HACCP YIN Temporary Suspect Illness v
Caterer General Complaint
a
9 ( )
Person in Char PIC Time HACCP
In: + _
Bed&Breakfast OtFier
Inspector f� 4
p 4��v',+L/ L1�. � fnn �� Out: f I
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 Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑
Action as determined by the Board of Health.
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 orColor Additives
❑ 3. Personnel with Infectious Restrided/Excluded ❑ 15. Toxic Chemicals
''FrFOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑ 4. Food and Water from Approved Source ❑ 16. Cooking Temperatures tir
115. Receiving/Condition ❑ 17. Reheating
❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 18. Cooling
❑ 7. Conformance with Approved ProcedurestHACCP 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) i
119. Food Contact Surfaces Cleaning and Sanitizing
❑ 21. Food and Food Preparation for HSP
❑ 10. Proper Adequate Handwashing
CONSUMER ADVISORY
1111.Good Hygienic Practices
+w
Violations Related to.Good Retail Practices (Blue Items) ❑ 22• Posting of Consumer Advisories k
Critical(C)violations marked must be corrected immediately. Norte Total Number of Critical Violations
Non-
critical(N)violations must be corrected immediately or
within 90 days as determined by the Board of Health. (blue&red items) {
c N Overall Rating ~
Corrective Action Required: 11 No ❑ Yes
23.Mana erhent and Personnel (FC-2)(590.003) Official Order for Correction: Based on an inspection today,the items
g checked indicate violations of 105 CMR 590:000/federal Food Code. r
f
24.Food and Food Protection (FC--3)(590.004) This report,when signed below,by a Board of Health member or its 11Voluntary Compliances ❑ Employee Restriction/Exclusion ❑Re-inspection Scheduled ❑ Emergency Suspension
25.Equipment and Utensils (FC a)(s9o.00s) agent constitutes an order of,the Board of Health. Failure'to correct
26.Water, Plumbing and Waste (FC-5)(590.006) violations cited in this report may result in'sus-pension or revocation of ❑Embargo ❑ Emergency Closure ❑Voluntary Disposal ❑ Other:
27. Physical Facility (FC-6)(590:007) the food establishment permit and ces-sation of food establishment Y
28. Poisonous or Toxic Materials (FC-7)(590.008) operations. If aggrieved by this order,you have a right to a hearing. A= Zero critical violations and no more than anon-critical violations. F= 3 or more critical violations. If no critical violations observed,
29.Special Requirements (5s0.00s) Your request must be in writing and submitted to the Board of Health at 8= One critical violation and ass than 4non-critical violations. 9 or more non-critical violations=F.
the above address within 10 days of receipt of this order. If no critical violations observed,4 to 6 non-critical violations= B. Serious) Critical Violation= F is scored automatically if no hot water,
30. Other ,. - „ y y
DATE OF RE-INSPECTION: sewage back-up, infestation of rodents or insects, lack of refrigeration,or,
31. Dumpster screened from public view C= 2 critical violations and less than 4 non-critical. If no critical violations
obocrved-7,to non-caitical violations=C. no r IC or alterrale PIC present.
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Ren+la+ed? Y N t ) \ 11 n
141"'r;i #Seats Observed Frozen Dessert Machines: k Outside Dining Y N Inspector's Signafuret Print: l J
i Self Service Waft Service Provided Grease Trap Size Variance Letter Posted Y N
��snature`s Print:
Dumpster Screen? Y N
I
Violations Related to Foodbome Illness
Interventions and Risk Factors(Red Items 1-22) 3-501.14(C) PHFs Received at Temperatures
Violations Related to Foodbome Illness Interventions and Risk According to Law Cooled to
PROTECTION FROM CONTAMINATION Factors(Red Items 1-22) (Cont.) 41°F/4S°F Within 4 Hours.
FOOD PROTECTION MANAGEMENT 8 Cross-contamination
1 590.003 A Assi ent ofResponsibility* 3-302.11(AXI) Raw Artimal Foods Separated from PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs
590.003 B Demonstration of Knowledge* Cooked and RTE Foods*% 19 14 Food or Color Additives PHF Hot and Cold Holding
2-103.1 1 Person in char e-duties Contamination from Raw Ingredients 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below
3-302.14 Protection from Una roved Additives* 590.004(P) 41°/45°F*
3-302.11(Ax2) Raw Animal Foods Separated from Each pp
EMPLOYEE HEALTH Other* 15 Poisonous or Toxic Substances 3-501.16(A) I lot PHFs Maintained at or above
2 590.003(C) Responsibility of the person in charge to Contamination tram the Environment 7-101.1 1 Identifying Information-Original 140°F.*
require reporting by food employees and 3-302.11 A Food Protection* I »i Containers* 3-501.16(A) Roasts Held at or above 130°F.
applicants* 3-302.15 Washing Fruits and Vegetables 7-102.1 1 Common Name-Working Containers* 20 Time as a Public Health Control
590.003(F) Responsibility Of A Food Employee Or An 3-304.1 1 Food Contact with Equipment and 7-201.1 1 Separation-Storage* 3-501.19 Time as a Public Health Control*
Applicant To Report To The Person In Utensils* 7-202.1 1 Restriction-Presence and Use* 590.004(14) Variance Requirement
Charge* Contamination from the Consumer 7-202.12 Conditions of Use*
590.003 G Reporting by Person in Charge* 3-30&14 A B Returned Food and Reservice of Food* 7-203.1 1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
3 590.003 D Exclusions and Restrictions* Disposition of Adulterated or Contaminated 7-204.11 Sanitiiers,Criteria-Chemicals* POPULATIONS(HSP)
590.00 Removal.of Exclusions and Restrictions Food 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.1 1(A) Unpasteurized Pre-packaged Juices and
3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels*
FOOD FROM APPROVED SOURCE Food* 7-205.11 Incidental Food Contact,Lubricants* 3-801.1 1(B) Use of Pasteurized Eggs*
q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.1 1 Restricted Use Pesticides,Criteria* 3-801.1 1(D) Raw or Partially Cooked Animal Food and
590. A-B Compliance with Food Law* 4-501.1 11 Manual Warewashing-Hot Water 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.
3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-801.1 1(C) Unopened Food Package Not Re-served.
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water
Sanitization Temperatures* Monitoring*
3-202.13 Shell Eggs* CONSUMER ADVISORY
3-202.14 Eggs and NEW Products,Pasteurized* 4-SOLI 14 Chemical Sanitization-temp.,pH' TIME/TEMPERATURE CONTROLS 22 3-603.1 1 Consumer Advisory Posted for Consumption of
concentration and hardness.' Animal Foods That are Raw,Undercooked or
3-202.16 Ice Made From Potable Drinking Water 16 Proper Cooking Temperatures for
5-101.11 Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and PHFs Not Otherwise Processed to Eliminate
590. A Bottled Dnnkm Water* Utensils Clean* 3-401.11 A(I)(2) Eggs- 155°F 15 Sec. Pathogens.*enenvr om
590. Water Meets Standards in 310 CMR 22.0• Contact Surfaces and Utensils*4-602- Eggs-11 Cleaning Frequency of Equipment Food- E s-Immediate Service 145°FI5sec• 3-102.13 Pasteurized Eggs Substitute for Raw Shell Eggs*
SheChsh and Fish From an Approved Source 3-401.1 1(A)(2) Comminuted Fish,Meats&Game
4-702.11 Frequency of Sanitization of Utensils and * SPECIAL REQUIREMENTS
3-201.14 Fish and Recreationally Caught Molluscan Food Contact Stufaces of Equipment Animals-155°F 15 sec.
Shellfish* Food
I B I 2 * 590.009(A)-(D) Violations of Section 590.009(A)-(D)in
4-703.1 1 Methods of Sani tization-Hot Water and ( )( )O Pork and Beef Roast- 130°P 121 min
3-201.1 S Molluscan Shellfish from NSSP Listed Chemical, (2) Ratites,Injected Meats-155°I'15 sec. catering,mobile food,temporary and
Sources* 10 Proper,Adequate Handwashing * residential kitchen operations should be
Game and WQd Mushrooms Approved by 3-401.I 1 A 3 Poultry, debited under the appropriate sections
Regulatory Authority. 2-301.11 Clean Condition-Hands and Arms' ( )O ry,Wild Game,Stuffed I'HI's,
Stuffing Containing Fish,Meat, above if related to foodborne illness
3-202.18 Shellstock Identification Present' 2-301.12 Cl Procedure g g * interventions and risk factors. Other I'
590. C Wild Mushrooms* 2-301.14 When to Wash* Poultry or Ratitcs-165°F 15 sec.
3-201.17 Game Animals, 11 Good Hygienic Practices 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail
5 ReceivinglCondition 2401.11 Eating,Drinking or Using Tobacco* 145°F* practices should be debited under#29-
3-202.11 PHFs Received at Proper Temperatures. 2-401.12 Discharges From the Eyes,Nose and 3-401.12 Raw Animal Foods Cooked in a Special Requirements.
3-202.15 Package Integrity* Mouth* Microwave 165°F*
3-301.12 Prevent Contamination When Tast * 3-401.1 I(A)(1)(b) All Other PHFs-145°F 15 sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-101.11 Food Safe and Unadulterated 6 TagslRecords-Shellstock 12 Prevention of Contamination from Hands 17 Reheating for Hot Holding (Blue Items 23-30)
3-202.18 Shellstock Identification' 590.004(E) Preventing Contamination Gom 3-403.11(A)&(D) PHFs 165°F 15 sec.*
Critical and non-critical violations, which do not relate to the
oodhorne illness interventions and risk actors listed above,can be
Tags/Records:Fish Products Time
3-203.12 Shellstock Identification Maintained* Employees. 3-403.11(B) Microwave-165°F 2 Minute Standing f
13 Handwash Facilities * found in the following sections of the Food Code and 105 CA4R
Conveniently Located and Accessible 590.000.
3A02.11 Parasite Destruction* 3-403.11(C) Commercially Processed RTE Food-
5-2031 1 Numbers and Capacities* Item Good Retail Practices FC :6-0 0
3-402.12 Records,Creation and Retention . 140°F* 23. Management and Personnel FC-2 3
590. J Labeling of Ingredients' 5-204.11 Location and Placement* 3-403.1 1(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004
Conformance with Approved Procedures 5-205.11 Accessibility, lion and Maintenance Roasts* 25. Equipment and Utensils FC-4 .005
/HACCP Plans Supplied with Soap and Hand Drying 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006
3-502.11 Specialized Processing Methods* Devices 3-501.14 A 27. Physical Facility FC-6 .007
3-502.12 Reduced oxygenpackaging,criteria* 6-301.11 hlandwashin Cleanser,Availability ( ) Cooling Cooked PI IFs from 140°I= 28 Poisonous or Toxic Materials FC-7 .008
6-301.12 Hand Provision 70°F Within 2 Hours and From 70°F 29. Special Requirements 009
8-]03.12 Conformance with Approved Procedures to 41°F/45°F Within 4 Hours.* W Other
3-501.14(B) Cooling PHFs Made From Ambient 55wiro.me.x,.-2a
Temperature Ingredients to 41°F/45°F
Within 4 Hours* 4
*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.
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Company Profiles> Find Companies> Osterville. MA > Food&Beverage> I ood > Fish and Seafoods> Fish and seafoods> Premier roods Company Profile
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812 Main St, Osterville, MA 02655-2047, United States (Mao) (Add Company Info)
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Detailed Premier Foods Company Profile
This company profile is for the private company Premier Foods, located in Osterville, MA. Premier
Foods's line of business is whol fish/seafood.
Learn Why a Million+
Company Profile: Premier Foods Businesses Choose Pitney
Bowes
Year Started: N/A
State of Incorporation: N/A
URL: N/A Online Menu wl Prices
Fresh seafood, garlic shrimp, Steak Fine dining at
Location Type: Single Location the Hearth n Kettle.
www.HearthNKettie.com ,•
Stock Symbol: N/A
Stock Exchange: N/A
Also Does Business As: N/A
• m
NAICS: N/A
SIC #Code: r View Details Fresh Seafood For Sale
Looking For Fresh Seafood At Cost Lobsters,
Est. Annual Sales: ��� View Details 9
Est. Employees: 3 Clams, Fish & Much More
-
t ome.eazydealz.com .
Est. Employees at Location: 3 W 7
Contact Name: N/A
Contact Title: N/A Ada.by C�aIe
Data above provided by D&e. "h
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RAXTER & NYE, INC.
Registered Land Surveyors and Civil Engineers
7 Parker Road/Osterville,Massachusetts 02655/Tel. (617)428-9131
WILLIAM C.NYE,R.L.S.-President
RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering
February 26 , 1988
Town of Barnstable
Board of Health
367 Main Street
Hyannis, Ma. 02601
RE : 812 Main Street, Osterville
Septic Inspection
Dear Board:
Per Health Department regulations, I have inspected the
installed commercial septic system at 812 Main Street. The
system has been installed as per the approved plan.
Very truly yours,
Peter Sullivan, P.E.
Baxter &. Nye,. Inc .
P S 1 p P,,` n"`OF
MEN
St?t.LE W1 t l
1,110. 29733 �..
MEMBERS OF
CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING
MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGMFMS
TOWN OF BARNSTABLE
LOCATION SEWAGE #
C ff
VILLAGE' ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY (S )
LEACHING FACILITY: (type) ' tl (size) tow
NO.OF BEDROOMS
BUILDER OR OWNER '( C
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wet! s exist
within 300 feet of leaching facility) �o( Feet
Furnished by
Rr
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flC �3c �
�a loc .
TOWN OF BARNSTABLE
r�
I LOA10 jV9//r/ SEWAGE
VILLAGE (_1/1, iF ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY °�bba 14 (,
LEACHING FACILITY:(type # AO (size)
NO, OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
,
BUILDER OR OWNER j'�/�1//:4- �- �'�/� (//
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No ���
f y
O
I
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No.... ._...... Fps .... ..
BOARDTHE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.t.. ...................OF..... .. . Q-N.-STX �.----------------.......------------
Aptirtation for DivpngFal Workg Tnnitrur#iun rumit
Application is hereby made for a Permit to Construct ( or-Repair ( ). an Individual Sewage Disposal
System at:
.....r!A;!!1,A..S Tr ii �-...O��X LLB........--•---. - tom, - ...............
. / Locay'o -Address Lot
1 .c._.. I_�1.�................ .1��ZK��'..���.._..Sl.`l.�.ica3=- s..C.:i..a-.........-
W � �P4L�Ga.►-t 1 Ad�re�ss
aig..
Installer
� Address
Type of Building Size Lot._. }z ..Sq. feet
Dwelling—No. of a Bedrooms.................. t p.__.-----Expansion Attic ( ) Garbage Grinder ( }
—Other—Type of Building'F4Q� .__.... o. of persons............................ Showers ( ) Cafeteria ( )
Otherfixtures -----------••---•---•-- .............•--•--••••••--•-----•-----•-•-------•--•-••--•••••-•-••-•--•---...........••......_......•...
WDesign Flow............................................gallons per person per day. Total daily flow__._.._.�.100...........:.........gallons.
W Septic Tank—Liquid capacity�_.gallons Length 1l`:'.�!"a.. Width.14P t........._ Diameter------- Depth...5_-......._.'r
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No._...Z�_...__._.. Diameter....\?........... Depth below inlet....CA?...........Total leaching area.4715_....sq. ft.
z Other Distribution box (�� Dosing,tank
4 Percolation Test Results Performed by__: .R1CT�12.`s�,:{�Ir`�.CE`.f-�L....................... Date..... `��c�:�_�_......__..
1.4 Test Pit No. 1...4.z......minutes per inch' Depth of Test Pit-----Vb.......... Depth to ground water_.? fir. Mu�ios�tw
fs, Test Pit No. 2../-'L......minutes per inch Depth of Test Pit.....101. ...... Depth to ground water__ dT !�►_4ot==u� )
--•----------------------------------------------••••••.=..-
O Description of Soil.ThLi•---- SAr Ptk� p�VrL- ! ..?'9_-l�o�L!s� _$u.45c�1�,9 p -�.
U - �4G •677- SAtu Al
UNature of Repairs or Alterations—Answer when applicable..............................................................................................
--------------------•--•----•---•---------------•-••-----•-•---•--••---------------•-...............------•-•--------•----------•--------------•-------------..._.......--••--•-••-•••••...........••••.
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance hasjxe4 issued j, e d of health.
Signed -- ............... Za o g
�D to
Application Approved By.................................... ---•_.8• --- �.
Date
!,
Application Disapproved for the following reaso s -•-••----••-•••---•--•-•----•----••-•------•••-•......---•-•••-•-•-•-••-----•-••--•----...•.
C Date
PermitNo.---......- ---------------------- Issued........................................... ......
Date
No.......................... ' 7 r - ` �. Fmc..........................
THE COMMONWEALTH OF MASSACHU5�E7S*,%
BOARD OF HEALTP11 %
OFF. JG A.... . .....................................
Appliratilan for Uiipusal Works Tonotrurtuan ramit
k Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage. Disposal
System at: `
Locat' n-Address or Lot ITT I
LL.t � � . ..� - ......�..... ... ... ..... .._.. . .............. ...:_._ ----•- .. . .......-
t W '� p \JtlLk —
Ht..... ... T ._T_
..... •• ress •.............
CGt
Installer Address
Type of Building Size Lot..._I_ .�_ q. feet
Dwelling—No. of Bedrooms..................f L,._-----Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building 0__ +C E/ of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures -------------------------------•
W Design Flow............................................gallons per person per day. Total daily flow..........!7(.._....._............gallons.�f
�; Septic Tank—Liquid capacity_Z .gallons Length_tl.:11.._.. Width_G_........... Diameter____- Depth_.
W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
x
Seepage Pit No......Z............. Diameter-----�:......... Depth below inlet..... ........... Total leaching area_.G7 :.__sq. ft.
Z Other Distribution box (i1t�)j Dosing3tank (0 Oa , I
Percolation Test Results Performed by__._�__AxE�z�_ __hl:'!_e_� :�___________________ l_�_
•. Date. `__? ------....
Test Pit No. I.._�_Z-----minutes per inch Depth of Test Pit___1_�____.___ Depth to ground water !......_......! ou+s M-CCD
Test Pit No. 2..G Z.._._minutes per inch Depth of Test Pit...... Depth to ground water--
........................................
a -•- --------• ...............................................•--•--- =••-•----•-...........---•••......•••--
O Description of Soil----t�-�•�--�•••••6)--?.....
--rn;.i �#Czli Ur c `` �9- I o wt S ..........................
- ....h Q 5?. ny- 1« 1c� s�.a _0-47 6 a rS� a ,cav c, �'_�O,_ _� ��i7- �► ��
U Nature of Repairs or Alterationss" Answer when applicable------------------------ ...............................................
t ----••----•--------------•-•-.....--•--•---•-----••-••---•-••••-•-•-•-•-••-...._..-••-'..-----•---••••---...•--•-----------••--••---------•-•- ••-•-••-••••--
Agreement: ;
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in `
operation until a Certificate of Compliance hasbeeiA issued b e b' d i health.
Signed---- - ..._..� -
�, Da e
Application Approved By......................................
( `- ._... `'�`: ��
Date
Application Disapproved for the following reaso s ....................
..........................................................:....................................
..........................................._..............................................................
Date
PermitNo......................................................... Issued--------------- •-•.......................-. .
Date',.
THE COMMONWEALTH OF M'ASSACHUSETTS
•
BOARD OF HEALTH
..........................................OF............................. -
(Intgf irttte of Tnntplianrr 1 r
THIS IS TO CER FY That the Indivi u l Sewage Disposal System constructed or Repaired ( )
b3------------------------ - r`�. .'_ .........--j-c(.L....-----•--------------•---......----•-•-•---•----...----•---- -
Installer '
at--••-••-----------------•.. 1 1. n t V1 T� r j2 v t y
....-----••----------•---------------------------•---------------•--•----•--•---•--••-•....---•-•-----.....--•----------•-•-•-•••••--•---•----•............---
has been installed in accordance with the provisions of TIME 5 fkhe State Sanitary Codes de' r'bed in the
application for Disposal Works Construction Permit No.___ 6'- . -7..._... dated_.------0.1 ___E:�.............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANT E THAT THE
SYSTEM,WILL FUNCTIONSATISFACTORY
DATE.................•-. ..r. .'.A. ...... .................... Inspector ---
!C SYSTEM MUST
DESIGNING ENGINEER MUST SUP �V1S IN co
�� e I^M AND CERTIFY IN W LLE®
- g / rHE THEYa9 EMLWASO INii+ �EU�S,E
WIT& TITLE 5
r;BQA,R•DE®�FPIW,E•ALTH Tr�L
No._..v �....V. . ........................... OF................................................ ......... .................�Wq �F r�
FEE........................
Disposal Workii inn ion rrantt
r A �' O
Permission is hereby granted .5 .�1..1.............................•----------•-------------------•••-•-•-••---.......----....................
to Construct (X ) or Repair. ( ) an Individual Sewage Disposal System
at No. .I. ... ..�.. t .........................................................?gE t�l
- ...........................
Street a
as shown on the application for Disposal Works Construction Permit No.S6-88.. Dated 6 � G
--........
J .................................................. , _?. ....... ........................
—
Boar o Health
DATE-------------- "._st. .rs . ...........................
=ORNI 1255 HOBBS & WARREN, INC.. PUBLISHERS '
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