HomeMy WebLinkAboutCRAIGVILLE BEACH SNACK BAR - FOOD (2) + Craigville Snack Bar
915 Craigville Beach Rd.
Centerville ` 16- bo\
Bellaire, Dianna
From: Nancy Brown <nancyb66888@gmail.com>
Sent: Friday, January 21, 2022 5:41 PM
To: Bellaire, Dianna
Subject: Re: CBA Snack Bar
Hi Dianna,
So nice to hear from you. Yes, I am going to give the Snack Bar my best shot this year. My address is still 34 Horatio
Lane, Centerville 02632.
Thank you for getting in touch with me. I was going to call you the first of next week. Looking forward to being part of
CBA again.
Nancy
508-776-5203
On Fri,Jan 21, 2022 at 4:02 PM Bellaire, Dianna <Dianna.Bellaire@town.barnstable.ma.us>wrote:
> Nancy,
> I was told by Jason Siscoe that you were going to return to the Centerville Beach Snack Bar. Is this true? If so, please
give me an address for mailing the renewal in the Spring for the food permit. If you would like a different address for
correspondence, let me know.
>This was the one I had on file.
> Have a nice weekend:)
> Dianna Bellaire
> Permit Technician
>Town of Barnstable
> Health Division
> 200 Main Street
> Hyannis, MA 02601
> P:508-862-4643
> Fax:508-790-6304
> Email:Dianna.Bellaire@town.barnstable.ma.us
>The information contained in this electronic transmission ("e-mail"), including any attachment (the "Information"),
may be confidential or otherwise exempt from disclosure. It is for the addressee only.This Information may be
privileged and confidential work-product or a privileged and confidential communication.The Information may also be
deliberative and pre-decisional in nature. As such, it is for internal use only.The Information may not be disclosed .
without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of
Barnstable. If you have received this e-mail by mistake, please notify the sender and delete it from your system. Please
do not copy or forward it.Thank you for your cooperation.
>
>-----Original Message-----
> From: Nancy Brown (mailto:nancyb66888@gmail.com]
1
i
Town of Barnstable BOARD OF HEALTH
John T. Norman
Board of Health Donald A.Gaudagnoli,M.D.
BARNsran�e F.P.(Thomas)Lee
6q• ..� 200 Main Street, Hyannis, MA 02601
Daniel Luczkow,M.D.,Alt.
Phone: (508) 862-4644 Fax: (508)790-6304
www.townofbarnstablems
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: 279 Issue Date: 06/01/2021
DBA: CRAIGVILLE BEACH ASSOC. SNACK BAR
OWNER: RIVERWAY LOBSTER HOUSE INC
Location of Establishment: 915-B CRAIGVILLE BEACH RD CENTERVILLE, MA 02632
Type of Business Permit: FOOD SERVICE
Annual: Seasonal: YES
IndoorSeating: 0 OutdoorSeating: 24 Total Seating: 24
FEES FOOD SERVICE ESTABLISHMENT: $250.00 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
i
Restrictions:
I
Town of Barnstable Initials:
? Inspectional ServicesMAM
$�
Public Health Division Che—
Thomas McKean,Directot .
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
DATE 1 a NEW OWNERSHIP RENEWAL
NAME OF FOOD ESTABLISHMENT: l.. r-a 1 y I I
Q yYl
ADDRESS OF FOOD ESTABLISHMENT: `") l qv) ) iBRQ Gti �� . .V1 �✓I (p1 MA WL 6D-
MAILING ADDRESS(IF DIFFERENT FROM ABOVE): a-� �'l/Z
E-MAIL ADDRESS:
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5t 1-7 S- 9 G
TOTAL NUMBER OF BATHROOMS: � FIO(7r 1 n
WELL WATER:YES NO V---.. ANNUAL WATER ANALYSIS REQUIRED) S
ANNUAL: SEASONAL:: v DATES OF OPERATION: / / TO / / I G 5 t U Lai-
NUMBER OF SEATS: INSIDE: OUTSIDE: )H TOTAL: aq
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? h 0
IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? f1
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 ldtcben)
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:\Appfication FormsTOODAPP 2020.doc
OWNER INFORMATION:
FULL NAME OF APPLICANT G 6 V A S t'0
SOLE OWNER: YES NO D.O.B 91 115 I j OWNER PHONE# 5tq
ADDRESSl -T-ctAq g L n QitA i f AA A '0 d,(Q 3 5-
CORPORATE OWNER: WA U Lo lo� ft-U- I h C-
T
CORPORATE ADDRESS: 3 3� }- �a r o fti .�1 h 10 (P y
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 Ex iration Date
24
SIGNATU 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 ovenine!! 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 htta://www.townofbarnstable.us/healthdivision/applications.ast).
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.31'`each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st.
Q:\Application FormsTOODAPP REV3-2019.doc
Workers Compensation and Employers Liability
Insurance Policy
Insurer ID No(s):34355
MA Retail Merchants WC Group Inc. Carrier Poiic #: Policy Period
PO Box 859222-9222 -
Braintree,MA 02185-0000 014005032222121 01/0112021 to 01/01/2022
Information:Page
FEIN:264818290 Renewal Policy
Item 1: Named Insured and Address Carrier Prior Poli #:Oi4005032222120
Riverway Lobster House,Inc. A enc
1338 Route 28 Mark Sylvia Insurance Agency,.LLC
South Yarmouth,MA 02664 404 Main Street
Centerville,MA 02632
Other Workplaces Not Shown Above: See Schedule of Operations
Additional Named Insured:- See Additional Named Insureds if Applicable
Type of Business; Corporation Federal 10M. 264818290
Risk ID: 000000000 NCCI/Bureau M 34355
Unemployment ID#: File#:014005032222121
Item 2.Policy Period The policy period is from 12:01 AM on 01/01/2021 to 12:01AM on 01/01/2022 based on the insured's mailing
address time zone.
Item 3.Coverage:
A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed:
MA
B. Employers Liability insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part
Two are:
Bodily injury by Accident $1,000,000.00 each accident
Bodily Injury by Disease $1,000,000.00 policy limit
C. Other States Insurance: Bodily Injury by Disease $1,000,000.00 each employee
D. This policy includes these endorsements and schedules:
WC000000C(01/15),W0000414A(01/19),W0000422B(01/15),NOE(01/01),WC200102(01/14),WC200301(04/84),
WC200302A(09/08),WC200303D(08/10),WC200306B(06/13),WC200405(06/01),WC200601A(07/08)
Item 4: Premium
The Premium for the policy will be determined by our Manual of Rules,Classifications,Rates and Rating Plans. All information required below
is subject to verification and change by audit
Classifications Code# Premium Basis Rate Per$100 of Estimated Annual Premium
Total Estimated Remuneration
Annual Remuneration
See Schedule of Operations on Following Page(s)
Minimum Premium Prorated Premium Estimated Annual Premium Expense Constant De osit
$286.00 - $5,509.00 $5,509.00 $0.00 $0.00
sluing Office: 35 Braintree Hill Office Park Ste 206 Date Printed: Countersigned by: �-
3raintree MA 02185-0000 01-15-2021 1
Drm#WC 00 00 01 C
id.)
The Commonwealth of Massachusetts
FEE Department of Industrial Accldents
Ofll"ce oflnve:;Wgadons
kv Lafayette aly Center
2Avenue de Lafayette, Boston,MA 02111-17S0
www mass gov/dia
Workers'Compensation Insurance Affidavit: General Businesses
Applicant Information Please Print LegIMIX
Business/Organization Name: ?�vt,vwaqLobs Inc . O ✓cl v�`I(R- G(A
Address: 1339 i fC;)g AS oc nu(If 6Q r
city/stateaip:S- ya r m ak M A 0.)&& Phone#:
Are u an employer? Check the appropriate box: Business Type(required):
ll am a employer with oZo employees(full and/ 5. ❑Retail
or part-time).* 6. aRestaurantBar/Eating Establishment
2.ElI am a sole proprietor or partnership and have no
7. ❑Office and/or Sales(incl.real estate,auto,etc.)
employees working for me in any capacity. g. Non-profit'
[No workers' comp.insurance required]
3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152, §1(4),and we have 10.0 Manufacturing
no employees. [No workers' comp. insurance required]* 11.0 Health Care
4.❑ We are a non-profit organization,staffed by volunteers,
with no employees. [No workers' comp. insurance req.] 12.[]Other
'Any applicant that checks box#1 must also fill out the section below showing their vw leers'compensation policy information.
**If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box#1.
Ion an employer that is prouMbg workers'compmsatlon insurance for my employees Below is the pe ft information.
Insurance Company Name:_ MA /\A?_.t'CJ\Q n t5 W C t l M�!T In d
Insurer's Address: P- 01 8 o )L
City/State/zip: CI i Afirt e M 0 I g S
Policy#or Self-ins. Lie. #_0 [y Q d�l ��a [ a Expiration Date:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under§25A of MGL c. 152 can lead to the imposition of criminal penalties ofa fine up
to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to
$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of
the DIA for insurance coverage verification.
I do hereby certify,un the pains and penalties ofperjury that the Wormaden provided above!S true and correct
Signature: Date: i
Phone#: 5 — ��"9 — 3 a��(o
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permiit/lAcense#
Issuing Authority(check one):
1OBoard of Health 2.0 Building Department 3.0 City/Town Clerk 4.(3Licensing Board
50 Selectmen's Office 6 OOther
Contact Person: Phone M,
www.man.gov/dis
0001
VXV
R PL ,o�-�,s tMDl.cr� L1' 170 C.,OOR U-G�
Q F � `" 1=�'
Mal
Y,
a ..
ti
R
e
c ° x• .
00
f
C8A Snack Bar featuring Four Seas Ice Cream /Af
915 .Craigvitle Beach Rd, Centerville MA 02632 �l
�NStb� S�jA�7"lT�l�
1
.�IIlf a�R�ay^� �' �y,l flp(♦Rt♦RI�I' ! 1-61,
tEiti y
'„n•r-�
' , r oc
� I�f��rR'4cf"1Ns:
�� ,i�R6 i�iksRRR�! :�#�aC ngo•�l i�-s r
r'.Ei. �' !STisJ4�•"Sins".i'SS:.9S". ^.."S'115Y'..�1Y.�.Z ae,+l'.a
'sTg..1 SI'S'Gn���^' ^t•'IPA:�." ?.?Btiti.'..kr'G9w"iS'Ci'Z
"1C?kTJM.?ff34S�3S .S�2'Tdt'.zT.'S4 TiT.4'�95::�3^ '_L-MVI"S=^=-Im' ac:14M
-.4.®TdS. 1Rt�.. '$i'9'�`^��`.'.✓E•.T^T 'v.FP2;'C.SCs"X.n�RS"°4`Tu'l�.-'^^' YaG.�iT.SF i"'f.A
_smr t +zcstt�svnm:asesraaia^ssrr..c. :1.I�i.„C
s=Zr.
Site .•�^� '�l=.Z4' i.L'�:'SY25Als1.R''t^.A-:�."+&'.,3t¢'^G..GiC^w T42at.t¢z:3 s
S>�C'RSSF�"�'itiZLS4S".+'*'L.^.4.A�irCd".3^J£CL:.`29tL"CC4. .A'3„F"'9.tr^..171 k!f �CF"iPl
5,a- air
_ ��
( -
Y _�,.�:..,. .'�
���� '�"♦:e..7 .�q�7 Y� f� ,. Y Ca"P=,.«�9"9s::IB.:r�^i+is.s � ,. s, � 7. ^W
.5R3:d f�`g�"''U"�y*G.'3�� 5�U c3`t+"�s'f} �u,e�rY§' S:'k l}" S Y i S t } Sp a tC.�.o•'J.Lcea ^y
ssssxxe=�•.r..-au,.ws�si' [ �{ cr teuasmxsrcrsav�.rarwca �a+ P" �-} esa^.=:m�••�c3s; ..ux•-n.,tt.g 'na 51" �acc-° z-A�zt.x
k&SRlCS^.LY41w.4aC.la?k.�a^t7atL'
tz,$va�,a+ma:.nvsss.n�amaoesx ¢ 3i �` n 1 '4t �-` Sir" fi5�}/' 5�� � t se�exiataaci.eraxcm-'cawr.. F -t ' 3 3iC � - ,aas•r-�•a^-i+-i�tr�;s
eimr�sr.�ekseas $ }.�' � `S.,t'-i �+��. � er�+a2tgs-;rn:�m_-a3e�rm�h 3 t ;r y ' 1 '�..r.+':•�^s+c+tsa
1t>1SSS�t34@�i»�$.J SfS1f�"�� ,n.�,�'"� � +"" 1�- - - y f. •/ - t ^d' ''�_^..EY^+' .eCS
�axa �tasa*>�ra rse� b:b�fir't �mP"' '7}`� z s,� v �'-��+ .r vT� � ���.M.-^ i`i . .�,r �<< r t•.+¢��s -s?na
Rsa ezrss$v.a� ��� � �' ' �Ss". ..v.�e �t x�ci�{y�p� ¢nr�.�,r ✓1 f � i 1 t>ra:.a".rzrz...r-�ctar...:.—a
�{'Ei .,y�r,��� t�
�S +"Z4. 'aFfl�'f.'eT3�S'+I.'R1"w'k.'12n'T^'Ct1r8L2'4�'J �R'�i4'2DRs�R�,t
[ET.ls.45'WSR.isTfS'4A[' -' . ^?s'!,!:4`�7'.^ryf'3p;E' •^6.�+«1C5�•6'�'..Lt'^`o.:�R..:.bdiic:_�.',S.L�i^F.a^ ...:� A
RSSC.IA)�.SII�3N^^!^`�^• �.:Sgi St£tCS51�.iC.:�'t€"33tSn&tt...Zl✓araCO
L' .,."'^9,9.+z.^�Se;�.2ass.z:.z�rc32^�- a'E3•.�.Ge..:...2J:.c.�u'n
rssva.�asal:al:aas:s. .rr�.*:,.:.»:-^;:.r�.�..sr-..sa:ra�tsz >• i
m.zxacsnriums�.�$sarrsnias�+seisr.�srsze
�161 Zffi153
226009 o
�17
004G40 s29 Ab,
3,10OG l W-932 226162
i226008001 [ 2261600 0 4A
2'+5004 #946 ( / 2S 226163 3
2.;Rl ( I j a aaa�
8966 //
C
8159ft
72 (225165
_ Q � 726171
/A r_6166 2
236173
225001
$861
22SON
0857
0 64 Feet
OGCtJ:atiSi TNss btrspatnttfl is 's0m•tSOd adeWats fw M p:Z!S Parwk 001 Selected P.IW Q .
hrnst6aT deml'htiO�t arta4'f�f trfagmm a b yon0 a sme d Off;CHRISTIAN CAW MEMING Total Ass—d%ftk-SM MM
Ye1RY at➢r il�if>sd Wd:EdRotttap Occtgy'R+I�uIIa TIt6 pSM 0tes Oft lt�aTle - AmeageAbutters:2.45 acres Abutters
Ore war rprplk teV,=r9Ow%of Ac smel tv P&Cdc Thal ate ttd M*WO" /.�
W.dlift VA di mtngaeM asant td to prydsd kauasmtltemnjr L=6wc_915 CFLAGV81E BEACH ROAD Mor
0
CBA Snack Bar Menu
Quahog Chowder-Bowl $7.50, Cup $5.50
Stuffed Quahog $5.50
Burger $7
Cheeseburger $7
Hot Dog $4
Grilled Cheese $4
Italian Sausage $7
B.L.T. $8.50
Grilled Chicken Sandwich $8.50
Grilled Ham & Swiss $8.50
Roast Beef Wrap $8.50
Turkey Club Wrap $8.50
Lobster Salad Roll mkt price
Fish Sandwich $9.50
Chicken Tenders $8
Fried Calamari $10
Fish & Chips $17
Fried Clam Plate mkt price
Fried Scallop Plate mkt price
Garden Salad $7.50
Chef Salad $9.50
Sides
French Fries
Pasta Salad
Cole Slaw
Ice Cream, Milkshakes
°F IME 1 TOWN OF BARNSTABLE _ _ HEATH wsPECTOR's Establishment Name. Date: �P P 7 11) Page:�_of 1.
SAB E., LIC MAIN STREET E HOURS
OFFICE
PUBLIC HEALTH DIVISION eoo-s:3oA.M.
3 30 4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
MASS. g' MON.-FRI.
�p •639-e m HYANNIS, MA 02601 508-862-464a No Reference R-Red Item PLEASE PRINT CLEARLY
rFD MPr FOOD ESTABLISHMENT INSPECTION REPORT
Name ^ �C��il�e Date (-� L T e o Tyne of Inspection ll
g Routine 1 !✓l C�i7'Y
Address Risk Food ervice Re-inspection
l Level Previous Inspection
Telephone Residential Kitchen
Mobile
Owner HACCP Y/N Temporary Suspect.11lness �`�
Caterer General Complaint
Person in Charge(PIC) �� ;Time Bed&Breakfast HACCP
VA In:k I T Other pI
Inspector 1� d-O"JD Out: It
Q � ,. 91 In ✓1�
�•�• C of ��. �'i>�
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated.
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ -
Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ 3 vt/f�. �� crr/
Action as determined by the Board of Health. Allergen Awareness 590.009(G)
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands �� ✓ - ^ �
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS
❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives
❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) C( {J-
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ` n h kl--e
❑ 5.Receiving/Condition ❑ 17.Reheating -
❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling n /, �J_
❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding (�l lltr(iJ
PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control I - .QUL p u
❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) C Q f L:ra, I�-
❑ 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 1
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations ! l � .� J d( QC
Critical(C)violations marked must be corrected immediately. (blue&red items) u Corrective Action Required: t Q j`j�� Ntr Yes
Non-critical(N)violations must be corrected immediately or11
within 90 days as determined b the Board of Health. Overall Rating
y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusio ❑ e-inspection Sc edule Q 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. ❑ g ❑ Emergency Closure ❑ Voluntary Disposal Other:
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 4non-critical violations
I,
26.Water,Plumbing and w aste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 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.
29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C.
30.Other DATE OF RE-INSPECTION, Inspect 's Signature Print:
31.Dumps 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 _ nature Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Screen? Y N
�' _.. :...a.a..,titi?-.�Ir av--:a-�--..ia.-'_V.i".'-..�_-++a•.'ate-awa=Y�`.e-Y��"aM'r..�-r.w v�'..•.•+n+-.�,.._--. �..-�l-c-,V .-�^.Tom. f.<.-.-. �----.....N,yr '�. __ ... �... a..+^c_w•_ a._ _... -.•-^+- ti -..+--.s-_ _ ` Ns•. . ,.s. �� �.. ♦ .r -r,- -^ •a i _ �. }_ -
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors-(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 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 1 3-501.15 Cooling Methods for PHFs
g * ( ) p „ 3-202.12 Additives*
Cooked and RTE Foods.* t - _ _19 PHF Hot and Cold Holding
2-103.11 Person-in-Charge Duties - - - 3-302.14 Protection from-Unapproved,Additives*-
Contamination from Raw Ingredients t 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F.
15 Poisonous or Toxic Substances 590.004(F)
EMPLOYEE HEALTH _ 3-302.1 1(A)(2) Raw Animal Foods Separated from Each 7-101.11•-,.._ Identifying Information-Original Containers*
- 3-501.16(A) Hot PHFs Maintained At or Above 140°
Other* t F
2 590.003(C) Responsibility of the Person-in-Charge to 7-102.1.1 Common Name-Working Containers* -
Require Reporting by Food Employees and Contamination from the Environment 4 3-501.16(A) Roasts Held At or Above 130°F*
Applicants* - 3-302.11(A)- Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control
590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*
Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements
3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q
590.003(G) Reporting by Person in Charge* - Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-.Chemicals* REQUIREMENTS FOR
_ 3-306.14(A)(B)Returned Food and Reservior of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated 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,Lubric2nts* 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 Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and
3-201.12 Food in a Hermetical] Sealed Container* Sanitization ewa Temperatures* Raw Seed Sprouts Not Served*
Y Pe 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
Concentration and Hardness*' 22 3-603.11 Consumer Advisory Posted for Consumption of
3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs- sec Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immemedisate Service 145°F 15 sec*
Equipment* Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game , t Pathogens* Effective lnrzoot
_ __ 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=3D2.13 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 StuffingContaining Fish,Meat,Poultry or
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary
and -ide 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 - 27301-11 Clean Condition-Hands and Arms*
Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave foodbthe appropriate sections above if related to
- 3-202.18 Shellstock Identification Present* _ 2-301.12 Cleaning Procedure* 165°F* Other me illnessviolations
relating
and risk factors.
2-301.14 When to Wash* * Other 590.009 violations relating to good retail
590.004 C Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
2-401.11 Eating,Drinking or Using Tobacco* 3-403.11 A&D PHFs 165°F 15 sec*
g Receiving/Condition - ( ) ( )
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) Commercially Processed RTE Food-140°F* (Blue Items 23-30)
3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne
3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness-interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock
590.004(E) Preventing Contamination from Employees* 18 Proper following sections P Cling of PHFs the Food Code and 105 CMR 590.000
o
3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.Od0
3-203.12 Shellstock Identification Maintained*
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
Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
590.004(J) 9 9 Y� tY
7' Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008
HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009
3-502.11 Specialized Processing Methods* 30. Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* S.590Fbrmback6-2doc
'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.
yip IKE re TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: Date:' ( ' 2 Page: of I
OFFICE HOURS
BAR E. PUBLIC
2 0 MAN STREET
EEVT 3:30-4:30 P.M.
DIVISION - - - : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified -
MA55. HYANNIS,MA 02601 MON.-FRI.508-862-464a No Reference R•Red Item PLEASE PRINT CLEARLY
rFD MP'� FOOD ESTABLISHMENT INSPECTION REPORT - -
Name P A Date(� ( Z� T e o Type of Inspection L421 �
Address I�C � �� Risk Food Servi :Re-insp�ectioLevel a aI e ection
Telephone 0 Residential Kitchen Date:
Mobile Pre-operation
Owner HACCP Y/N Temporary Suspect Illness
Caterer General Complaint
Person in Charge(PIC) Time 3p - Bed&Breakfast HACCP � � IL
In:tZ Lf'<',- Other
Inspector V1 S� Out: Q h I �n
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. N
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ }2�r
Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ J
Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ i
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands cs
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities G
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved-Food or Color Additives
❑ 3.Personnel with,Infectious Restricted/Excluded ❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures
❑ 5.Receiving/Condition ❑ 17.Reheating
❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling
❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding
PROTECTION FROM CONTAMINATION ❑20.Time 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.ProperAdequatc Handwashing CONSUMER ADVISORY
❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories (FO
�Q _
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations r v
Critical(C)violations marked must be corrected immediately. (blue&red items) 1. Corrective Action Required: ❑ No ❑ Yes
Non-critical(N)violations must be corrected immediately or
within 90 days as determined b the Board of Health. Overall Rating
Y y ❑ Voluntary Compliance ❑-Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction:Based on an inspection today,the items
checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations
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 (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of
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.
29.Special Requirements (590.009) within 10 days of receipt of this order.
violation,4 to 8 non-cr• I violations=C.
30.Other DATE OF RE-INSPECTION: Inspector's Signatur 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 Signature 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* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
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 7-101.11 Identi m Information-Ori Original Containers*
r590.003 C) Responsibility of the Person-in-Charge[o _ Other* g g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F*
( P Y7-102.11 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
Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control
7-202.11 Restriction-Presence and Use*
590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control*
Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements
3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions*
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
590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or
_- 3-306.14(A)(B)Returned Food and Rated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
Contaminated
- _ Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
es Bevera with Warning Labels*
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* B g
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*
590.004A-B with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and
( ) Compliance P .. 4-501.111 Manual Wazewashin Hot Water 7.206.12 Rodent Bait Stations
3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served*
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical 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 Not Otherwise Processed to Eliminate
Equipment* ( )( ) Pathogens
590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game * 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 ui 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source _ Equipment*
Pment* 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 StuffingContaining Fish,Meat,Poultry or
g trY 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 j
1 o 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* I 165°F* foodborne illness interventions and risk factors.
2-301.14 When to Wash* 3-401:1I(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
590.004(C) Wild Mushrooms* - practices should be debited under#29-Special
3-201.17 Game Animals* Ell Good Hygienic Practices 17 Reheating for Hot Holding
' � Requirements.
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs_165°F 15 sec*r ..
3-202.11 PHFs 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) - Commercially Processed RTE Food-'140°F* (Blue Items 23-30)
3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne
3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1g 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. 1 Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009
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
F,
*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.
�oFT ,oy� TOWN OF BARNSTABLE HEALTHwsPECTORs Establishment Name:�/1►i Date: ti� 'u Page: Of
OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30A.M.
BARNSTABLE. ` 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
MASS. 8 MON.-FRI.
.a,q.ate• HYANNIS,MA 02601 508-862-4644 No Reference R-Red item PLEASE PRINT CLEARLY
r r
F
FOOD ESTABLISHMENT INSPECTI N REPORT
Name Date Type of Tyoe of Inspection
ESE�2
-
Address 9r/� /� �j„ .� ./ Risk Food Se ice s �Le ��cV Level Retail on
Telephone Residential Kitchen Date:
Mobile
Pre-operation
Owner HACCP YIN Temporary Suspect Illness
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP
�O
Other
Inspector Out:
Each violation checked r uires an explanation on the narrative page(s)and a citation of specific provision(s)violated. 13
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ G r
� Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009 F G{Z
Action as determined by the Board of Health. Allergen Awareness, 590.009(G) ❑
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives
❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures
❑ 5.Receiving/Condition ❑ 17.Reheating
❑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 rn
Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No TO 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
checked indicate violations of 105 CMR 590.000/Federal Food Code. Embargo Emergency Closure El Voluntary Disposal ❑ Other:
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
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
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing.-Your request must violations observed,7 to anon-cri
28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address non-critical violations. If 1 critical refrigeration.
violation,4 to Snon-critical violations C.
29.Special Requirements (590.009) within 10 days of receipt of this order.
} =
30.Other _DATE OF RE-INSPECTION:
Inspector's Si ture 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 Signature Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Screen? Y N
Violations related to Foodborne Illness Violation Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION - PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* $ Cross-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 * 3-501.15 Cooling Methods for PHFs
g ( )( ) p � 3-202.12 Additives
Cooked and RTE Foods.* ) 19 PHF Hot and Cold Holding
' 2-103.11 Person-in-Charge Duties � 3-302.14 Protection from Unapproved Additives*
Contamination from Raw Ingredients 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 Identifying Information-Original Containers*
590.004(F)
2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F*
G
Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers* 3-501.16(A) Roasts Held At or Above 130°F*
Applicants* - 3-302.11(A) Food Protection* I 7-201.11 Separation-Storage* 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*
uirements
3-304.11 Food Contact with Equipment and Utensils* Variance Re q
590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* 590.004(11)
Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* i� 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR" -
3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions - g
Disposition of Adulterated or Contaminated
Food _ 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources g - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and
( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations
3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served*
3-201.13 Fluid Milk and Milk Products* 4-501 A U 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 Not Otherwise Processed to Eliminate
Equipment ( )( ) Pathogens* J/
590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g * e ecti-11112001
4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec*
590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs*
4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) 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.
g 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 CommerciallyProcessed RTE Food-140°F* (Blue Items 23-30)
3-201.11 Package Integrity ( ) 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
r
3-202.18 Shellstock Identification* 13 Handwashing Facilities r 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained*
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
* 5-205.11 Accessibility,Operation and Maintenance
3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006
Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
590.004(J) 9 9 y' b
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008
HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 1.009
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.
TOWN OF BARNSTABLE
LOCATION 915- 10 ral i/e J /Zd SEWAGE# 2-008— 5-14
VILLAGE l ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. (�GtT�p pT r/�S
SEPTIC TANK CAPACITY JCX)o (�f 2U 100®
LE?.:CHING FACILITY:(type)((,��[e ,hr.[� (size) X 5 U
NO.OF BEDROOMS
OWNER
PERMITDATE: is-3o— WE COMPLIANCE DATE:
fl
Separation Distance Between the:
i
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility -7 feet
Private Water Supply Well and Leaching Facility(if any wells exist
on site or within 200 feet of leaching facility) feet
Edge of Wetland and L.aching Facility(if any wetlands exist
within 300 feet of leaching:facility). -feet
FURNISHED BY CMG �' 6XI-CrI0 C-S U-C
I .4 ~ ® 1
<41 Y
v
�i o�a•v
.-
t'L
3 '131 133 Vb q
Pf 381 3� 81 ,D
b y5.0 Qyto L6,0
ss8, 3
yZ,u
P9 3s•O g9 'Ale.0
TOWN OF BARNSTABtE
LOCATION I � '�1�'p��e Gti SEWAGE—`-�
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY J a
_ . ems.� -
LEACHING FACILITY:(type)
NO F nEDR4XX S PRIVATE WELL PUBLIC WATE -
BUILDER OR OWNER ,1� ��� � �_ �
DATE PERMIT ISSUED:
DATE COUPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
.;,.e.�..ynr^+..gym-,:�..�•.. �� s.� ®.�....ss..,.-..�..im.,. � ..�
r
i.
jq
jV . tie��3`3.ass:• ,. ,yam ,>
3 x'
zi
• OsGES
$gRS MAP NO*
-
- -- PARCEL NO:
Fxs... ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE �1
Appltrattlan for U osal larks Tonstrnrtiun rrntit
�
Application is hereby made for a Permit to Construct ( ) or Repair (,-�4 an Individual Sewage Disposal
System at:
i .. �=!� 1
•--
��Q: .� H -P...... ............................................................
-----------,--
- Location-Ad ess r Lot No.
--------•..........................................•-•--
.... Owner Address
W
Installer Address
d Type of Building Size Lot............................Sq. feet
UDwelling—No. of Bedrooms--_-_------_d>...........................Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------•-----•---••
W Design Flow.............�P-:�C..............gallons pef-pe%" per day. Total daily flow...........9.q ..................gallons.
WSeptic Tank—Liquid*capacity.1a..`..®®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........................................
a Test Pit No. 1--- _Z...minutes per inch Depth of Test Pit.................... Depth to ground water........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a --- ---------•----•-••--•------- -----------••••--•--•...-----...------•--•--•-•-•-•••••--••-........._........---••--•••••--------••-..._-•••-••-••-.--•-- j
ODescription of Soil....... �r��cr!�1 _ '! -....................<........................................................................................ I)
x
-------------------------------------------------- -------------------------------------------------------------------------------------------------•-•---•-•-•------.------•-••--•••••.....--••-----•-
V Nature of Repairs or Alterations—Answer when applicable >___L'�� (�� 6..-___--!frVT=6...................
---------•---= � �1.. 1 ._.` _� _e e_�w... ...._....A ----.....��.me:®-e-,4ee...-----`...f5ffn_.r %J ;.r........
+�::
Agreement. 'r
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 Certifi ate p a en issued b the board of ealth.
2 & - C10..----
Dace
Application Approved BY - -- - --------- --- �1. -`--"''''S. -- ------------. ------........................... -- - "
Dne
Application Disapproved for the following reasons- ----------------------------------------------------------------------...............................................................
--------------------------------------------------------------------------------------------- ---------------------------------------------------- ................................................. ----------....----- ...------.........
Permit No. l- �---------------------------- Issued ....................------ --------------..Date------
Date
®Fss..... 3.. .......... �
THE COMMONWEALTH OF MASSACHUSETTS
,it - BOARD OF HEALTH
' J TOWN OF BARNSTA_BLE
f- A *11pliration for Bisposal lVorks Tonstrur inn 1hrntit -
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at: ---�
......... -- .......................................Z r...._00 1....................................
. Location-Address or Lot No...-
Owner Address
W
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling;--,No.- of Bedrooms..................................._--------Expansion Attic ( ) Garbage Grinder ( )
f a Other` Type of Building �!�T�__�?4?SENo. of persons____________________________ Showers (- ) — Cafeteria ( )
d = Other fixtures --------------------------------------•---------------------------•--------------
W Design Flow..............�� -?�______.._.....gallons per person,per day. Total daily flow____._.__._. r.................gallons.
WSeptic Tank—Liquid capacity..ae4 OSgallons 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...;?.Z..minutes per inch Depth of Test Pit.................... Depth to ground water-___.__--_-__-__-_-__.-.
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to groundwater.......................
--••---------------------------•--•------------ ---
ODescription of=Soil......-----t.4 « ..r ... --.Pnn�....................-.....................................................------ ::..
U -
W � 1
........................................•._..__....___________.._.........._ __ .. ----..........-.---......_ .....................
U Nature of Repairs or Alterations—Answer when applicable..___ ..��_.� ...0 t ...... .............. r..__.
------------•--1 1 ......... ,�.n-, oa�a G-atl�c r fir. �•'TT.! ,Jam, -
Agreement: `
E 1 )
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_Certificte of-Co'-�plance'has been issued by the board of health.
/ .. Dace
ApplicationApproved By ........:..... . --- ( � e --.-�. �.......... .......----------- . ------------------....... a .-.�----... .... .. -------c L..V
f Date
Application Disapproved for the following reasons: ................................................................................ -------------------------------------------...
v
-------------------------------------------------------------------------------------------------- ------------.............................................................................. ........................................
......................
Da
Permit No. ........ - y Issued ....................... . ---------------........ ce-----
.. ... . ....... Dae
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTAbtt
1=1 &ING ENGINEER 1"JI SST SUPERVISL
TPtftc #e of TIItXt WRITING
THE STEM WAS I NSTALLED�!STRICT
THIS IS TO CERTIFY, That the Individual Sewage Disposal Sy fiAN@FeaQ PI.j',)'!or Repaired ( )
by -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
at .........yL 1-. - .... -...... !17rA ....._.�:��t'x!a �. 5�?(r - `.... .2.c__,.k e:I- ,J�Y.F--------'.....------- -- --------------- --------------
has been installed'in�dance with the provisions of TITLE 5 of The State Environmental Code as described in
~tlie application for Disposal Works Construction Permit.No. ..... -y..._<-/.......... ..... dated -----------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AV-A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
� 1 %
DATE---------<----J --- - /,d✓'- nspector..... ...:...../ -------..........,..................................................
THE COMMONWEALTH OF MASSACHUS T1S�-NGINEEr, :j oUPERVISr-
UESIGigI�iVG
BOARD OF HEALIMMALLATION AND CERT!i:Y IN WRITING
:TOWN OF BARNSTTEM WAS INSTALLED IN STRICT
.
p. ANCE TO PLAN. FEE ����
.-..._L=
Dispoottl Works Tonotrnrtion "Plerntit
��
Permission is hereby granted.............. n�^..,..............._...-,_4 ..: .............---
to Construct ( ) or Repair O' an Individual Sewage Disposal System
at No.. d ...... ..... .:1 ,• i . (. T n ;,--" � -----
- ......
Street
as shown on the application for Disposal Works Construction Permit No Of. t.l. Dated.......................................... 1
t DATE......... f k Board of Health J
FORM-38808 HOBBS at WARREN,INC:,PUBLISHERS
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
...Lawn.............OF... . ..r26r.6..b1:----.---.........-----............_..--
Appliration for 14ollnsttl Works Tumitrnrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( Z+an Individual Sewage Disposal
tat
Sys • --------------------- ---------- .....--•---.._....------. ----------................................
.�`!�...�� ... cad.
Loca' ss or Lot No.
650
Owner Address
.R----MaC�1 ^--` �?t C 1� �--------------------------------------------------
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( )
'k Other—Type of Building No. of persons............................ Showers — Cafeteria
Q+ Other fixtures -------••--•--•---••--••......•. .
W Design Flow....................................:......gallons per person per day. Total daily flow............................................gallons.
W Septic 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........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
x ------------ ----------- ----------- J....
0 Description of Soil.......................
• - L�-r- ..... - - - - - ----
x
U -----------------------------------------•---.......---•----- •-----------•---- ••--•-••--••--....---••------•-----------•--------•---••-----•••-•---••--•-•••---------•--•--------•-..__.._..•---
x %mac se Y_- �...__ ,, __._ .�.. - -----
j
V Nature of Repairs or Alterations—Answer wl}er>,,a plicable____ _=�U � ,[-___ .. ..................................
------------------------------------------------- ------------------------------------------------------------------------.....----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITI.1J 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be issued by}thhee board of health. i 9,
igned - f-=-- ��{ ---.._ '7-- .
e - _.-- /,Da �_A lication A roved BPP PP Y•-•-•• . ---------------------------------•------......••
Date
Application Disapproved f r t f ollowing reasons---------------••----•-----------•---•----------------------------------------...-----•-•---•......------.......
----•--••--•--•--------•--....••-•------------•----------•-•-•-•--•--•••----•--------•--•--•--•••--------------•••-•-.....---•---•----•--••-•--•--•--•-•--•--•---------•---•---•----•----•••----•-------
Date
Permit No. ed.
. -• ,.Date
THE COMMONWEALTH OF MASSACHUSETTS
_) BOARD OF HEALTH
..............0F.. ��1�.'-d' �.. � ........................................
Appliration for Disposal Works Tonstrnrtiun Vamit
Application is hereby made for a Permit to Construct ( ) or Repair (l} an Individual Sewage Disposal
SyStpn at:
m VI ... 3 :....tn ....f� ....................... --•...... ..---•••-----•............. --...----•------•------•.................
.* / a
Loca�on_m�k4 rless f � or Lot No.
L.
......---•-------------------------------•
Owner
....+ y /_ 1 L.�: I ... .._4 � :f r....... .•. fi�1�, jf. -----..--•.....................................
Installer Address
QType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' 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........................................
aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(r Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 ••-••••--• ==----------------------- •••-•-•.....
Descriptionof Soil.................... `� f'cr4 - ... . =------•--••----------------------------•--•--•-•----------------------------------
V ....---•••-•--•••••--......•...............••-•-•----•-•-•-•-•------•-•--•--••••••....--•....._...........-••••-•••••••---•••-••-••-••••---------....•-•-••••••••••............-••-----••-•...........--
W
UNature of Repairs or Alterations—Answer whe ,applicable._.__�_'i)V6) f...f 22 .................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has ben issued by the board of health.
Signed,. .1 :✓,�r ,/ 1�� r;% _ .....
^�+ � r
......__ Dat •--------
Application Approved By. `---•............... -------------------------------------------------------------• ....
ate
Application Disapproved r t following reasons_............................................................
..........................................
...............•••••.-•-••---••-•----••••....•••.....••••-•••-----••--••••---••••--------...-•••-•-•----•........••-•-•--••-•••-•-•---•-••-•••-•--•------•----••-------••••--••-•-......--•••••---.-----
Date
PermitNo.......................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�441 )
Nt. .............. ? �" ........O F......:�f '� rf. ....................................
(Inr of irat a of Tumplianrr
THZ R� TO CERTIFY, That the In ividual Sew ige Disposal System constructed ( ) or Repaired
by ,s . 1.r�r����42 r-�� �-� .� 2 �. .. .. '.::._..
---
I st Iler 5 ) J� �y' y `
a `w,S c _y_...t...........................fi Y t t rv� g �� A ............• 11 f
at.-. _. ._ E _._... r'.
has been Installed in accordance with the provisions of TITLE 5 of The State Sanitary Code s de ibed in the
application for Disposal Works Construction Permit No.... .-.._.__-... $i�..._....... dated.6,..... _
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRI! D AS A ARA TEE THAT THE
SYSTEM WIL FU TION SATISFACTORY.
DATE__.:!...���. ................................................... Inspector._ .._ .,......................•------- ---------------------------
THE COMMONWEALTH OF MASSACHUSETTS
� BOARDS OF HEALTH
1 ...........0F... b)L/� � FEE ��y-
�No ; .....---. M11011sa1 Works flan rnr Uan, fermi#
Permission is hereby granted....i: _. .... d� ` .. .: & _z� C.............:.
to Con iict ( ) or�P epair L-T a In ' ual gage Disposal ystem
at No ' ,l 1�L�1 _ ._:� V1/�._ ..A.0........_
Street
as.shown on/theapfor Disposal Works Construction Permit No _________________ Dated.....•.....____..._.....__.:...._.._...._.
----•---•--•---•--•• ---•• --•--•----------•-------••-••-•-••................•-••.........Board of Health
DATE--:---•- r
FORM 1255 A. M. SULKIN. INC.. BOSTON -
S CM�5 I1�
6eaLt, ►� sso�
or o+
i 1
h i
i
-A
TOWN OF BARNSTABL
LOCATION J� ` SEWAGE#
VILLAGE - ASSESSOR'S MAP&PARCEL 0-6)
INSTALLERS NAME&PHONE NO.
SEPTIC 1,,ANK CAPACITY
LEACHTjPiG FACILITY:(type) (size)
NO.OF BEDROOMS
OWNER
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the: }
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
wilin 300 feet of leaching facility) Feet
FURNISHED BY A � i
m
v4WNC
Q� s.
Chnstian CanpMeetuzq, Association
l
CRAIGVILLE(CAPE COD) MASSACHUSETTS 02632 TELEPHONE 508-775-1265
J �L
J L-
P For All People In All Seasons
O JJ
VC
IOR tHE
September 15, 2006
Thomas McKean, Director
Town of Barnstable, Public Health Div
200 Main Street
Hyannis, MA 02601
Dear Sir
This is in response to you Certified Mail letter concerning our dumpster located at 915
Craigville Beach Road, Centerville, MA 02632 4
1 cr,
We have authorized Macomber's to remove the dumpster till late spring of 2007, so wi—`
can explore our alternatives to complying with your order letter.
Please rest assured we will fully comply with the Town of Barnstable health code.
Thank You
Edward Lynch
Christian Camp Meeting Association Administrator
Cc Mr Tim McDonough
c/o Breaking Ground Cafe
791 Main St
Osterville, MA 02655
r + ! i
,� �
�} A"', V, +j ~4� `r i r..._ '� f'I r I j h,, z r•;..+ q +r`+ Y''i c 1.`cP t+r+` } 1 A .% w `
." ` K t + .mo t w, V. r 't r !i. +, r .0 .
AttFic nn�'rtI s P r '•* t.r !? r r r. i. r c'! 4.rt ,I9 •}I.,' 1ih S 41.— Aa .
j , :r M ) y i v';?c r t4aA'�4.,, r } `� ' it kKI. t f, e
.rry fI •�. �'•°" d a r Xi1 w pr F +.fi ' yy. +r �` Zts,
1 11 I , L rG +lr- t [ F _,°a� .ly'tl"'. 7 ,7 +yCrrI tr,2, FYI,J. •;1 .' ,f; ��0 11',. :'*. �U T"o i ,Y t •u,,. ..
.>L. €j Ir �r<, _'y s-..., f��' 'ni f.tSM L '}�{, its.`^.6 `i lr a € ; 1,,,� -4 _;.t �M " r
Z5 ' y ..r rr yr4"I " ,.r f kj F I' ,•a I a r�•.y�r ¢ l,r�'•ay Yr iT$s�'�c j^ �."d r�+4 •A .•4" _ r'r ;•c
4,,p� i a .'. r+ `.. r• '9.p, I � 3, `i J s� t i.`�.r e'c,. .o y -''' •C s"' ', '
A k,� }�, w f e ? `,'w , t. ,.� . e 3, _ r df y 4' ,-F . v;4`t 1.1 !,�i. s ',v, 4 tw.� r t a k '. '
' 'W". 8 a Y:r f 't i-4 .'f.I t +5e„ x+I �. 4fy 4 �,� iy7, s:*in r1 r kkN a ,Yi:,.,e 1 �r +k'., ,<.rm�€:,Y r,1 k M t R. t �.;; v
ry rF� r r�,�,"kE ". Jir 11 � s .,K t ,I, 4 -4, ''C', ,4.. � -.:*. M,, I, A" y,!` '` A Y + 'h r�. .
> tf!rr• a .'1. , r } x a ii+, + , r' if 3 . # y
i $i. r p -"a ut+'. ,y'',",'t •r. a^c' �r6,."X 5 x eta.y' T \ ,.e !'i ?
rV...Ii' t 't .,. f �`. r4 +{'F �' v 's�fi'"1,•'�' t}i rfr`,t r, e .;sJ #.': ,+s• ri Y + �i„ Y,e,'i .I.,n'' {+ '
I fir[' t.i 1 e "� t., '+ � �' i, � f.r I t•"" f��h J€ �+•t'� 3 '"� t,.u+. A,r4a: [ r a.'d,.�f I Y � `�{�, _1 <:� I'':.t f
"'+ 4 s , t,� .Ir} e} ,{. `•y ,p 4 b •<•5. e w ii '", SE Ii f• . 1 +r G ,€ * �"e;`• 1 r},,
b J t k rC F rt y f+ a `i. t dl�i y q .5, k r i. r d 6 L 1. ar 1 �i y fA.
fr.t J. 3 tr". a , '+ 4 }S g, 5 "'`44 y r; it - W^T ;., ,I t r,fie 1
d' I- •a r {" Ir a _�4 ",i�'e : G' ..- `r , }_`' Y1 ,-_, o t �� } .. _ t t `` I 1 M �i c� r •�- yi
Jt'4' rs ^�I' :� x" ,,�, [ .v. y- ... y '.# S,Y' .Jy y 'J�, r�A�Ht 't`h v �'. F r F',' ' ,,4x.4 ,� On. Ir.. f r..
'i v' mr, Y i ,r1 7 PIt"i ,y
L 1 kl F _ �:} it I� • 4 '• .a t 'I �.'` iA �aR 3
Y h , .{%r t .,ft Y,i ,f .M.�lr r.}, 'f1 3 € A f...
'' .rr Ya ''e, ,.$t ra' "`++. }'�' i vYs�-?ft, - �•^ k1.'` ,fi`a,$:^t' t �" � rj, '�I,♦ i i i A 5,.. .j,• �,t +-. `•l'~gj..0 f s r��
,"4fFr4 1 Gir iFF., 'i .r' .1 } „,• f cam,.. t... rTyx�,�t {?` .t." + 3,7 'F'. r4+1 z+ a�,F p.+ I.
4• ri T I t s, t,,,aa u, a^r + a> fi•r• +f,,,7 � , t, 'k, s
t3' v,f s i °` -r! '• € 'I,,rv _ 4'1`t .dc a:".,. t,`r,.`r7� 5c 3.r b" :Z" I• i .Y{a i r R:' l•i '- .l;I'If '.' F i",
t ds ^> y (. .t } ;r ,.t •t•" r! e i • I Rt .i. t .,
Y ,r Jul ,B -1987€ ,.4 r F , t , ,, f x , _ ;,
q Ii,t ' r J 1 i 1. t i'.,€tw Yi ,if4 4'r4}•sA' e v -III ,1 l tt Y I a Y1 1 y w i k
--i'.• + Z. ,Kp. Na. .y. r t : p -:W r rr, Tr fE:r,trr ,, ,' -, j-• r .d" , ' �; f t f•Pt t I
r S jn x ; t d f t r;�...6} r 7 i'Sr>i #. : c _w y t., y._yr
A f I ., t t ( ,,I � }., ;,, .� d }' drt '` r'Fe • n aN ' i} � ,T v ..r' r ;,e f'r, �'' (Y .vr� +
i Cf .r M1♦7 t `t r w y r8 ;y L '• r A { - rtri d'R. :L 'IM r a is f ,y,.': r r, r r r f" }° ;y, .1,ay ,�
' t t`" }'• i K yS r
Y s•t p 'c+ S ; a "(i a,, r.<, 4 :.. ♦ .. 4 f1 J
r ai.'.,.. r •,. .�s n # c w ,t, s$ t , �'V,,',J� ,'+fad+>it > 'I• : e�r2 �'. Y.;. n u �s t' "� C r ,,aa .i I _ f• grin.
+ ,.r 1 y,,v a a. a k +.-a t "�° a( !. }`i'+4 ` ''I c .r-,y t r r IL J"'°t.s`"i t}�.-
t�;'t. • 2 iry ' T^` e �S'e iTa• ys i .-y ,f$.'. d r x. d • 3r 1 r 7
`J4il ..$,p+" +z,,, b;y I :-t "�" ,,,t.. . a:.a.. ,v f y i.. #2 •'f r ,.5 r.yE` 3 s v * �r '
r l{S �
<y ''• '.•t' i� p.�. S.4 r 4 3 i r,'k # r 1 F r 'y Y` 1;,,: i '-` ,' y!z.; ' s ,;ti •.Sn +e. c .r : " r +r+ 1 y ,,,
v 1 a { r 4 i?4 .W.
P k"t a t ,fit r* t *W, f ay - t .
r { �3 C +- t l .+ N I ,r sr 7 - .k s r I ` a A. i +,' r.. .".Ir '4^,r , - '9, n ,I` f
,r is `'+, l 4 ^• -.t,.r r,'1 `5 v ': t f, S Y :L r A. -; ,�'�,� �1 !ti r' i, y�I ( I p r 4 1� ,_
t `y f '": _r a s.,',� t f�' +r,. � -- t Y'P•..^q. i f4 r . ;7 . i y'-io r r I�•- A, G N ti r .� `a.:< s
w• 4 ,� .,+i I a % ,f++tt Y ,; d ra a t"y t 4.i l° '" 7 ,r c y } .
ki „ X .,. r 1 Tt * tj ' ' -� S, t.' ; y
k � ...`r v f y(t 1.9 K+-,r.. .% ,. rl_,'+ ,s ,'?;,,�• "r'k�-'F +r a.' ii.l o,*t' v;.. iJ'r:; a't S y ., r '"y ', 4 ,'. r� !
"4 yV k f Mr.'-Robert J''aDonatiue, -,r i fi r�' a r 4 4, K
a 11 it fa♦ I S t i. 4 1, r ,;err"?; i " 3�� € a f '�♦ t; +I` rt '..
7'] ,,.D ,p F� _
!�r. y.< _,�,. <y �t r j°Ie�l •1.7� i .t0 w lb.,.:e '' "It { as { - yy�, '' r x .C... } +, a iI .",S;+Y) �• t.
Ir� ,t d r - ,•. i I ' 3 4•`� 'k `:r f 't , 7 J .a t.e's,,c 'C til„ d f (' t t '� i r'"` }... ' °rJ _ I s
�� .- . ,:, a 436;Main, StreeC„ � r I. * > �" '. : r 1 I Iw ,
.+� s y -11
r{`� .}. r k� e'4 `arinis,'hia 026D1" f'"M a- r ,,, .I y ",i Y a'k,+ f'l", ,'- 1 r I r" - iµ C d' 'A' ! `;.F -A• 1 Y 5 } wu' § f .�,. ..I
I y�' .}rr v,.• s,Y, •S , ~,i, .f Y 'v';y ,�� sH ��,e t +��,•F r � :` t,� k -s s a >.f i,r.As`� 4;1 s1€ .� + y r�,+l.Y �/* r"x;,+,A-. � 'j I' r•4, +t1
`� w qt ,.11 r C' .r
T 7". u r Q .:3 v i ( , gY7��.3" S.7 ss� I 55 .'ry K u .+
y:'1' a C'! i..r ;23s. r r 4 r,:..Sl e.°r "r3'" fa tJt+n�`; d �.r�'�a.i i'k. 'w�`"' Kg~x w.a,. t ',{#' '':• » IX j ,'I r:. •�.. 6 µ{4
t 7 +, �. rr' 4 s.- I +, '- 3�1 { a ♦ E sad ..i. ,W '# n Y' ri.
`� "' ` .y f«. $r If','A 1t}'.'' N � F � h * , }w 3 r t 4 .tr, 1s r I"t !r , s
y ! t. K I .. s a+ ۥ 4 + r it er c t, t fit" r
I.. #''a s�f � Y Il 1p'h e.e, c1 ,j� � r" . Ii, �k' � .�'r-.. t' Rl' r s .f� `r -ev � >y�;4 � Jr� 1 - r I.
q, t '�"5F JFa +..rt c• - %. L 7 7. r O rr 1.:E ',
,�� 4 i r '1RE -„Christian Camp Meet ng,A soda"tign,$eacch:Snack Bat ## � ,� r a.ti r �w �y "r *16 - --
y r C �,,<�" :b 1. r,r: t"r` ., �s�`'"� } n 5, r;.`�e1. a I 1 _ * r ;a , �E "> r ,j .:��I ,r ,%
♦ y y ` € i�•• -^ 'iP .,a. 7`r'"t ,p a7'e a", y4 ' m +y;FJt �yt 1'}�,e'#,, � I r`' rF�. 'r ti
". r t N". ,,. i' M''' s 5 ., s.4 x '� ,.,..'-,IC ., JO ! e+I 4':.'Sg Ys +f a ?t'�."zSt r r 4
' I� r t , ; "`'` Dear Mr ,Donahue ;n .u1'� ,q ,.,=!� � y" ��r :Ig• 4 t r'; f 4 i fr i' t I ,v
y rr + t_ u I G n r f r r ''. f ft p i ., r J {.� c 4 a w s ..
?+ s.,y a• ?'r r' I •s r a s'ixy f is " +-7�a;�•� ,,d.i, a R „r,t y,`i N, 4 r•...4 i raa:'i^5, 7 -r ck ri t 4�, Y ?-.`i'°r" •`t,,q r•i,' '"r= € ,,
ram: r�.fu - , 'You' are 'grantedv',"' extension'-of, time•�toAlns'tall. hot I_wat�r -in the Test, room , �,.,.+ys y r .. �i`^'t 'II },,.i' 'b;,. 'i'l :'kr t a .}.-.,,r.v. '4`1 tj�_ '1' "4 • J .' , ..� sr"':;' ' '. t;. s:
� 1 #w, x f. �facilities�at.theICraigville.$each Assoc anon used by tNe�Sn�ck=Bar personnel. ; r �'I, b
t, Y }i.. r a r3;i. ' . ", it , ' .� r' , 0 ,3' g. $ ;5 r 1'. .y r3r fa
•� + 3 I 'Sig .rf.x� '� Jti t i r�� f ' # ,, *• + III I".; �. r f, ,::.Y _,i'^ •Y`I f-.', .� ryr
f ' *r
a r,t.._ r 4�'! Yoi will_be_`requir d;•to .provide hate*ater to the restroom°facilities. t�or to =i , ,
i, r -the opening of the Snack€bariin the__ S ring 'of-1988 i',k , `>"� L, � ` ' ',.. a
" fi i .P g P g s'. 5�� w . r r ar na:r �' r f
-� 1.'1.4 is; ,r - +''�l•'-'3 S td{s t r..r6F it"' 4 iyk ,r�'€"i ."4.,I.x s V,,I 1 s 1? •1i Y r-•
i r° „r' ,,: { Y .} r+� fi j r < ` r i r •- i.. -- +t... sIe t•, od " t,Y .st -si y�'# v
�tT,�4 3 •J :"' f,%A yn `i.i F� 'y 3'. tt�'mj,c,1:: F I ., r i^ s. .` ;ycr bt s °S I ��
y i, `..: Y I I t • OUTs,1' �, N. y� p d ,4a wvs� W L� r is r
1i ?
is r4, � • . v p a 1 t . ' �., x ? r' a E kr, .t h, ti#
t i s k - ^c rt I
'rG *t t:., `•x� }, r ''S-,r;; ,.,3 t J:::+-t I`r^r, I.'A"#`;w ,t Y�,ry*ti , .`"." a-at vs p�lw r '�+4 S,.4 ° � �, 7,
Il t r r... Ir` + ? r' }%f1 4' rr a, y'r. + *. .L,d •ks t� .w•';j to. 1
tId•.I.y,4 r l y € �s1a + {"c„ d s,wt i.,_ i f A�,,,g.j � ;.
"4',_ , t' i� ,`r {,p J'} " 6 < !' t r- r f y. C <t W* y-'r"' i ,f '
!ia
:, £:�, y abe } . ills ,�*4k. 'a',y+-.€ r% } S "-p,. i ,+ v f,'. ,tc s «L r/l;,e Wit) 'k f f t,. 1.S': t.
t,t= I i ;; : fiairman> �''.,i r -i". �V r •'µ i 1 t< J .+f _ �C"b F. t� +t k`X a"<♦ i $ +
'4''r 'ri+ .: y t ,r,.r, ry rG, 7. .na' .J�„. "'. x' r'i x; , a.. i'•w, i ,r`nor. �,..` fral,5i. +f♦ + .. Spa �k ��; ,.. t,yy r
y°r^III t i Board of'health f ti+� ,,� I .,�. i : , • ,' 1 h r .1+ �a r JIB',` � x�; , .
r•4 L,r'1AI,` H 45' .'t ,4 ,�,'. ,• .. I s. i Y Sr t •i $ i' / .j, f', .,. . N $ I,• i F 1,..'.
tt
a`� ?> 7 t :" •TOWn of:Barnstable xr. 5Y z k It III`6- , rt# r. r r . 3:I fxA ,.,a 4'a�th , t r,`: t 'r X,
'!?.�:� r t €: -.'v.ri' e R x -:.; i s" �*; �'.+ c_ : r € s,Y,t s ..'o a.- v j 'I. P t'.g>. at. .r ..
G ' w'"r+ er r,.+r a S.T{ `+'ir ?`� f .+ r!e:) $dvvSr. y.,_�i 't. kr r +ylF�,..i ar ,p y . 'a c I zz r I i a M {
r i y r t. 3"• r u_W •n. >- ra H S> Iy I, t Y, ," ,,' A
.,} ysr i i' .s r s. Li I z" °fi 1I .r j..'� `er4 r,. r s •, i `„ J,�` € p.. *�, j�3'S€ '1r .3.� g` J 4s:t_ r.
�+ (.I
i } i, s ! Jt1-K:/bs ''FN "'' r�r'L it s,,tr :r< l • i $ .,,,.'� } '`i.. .e lb'` '/<
}l F3- 11
d; +} ''.,t ,f -y ,�' �-.t R- ," ."� Y ,., 'i' 'vk, tN JI',, ^P,"f t •_�., iPr P' v:e"ri"�fj• * '•:.,' t, i.. ,, l
.. <„ F.t ,4 A '' , I'.,•r• ,�, g `"t a,} Yv';#',�i, .I`' i _ , s .i w +,;,' } ji, : y - +�. y.:sr'. y,•+y.:ft' 4 �•iir:. t _'�7, I,% ''..
i y•+' '. it t t n} �,. dnr t ."-,ra x!. vy' 4x7 s. . rr " 1r ,za 3 Rr r,
Rs4 f t +. t,.,t r .i C� r ,r: w.1i',:. I "` 71 �, r:-+.+ r f 4. ,ty a y „aa a'•a ;,5 1t 'N Ff•... 4.
,I'C• = , I, t 1 y'4'' ,7 ."rgyp€'�I)i '�'!-k��^rµ•v .Bb't'` +tI r r'�..�;a q,J + ry,.f i JA ,I r T*31 fr i,x'r 'S .,. 'I'� ''ar'F.f�' €I'r^'a E i.t" *r-
Y.• I .`�M +..# :'R'.!' -tS A f. t.# y '8.'.�`, , •I't w:'• I �.••y 7\ , � ..
x �rl xi. L3 , },''.... Er t •G t .s�* t''s� t..lt i. <F'r, ., V i,..: r is re Sa •y. �i"srK''< y
h e a '°* r(,r, ,5 r• a. Y?.• rt Y,r Siff i +g r '
{?,,`° *a vs r�x "�' f yr W r r , , � ' s a",:•{ f, ' ) r i� r¢�, r d` , ^,r. ; -
. i,t P.- :' 1 �' L'`Y y .* �, 2"+ ! t jL
• t A H !4 a* Na.,1 " r�br•.
I.
+ .,OZ F .^ rr. # - a''RR"r f. /s rs If , t � ti a t- ,^. , IN 1'P „ .f..•. t r s s -' yy ,i Ih
aiM .,- % +'* +s r I t. v r�':.`„�"k. a_?,. i i II, it ,# r�C211!;:`.: 'iA ,:�� h' r'.., Ti i. ��. s'a �ti a�� �Y� ryi r � t" 11
,,rI.., A r c ^:. . ✓rp •s .''"� 1 f^ 't ,{ ar Y s,i, .a r..J4 tiffs . 7'y;:�,X.f t y p. i,.'} "� f-� 3 ,4,f a• t."d 1 f,yf s si '+ 1., "S.
p
# � �,,, *1 � � J4,,�^� }�• i +.Y, ,N"r `�.I I { � r`ro �dk -.,a,i' t '°. 't' f 'P L r< I 'r�,,;�, "�l+a�, i, ,,I'l t f :r' t R,, a'rA�.4 ,, r.
t .Z, t I. I4- r d ..P 'i J d y.§t t '�,<L ,i � r� % .S""i,,J I J,w I ` 4� ""vrt ,y a t°-,v"r ,r r 1 i'.
1 s� 1 u a to +"~ r J. �' _% t a t .`� ` fix: Orr c .tit" f i� � 4.`
.r :yr{+.:' r' ti 1 i r 1 A`�,� - a I%, I` Y J t x a k.: : y + ..,. , d: , ,,
t r y . I, 4.'::• *, , s.', .' f y,,a: �`,y�r y,,,'!^%yG� �,t -:' ;±.,fir ,� ' r._, I -Y:,. , i'Jtti�' r sri r° '. 't 'fr ,�', �.�.tc-�r �$.
.re f'r'
-n{.. +,', r t ,....^' *'t n,. I't�,'"s a .kr} ,.v� ,. S , y, ., , X s v, ' f x f t t i. �,m d- d r% r,* k f x I' y , i a, •. I1 di' s ti •� J t n w a
`t e. ! �, 'yrs�€'e,,.tyl. +F t w i r ,1F l x r
' r •-a .t r> 5 i, d s`: .k' � A7Y;;. 'e��r ,�, r rw;i } 1 �',�a.u ` '"'.'. �'eert w�': l,� ��r "t tr^C4�yr'"
t a �r.r t w -,.I -..r c rF F '` * ry,ri : JI.,;.�. y 1 _ i h#'
y«i «f ;" a ♦`,1't; 11 ,r Y t,Le ",_-_ y r^',t.,I irs w y. 'i & I .r N r Aa ";t • KI a
f4 r s,F t .+,..• N r c..r 'x, v, ' ..lt1 r ySS •i
i R" `, - „ti' Fr ,, ,�, 1 s,Y r� ,t+gVr ' £ , ��rt f 1; a ,,Y"f t . P r -.
k t^ t n 'aJ 9F I r A 1`.s +.� '?:F.'. ra t r y
<, .�'', s;' a, r'. i a ,.t 4 A't 9r. '�''i7.s> , !../,rt ,.i° 'n' + �c"e"Y f F<r '. 'r'I" yy. g .. t�°'+:'t
r+ r'P t }".;;i '� •IR i .i ,r S. iy I,'.4t , ."� e�, 0 i,,.i1 y# F 1` r%1_4 -t• Jl I t�Iy .. , � 1 1 � n
s r W. t :f°' �P,'' a .i Nt "t er L,c f F i' 4 S:i d' . I s . -� +}; ,�.,•
h t.:,f- �' .. r r: t ,+s* r r%ii ar.. ,� I`. k . f. S ', s r t rk'r-t t yil It '� 5 <r 'I
a 1, r I I, 7I, } t 1 k ;'s i,+ ,l �y r y r r r t +,� t 'r� > 4/ r X € + i
r s f� ,, f X :j r �} k w- ' ; %;' . id i ik a x� }
II > .t_,,$ .,+t3.• %�'IY # 4�k at `,,.>.�r,, tF4 v %S_'I I ✓r w ar .rr ". r y , r1 I H3''I� vl'1,". . I a ,jr r..r r t
:C 'L 4 i r�l Y n I - k. it ± _*.4 ,t, ,I ,p
i '" ff •I.
>a-.� 4y n.f, c'R � i ;, , , „ u s q, r r C: #,: i d pJ' `k fir,-
S'r`it.s€ y Y ' d JI y .T. !+ :r„+ , M. 1,E 'Y i �''`1.f y <.d• ,r. 1 I f
`' ^ -:•P r f .fFlt r i i t•r. J I L '.r i W • I_e -y 3 ,�, 1 1#€'
t<ip t'; �5 r yt'�:S'r iY" 'rN f ,�p4-_r A t s. . 5 s} ,Z, S 4 1 ,;ram ,+r F:k ��' +". nr` ,., r },,.* IT " ( ?!
s s € wf ♦ rrrr� { i f ¢ I ' f I .6. „R r?, 'k 'Ir .,r 'S s y t, 11.+ i J ' e ''#Fj .
Ii,.t Y yy',{, - {.. 4 r). r 4• t,. Yr 9 �, r ?x� I„ "1 ,
r f" q 14+_•A.T 'r'r.+.�`� "T� `,.a '. J I f z;.}.y . k�: 'a 'S`.x ji'v. . 1 i r -J i 1_. . J4"., , I. k 7 tic'v� f �''�t y _ y l
4.
' t 1 _iiy _ y? ti a" .,.5•Ir-I -r' •€T,., , t.€ !I t t.� e'' r r . J>.a .*-T . `_. .� "7"..,
��` r a.� 7 �:,4., ,t f YY r%r..� S n.t. .4 4 i ,,yr I .<.'+�r - K M' 1. - s $I. • '+ 1 yid. 1�1y4'*`:} a� i,.w Y':¢
« a rt.. 1 �e t !t y r t h d'x I`� ti 4 • 3 ..�I e' ` : ti � g p a a t 4 �S` i ' °' t a y r r J`,
{ :i"jr X •,,r i'Si I '+" - a t v I., €g `-6 ti ry. '- "' .' r t1- r4 'e ti
r er y.wa� ,t3!' $ Irt.+. +tf`I. 1vt•E�r€ "'kR._a'. i. 5.. x Y It ^J : i tt'- 'L ..:,Iti 'i. +• 1 : t
"l r1 a ,�, 5. F , D 'ar > (f .,;., 7 €.r , «+•.�: eK�,l Fvi'`i I$i,t r - �xr
rt `�' +rd i.i �' t"R s s"r+ `" i I L_ I, t if'i' F '-. .-_ I ,r.�i `:f.i.�.td' I,�i�. f yr =,.N r ti�i,•`a Y;�I „ «-X i
'' '�,� ,I`;77f i"'irtFr. r, ,tr`., fi,t 1,r.r'. .u+ r.t-s, i.,,,, 3 • k,IL..ay't '", .�r-•. "-A! .. I.I _ _r t-r_ r. i", d,•t -,i $ �E�'�V I .�r.�'r.r�.. sf ` ..-11 P
r •
FERN, ANDERSON, DONAHUE, JONES & SABATT, P_ A_
ATTORNEYS AT LAW
DANIEL J. FERN P. O. BOX SIB
RICHARD C. ANDERSON 435 MAIN STREET
ROBERT J. DONAHUE HYANNIS. MASSACHUSETTS 02501
STEPHEN C. JONES -
AREA CODE S17 77S-5625
CHARLES M. SABATT
July 6, 1987
Mr. John M. Kelly
Director of Public Health
Town of Barnstable
South Street
Hyannis, MA 02601
Re: Christian Camp Meeting Association beach
File #84-362
Dear Mr. Kelly:
In accord with our telephone conversation of last week, wnclosed please
find an itemization with respect tothe requested hot water installation. As
I explained to you, there is hot water in the restaurant and in a room ad-
jacent to the kitchen. The latter room is where the employees wash their
hands.
Because of financial pressures caused by the D.E.Q.E. action, it would
be very difficult for us to do the work this year. However, if the Board
were to delete that requirement from the present license, we would .be willing
to perform the necessary installation prior to the opening of the snack bar
in the Spring of 1988.
Would you kindly review the matter with .the Board and get back to me.
Should there be any questions please contact me.
Sincerely,
Robert J. Donahue
RJD/cpe
Enclosure
0
Fhr*st"an (Cal* Meeting Assocnat0n Beach
Affiliated with the Christian Camp Meeting Association
operating the original Craigville Beach since 1872
.(porncemo Ee a d" 4s'n - JJA, o �a v f ; CC - C,: 0(V o- �--
\a c ap- a �dl f�v I, vl a I-�.�co
�-�.��►'1�' Svc}-,� '�
�ea �b l V-Y\tt/L `S movV.
(,6
co
Lo S�
LP
J.
915 CRAIGVILLE BEACH RD. CRAIGVILLE(CAPE COD) MASSACHUSETTS 02636
I
COMPLETE THIS SECTION ON DELIVERY
SENDER: COMPLETE THIS SECTION
■ Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. Agent
■ Print your name and address on the reverse X ❑Addressee
so that we can return the card to you. B. Received b (Printed Name) C. ate Delivery
■ Attach this card to the back of the mailpiece, �--
or on the front if space permits. ovY
D. Is delivery address different from Rem In Yes
1. Article Addressed to: If YES,enter delivery address below: ❑No
U/O 4a 3. Service Type
0�� tegistered
ertified Mar ❑Return"
Mail
[3Retam Rec44 for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number ; 7006 081R:0000 3525 256B
(Transfer from service Iabeq I` I
BPS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540
i
UNITED STATEMUt SkOft�RA 10-13� � 1 �,. Q'.� #h�.
d
IS SEE 2CV& PfV1 ra ,a
I
• Sender:Please print your name, address, and ZIP+4 in this box•
I r I
Town of Barnstable '
�O Health Division
M 1 "� 200 Main Street
Hyannis,MA 02601
� I
1111111111161l?illllii?1(11111111[till?M 11i Iiii?dl11!ildl11
'CERTIFIED ML�ILTM RECEIPT § `� �`
�a'(Domestic Matl;Oiily,�No"ulnsurance Coverage,Prodrded),
.�Forudeliveryxinformation1visitour�website at www:usps:com® ��'`
�,FA
.
1
PS'Form 3800,June 2002,ti _ _ ;See Reverse`for Instructions
®Certified Mail Provides: (—eney)aooa eunr'0088 u„0:4 Sd
o A unique identifier for your mailpiece
:0 A record of delivery kept by the Postal Service for two years
Important geminders:
• Certifiel5 Mail may ONLY be combined with First-Class Mail®or Priority Mail&
■ Certified Mail is not available for any class of intemational mail.
p NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please consider Insured or Registered Mail.
n For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPS®postmark on your Certified Mall receipt is
required.
® For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mallpiece with the
endorsement"Restricted Delivery".
p If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail.
IMPORTANT:Save this receipt and present it when making an inquiry:
Internet access to delivery information is not available on mail
addressed to APOs and FPOs.
Certified Mail#7006 0810 0000 3525 2568
Town of Barnstable
Regulatory Services
rsra , Thomas F. Geiler,Director
MAM
► '` Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
September 14, 2006
p
Christian Camp Meeting Association
915 Craigville Beach Road
Centerville, MA 02632
NOTICE_TO ABATE VIOLATIONS OF SECTION 353-5, TOWN OF BARNSTABLE
CODE.
The property owned by you located at 915 Craigville Beach Road, Centerville, and doing
business as Craigville Beach Association Snack Bar, was inspected on September 13, 2006 by
Donna Z. Miorandi, RS,Health Inspector for the Town of Barnstable, because of an order.
The following violation of Section 353-5 of the Town of Barnstable Code was observed:
• Outdoor rubbish and garbage storage area[s] [is\are] visible to neighbor's and\or public
view.
You are ordered to comply with this Code by:
Completely screening in the outdoor rubbish and garbage storage area(s) within +I
sixty(60) days of your receipt of this order letter.
You may request a hearing before the Board of Health if written petition requesting same is
received within ten(10) days after the date the order is served.
Please be advised that failure to comply with an order will result in a fine of$100.00 and\or revocation of
your Health Department permit. Each day's failure to comply with an order shall constitute a "
separate violation.
Q:\Order letters\Donna-Dumpster letters\Craigville Beach Association Snack Bar.doc
PER ORDER OF THE B ARD OF HEALTH
Thomas McKean, RS, CHO
Health Agent
Cc: Mr. Tim McDonough
c/o Breaking Ground Caf6
791 Main Street
Osterville, MA 02655
Q:\Order letters\Donna-Dumpster letters\Craigville Beach Association Snack Bandoc
epose8 S S')eC-A T,
A^A�e- by S ,�,0
�-f�s ��•f /3 �ei�. �t P Pr�ve�
t
C.
4.0
�S s IL J
sN
INI
a
^L
aO �,�v�po�eNlS f'F Sffe:) SPC( 1)
l[1cc�/�lrcM�Ss.�
I
r
- z
GENERA
L NOTES -
!� THE EXISTING CESSPOOL SHALL BE PUMPED
AND FILLED WITH CLEAN, MEDIUM] SAND.
_-�i"
2JTHE DESIGN AND .COMPONENTS OF THE SEPTIC -.:.� �'` TYPICAL BOTH SIDES
SYSTEM SHALL BE /N COMPLIANCE WITH THE
MASSACHUSETTS TITLE SANITARY CObE d sILL- �'L. =_10NDA
t L'1�'DATION
THE L 0CAL BOARD OF HEAL TH RULES d REG'S.
® ® t 3) THE CONTRACTOR SHALL BE RESPONSIBLE FOR GROUND EL.= IO CONCRETE' CO MRS
iRo. T'�LOCH T/ON OF ALL UNDERGROUND UTILITIES AND 4 cAT 12
OR SCHEDULE 40 _
WILL NOTIFY DIG-SAFE PRIOR TO CONSTRUCTION. P v.C. PIPE 4� SCHEDULE 40 P vc.LoNIY� rn
US,E td x.f FL Di(y L�/FFL/SO.eS PITCH 114 PF.R '
PIPE' - MIN - N
41 septic SYSTEMS UNDER DR/1/E AREAS SHALL PIcrH I/4 PER Fr.
COMPL Y WITH H-20 LOADING.
5) TA YL OR DESIGN ASSOC.(790-4686) d BOARD OF INVERT ! ELEV. - 6.40•
HEAL TH ARE TO BE NO TIFIED PRIOR TO EL.= 8.4 0'
SEPTIC TANK INVERT
BACKFILLING OF SEPTIC SYSTEM. rNVERr .�2000 GALLONS EL.= 765' c-Is•x 4•Flow D/FF1/SORs
.6I THIS L 0 T IS /N THE FLOOD PLAIN t ZONE ,'B.. J - INi�,R
EL. —_740'_ NOTE:
7) REMO VE GUY U-POLE IN WA Y OF FLOW y -
24' USE; /' OF 3/4" TOP' OF WAS!•tLM CRUSHED
w DIFFUSORS.. 12.0 STOAIE ALL AROUND d UMDERNEA TH
NOTE: NOT TO SCALE.
DFFUSORS '
PROFILE OF o
GROUND NALU TABLE
SEWAGE DISPOSAL SYSTEM
•
i
SOIL LOG NO SCALE WITNESSED BY:
3/13/86 WITNESS:
DA TE NU�6fBER 5477--,— row of CRAIGVLLE_, WAL OMCER THOMAS MCKEAN
TEST HOLE ,fl =T HOLE ,fR BARNSTAI "
ENGINEER-0. GREGORY TAYLOR
EL. 9 . -.80' EL.
V Rl B� t� WID �l I sve Soy. DESIGN DATA.
EL-8.30'
A, AIG ��VIL L E 15[—A CH , /7/S) MEDIUM NUMBER of 2 PUBLIC BATHROOMS
SAND
TOTAL ESTIMATED FLOW 452 0 ■905 (TWICE AVERAGE) GPD
1 ' ^SIN B
B BOTTOM LEACHING AREA 6 (89) - 534
WA TER EDGE E ENT _1—_ ——____—— EL 2.3 _ WATER
------i------------------- —•---------�•---.----.———— -- — --- _—_._—. _-- _------__ —OF' _PAV M _-------- � - — S0. .
�, ,--— SIDE LEACHING AREA— 2 (89) - 178 SQ �
— REMOVE �� �`✓ -/ j --' — GARBAGE DISPOSAL N0 NONE 50Z INCREASE
- � 631. 75 _
r� MEDIUM TOTAL LEACHING AREA 'n2 SO F•F;
' ► - �� SAND PERCOLATION RATE ,�� 2 MIN IN.
--- 182. 37 � ... - TEST SE�'TrC �• -�----- yE E�C15-TINO sD (6;1-8'X 4' FLOW DIFFUSORS 449..38 CA S ��
f6J-87f4 FLOW aM77JCS1AR T�4M�f �'`� — �� R CR
f�T LEACHING AREA PER PERCOLATION RATE:1035 GP.D.,� 905 G.P.D.
CRUSHED STONE USE J' Off' WASHIED STOVYE v �f} y
. 1/S� ' OF�IVASHEO � t �._,20� NUMBER OF FLOW DIFFUSORS = '12
l �'f
ALL ABOUND d UVDERNEA-TH _ ALL AROIA'Ib d UA
CALCULA 770NS 034-CIA) - 534 GPD.
178 12.5) ■ 445 GP.D.
48' i 1 ,�. _ EL. 22' WA TER ENCOUNTERED 979 G.PD.
� 4B' SILL ELEV.=lO..�D.t �� CsUY�£ '
t�• ' TOTAL -
f �"-'- �----� r-'-' 1 SEPkTIC TANK L5 (905) 1358 GALLONS<
,..�_._...� �----- ----------�� __---, r-----� r-----� i I , , ' .�- , ��` - 4000 GAL.
\ APPROVED ..BOARD OF HEALTH _
------+ r-----� 1 ---� r--_`-1 t ! i 1 + i 1 ! \`
n r---" i --i-'' .., t f 1 t i j � i t I 1 i i 1 1 1 1 1 1 / _ •
"l
t 1✓_ 1 1 1 t 1 1 - 1 I 1 1 } � t t 1 1 ! t
..:.... ;. ... . .
DATE'
AGENT OR INSPECTOR
�-z--------- +
i ! _.�_ Fill GENERAL .NOTES.' REPAIR OF EXISTING SYSTEM
I ,
-----=------�_...._------------
--
-----------------------------
' 0
LQ
t
Y . -
/ -
TON of W ---- - ---
BARNSTALBE /
ct • r_ SI TE PLAN IN HARNS-TI48LE
(CE N ER VILLE)
J?'4 C'�s
FOR`i _ - ---- r-
------- ---
_ CHRIST/ A N CA MP ME E INC A SSO C.
----- - - - -- - --_
sO2� DEC. a 1989 SCALE T = JO
4 l - "HW ELEI —�20
O E- /V
.,O TOURS AND L OCA 7�lDNS BASED ON PLAN
SOUND
N TU C�E TB'Y' (� ARD EKELLEY DONE MAP, CH 16, 1986
NAw
(' EL EVA TONS ARE HIS, BA SED ON MEAN SEA L E VEL
AND RM. -26
AL SCE SEE DASD COURT PLAN
GRAPHIC SCALE ..,'
?EFi 4 6� 7 _ ;�
30 0 15 30 60 120 r.
-
( IN FEET
TA YLOR DESIGN ASSOCIATES INC.
l inch = 30 ft.
- �8 BA_RNSTABL�' ROAD YANKEE SURVEY CONSULTANTS
.N 4 tin
HYANNIS. MASS. 02601 143 ROUTE 14 9 O. BOX
is
CR
7 0-- 4686 :. M A STONS MILLS .MASS' 0�648
FLOOD ZONE' B Ala JOB h"UMBER. 1862
$ - REVISED: 2/26/90 --- �