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HomeMy WebLinkAboutCRAIGVILLE PIZZA & MEXICAN - FOODr Craigville Pizza &Mexican 618 Craigvill Bch.Rd. CENT' rtT Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. UAMN37AUM � F.P.(Thomas)Lee,. 4 ` 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. 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: 276 Issue Date: 01/01/2022 DBA: CRAIGVILLE PIZZA AND MEXICAN OWNER: ANTONIOS REVIS ENTERPRISE, INC. Location of Establishment: 618 CRAIGVILLE BEACH ROAD CENTERV ILLE„ MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 70 OutdoorSeating: 0 Total Seating: 70 FEES ^� FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE- ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent i FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE j Restrictions: Town of Barnstable �For Office Initials' _ Date Paid I Amt pd$ _ 9gp�gpgg� Inspectional Services � Public Health Division FD MA't 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 �a at �aa DATE l a NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: `�v i ll� + -� BEN(�6Ar✓ ADDRESS OF FOOD ESTABLISHMENT: ° ( � C ' ``��l 11e i3 e+A-C-1-\ 704---) . C O r1 14'al, 1 HA s, MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: t% N O V4A r1 A 0 L „ 9:5 u M t TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 2 ) V TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO_Y_ ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUA3----, SEASONAL: DATES OF OPERATION: lk•/_/ TO NUMBER OF SEATS: INSIDE: 1 OUTSIDE: <!S) TOTAL: 9-1 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) X 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(SEEPAGE 42) *** 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: �, f A M FULL NAME OF APPLICANT 0 1" ` A d � SOLE OWNER: YE /NO OWNER PHONE # ADDRESS_ LE r-TEJRui 1e. -A CL ill a..vilt�, M� S> CORPORATE OWNER: . ZuNtj t-�A�\aL,- CORPORATE ADDRESS: 2k CRrylsfvltlL K�vQ— 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 a �o�+r 1`1+94vr12 1. .�ul+n/ 1"`,q E+o n-� � / � / offal, 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/healthdivision/applications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31'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 Town of Barnstable BOARD OF HEALTH John T.Norman Board Of Health Donald A.Gaudagnoli,M.D. A �rSAI�L� Paul J.Canniff,D.M.D. F.P. Thomas Lee Alternate � 4. 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: 276 Issue Date: 01/01/2021 DBA: CRAIGVILLE PIZZA AND MEXICAN OWNER: ANTONIOS REVIS ENTERPRISE, INC. Location of Establishment: 618 CRAIGVILLE BEACH ROAD CENTERV ILLE„ MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeatin : 70 OutdoorSeatin : 0 Total Seating: 70 g g g FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: �I MMEt Initials: ti Town of Barnstable For Office Use Date Paid'�� Amy$�_ uRrrsrasLe, Inspectional Services Public Health Division R � 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 V[n9LLjf9D NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: C.Q'A`S. j\` ' "J'X-0, ADDRESS OF FOOD ESTABLISHMENT: & MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: tt C! �" D L '\/` TELEPHONE NUMBER OF FOOD ESTABLISHMENT: uY 'X TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO—V...(ANNUAL WATER ANALYSIS REQUIRED) I ANNUAL:_� SEASONAL: DATES OF OPERATION: / /_ TO NUMBER OF SEATS: INSIDE: TO 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 REOUIREMENTS. 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) \ V 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 Q:Wpplication FormsTOODAPP 2020.doc OWNER INFORMATION: _ FULL NAME OF APPLICANT JO Y-j SOLE OWNER(5/NrO,- OWNER PHONE# ADDRESS- a �,G(1 �tJ 1\1.t. P y c CORPORATE OWNER: a 1 +J A nAA.}4,.y\f:i CORPORATE ADDRESS: P C>t � {�:� S� ���° 3 a PERSON IN CHARGE OF DAILY OPERATIONS: 5b 6 ,4oy� 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. ���lJ b / �0 old L �o (`lA v /C n n qrv� 2. ACLU 1�,L �1 i Y1 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 openinz!! 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 htti)://www.townofbarnstable.us/healthdivision/apt)lications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q:\Appfication FormsTOODAPP REV3-2019.doc TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Pa of 2� ' g ne,•� OFFICE HOURS •- d ° PUBLIC HEALTH DIVISION "" 8:00-9:30A.M. 3:30-4:30 P.M. RARNSTABLC'. ` 200 MAIN STREET Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified :'e q: HYANNIS, MA 02601 M-8 -FR' No Reference R-Red.Item PLEASE PRINT CLEARLY �A 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT _ �d Name (�20� lv G Date ((� v Type o of In ection g - - outine Address lNG(�l �� Risk e-inspection // .�� Level Retail Previous Inspection <Y Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness T � Caterer General Complaint Person in Charge(PIC), Time Bed&Breakfast HACCP `� C��ig" G;,L/(- In: ' l Other Inspector j Out: �S Each violation checked req Tres an explanation on the narrative page(s)and a citation of specific provision(s)violated. ^ e.qd � 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 IXXrL i'l b l�1/ EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives f mct ❑ 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 � kzD ct ❑ 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 b e y PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control Cr! (',I GAS ❑ 8. aration/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) i Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP o C ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories /\ Violations Related to Good Retail Practices(Blue Itemsi Total Number of Critical Violations 1 C. Critical(C)violations marked must be corrected immediately. (blue&red items) I� U� 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,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ ❑ 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 g ardless of the number of critical, results in an F. if no critical violations 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 o 6 non-critical violations non-critical violations re 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 observed,4 to =B. Seriously Critical Violation=F is scored automatically if: no hot critical violations and less than non-critical. If f 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 anon-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non- ritical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Sign re 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 Siature Print: - Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N cre Dumpster Sen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions r 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 Law Cooled to 41°F/45°F Within 4 Hours* 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives S 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'Additives Contamination from Raw Ingredients F 7 5 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 7-101.11 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers*Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 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 11 Variance Re uirements 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)Resumed 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 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 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* TIMEIrEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 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 E s-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* 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* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* � faces 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- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 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)(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 practices should be debited under#29-Special Requirements. $ 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 non-critical 3-202.15 Package Integrity Y n Critical and non-critical violations,which do not relate to the Foodborne * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g 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 13 Handwashing Facilities 3-202.18 Shellstock Identification* 3-501.14(A) g Coolin 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 ]Hand 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 Supplied with Soap and hand Drying Devices 3 402.12 Records,Creation and Retention* 5-205.11Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 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. p THE rqi• TOWN OF BARNSTABLE HEALTH.INSPECTOR'S Establishment Name: - - Date: . .Page,: _of �-- ti OFFICE HOURS PUBLIC HEALTH DIVISION 800-9:30A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ,659. `0� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Dal Type of Type of Inspection C� l Z Operation(s) Routine ^ Address Risk Food.Service Re-inspection /tcj C, Inspection Previous Ins �� eve) Retail P Telephone Residential Kitchen Date: Imo- f Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP C� In: Other Inspector Out: 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) ❑ Action as determined by the Board of Health. Allergen Awareness 590.1)09(G) ❑ t FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities / EMPLOYEE HEALTH PROTECTION FROM CHEMICALS (I ❑ 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) J� ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures PR ❑ 5.Receiving/Condition ❑ 17.Reheating - �� ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling % y� ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding a PROTECTION FROM CONTAMINATION ❑20.Time Asa Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) QI/ 1 ❑ 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 A9Z?Ar_ QL Critical(C)violations marked must be corrected immediately. (blue&red items ❑ ) Corrective Action Required: ❑ No Yes Non-critical N violation corrected immediate) or( ) s must be co y Overall Rattng 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. F] 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 g ardless 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 6=One critical violation and less than non-critical violations re if no critical violations observed,4 too 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 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 i 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 anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008) 9 violation,4 to 8npn-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. Inspector's g Print: 30.Other DATE OF RE-INSPECTION: � J 31.Dumpster screened from public view. L Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's S to 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.) r� i 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-contamination 14 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 3-262.12 Additives* Cooked and RTE Foods.* 19 PHF.Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* 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 i 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(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-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* Requirements 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.004(11) Variance Re q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(13) 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* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashin Hot Water 7.206.12 . Rodent Bait Stations 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. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.1]A(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 Equipment 5-101.11 Drinking Water from an Approved System* * Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective uuzooi 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 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* ing,mobile food,temporary and residential 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 1 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* 3-401.11 A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms _ ( )( )(b) 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 * E Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed R E Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome * 12Prevention of Contamination from Hands 3-403.11E Remainin Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13Handwashing Facilities 3-501.14 A Coolin Cooked PHFs from 140°F to 70°F3-202.18 Shellstock Identification ( ) g Item Good Retell Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°FTags/Records:Fish Products Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 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 Hand Drying Provision 129. 1 special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 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.HE r TOWN OF BARNSTABLE, HEALTH INSPECTOR,s Establishment Name: /`�IL! �" ( Date: �Page: of o OFFICE HOURS PUBLIC HEALTH DIVISION 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 P 639.>�0� , HYANNIS,MA 02601 M-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY rFD MP'� 508-862-4644 FOOD ESTABLISHME T INS EC ION REPORT Name Date Type of Ins ect'on ,Y outin / J Address Risk ood Service," spection Level Previo%tru Telephone Residential Kitchen Date: p Mobile Pre.op tioTTI J " Owner HACCP Y/N Temporary Suspect Illness V111 /- Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspecto p : JANi Each violation checked requires an explanati n on the narra�ve 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 ? f ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities .' EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 9. ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives e' ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 7 , ❑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 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 1 Critical(C)violations marked must be corrected immediately. (blue&red items) 1 3p'aM G Corrective Action Required: ❑ Noi Y Non-critical(N)violations must be corrected immediately or Overall Rating vdl within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspecti n Sc eduled ❑ Emergency Suspen ion C N " Official Order for Correction:Based on an inspection today, s ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) checked indicate violations of 105 CMR 590.000/Federal Foo Co e. 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 4 non-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 operations. If 27.Physical Facility 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 (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-critical violations. If 1 critical refrigeration. violation,4 to 8 non-critical v' ations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. �% 30.Other DATE OF RE-INSPECTION: I? o's Signat g 8 rin. !' 31.Dumpster screened from public view A _ Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y NVX #Seats Observed Frozen Dessert Machines: Outside Dining Y N I ys igna Ae 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* 6 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°F/45°F - * - 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 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 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 3-304.11 Food Contact with Equipment and Utensils* 590:004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* - 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR �. 3-306.14(A)(B)Resumed 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* 590.004(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 Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* _ 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* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 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 * E r ///R001 ( ) g Pathogens °"'e A-60211 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* 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 or 590.009 A - D Violations of Section 590.009 A - D in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) ( ) ( � Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 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* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(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 practices should be debited under#29-Special Requirements. $ 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* d 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 PreventingContamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 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* 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* 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 009 3-502.11 Specialized Processing Methods* 130. 1 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. i Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. EAMSrABIA `+ PaulJ.Canniff,D.M.D. NAM 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: 276 Issue Date: 12/10/2019 DBA: CRAIGVILLE PIZZA AND MEXICAN OWNER: ANTONIOS REVIS ENTERPRISE, INC. Location of Establishment: 618 CRAIGVILLE BEACH ROAD CENTERV ILLE, MA 02632 Type of Business Permit: FOOD SERVICE 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: C,�n FROZEN DESSERT: Thomas A. McKean, RS, 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 Initials: Town of Barnstable rT Date Paid -1 AmtZd s '» ,ARNgrABU, : Inspectional Services ; KAM 16 y� � Public Health Division ? ��` �� Thomas McKean Director sIL 200 Main Street,Hyannis,MA 02601 ' Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A, FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Cizp; J►1�� n r'I.Q ADDRESS OF FOOD ESTABLISHMENT: f s'jtHC_ `6t-A .L' MAs) MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: �A � ,E 0 ��rn, y L ppl TELEPHONE NUMBER OF FOOD ESTABLISHMENT: &aW - TOTAL NUMBER OF BATHROOMS: WELL N �TER:YES_' NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: 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 Q:\Application FormsTOODAPP 2020.doc 1 ,E OWNER INFORMATION: FULL NAME OF APPLICANT 0 SOLE OWNER: YE NO OWNER PHONE# 4.tI I I ADDRESS_ a (,- -j A53 076-32 CORPORATE OWNER: S® kto MP odd CORPORATE ADDRESS: AILC PERSON IN CHARGE OF DAILY OPERATIONS: -.3 O MA 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 0 h-li 2.aSp L u SIGNATURE OF APPLIC NT 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.as1). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3151 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 Fee. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Migaar *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(V)Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. p f B f�jrpU�1�/� Owner's Name,Address and Tel.No. Assessor's Map/Parcel ' r e rr/✓ O7,41'_ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 26 4-ylnow No.of Persons *7 244,`,15 —Showers( ) Cafeteria( ) Other Fixtures / Design Flow 7i gallons per day. Calculated daily flow Z ev gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank D J' 14,w,5e Z ft Type of S.A.S. Description of Soil Nature of Repairs o 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 thisJ3oard o Ith Signed Date Application Approved by Date I/�® Application Disapproved for the following reasons Permit No. 7 OLa4 Date Issued 40 N � �— ,�. . ?'.� - W Fee �— — ..` - THE COMMONWEALTH OF MASSACHUSETTS Entered,in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS ricatio-ttsfor-: i ogaY *p�teth,Congtruction Verrhit oe Application fora Permit to Construct(" )Repair( )Upgrade(✓)Abandon( ) O Complete System El Individual Components 4 Location Address or Lot No.' Owner's Name,Address and Tel.No.G��,�, fin,.. Assessor's Map/Parcel , Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 77/ Type of Building:, f Dwelling No.of Bedrooms _Lot Size sq. ft. Garbage Grinder( ) F Other `�- Type of Building /s'�fif4UtD/t% No.of Persons 13' Srof 5 Showers( ) Cafeteria( ) F Other Fixtures Design Flow 2-.3 gallons per day. Calculated daily flow � �9�� gallons. Plan Date Number of sheets Revision Date : Title Size of Septic Tank T,,9&)4V A61W,3c° 2 Type of S.A.S. / Description of Soil Nature of Repairs or Alterations.(Answer when a plicable) j?' 7d 3 -Ame 4,Q/- le,041r Dins' i Date last inspected: ~� Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system j 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 this oard o Health. Signed Date Application Approved by Date _3Q `p Application Disapproved for the following reasons i \a Permit No, Date Issued t 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 �G'�1��d /' C /?✓7` at i/ /A/f Ile has been constructed in accordance with the p A Construction provisions of Tide 5 and the for Disposal Systemuction ermit No. dated Installere 404��/ Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date — �. (i / Inspector �— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lizpozal *paem Con.5truuction Vermit Permission is hereby granted to Construct( )Re air( /)Up rade( ✓)Abandon( ) System located at / C/�19Ui���' zeClGh /AA 141. �yOX�i Iele 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: =, U / Approved by r., w I I 0 O Q � ��T JZ Va 1 _ i I 7L/.3 - � ��/LJ!LLB J C'cj cz f i fI i I 1 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL. WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) 1. �LIrLI'7% f Agg�" hereby certify that the application for disposal works construction permit signed by me dated yl?r0l1'l concerning the property located at P6 gaiQl l'lle ir�/' meets all of the v following criteria: Xnere are no wetlands within 300 feet of the proposed septic system ,✓ There are no private wells within 150 feet of the proposed septic system v�e observed groundwater table is lY feet or greater below the bottom of the leaching facilin" re is no increase in flow and/or change in use proposed There are no variances requested or needed. SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan. this plan should be submitted]. q:health folder:cert TOWN OF BAl`tNSTA'BLE C v ,11 LOCATION 6� Q'/dll/f!/� ��QGI� / SEWAGE # �7 VILLAGE ,F'T • ASSESSOR'S MAP & LOT Z`� INSTALLER'S NAME&PHONE NO. ,U�D��BLB�f% G4�t5f" 771`93e-e SEPTIC TANK CAPACITY ��D07�1IS��d �' Zmm© v—,44> e LEACHING FACILITY: (type) �"'Q"'� '�c""`e (size) NO,.OF BEDROOMS BUILDER'OR PERMITDATE: COMPLIANCE DATE: ��^ L 7 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 oq:site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist >.within 300 feet of leaching facility) Feet Furnished by i 2�=0A &r a t cl f_N 1 t�1 Ez �.4-tl I` Etr2CfF�t� G't�fl �� 0 (4q, 51z�OWN OF BARNSTABLEv 0 LOCATION SEWAGE # 17` VILLAGE 1 CeWr. ASSESSOR'S MAP &LOT 2�" INSTALLER'S NAME&PHONE NO. 127Z-410� — 771`e'3MY SEPTIC TANK CAPACITY daP�wltb� Ll? LEACHING FACILITY: (type) n ""` (size) NO.OF BEDROOMS BUILDER OR� PERMI 'DATE: l `3�9`�7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet e 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 wetlands exist within 300 feet of leaching facility) Feet Furnished by f2s'. Z &V cum LD murl -r-A-4 I` . LL. NLL'At- �o2r�,utc_�-- 0 i TOWN OF BARNSTABLE , 6 LOCATION' Ic.e° EWAGE # VILLAGE 0(,e- + ASSESSOR'S MAP 6z LOT INSTALLER'S NAME & PHONE NO.J�)b"o-!LXg ICLk4, SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) &V(P NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER `e(fC Off" Cr C71I ke *-r A 2Z� DATE PERMIT ISSUED: .. `?,c,_ DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No a d 55 01 L5 No..B)L-..-.U..... Fms$...10,.00......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................. .................OF..........Barnst-ble..... Apptiratiun for RspoiiFal lgorkri Toustratrtiun 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: 618 Craigville._Beach Rd. , Craigville, MA Craigville Sub & Pizza Shop ................... .. .. .... .. .................................................. .................................... Jerry Ott Location-Address 58 Gunstock Rd. , Dservllle, MA 02655 ......................-.......................................................................... ..........--..................................__._.............................. ..........-- W A & B Cesspool Service 128 Bishops Terrace, yannis, MA 02601 a -•••---•-•._._...... ........ Installer Address QType of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a, Other fixtures <- ... W Design Flow..3114?� ...........................gallons per person per day. Total daily flow.. 15 ........................gallons. WSeptic Tank—i_'iquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date------------------------------------.... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_.--_.-._--.-.---. ----. Test Pit No. 2................minutes per i ch Depth of Test it--.................. Depth to ground water........................ - 0 Description of Soil..•-••-•-----Sand...---•--•---- ... ... ... -•-••- ------------------------------------------------------------------------------- x U -•-------•-••---------•-•------•-----•----••-•--•----••---••--•••--- ------------ --- ------ ---•----•--•-•-----------••----•-••---•••-------•----------••••••--•--------•--•-•--------......------ W ------•-•--------------------•---•--------••---------------•-••--•----•--•-•----------•-•••••-------••--•••--------•-•----------------•--•••--•••--•.............................................. U Nature of Repairs or Alterations—Answer when applicable-.PxesentIy--.a-.2QQQ...ga:l t�nk.-there_,will.-be a greaze---tra.p.,_..will._im9tall._a._4kOQQ---ga1..--. azk,,...p �s-�ntly-2-1Q99..g 1 .._leach..p ts_,...will-_install Agreement: a 1,000 gallon leach pit with apprx. 4' of stone. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL L 5 of the State Sanitary Code— The undersigned further agrees not t place the system in operation until a Certificate of Compliance i d by the b ar o lth. .' igne (i ``' 1-1 .. .............. te ApplicationApproved By •----•-•........... •. ..................................................... ..........1!!Q_-' ......--.....-- Date Application Disapprove or th following reasons:................................................................................................................ --------•----------------------------•--...--•--....--------•------------------------------•-----•---------•••-•-----•---•-----•----••--•---•-----•••---••-•----•---------•-•--••-------•-••---•-------- Date Permit No.-83 ----•------------------------------------------- Issued..1-13-83 Date :10.00........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Ton.................OF..........Barnst Able Appliratilan for Disposal Works Tomitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: 618 Craigville--beach Rd.� Craig.ville, •A Craigville Sub & Pizza Shop - -•--•..................................................•....----•---------•---............--..--•- Location-Address Lot Jerry Ott . dr - 58 Gunstock Rd., O&LeMlle, MA 02655 �------------------------------------------------- •-------•-••••--•-••-----•......_...._.......--•-.................•- W A & B Cesspool Servi eer 128 Bishops Terrace;d`�yannis, '!A 02601 Type of Building Size Lot feet ` ..... Installer :...... :_.__..._.. . Sq. U Dwelling No. of Bedrooms.............................. .....Ex Expansion Attic x, a g— ._.__..__ p ( ) Garbage Grinder p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P' Other fixtures ----------•---- ----------------------------• v- --------------------------------- rV W Design Flow.. ..........................gallons per person per day. Total daily flow__-5,5 f_ ._____......._.._...gallons. I W Septic Tank— �iquid capacity............gallons Length................ Width__.._........___ Diameter------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by----------- .............................................................. Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fZ4 Test Pit No. 2................minutes pejirWh Depth of Test it.__................. Depth to ground water..____..............____ -- .....- .ODescription of Soil--------------$$. t1L ---••--_.... {� '------------•-----------------------•-•---•-------------------...------•-----. VW ---------------.................................................................-..........-..........------Presentl - a 2000---�--1.---tank there will. be a Nature of Repairs or Alterations—Answer when applicable.______________________Y__._._.._.___..._._ .__......_..._....:..._...re.._._____.... �;xease__trp,-_All__install- a-.4000--I;al. tank; presently ?-1000a11 leach pits, `rill install Agreement: a 1,000 gallon leach pit with apprx. 4' of stone.. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIZ 5 of the State Sanitary Code— The undersigned further agrees ndl.-13--83 lace the system in operation until a Certificate of Compliance has bee is ed by the bo rd o ea igne - ----------- - -- ---- --------- -----•---••------•.... .------••...- ApplicationApproved By---........--...... '.--......-•----•-•-•--•--••••----•-••-••--•---•-•-••-•--•..._..-•---• ..........1.=13 ............. Date Application Disapprove or thy, ollowing reasons-................................................. .............................................................. Y ...................................................------......------------....----------•--••-------...--'--------.._.....------------------1•�1--�8 ^` Date PermitNo...._..---•-•.........................•••-•-•--- .. Issued..1..................................................... to Date THE COMRON.INEALTH OF MASSACHUSETTS (/ BOARD OF HEALTH 'own Barnstable ..........................................O F..................................................................................... CoM ifirFatr of ToutpliFanrr THIS IS TO CERTIFY That the II ividu 1 Sewage Dis osa1 S ste co ru• d (- ) or Repaired ( X) A & B Cesspool Service 128 Bis hops Terrace, Hyann�'s, 1'� �S (�01 by-------------------------------------------------------------------------------------------------------------------------...- ---s Craigville Beach Rd. , Craigville Installer Jerry Ott - Craigville Sub & Pizza. Shop has been installed in accordance with the provisions of TITL 3 5 he State Sanitary �jj /ab jescribed in the application for Disposal Works Construction Permit No.. .................. ................ d-ated_............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE ACONSTRUAS A GUARANTEE THAT THE SYSTEWI 16VI �FNCTION SATISFACTORY. DATE....3.e .�1....................... ...........•-------..•....------. Inspector- ---•-•----------•--..................----------•-•-•---. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t 3_ .................I.Town .......OF............Barnstable----........._............•--................. $ 10.00 No......................... FEE........................ Dispsal Worku Tnntrnrtuan rrmi# A & B Cesspool Service Permissionis hereby granted----•-----------------------------•-•------•--.-----------------•-------•-•----•-•--------------••----•-•-------•......--•-................... to Cons �t t ( ) or Repair ( X)) Individu 1 S e Disposal S stem at No.._ l _Craigrville Beachd., Cragvi � Jury Ott — Craigville Sub & Pizza Shop --•---------•-- Street as shown on the application for Disposal Works Construction Permit No..83...................... 3. ji4ted.._ ......__13— 3 .. Bo d of Health .DATE..--•-----------------------------------------------------------------•...--•--- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS No..... Fux..�.................. THE COMMONWEALTH OF MASSACHUSETTS, 1 BOARD 2 OF........Ea .. . ......... Appliration -fur 43hipagal Marks Tongtrurtion Vrrntit r' 4 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an /Inivid,-- Sewage Disposal System at: ,...L' 411o�,ttiioWddr /1 or Lot No. . . •.. /° ---••----•-•--••-----.....-•----...--•-•..............••----•-••---- O" weer Address a ��'------� Installer ............................................. �S..f� Address UType of Building Size Lot......I......................Sq. feet !Dwelling—No. of Bedroom ... .... _____Expansi�Att• ( Garbage Grinder ( ) aOther of Building may _ No. of persons.._ _ .__ offers ( ) — Cafeteria ( ) dOther fixture�f-------- ----- ----------------_----------------------------------------------------------.--=--:•-----4'7- ------------------•----------- W Design Flow____-_-:.. J�C Mons er erson er da Total dal] flow___.___ n g P P P Y Y I-=I/---------------------------gallons. WSeptic Tank L Liquid capacityt2TA-----gallons Length................ Width.____..._.-.._-. Diameter-----...-------- Depth-_.._.____-----. x Disposal Trench—No. .................... Width._._.__.. _ _ Total Length_.._ __._ ____.. Total leaching area_-__._.__.�,__-_._sq. ft. Seepage Pit No..�_--_____-- Diameter.-.��.47 Depth below inlet.. ¢.____ Total leaching area,j1__.d_�sq.ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date--------------------------------------- ,� Test Pit No. 1----------------minutes per inch Depth of Test"Pit.................... Depth to ground water.._.___-__._______._.. w Test Pit No. 2................minutes per inch, Depth of Test Pit________..--____-._- Depth to ground water-_.__.______.__.____---- -a - -------------------------- --------------- - ........................... _ - -------- ----XLC, Description oil Gvi ` :__ !._ = c:� U ��. - W ..--- . -•--- - 2 � �.0, /� - ----------------------------------------------- U Nature: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 Article YI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beeii issued by the board of health. Agri d... ` qa 7�---------------------- - ------ e Application Approved B - -.-`-- f-_ PP PP Y = U_o4"A VZ ------- ! � Date Application Disapproved for the f o,lowing reasons: ....�... y v ��- � �� Date Permit ----- --- --•--- - --------`----��-nn-- .... � ,- sued-- ------------------------•-----=-------- lei //y -/ Date p A* No...... FEs... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD 9f HEALTH Appliratinn -fur Uispoiial Morho Tomitrnrtinn Vrrniit Application is hereby made for a Permit to Construct ( .) or Repair ( ) an In ivid a Sewage Disposal System at: Omanl-.- `•. Y ., LVto ddr f _ or Lot No. �.. --- •. .. ...• W/ri/i �---••---------•-•--------------•--•-•------------------•-------•--- /J Owner Address Installer Address Q Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedroom . ___...._ E �panst Att ( Garbage Grinder ( ) Other I ype of Building rs :� 4__� ' o. of erson5 ._._ _ _.. _._ w�ers — Cafeteria P-4 Other fixture -------------------------------•- ------------------------------------------- ------••--- ................. 0 ' W Design Flow__::_+ -i __. allons per person per day. Total daily flow _.g gallons. P� Septic Tank Liquid capacitye-.:--,,----gallons,- Length---------------- Width.............. 'r 1 lliameter________________ Depth xx. _ n} Disposal Trench No.......................VVtdth._. _,.Total Length __ __ . Total leaching area---_ _-------sq Seepage Pit No _"'"._______ Diameter x .-_:_'Depth belo,.v'inlet__ ._,_. Total leaching area sq tt. Z dl Other Distribution box (. )': Dosing,tank ( ) a Percolation Test Results," Performed by - - Date------------------------------------ _ . Test Pit No. l.----------------minutes per inch Depth of "Pest Pit----------------:--- Depth to ground water-:.._a.-_-_---_.--.--- f14 Test Pit No. 2................minutes per inch Depth of Test Pit............ ....... Depth to ground water.-.--'-._- .___----- ------------•----------- = ;- = •-•- ...... O Description Soil___ mi27.. -- __ ----- - ---- --- --- UNature of Repairs or'Alterations—Answer when applicable.-.-__-_.-_-:::_.;;---------------------_._........._-_-.--._-____--_-...__-_______-_---- -•-•-------•---------------------•------••--------•---------•---------•-••--•----•------=•--------•------._.------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systems in accordance with the provisions of Article Xl of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beeq issued by the board of eald.. gned-t'.' . ._.. ..�" ate Application Approved BY--=----------- ----- . - --7 - - 1-)----- •- /-��7� Date Application Disapproved for the f o lowing reasons:.- ................................ . --- ............................................................. --•-•--••-•--•---------•---•--------------------------------------•------•------•--•-------•-------•---•--•---------------•-------•--••-----------•-----------•--------------------.------------------- Date PermitNo......................................................... Issued........................................................ 3 Date THE COMMONWEALTW"OF MASSACHUSETTS BOARD OF= EALTH'':'' b Trrfif iratr of (9o*' Viianrr i T S IS FO C RTIFY That e Indi u Sewage Disposal System constructed /oril e aired g P �' ( "") P (•� ) / � ,' � I llet - � ---- at.---- ... rc --' has been installed in accordance with the provisions of Article XI of The State Sanit2ry Code a describ d in the application for Disposal Works Construction Permit No._._-...___( _. ..�._.._._. dated__-_/a- ___�._ ..7,.,s7.__...- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................................................--..................... Inspector--------------------- ------------------------------••--•--------•-••••--•---•-•-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ... . O F........... -..gz X......... i No..=( + --'^ r FEE...2. Dien 1 n �k Qluntru i,aat r if` Permissionitereby granted__-- _, -- '.:v Cam,. -,[wit----- ---- t- to Constru t ( ) o Repair ( ,) arr d' 1 Sew a e D.' posal System at No,- �: f T.rc CYL. •" / c-%- - Street r♦;' Y - ` 7""""" �f� '' i-• ... : ... as shown on the'application for Disposal Works Construction Pe t No-_� --- ___:. Dated... -.2, �_&- 7 .-.--•. ------ ------ ------ oar of Health DATE. .... . s FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r r v � TOWN OF BAR/NSTABLE ; LOCATION �f er�f/"r/% ' �G'i7GLt i" SEWAGE # �I VELLAGE -tl— ASSESSOR'S MAP& LOT-? INSTALLER'S NAME&PHONE NO. A4rl'`d'LB// SEPTIC TANK CAPACITY i LEACHING FACUTY: (type) (size) NO.OF BEDROOMS BUILDER.OR U PERMTTDATE: f ! `�`�7 COMPLIANCE DATE: Separation Distance Between the: j i Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist i on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i i i ��jj 1 No....//:: 225 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Diipaiial Workii Tnnitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal System at: &-CJ`=-� ............................. ! ...... .....- ............ LocatTbn A re ` 1 or Lot ._.. �! � 4��!�.l _. ti..t. .... ... Ir:Z ba--------- --------- Owner Addres a ................ JC.LN0Je_.LA('_1W.-s ----------------- P..Q.:_& �0 ...F--` G.�----....1 ! .. . Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedroo _.._.Expansion Attic ( ) Garbage Grinder ( ) WOther—Type of Build' 1Z. r, T..... No, of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures ------------------------------------------------------••-•-•--•-----------••••••---•••------•----•-••-------------------....._................_------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................... ................................................ Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fr4 Test Pit No. 2................minutes per inch. Depth of.Test Pit.................... .Depth to ground water........................ x -----'---------------------------------------------=...................................................................-------------...---•---------------•-- 0 Description of Soil.................................................................................. x •--••--•••...••----•........................•-------•-- U U Natur of Repairs or Alterations—Answer when applicable._ .... --r�--_-I-.s`��--�-� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Com liance has been issued by the board qf health. r Signed �L..� ���................ --�--.a'44`---`------ Date cy Application Approved By .. �.r'.:-.-f....-:1... Application Disapproved for the following reasons- ---------- --------------------------------------------------------- - ----------------------------------------------------- - - Date Permit No. ...... .. .1.......... - .t -------- --------------- Issued .-------------------------------..........------ ---- ---------- . -- . I`I Date I. f .._ s k THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARN-STABLE Applirdtion for Disposal Vorkii Tomitrnr#ion Errant Application is hereby made for a Permit to Construct ( ) or Repair (�, )an Individual Sewage Disposal System at: GI -..----.Locatton-Ad ress W C� Owner � - Address ..---....--•--...0_. .n�' I a'1 r1 .4 rS t. f�n �! Installer Address Type of Building ' Size Lot............................Sq. feet V Dwelling No. of Bedrs-------------------------------- _Ex Expansion Attic� g Bedrooms� ----------- p ( ) Garbage Grinder ( ) a Other—Type of Buildi>g ... No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures .............. ... -------------------------------------------------------------------------------------------•-•-------------------------------.---------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity........._._gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date..........................-............. Test Pit No. I................minutes per inch Depth of Test Pit............_....... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ M ..........-.................................................................................................................................................. 0 Description of Soil-........................................................................ -----------------------•------------------------------------...............-•---••-••_.. x f c ----------------- ......................................................... ------ ----- - - ------------- --- ----------------- - --------------- - ----- --------- -------• -f-- U Nature of Repairs or Alterations—Answer when applicable. r_< . _ n.._�!__`'70- .:_ _��.a'•_ !!'t� ----------(2 ---I<:1 7_.. .f T ��� T_ :::. ' ``� c.`1 1.c _ l c'-sy Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed'., 1�- . ._..... J� c�t ----�/--- Date Application Approved B -------------- �_.<,� �� ------------------------------------ ----------.....- / Date Application Disapproved for the following reasons- .................................................................................................. -------------------------------- ---------------------------------- ---------- ------ -------------------------------- -- ---------------- Da' ------ e Permit No. / ' ------------------------- Issued ------------------....------------.--------...----------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertiftrate of C antlalittne THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( .--- by .................. '...., __ :...-/.,:. �'�...:.. ...'?..!.C.- ------------------------- ................................---------...........-------- Installer at ............ lr.�..�� ........... ---r........ - ..............�t c ------- ...............-------- has been installed in accordance with the provisions of TITLE 5 o6The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....... ­5------- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATES ?�.- ..1.-1.-- Inspector -- --- --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9l� 2 �� TOWN OF BARNSTABLE ?,) No.....�......... .... FEE..-�Y Disposal Vorkv T-1nni#rnrtion ramit Permission is hereby granted................. ..:4 �� L A P"0 ... _ . .._. ---- -----------�---•�••. r`j='=.........---•-•--.....---•--...............------. to Construct ( ) or Repair (...)_an Individual Sewage Disposal System at No............. I / r/ram, c.. t a!1I I0rc e � �� < � &., T! •---------------•-•-•--•--•------...•--• ----------•-•••------------------•------•-----...--•----------••-------........--...... �Ij Street �/ ^-� as shown on the application for Disposal Works Construction Permit No.. ._ ..._ Dated.......................................... ................:............:.:~ . q / ) DATE.................�-=---�l'�- ................................... V Board of Health FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS 'w TOWN OF BARI'ABLE 6 LOCATION �LSEWAGE VILLAGE C�Q ASSESSOR'S MAP & LOT INSTALLER'S NAME G PHONE NO.A 'SEPni2 TANK CAPACITY LEACHING FACILITY:(type) (size) I( NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �+(Y- DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� yy OEM Gerald Ott Craigville Sub & Pizza Craigville Beach Road West H.-annisport, MA 02672 Permit #83-029 Completed: 3/16/83 A & B Cesspool Service 128 Bishops Terrace Hyannis, MA 02601 . aRcK D� �U/[-DIN4 t yo°o 1. se p r c Q �O 0 � D ' j4,D .LFW-M C I000, � C'p• F3OX� \V_�ro N•a• ,�,EacN��f ,_ C 1 0 O°, rol � �-i Abe _ �p•c,� �-o� __._.. -- 01 . bc 7.4 Of n 1t ;� �• r.;a �. a ���. G• ,J, 1i► 1{ '''' �� :'1 � .���. .•� , �; .� /SIB ;.. '1 Gerald Ott Craig ville Sub & Pizza C raigville Beach Road West H�annisport, MA 02672 Permit #83-029 Completed: 3/16/83 A & B Cesspool Service 128 Bishops Terrace Hyannis, MA 02601 3oleK 44 13L)IL p+0'4 1 y000 L Sept:c p �o 6 a' O . P D 14.D..IEfMN p)t C� eox) ( tvoe� I1•D• ,Z,E�c N'P;t ..1 • f ",','t,-,'-,,-,`_'.-, .s' t,• ?' 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'. .. . t Y-a«`, i x' •t- �..ia .y r N„ Sn i' No. DATE r� ' TOWN OF BARNSTABLE y F.TNE FEE d�-- OFFICE OF BOARD OF HEALTH 7 M11�1 679' �� 367 MAIN STREET �omrf HYANNIS, MASS. 02601 VARIANCE REQUEST FORM All variance requests must be submitted five (5) days prior to the scheduled Board of Health meeting. r�1,� ��� - NAME OF APPLICANT G;e-nq-L-o 1 '1 ��'�'9-' TEL. NO. a, ADDRESS OF APPLICANT 5g (5 oyS no NAME OF OWNER OF PROPERTY �,,Tc e V! I-L L SUBDIVISION NAME DATE- APPROVED LOCATION .OF REQUEST l�IZn 161 Lj 1 VARIANCE FROM REGULATION (List regulation) /'�/,/� //�4 " f/Ti/iti -F ►^ 'rtc� ' 't vi � T VARIANCE- REQUESTED :(Specific request) - / - REASON FOR VARIANCE (May attach letter if more space needed) - PLANS - .Two copies of plan must be submitted -clearly outlining variance requested. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPPROVAL Robert L.. Childs, Chairman _Ann Jane Eshbaugh Grover C.M. Farrish M. D. BOARD OF HEALTH _ _ 1 LL _ 58_�G-I NSTbQIK QST EkV L E MA '-0''655 I i i QT�_,_L ! , I ! j I ; 1 I AID! i I Q co 4-1 i t • � z i - EfT PC-tiu a Widih5 4 ` 1 iNP O O ' O O k ilk � v O 03r..0 O O QF O O O LEA i kIlAIG P IT D AT A THE% , i BABIISTAHLL, i 2 � rAee � ' 19. to MFY 16. 367 Kin S1reel, Arnnie, Masi. 02601 May 10, 19 83 NOTICE OF HEARING CHANGE OF DESCRIPTION OF PREMISES: In accordance with Chapter 138 of the General Laws , as amended, G & L INC. , d/b/a Craigville Sub & Pizza, Gerald M. Ott, Mqr. has 4 petitioned the local licensing authority for a channe of description of premises by adding to the current description: a 25x13�greenhouse dining room with seating for approximately 20 persons , two handicapped restrooms and handicapped ramp." Said premises are the same premises as currently licensed and located at 618 Craigville Beach Road, Centerville, Ma. A public hearing on this application will be held in the Town Office Building, 367 Main Street, Hyannis , Ma, on Tuesday, May 24, 1983 at 10:30 a.m. John C. Klimm Martin J. Flynn Jeffrey.D. Pi l son Board of Selectmen Town of Barnstable Legal Ad - BP 5/12/83 t� PLEASE BILL LEGAL AD TO: Gerald M. Ott 58 Gunstock Road Osterville, Ma. 02655 " SENDER: Be sure to follow instructiM on other side PLEASE FURNISH SERVICE(S) INDICATEdW CHECKED BLOCK(S) (Additional charges required for these services) ❑ Show to whom.date and address Deliver ONLY where delivered ❑ to addressee RECEIPT Received the numbered article described below REGISTERED NO. SI TORE R NAME OF ADDRESSEE(Must ahuays 8e filled in) CERTIFIED NO. i 825488 S ATURE OF ADDRESSEE'S A INSURED NO. DATE DELIVERED SHOW WHERE DELIVERED(Only if requested,and include ZIP Code) —y U.S.POSTAL SERVICE OFFICIAL BUSINESS PENALTY FOR PRIVATE 1 USE TO AVOID PAYMENT f OF POSTAGE,$300 A 9 aPostmork of Delivering Offite e SENDER INSTRUCTIONS i Print in the space below Your name,address,including ZIP Code. RETURN • If special services are desired,check block(s)on other side. TO z • Moisten gummed ends and attach to back of article. f CO Board of Health - Town of Barnstable �, O 397 Main St. rd HYANNIS MASS. 02601 $4 l= R' t �Ji•Ml 3i y!s siysa4sge iW M7GZ 4 1 plan dated November l"S�` ��3 Charles savory * � � ' . Air. i�..�.,�.�►� T3 .Bat lay Sfia-'Witc her's .Way :4 r Hyannis; 'Massachusetts Dear Mr• Barcla s Your xeVest to install• a 2000 ga1l.an sep :d " �k fan ; UOU.,af a '2500: gallon tank�as showox �►, ,-guar ,p�•� , : o,• .not •. •approved for=your $eating ,capacity'of 40 persons,. =#� State Sanitary Code, : clearly defines size of soptic " tanks. I cre$sinc . thy: leachin 6apabi13.ties hae:ho bear3ne on .tho requirement' for sep is:tanks ' ;we oil however approve' a 2�i4€} f a1lvn tank r v yeu. decarease your 'seating ca aacit j • from 4b , eats to. a 7 sea e t C This decreasing 'will then meet there r�ainents of the stite ; anitary Cade. . _ ''Ya ery • TOWN OF R STABLE BOARD;OF HEALTH . e. ec merles .Savory, AA• re ! • �.��1h — 1. 1 - VIU, MAR 2 81974 tl�' TGV''} OF RARNSTAbLE - _ c�-_-j °✓ — 61, - fG ti n.. _ • -e... _s .,r.z .. a... .. ....s. _. .�7..a'w.-M1-..�._...�.a. t r� SENDER: Be sure to follow instructio on other side PLEASE FURNISH SERVICE(S) INDICATED HECKED BLOCK(S) i (Additional charges required for the ¢"vices) " Show to whom,date and address Deliver ONLY ❑where delivered ❑ to addressee RECEIPT Received the numbered article described below i REGISTERED NO. SIGNATURE OR NAME OF ADDRESSEE(Must akvays be filled in) I 2 SIGNATURE OF ADDRESSEE'S AGE!(;IF ANY INSURED N0. I _ � { DATE DELIVERED SHOW WHERE DELIVERED(Only if requested,and include ZIP Code) I` v U.S.POSTAL SERVICE OFFICIAL BUSINESS PENALTY FOR PRIVATE USE TO AVOID PAYMENT OF POSTAGE,$300 u Postmark of Dooming Off ee o SENDER INSTRUCTIONS Print in the space below Your name,address,including ZIP Code. RETURN • H special services are desired.check block(s)on other side. TO z • Moisten gummed ends and attach to back of article. MBoard of Health - Town of Barnstable 397 Main Street x HYANNTS M-ASSACHUSETT So 601 i , MAY 2 1974 , , TOWN OF BARNSTAb:LE BOARD of HEALTFJ April ­26 74 Per ... Re: Bill and Ruby Sewage .Disposal • • 1, ` • •. ; •. ' `•• • 1.. '... i, .. .41 Mr Charles N.: Savory ; Charles N. siavery, Inc. 4• 7.12• Main street Hyannis, Massachusetts Dear Mr. Savory t„ t a Stour letter of' April 26 has been received.. Your plan dated April l8 , 1974; has been conditionally approved contingent on the installation of the third ;6 -toot• by 11 foot leaehiig it prior to licensure for year 1975..- ' • ;: However, your attention is called to .the plan- submitted by, your office November 15, 1974` and approved by the..Hea#th'' epartment showing two, -.Q) ,pits 19.5 foot in.diamdter 'and -9 foot depth. This approved plan was completely ignored fay,the installer,-and .your present plan: appoars to` be ''compensat .ng�and ad usting ,.to his ;error; Your attention is further called to Paragraph '7t0f'Article: -Xl which states "-leaching facil.itles used only during the ,s immer'.,for a..: .,Period of 1, months or less may be reduced"20 per `cent"' , 'the word ,,may":''�.s discretionary and totaily,,dependent on the Doard's j4dger�ent. " It. is also seriously doubted ghat-,yt>ur• client intends to remain x `-open three' months or less. ,•Under ,this formula. if"he opened to , , 1 .; he would be Glost august 1e.- 1974' . is •your client".aware of .this and, wi, .ing to do soy . , As previously stated, the Baard !a'pproves this system, for ,year 3974.: The third pit mu it be_Install o�r to . idensi.q for'the summer-of .197 . ` '• i _ t$♦ , ... -. _ ,•ti•, y�r a ., -, . fi MSC , Charles N. Lavery - Apra . 1374 II s sincerely g o d tha future occurrences .sihilar •to,•t�i�s . can. be avoided `by Fiore, careful. coordination on your,part with builders, wn6r t and, sewage disposal i•nstallers .- '. Yours' Nary t; , Y, ` TOW OF-BARN8TABLE_.BOAR'D OF MALTH mm cc: Mr. William Barclay ' Bill & Ruby r E� c 712 MAIN HYANNIS. MASS. CHARLES N. SAVERY, INCORPORATED (617) 775-2244 REGISTERED CHARLES N. SAVERY. P.E.. R.L.S. PROFESSIONAL LAND MEMBER OF: ROBERT P. BUNIKIS, P.E.. R.L.S. ENGINEERS SURVEYORS AMERICAN SOCIETY CIVIL ENGINEERS ALBERT A. MORSE. P.E.. R.L.S. AMERICAN CONGRESS SURVEYING ROBERTS. JOHNSON, P.E.. R.L.S. CAPE COD MASS. ASSOC. SURVEYORS B ENGINEERS CAPE COD SOCIETY ENGINEERS 9 SURVEYORS SOCIETY AMERICAN MILITARY ENGINEERS CANADIAN INSTITUTE OF SURVEYING Dg 21 April 26, 1974 APR 2 q 1974 -TOWN OF BARNSTAL BOARD of HEALTH ..........�f�t� Town of Barnstable Board of Health Hyannis, Mass. 02601 � Re: $il1 and Ruby's (S,etage Disposal Attn: Mr. John M. Kell ,,,,'Agent 141, Dear John: Reference is made to ,the t{letter-dated April 4, fr`om th ' Board relative to the above disposal system.-ilThe system that we have called for on our plans has an effective leaching [ar'ea,�of=604 squarejeet. The 'required leaching area, in accordance with Art6lerll_6f the`State Sanitary Gode, is. 700 square feet. However, I call your , tte tion to paragraph 7.11 relating to summer use. It i states where facilitiestl%at are Ito be usedduring the` summer for a period of 3 months or less, -the dispo"§al' area may be reduced-,by20%. Under this formula the requirements would, b°e,S,60Ns;quare feet. It is my considered opinion that seven though these 2 pits are not built symmetrically, they do cover the`equirement and are adequate to take care of the demand that will be placed upon them by the summer use of the snack bar which they serve. I enclose herewith a chart which we made up in the office for our use, which you might find helpful. I trust you will find this information and explanation satisfactory and sufficient for your approval of the facility. - Should you have any questions, please feel free to contact me. Sincerely yours, CHARLES N. SAVERY, INC. �eX � Charles N. Savery CNS:JF Enclosure �i77 � r o 0 0 o .� o o o er v o9) o o o ` L O O O 6 / - V y O y. O O O LA W 6 t is or LEA I NG PIT ® AT A TOTAL EFFECTIVE AREA 41 �r , = `s 6. 5� 0.16 8.0� Zo1 .07 2.76.41 351.8T 1. 00 _ 8.5 ZI (6.95 257. 05 37 . 15 1.2.5 233.26 315.013 40 Z.91 1. 50 9. 5 2 4S.95 3 39.49 429.02 1,75 10.0 2(67• 04 1.2 455.53 Z.00 10. 5 284.53 383.50 48 2.47 2.25 II .o 30'z.38 4.06.05 509.73 " Z.50 11 . 5 320.04 4.29.02. 537.41 2.75 I2.0 339.z,9 4.52.39 565. 49 358.34. V7 6. 15 593,56 3.z5 13.o 3 77. 78 500.30 G 22.8 2 3.50 13.5 397,62 S2,4.86 (.52.09 3.15 14.o 4.17- 83 549.18 G8 1. 72 4,00 14 .9 438.43 575.08 7II. ? 3 " 4.25 1510 459.4C, 600.84 742.21 4.50 15.5 4.80.86 626.95 773.63 75 1(0.0 50z.66 653.45 804.25 5.00 ) (0,5 5Z4.81 6§0.39 835.91 ` 5 .25 17.0 5 47. 42 107.64 86l.86 5.50 +1. 5 5070.40 735.33 900.2.7 5,15 15.0 593.76 763.41 C333. 06 " 6.00 15.5 7451.88 166.2.4 TOWN OFORNSTABLE TOBACCO CONTROL PRAM BARNSTABLE DEPARTMENT OF HEALTH BARNSTABLE, : 367 Main Street, Hyannis, MA 02601 MASS r� 1 `0� Patrick R. McCormack, MPH ArFOts Tobacco Compliance / Health Inspector Tel: (508)'862-4644 E-mail: mccormackp@?town.bernstable.ma.us Fax: (508) 790-6304 ETS INSPECTION REPORT Board of Health: Village of: ❑Hyannis l3eenterville ❑Osterville ❑Cotuit ❑Marstons Mills ❑West Date:2/ //01 Barnstable ❑Barnstable Establishment Name: a NQL Purpose of check Address: a eH ,. / Routine Telephone: - Follow-up Owner's Name Other . OF BUSINESS or i ' ❑Cie Ciga b/bar ❑ Office ❑ r ❑ Retail store Restaurant ❑ Public place ❑ Bar area of restaurant ❑ Indoor sports arena ❑ Retail food establishment ❑ Public transportation vehicle ❑ School ❑ Based on an inspection today,the items checked below indicate the violated provisions of Board of Health REGULATIONS AFFECTING SMOKING IN CERTAIN PLACES. ❑ Smoking in public places ❑ No signage ❑ Restrooms ❑ Bar area not enclosed(if applicable) ❑ Improper signage ❑ Waiting areas ❑ Seating capacity(20%max/enclosed area) ❑ No ventilation if applicable) ❑ ❑ Self closing doors(if applicable) ❑ Improper ventilation(if applicable) ❑ ❑ Negatively ressurized if applicable) ❑ Entrance was ❑ W On this day, the above listed establishment, business, or public place is in compliance with BOH tobacco regulations Comments: f / u'- Inspected by: I-Ocn'reo jN -2ns�5&F - Ilk SUO c-pn i sv i//� 2�*/1' C/ Poll C i1)A)65vI /t- Mn - 7 -7 OWN OF BARNSTABLE - inance or Regulations B =W43 . WARNING NOTICE Name of Offender/Manager N4nri icy eV ire su Address of Offender MV/MB Reg.# Village/State/Zip r Business- Name d !r,11 1� , /pm, on ,p f Business Address .a. Signafure of Enforcing Officer Village/State/Zip Cw Location of Offense (018 (Al i c yV)1� ea d p04� �j r�/j c ��(•�� v Enforcing Dept/Division Offense NU15c;I 6e � U/a`,j �- cts t .S c� (; ap e rc Se 1'►a't �er-s r-v lGn S r (� //��� J ��'"^' (� ?/r'� l` .. n ex �Cl�,l�(J! Y�S! S (brie a V-C On <VDJ This will serve only as a waning. At this time Ao legal action has-been taken. It is the goal of Town agencies to achieve voluntary compliance of _Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate Aegal action by the Town. r. oFtT , .own of Barnstable o� s,xivsrnaI.s Department of Health, Safety, and Environmental Services MAM Public Health Division ArfDN1P�A P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health RECORD OF VERBAL COMMUNICATION = 10 S its- C"a.�a.i�� '00`'Z LC-3 "t ",4&-x4z,ate-, n-4 ue-, • cL �i�,o(4tiw�-i ,- G�/e. t ova- !� G�•oC /.f-bL�c.c,� C' o�yL��f O'l,..cCc hC6 Ylni3af ,17 edl 2) Go-vcl„rs J o4i1 Gs�,��e ,— cJ� J A,- Gvwf 4- (oa-c&. l0 Y UJ-4 Ly a "dj d v�- �a (Ye d om J"�,�,� vlf►� �,.�Cd�w�.e . �� ?h, 1"'V .. -t11 . e� lam( ✓?� A.-. LI-14- "S'le 102 t Gik f �-> �� �� �-i�LL � •�►— �v4-•�--e-n-c�y �f Ulu— �,� re-lvr".C/ > etcCv S y"e J-0 IQ) cam„ Zee- c�Cj Le verbcomm.doc 1NP v�,rjn+ dum�� exec, Oueamec� Up, we No I on�T wcLn4 - -hur krGsh t n a-�-c c�6rd , we wc�h t c�ees 2 CLn rem ove d I vj(� u�hk �e� �c-r�Q `(�-rr-ove c� I U� �' reed c�� b-ec"d need 4-0 loe C't�IGCec1 ' YY1iGYY�P�1 I L �{e.�' J8 } \ J 42. . . y . � ) y / t � f W y CL du v 4rzu) E c• F, en 4 t I y } i � I y Dot t /0 �- ar W1 a �e `+ ► vim• � � .�' L�*s�. il�'A�,y �1 `� �+�y .� `K i� i y l 7CttT• e.' fit. s ►,�`� c y. r- `i\ `< a, J`y t 4 � l- !r low s kij { 0 � f I Owr SL& D. 'ou,bil Cam U-) Ck � �►�.�' � -�j ICU -� �� a � .� ,tit ?� *:� •� �jt� �. °' / a` �' .� • � o• �_ ,�.��� � ��� '7( UYy � �r- o;� / �� ��GL��� _,,,, � ,d p , •`y � ���.0 Cil�Vi► �y , �. ;�:� �( }' r"� 1 / � ♦ � / _ �' ice`-Jw.�'�,e'1? ;T.�t� (,' � �` .��1 _` 1r j 7c N � -.r��•�T�'"'T�r- LX+tS�"� f .� h � 'dam_ � � e �� _ � � i����4� � r�7�• .... �.�_.-. r�x,?'7+�... { '} _� �. ,� aA (12,-, G.' . • Health Complaints 04-Apr-00 Time: 1:15:00 PM Date: 4/4/00 Complaint Number: 2296 Referred To: JEROME DUNNING Taken By: K.S. Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: UNSANITARY CONDITIONS Business Name: Craigville Mexican Pizza Number: 620 Street: Craigville Beach Rd. Village: CeNTERVILLE Assessors Map-Parcel: Complaint Description: The dumpster area of Mexican Pizza is overflowing and trash blows around onto the abutter's property. Also, they are concerned about greese can from the dumpster area because the soaked fence and ground, and the trees are affected by this. Actions Taken/Results: Investigation Date: Investigation Time: x 1 Health Complaints 31-Mar-00 Time: 10:39:58 APA Date: 3/31/00 Complaint Number: 2292 Referred To: GLEN HARRINGTON Taken By: LS Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: CRAIGVILLE PIZZA Number: 618 Street: CRAIGVILLE BEACH ROAD Village: W. HYANN'ISPORT Assessors Map_Parcel: Complainant's Name: Address: Telephone Number: Complaint Description: HE LIVES BEHIND THIS PLACE AND SAID THERE IS A FREQUENT OVERFLOWING DUMPSTER AND TRASH BLOWS ONTO HIS PROPERTY. 55 GALLON DRUMS OF FRYERLATOR OIL STORED HALF OPEN NEXT TO DUMPSTER. HE SAID HE HAS COMPLAINED ABOUT THIS WHEN NEW OWNERS TOOK OVER, BUT NOTHING HAS BEEN DONE. TRASH SHOULD BE PICKED UP MORE OFTEN AND ISN'T THERE A REGULATION ABOUT STORING GREASE OUTSIDE? Actions Taken/Results: Investigation Date: Investigation Time: 17 `� `_t. oFtr Town of Barnstable o� Base"ram. # Department of Health, Safety, and Environmental Services 9� ' ��� Public Health Division ATEO""0�A P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health RECORD OF VERBAL COMMUNICATION /o :LO r&4" C vi l( •4-- /V e4-j ✓1Pjt.✓`- GlGi S Z [QI✓y� GJ) Q� l✓`Qi(n-, L hJ{76Z.fi(Q ? 4,we � �ee_ eta-�.� o-,ec,, 4 c,A-"k c-cam a lam. G. ,r�`= S a J'7 1 v tip►1, aw f i ),4,e-, � c � Ali .r�e� �� 164-&1111� t"4� -� !���`G r! G�y d- � ����=�.; I��L�-�.rr-vim•,� c,,.� J �'ll �e�cry(o% verbcomm.doc YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you . must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: Fill in please: fad WIN b'I��f�°,�'Tf"'�s APPLICANT'S YOUR NAME/S: Jt71-1 r�1 A- M ANU mac' USINESS YOUR HOME ADDRESS: mac, )- 2p "'tc.4=_c-s ,=a, TELEPHONE # Home Telephone Number (C uy) 4 i- ((�K NAME OF.CORPORATION: al-� c� NAME OF NEW BUSINESS Cs f-v:-_c { TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NQ.::� 02 b z ADDRESS OF BUSINESS Cptg -> (--ervIM4 '-MAP/PARCEL NUMBER! Ll Z() (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd_& Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER' OI This individual has been ' &FFCE of any pe r ents that pertain to this type of business. Authorle Si ure** COMMENTS: i 2. BOARD OF HEALTH This individual has been in I for46af e p it equirements that pertain to this type of business. Aut orized ature** ' COMMENTS: �D 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: ,,,.- g _. ..-. _ ,. _._._.._�..rc:.•.��-�.-yy^"'-.mow- -.-�--=-r.:..^,e+� �' ._... -�----_•-'....�-«--+.•..�w•+•-+..,,��,.�... ..mow.+.-'�•r--"._�• .' � . .. . -sue. `-_ .y _� ✓ �/ .i E - � `.. . �..=eM--rr r v.r v _w.-,,,.�_e.`_ �"+�ir►rr aM-'+�.�.rw-�1..-r�+.�ti•s -- - � _ _ ; • ' � t ��� f � � { �.��_.i.. ► 7-IT I `�- • - .. .....,�w�.c..�-mow. -._ .,rr':.i�rw.w-•r—,;,,.. �. r {��� ., f���i���� 'a .. SCAMa +.Cy, APPROVEOey OfiAWfV`8Y i f cacam. _�.... •,-.r-...._-�._ _�___.. __ . _- _ _ . 6 I . + 1 � ..y ',t .�44«� -. ..ram y�y�E.:_- rw ' n r � —�Y�•j�. rZ ot AFMOL QkmW TILE i. ,�„��`s p.1Y�1�„•`+ ItJ i s.i•..— . r r »- --�^- •+��¢� ���tj�•�{ 4 /CCC SIC? _ • r w .. � r}, ............•mac .----�•- F' SCALE APPRpYEE?BY Dw►WN BY DATE 14 tAlmt,.rf OM"NG NUM IIFII• rya ca,►uc. . . - . o /777 to ;terW OVE N �> >� Q v (-v-rT)N c, rr i3 if O 5� r- ilvcNOCD iZ 7` Sro v rilsk O 13. wOQj4 T,�)x3 /,r RECEIVED r , Ia rvaRK 7-,9 l� r t� 0 4 2000 TOWN OF BARNSTABLE HEALTH DEPT. 1 ci 3 SA y 5Jkk-c linNwwosytR l£ iz o c� ® w CO) )► 6sv ! L L C SUB -v Pizz Co R 16.5 U 1 £ 2&7 il- c9 R 0 a7 D _ i2 �l I GS V) /,V(N G !Zc—o✓tit Qto r o i I �y• l/'x Ct ,car" 1 c M 4"s I f�c I Ile r ie t \ r ro Y y AREA I 1 1 r 7 9 �� � PLOT PLAN OFLAN4 /"ter /y a. 5--0 a yr_ ` ,_--- ORAVVN BY SCAL E l /N [t X G Srs, F�gei e 7 �-H�CKED BY DA7`E Rec.�se d � X � f // %fir 6 rr= ' :aZ , s CN.4RL ES N. SAVERY INC. REG lSTE/PED � r god E/VvlNEERS S!/R►�EYOR N • 8 90.98 o Z 9 IN A� G / 1 k" ?� � • soo r,4 dK c t A PROX 40Cf4T/ON .:1'� � � EX/ST/iyC� CESS_PDOL �TO B E F/L L EO /Ny Qp0S�N O o\ Q oR ,� � 1 \ � a 32 + LL Z 'S J O RUBGK 5 B R o 4,- J W \t 1 7 9- yJ ° 48 Iq 88 �O EAG� �tOSe��x 3b94-vs•.:T x \ S = Z100Ir1 v sm Z 5o0 C)c.1 7C3-,O 1<. z \o0 x 0 5 5 F/GAL = \\SO S9 F;T- vsc$ 2V:'\'Ts \l-) PLOT PLAN OF LAND N w�sT SA R/VSTA S4,E Ass -/y,4 N/v s -io 'T- F wi ,Lc. /,4 1\4 e. e,41 RCZ-AY ux . lv'O7E L.oT DA7-A 0e7,4:n/c-L> Fie© DRAWN 9Y T ---- - PLA/V OFLA/vd OP /1NNA -& vVr�2REN CJ /�9 I SCALE . / 1/V• - 20 T. ,4. ao0ow/N, BEA QS6 & KELLoGG, ENv�s I _ _._ _ O.A T ED FEB /2, /947, D4RNSTf1BLE COUNTY /��C7/JTRY oFDEE�S CHECKED BY DATE ' /vov. / , 1973 //v PZ-A/V BDO.lC 77� PAGE !4 / .J ./ .^, CHARLE S N. SAVERY INC . , REGISTERED �\ CIVIL ENGINEERS 8 LAND SURVEYORS _ HYANNIS 8 SOUTH YARMOUTH N4 73267