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HomeMy WebLinkAboutTHE BARNACLE - FOOD �ARNAC EIY'T-iE--�__ -, ,�8�C vt(e�-- 1 Cenlee——`_�tUa�.�_��-1 NEW OWNER i h i l�t a a r- t 1 r Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. RAR.`STABLE", F.P.(Thomas)Lee 200 Main Street, Hyannis, MA 02601 Daniel Luczkow M.D. Alt. Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food. Establishment In accordance with regulatiors promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189.A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 306 Issue Date: 01/01/2022 DBA: BARNACLE, THE OWNER: BARNACLE ENTERPRISES INC Location of Establishment: 988 CRAIGVILLE BEACH ROAD CENTERVILLE, MA 02632 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 37 Total Seating: 37 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit. Expires: 12/31/2022 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Variance granted for one toilet on site, Self-closing screens shall be provided by all opening, No more than 37 seats are authorized, this equates to approx. 6 picnic tables depending on size of tables. { For Office Use Only: Initialst �•°Y'"E'O'�io Town of Barnstable i $ �Date Pais 3 — Inspectional Services NAM L — P 3 4(O Public Health Division Check# gyx Thomas McKean,Director 200 Main Street,Hyannis,NIA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE a 30"X I NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: 849ANACIA, 6A14& *R tS�5 ADDRESS OF FOOD ESTABLISHMENT: 89 CI A 1drV l-4, B&AGh MAILING ADDRESS(IF DIFFERENT FROM ABOVE): < < 1 ` cei� E=MAIL ADDRESS: �i Ift, lowm aA7or® All.� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: �7 4710- TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO X ...(ANNUAL WATER ANALYSIS REQtUIRED) ANNUAL: SEASONAL: _DATES OF OPERATION:?/ 1 /&O V/ NU MBER OF SEATS: INSIDE: D OUTSIDE: 3 TOTAL: _ SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE C RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE&NEW FOOD ONLY*** _REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:1Application EormsTOODAPP 2020.doc z o , c OWNER INFORMATION: `' Q FULL NAME OF APPLICANT -ro /Y VAkkI SOLE OWNER: YES/ 1) OWNER PHONE# SO g'd+QO.3 yDO ADDRESS PO S M,? 1j GST ri 7 0AN SPDX I CORPORATE OWNER: �DN� Carol J A! CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div.will NOT use past years' records.You must provide new copies and POST THE CERTIFICATES at your food establishment. , Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. 60ft Cc /®v- SIGNATU OF XLICANT DATE i ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. ` CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. 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 APPLICATIONS)AND REQUIRED FEES BY DEC 1 st.' f Q:Wpplication FormsTOODAPP REV3-2019.doc TOWN OF BARNSTABLE,. _ HEALTH INSPECTOR'S Establishment Name: Date:' Page: .of OFFICE HOURS PUBLIC HEALTH DIVISION a 0o s soA.M. % BARN STABLE. • �r 200 MAIN STREET s so a:so P.M. Item Code C-Critical Item DESCRIPTION O VIOLATION/PLAN OF CORRECTION Date Verified Mwss. g. - MON.-FRI. HYANNIS,MA 02601 No Reference _R.-Red item_ PLEASE PRINT CLEARLY 508-862 4 A4 FOOD ESTABLISHMENT INSPECTION REPORT Name Date Z h(pe 6 Trine of Insbection _ 6 C-. f s Routine Address �1 � - Risk- Food S Re-inspection - O {gyp�- Level Retail Previous Inspection I Telephone Residential Kitchen Date: . CL Mobile. e-operati n Owner HACCP Y/N Temporary uspec Hess p ry Caterer' General Complaint Person in Charge(PIC) Time Bed B Breakfast HACCP �j Z f In: Other ` - 1. . i Inspector -�v Out: Each violation checked'r uires an explanation on the narrative page(s)and a citation of-specific provision(s)violated. - Violations Related to Foodbo. me Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ l _ Violations marked may pose an imminent health hazard and require Immediate corrective Tobacco _ 590.009(F) ❑ 3 D d by the Board of Health. Allergen Awareness 590.009(G)Action.as determine 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) ow ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating jA ❑ 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 Cr ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for,HSP .. ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ' . ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No s❑_Ye .• . 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 6=One critical violation and less than 4.non-critical 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 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food.establishment operations. If _ if no critical violations observed,4 to 6Hon-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC=6)(590.007) aggrieved a this order,you have a right to a hearing. Your request must C=2 critical violations and less than.9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8Hon-critical violations. If 1 critical refrigeration.. 28.Poisonous or Toxic Materials FC-7 590.008 g violation,4 to 8 non- ''cal violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Sig to a Pri t: 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 Sig ature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted. -_ Y . N Dumpster Screen Y N - -- ..,�„ _r... - _ ;; - ..•N-.-tx•.�.--',i ,- ,-. z-.,.=z...--;,-iar. :r.-.r;5--- ..., ...�,•.�,�,. y..a,.y�..�q.,vF.�,-->....:•-.-..�vt.... -�v" ..-�-. �'^'�.-� - r.�i.''��3't,.. i zx,.w "` ...- . - -.�.. - a, Violations:related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45*F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked.and RTE Foods.* * 19 3• PHF Hot and Cold Holding 2-]03.11 Person-in-Charge Duties i 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 r 7-101.11 Identifying.Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other*.., ,,. a * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-101.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment ° 7-20 .11 Separation-Storage* 3-501.16 A, Roasts Held At or Above 130°F* P g 20 rime,as a Public Health Control Applicants* 3-302.11(A) Food Protection' 7-202.11 Restriction-Presence and Use* 590: 3-302.15 Washing Fruits and Vegetables 003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.1.1 Food Contact with Equipment.and Utensils* * 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3. 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food andRrated or of Foam* 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 *• 4-501.111 Manual Wazewashing-Hot Water 7.206:12 Rodent Bait Stations Raw.Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURECONTROLS. 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 5-101.11 Drinking Water from an Approved System* Eggs F 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145' 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* El/cave 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and-Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155`17 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 Stu Ratites-165ffi °F 15 sec*Stuffing Containing Fish,Meat,Poultry or 590.009 A D Violations Section 590.009 A in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( )-( ) ons o ( )-�) .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* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requires should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From.the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* (Blue Items non-critical 3-202.15 Package Integrity ( ) X Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11 Remaining Unsliced Portions of Beef Roasts* ' 3-101.11 Food Safe and Unadulterated* �) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.1 A Coolin Cooked PHFs from 140'F to 70`F 3-202.18 Shellstock Identification ) g Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F[0 41°F/45°F s Within 4 Hours* 23. Management and Personnel FC-2- .003 Tags/Records:Fish Products 5-203.1I Numbers and Capacities 24. Food and Food Protection FC-3 _ .004 4 3 402.11 Parasite Destruction* 5-20 .11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient * 5-20 .11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-Q2.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients' Supplied with Soap and hand Drying Devices ---- - 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 1 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:590Formback&2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590:000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. I flf�rik x Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli, M.D. rAnuscnoe.e,' Paul J.Canniff,D.M:D. r4}q. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 306 I Issue Date: 05/11/2021 DBA: BARNACLE, THE OWNER: BARNACLE ENTERPRISES INC Location of Establishment: 988 CRAIGVILLE BEACH ROAD CENTERVILLE, MA 02632 i Type of Business Permit: FOOD SERVICE { Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 37 Total Seating: 37 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: -- - - - - MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent i FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Variance granted for one toilet on site, Self-closing screens shall be provided by all opening, No more than 37 seats are authorized, this equates to approx. 61 t picnic tables depending on size of tables. i I f �pTNE 1 For Office Use Initials: Town of Barnstable n Date Paid ZI Amt Pd$D»S" BMWWABLE, » Inspectional Services L L MASS. 9� 1639. `0� Public Health Division iOrEn Ma+s Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 3 30�1� NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: URN p►tlL SN464PR iSES ADDRESS OF FOOD ESTABLISHMENT: 988 CRA l GV t A.1-6 B*Acoh Ad• MAILING ADDRESS(IF DIFFERENT FROM ABOVE): ^� L E-MAIL ADDRESS: -M f. i3nR �AG 1 ii®W m CAST- Al G-r TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 77 A TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO X ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: _ DATES OF OPERATION:?/ /»TO NUMBER OF SEATS: INSIDE: D OUTSIDE: 3S TOTAL: 3S SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT TO tj J M 91 VA GC-I SOLE OWNER: YES/ l) OWNER PHONE# Sa�'d�$0"3 JIM ADDRESS_ Pots I43 WEST N1ANN1SPv191 CORPORATE OWNER: ToNl * Carolitj CORPORATE ADDRESS: �D �r1��Y�'�� Q�RG� 1��, �'cI�1�1 �'�•MIq ('j�G�o► PERSON IN CHARGE OF DAILY OPERATIONS: SON did/ 0 1 List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date / / 1. 4 y 2. n�1 �l T�y�Ow l d 3/ a� SIGNATUA OF dPLIICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Application FormsWOODAPP REV3-2019.doc �C4_,C,U_ , I Sellaice, Dianna From: Soto, Kathryn Sent: Monday, May 17, 2021 9:36 AM To: Bellaire, Dianna Subject: RE: Barnacles and Salty Cow I asked them, including the owners husband that was involved with getting approval and they had no explanation. I noticed a letter in the.file from Marybeth to the inspectors that alluded to approval based on flow but did,not reference the great trap end of it so I am planning on asking her tomorrow. There has to be an explanation because Marybeth and Donna would not have let this go you know what I mean...very curious as to what From: Bellaire, Dianna Sent: Monday, May 17, 2021 9:31 AM To: Soto, Kathryn Cc: Bellaire, Dianna Subject: RE: Barnacles and Salty Cow No variance for Salty Cow? Is that all good? Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:S08-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The information contained in this electronic transmission t,"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 'Foxvn Attorney's Office of the'Fown of Barnstable. If you have.received this e-mail by mistake,please nioti.f,the sender and.delete it from your system. Please do not copy or forward it.Thank you for your cooperation. From: Soto, Kathryn Sent: Monday, May 17, 2021 9:31 AM To: Bellaire, Dianna Subject: RE: Barnacles and Salty Cow I did them both on Friday afternoon, they are all set. I must have them at my desk, I got back pretty late on Friday. I was planning on stopping in this afternoon to look up a couple things, I will give them to you then. Also Barnacle too will be ready for an inspection next week I think he said From: Bellaire, Dianna Sent: Monday, May 17, 2021 9:20 AM 1 i pp IME r - TOWN OF BARNSTABLE _ _ HEATH INSPECTOR,s Establishment Name: L � L: .Pa gyp` Wes" HEALTH N OFFICE HOURS Date: ' Z' page: I. Of PUBLIC LTH DIVISION 8:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 1639. `0S HYANNIS, MA 02601 MON.-FRI. No Reference R-:Red Item PLEASE PRINT CLEARLY ArFO1AP`` FOOD ESTABLISHMENT INSPECTION REPORT eoe-asz asaa Name Date 3 Tj/ue of Ty 12g of Inspection do s ou ine Address Risk Food Se ice e-inspection Level R eft ai Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation n ( Owner HACCP Y/N Temporary Suspect Illness I V _ ,.� G✓ 1. Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP pt,L.,.,ci,j k�!C In: ii Other d L Inspector u Sd Out: � ( la�w1Lv"l- f Each violation checked requi.es an explanation on the narrative page(s)and a citation of specific provision(s)violated. - Violations Related to Foo,Aborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen AatA wareness 590.009(G) ❑ .� r FOOD PROTECTION MANAGEME ❑ 12.Prevention of Contamination from Hands A � ❑ 1.PIC Assigned/Knowledgeable/Duties ` ❑ 13.Handwash Facilities C� 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 �i J G� FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) CAP- M 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 _ - - - W(,((� � ✓ �� PROTECTION FROM CONTAMINATION - ❑ 20.Time As a Public Health Control ❑ 8 Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) -2, ' •k, LJ y•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 AdvisoriesO I11 1 / � - L1 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ 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 ❑ 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 B=One critical violation and less than 4 non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents orinsects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8von-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 no -critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signa re Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date. Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's 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* 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 I Cooked and RTE Foods.*. I *. 19 PHF Hot and Cold Holding 2-103.11 Persorn 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 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 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* P g 20 Time as a Public Health Control 3-302.11(A) Food Protection* l 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables °- * 3-501.19 Time as a Public Health Control* -Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements - - -590.003(G) Reporting by Person in Charge*. v h 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice,gf Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ) 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,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111- - Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501112 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 Equipment 5-101.11 Drinking.Watenfroman-Approved-System*_. * gg Not Otherwise Processed to Eliminate 590.006(A) Battled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eycme 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 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 Surrff aces 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 Din cater- 3 201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) ( ) ( ) * / Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g• P �' 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 R 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* -- 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) _ Wild Mushrooms_* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 1 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-101.11 Package Integrity ( ) Y Critical and:non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities ' 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-203.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-002.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 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. `pF IKE roy, '- = a y;w ' TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: I V` -- Date: ( L Page: of NAP OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE = 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ­6}9• �00p HYANNIS,MA 02601 MON.-FRI.-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY rFD MA'�� FOOD ESTABLISHMENT INSPECTION REPORT S08 --l! i t2n-de- Oki 3^1 Name l v� �Qr Da f Type of �e of Insgection y'�Q� -�,�.a� p� l O s Routine Address �!QQ� `�(� � Risk ood Service> Re-inspection 1 1',, (- Level Re ai Previous Inspection Telephone Residential Kitchen Date Mobile re-operatio Owner HACCP Y/N Temporary ness ( - f c,'. L 2 Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP (,, In: 3 PVA Other Inspector ��� Out:3-Lt5lm Each violation checked req Tres 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) ❑ O Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) CL FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands /t� ✓ •� 1 w n ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities l � EMPLOYEE HEALTH PROTECTION FROM CHEMICALS V Lis &CI 10 Gt/! ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives V l �( t✓Z� ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) p ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating CAMCPA4 L4 VF- ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding `n PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control �K ❑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 ,n ` ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories ►JL� r Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) I$ aI Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating �---- within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ® Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4Oon-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8Oon-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's n Prin ,F,` 31.Dumpster screened from public view (k Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI�C'ss Signature �l �) Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N 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* S Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding - Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 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* 3-50 L 19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.1 I Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003 D Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* ( ) 3-306.14(A)(B)Returned Food and Reservice of Food* REQUIREMENTS FOR 590.003(E) I Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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* 3-401.11 A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food ContactEggs Surfaces of E s Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* 01"i-11112001 4602.11 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 3-401.1 1(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4 703.1 l Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g y 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* 10 Ratites-165°F 15 sec*Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory A uthority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 HandwashingFacilities 3-501.14 g 3-202.18 Shellstock Identification* (A) Cooling Cooked PHFs from 140°F[0 70°F Item Good Retail Practices FC 590.000 3-203.12. Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. !Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TC TOWN OF BARNSTABLE HE 9e: of HEALTH INSPECTOR-s Establishment Name: V�/ I�.l Date: Pa rowti OFFICE HOURS TT PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARN ABLE. • 200 MAIN STREET 3:3o-a:3o F.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ayy. `0$ HYANNIS, MA 02601 08-862-46644 No Reference R-Red Item PLEASE PRINT CLEARLY prEO MP+p FOOD ESTABLISHMENT INS C ION REPORT Name 4 Dateit e o Type of Inspection 'CA l' s Routine L Address i k od Se 81 Re-inspection C vel etail Previous Inspection Telephone / Residential Kitchen Date: ' y Mobile Pre-operation Owner HACCP Y/N Temporary Caterer General Complal t A Person in Charge(PIC) Time Bed 8 Breakfast GCF AA Other INV Inspector ut: Each violation checked requires lipl-an-a-ti I the narrative pale(s)and a citation of specific provision(s)violated. I Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ / ,, r, u 9 Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ ). Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ i FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS r,,A Ir r ❑ 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 TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking TemperaturesIL �q ❑ 5.Receiving/Condition ❑ 17.Reheating 1 , ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding - - - PROTECTION FROM CONTAMINATION F!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 f7 i ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY / ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations 1 '� Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Actio equired ❑ 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 Soyee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo Emergency Closure ❑ Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more 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. 590.005 B=One critical violation and less than 4 non-critical violations 25.Equipment and Utensils (FC 4 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address vi lions observed,7 to 8 non-crib al violations. If 1 critical refrigeration. 29.Special Requirements- (590.009) within 10 days of receipt of this order. 0la3 4 to 8 non-critical violati s=C 30.Other Inspe 's t f L PATE OF RE-INSPECTION: 31.Dumpster screened from public view Permit Posted? Greas e se Trap Previous Pumping Date Grease Rendered Y N N P P 9 l #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's i na ur .7, //, Pi \ Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y. N //✓ ( �Dumpster Screen? Y N 1Y Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 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 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 7-102.11 590.003(C) Responsibility of the Person-in-Charge to Common Name-Working Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140 F 2 _ Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F * 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.b03(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 * ( ) q 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) ' Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical 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 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* 18 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 Cl Uild Fd C Surfaces of * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* ( ) ean tenss an oo ontact Eggs-Immediate 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 Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 Jilin Eggs* 4-702.11 Frequency 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 Surf of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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 Requirements. radicsshould be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45'F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 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* I S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. i oFiNETo,," TOWN OF BARNSTABLE,. INSPECTOR'S Establishment Name: l ate: lJ Page: of h Q OFFICE HOURS PUBLIC HEALTH DIVISION . 800-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified e3. �e� HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY �fD"A°`' FOOD ESTABLISHMENT INSP ION REPORT Name DatMIT T e o Type of Inspection Hof F, f" Routine Address isk Food Sery Re-inspection MW Level Previous Inspection b Telephone Residential Kitchen Da Mobile re- era Owner HACCP Y/N Temporary ness t r Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP n: Other n Inspector d- Each violation checked requires an explanation on the narrat' a page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ / Action as determined by the Board of.Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM-CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals ON 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 f ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSPPPP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories 4 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations�� Critical(C)violations marked must be corrected immediately. (blue&red items) rj2Z Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance . ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical 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 if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation='F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 anon-critical violations. If 1 critical refrigeration. Within 10 days of receipt of this order. violation,4 to 8 non critical violation =C. 29.Special Requirements (590.009) Y P - 30.Other DATE OF RE-INSPECTION: InsliahlAkignature is rin 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 �T��M PI S net 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* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* ty g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* * 7-201.11 Separation-Storage* 20 Time as a Public Health Control 3-302.11(A) Food Protection 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 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(13) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef°ti° 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* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSY Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)incater- Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3 401:11(/1)(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. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3 403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 34103.11(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* 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 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 520511 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 2 . Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* - . Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. a - oFa rok I TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: 4e, Date: Page: of H OFFICE HOURS P PUBLIC HEALTH DIVISION 8:00-9:30 A.M. enansrne�e. 200 MAIN STREET 3:30-4:30 F.M. Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 1639. o� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY F0QQ ESTABLISHMENT INSPE TON REPORT 508-862A644 n Name Date Tyne of TvDe of Ins ec i n - outing n Address Risk od Servlc -fie' spection Level tai Previous In e n Telephone Residential Kitchen Date: r a Mobile Pre-op;retI d y Owner HACCP Y/N Temporary Suspect III ess r Caterer General Complaint Person in Charge(PIC) 0 Time Bed&Breakfast HACCP In OtherVft ✓ Inspector Each violation checked requires an explanati n on the narrativ page(s)and a citation of specific provision(s)violated. It Violations Related to Foodborne Illness Interventions and isk Factors Red Items), Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ n Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ f' 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 HSPMA A ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 'q �❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Itern-sl Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection toda ems ® Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 8=One critical violation and less than Orion-critical violations g( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically o la 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 i non-critical. . f critical water,sewage back-up,infestation of rodents or insects,or lack of )( be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008) 9 violation,4 to anon-critical vi ation =C. 29.Special Requirements (590.009) within 10 days of receipt of this order. . 30.Other DATE OF RE-INSPECTION: In tor's gnature lq'�4dj ' Prinft , 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's Sign 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* 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 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140'F 7-102.11 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* * 7-201.11 Separation-Storage* 20 Time as a Public Health Control 3-302.11(A) Food Protection 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 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for Washin Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 1g Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.000(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 1602.11 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 Beet Roast-130'F 121 uuu Eggs* _ 4-702.11 Frequency 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 Surf aces of Equipment* Shellfish* _ 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Chemical Ratites-165'17 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* i Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 1 Reheating for Hot Holding Requirements. radicsshould be debited under#29-Special 5 ReceivingiCondition 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 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23.30) 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 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* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41'F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.590Fon"back6-2doc *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 BARNSTAB.LE _ HEALTH INSPECTOR,s Establishment Name: Date: qlIWAPage: of F t r OFFICE HOURS • PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNS7'ABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 'FON1�" EPAD ESTABLISHMENT INSP C ION REPORT Name Dat Type of TXoe of Inspection OR outine Address Risk F od Service - --ac-ae ction Level Re Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Ll Caterer General Complaintry - Person in CharG51*.7, ge(PIC) Time Bed&Breakfast HACCP _ In: Other Inspector Out: Each violation checked reqPireia6e'xpianation on the narrative page(s)and a citation of specific provision(s)violated. ' Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities n 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 of 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 i ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP . ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&-red items) Corrective Action Required: No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils . (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC=6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to Snon-critical violations.'If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 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: Inspe M Prin 31.Dumpster screened from public view �rl Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's i t e 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* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12- Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 5 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45'F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140'F* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130'F* Applicants* 3-302.11(A) Food Protection* Separation-Storage*P g 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* 3-304.11 Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use* 590.00411) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reted of Food* Produce,Criteria* HSP HIGHLY SUSCEPTIBLE POPULATIONS 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or or Contaminated 7-204.12 Chemicals for Washing � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual 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 Temperatures* Raw Seed Sprouts Not Served* y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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`17 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145`F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e1/cnwc tnrzow 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell . Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* (A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165'F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3 401.11 C Game and Hr/d Mushrooms Approved By * ( )(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165`F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* Other 590.009 violations relating to good retail 59.0.004(C) r Wild Mushrooms 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec* 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'17 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140"17 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` I Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1 .009 3-502.11 Specialized Processing Methods* 30. 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. `oFt row HEALTH INSPECTOR'S Establishment Name: Date: Pa e: TOWN OF BARNSTABLE g. of do OFFICE HOURS P PUBLIC HEALTH.DIVISION 8:00-9:30 A.M. BARNS ABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p ,6M.s.0� HYANNIS,MA 02601 _ 50s 862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY rFD"""` FOO ESTABLISHMENT INSP CT ON REPORT Name. Dat Type of Type of Inspection g Routine Address isk P Fo ervice Re=inspection IGNP-1-6 aevel Previous Inspection Telephone Residential Kitchen • Mobile < Pre-operation Owner HACCP Y/N Temporary ss Caterer General Complaint Person in Charge(PIC) ATI'ne Bed&Breakfast HACCP Other Inspector t Each violation checked requires an explanation on the narrative pa e(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ 1 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 ❑ 1.4.Approved Food or Color Additives , ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling❑ 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 L O ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) I I A Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or J within 90 days as determined b the Board of Health. Overall Rating y y � ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled El Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3.non-critical violations. F=3 or more critical violations.9 or more no violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 6=One critical violation and less than 4npn-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical vi ations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. lion,4 to anon-critical viola"ns 30.Other DATE OF RE-INSPECTION: I s tor' " n t re 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 IC's Si a 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* 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 1 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) * Require Reporting by Food Employees and Contamination from the Environment 3-501.16 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers * (A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* p g 20 Time as a Public Health Control 7-201.11 Separation-Storage*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 * ( ) q 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Reaervice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served y 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* 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 Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* el/-n-1112001 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.l l(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Chemical Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2401.11 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 Tastin * * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Ln 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 * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41*F/45°F P25. 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* Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient Food and Food Protection FC-3 .004 ■ L63 .11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F Equipment and Utensils FC-4 .005 3-402.4( Records,Creation and Retention Within 4 Hours Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients' Supplied with Soap and hand Drying Devices Physical Facility FC-6 .007 7 - Conformance with Approved Procedures/ .11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans .12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Forrnback6-2doc *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. pp THE Tp TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: Date: Page: _of v� p OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified M.�p .6;q. .0� HYANNIS, MA 02601 508-862-4644 No Reference R Red Item PLEASE PRINT CLEARLY lFDN1P`p D ESTABLISHMENT INSPECTION REPORT 1 Namer� Date Tvneof T e-STfi ection Oaargflon 04outine Address ` l Risk od Service ection C l Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness 5� � G/L ! Caterer General Complaint Person in Charge(PI Time Bed&Breakfast HACCP l In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ l Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) t FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands l ❑ ,V 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS C ❑ 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 TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) l ❑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 FROMCONTAMINATION ❑20.Time As a Public Health Control V ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATION St D -01 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSPIj `u 10.Proper Adequate Handwashing CONSUMER ADVISORY f / 11.Good Hygienic Practices \ "_ (_ �LJ '❑ yg' ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Lam. Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: W . S 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/Excl si n.. ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more 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. 4 590.005 B=One critical violation and less than 4 non-critical violations 25.Equipment and Utensils (FC 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to a non.critical-violations. If 1 critical refrigeration. . 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations C. 30.Other DATE OF RE-INSPECTION: Inspector's Signat re Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered_` Y N #Seats Observed Frozen Dessert Machines: Outside Dining ` r 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* 8 Cross-contamination 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* - 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding._ 2-103.11 Person-in-Charge Duties - - 3-302.14 i 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 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person in Charge to 7-102.11 Common Name-WorkingContainers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130 F * 7-201.11 Separation-Storage* - Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 7-202.11 3-302.15 Washing Fruits and Vegetables 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* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11)- Variance Requirements 590.003(G) Reporting by Person in Charge* - - _ 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3306.14(A)(B)Returned Food and Rated or 7-204.12 Chemicals for Washing of Food* Produce,Criteria* HSP HIGHLY SUSCEPTIBLE POPULATIONS 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A7B) Compliance with Food Law* _ 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell.Eggs* Sanitization Temperatures* 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* 590.006(A) Bottled Drinking Water* _ 3-401.11(A)(2) Comminuted Fish,Meats&Game Patho ens* Ery cti-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155*F 15 sec* g 590.006(B) Water Meets Staudards 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 P 3-401.11(B)(1)(2) Pork and Beef Roast-13U'F 121 min"` Eggs* 4-702.11' Frequency rf cesSanitizationEquipment* 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°I7 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* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 ` Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 * (Blue Items 23-30) 3-202.15 Package Integrity (C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 4.11 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* 5-20 * 5-20 .11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 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 1 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. `gyp THE Tow TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: ' Date: Page: of v OFFICE HOURS PUBLIC HEALTH DIVISION e:oo-ssoA.M. BARNSTABLE. • 200 MAIN STREET 3:so-a:soP.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 9g,Me v �0� HYANNIS, MA 02601 soe-8' -4R644 MONNo Reference R-Red Item PLEASE PRINT CLEARLY 'FDN1P'6 FOOD ESTABLISHMENT INSPECTION REPORT Nam G D Moe of T ection ��� �� O s Routine L Address d Service e-inspec ion Ti L el Retai Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other l 1n Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items] Anti-Choking 590.009(E) ❑ ^ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ O J L� 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 l 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 L) ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling W I ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding / PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control L ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP G t L ] 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 L T Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: )�Q Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating Voluntary Compliance Employee Restriction/Exclusi ii S ection Scheduled Emergency Suspension Y YE ❑ rY P ❑ P ❑ 9 Y P C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations:9 or more 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. )(590.005 25.Equipment and Utensils (FC-4 B=One critical violation and less than 4non-critical violations ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must ' 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 29.Special Requirements ) within 10 days of receipt of this order. violation,4 to 8 non critical violations=C. p q (590.009 Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view ^ / Y l Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's 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* 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14. Protection from Unapproved Additives*- 19 - PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) 2 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*590.003(C) Responsibility of the Person-in-Charge to - Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* - 3-302.11(A) Food Protection* 7-201.11 Separation-Storage*g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* - _ 3-302.15 _Washing Fruits and Vegetables Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(l]) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS,FOR 3-306.14(A)(B)Returned Food and Rrated or of Foam* 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 O V - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B). Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.1-11 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* _ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System*. _ -. gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bnrtled Drinking Water* 3 401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ep i-inrzooi 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of utensils and Food Animals-155°F 15 sec* 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-13U`h 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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec* ut on on-Hands an Arms* 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and A Mushrooms Approved By 2-301.11 Clean Condition Hdd A * 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 929-Special Requirements. 5 Receiving/Condition 2-40.1.11 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. reventng Contamination When Tasting* C 3-403.11 Commercially - Blue Items 23-30y, 3-202.15 Package Integrity 12 Preventing C ii Wh T ( ) C ll y Processed RTE Food 140°F* Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands - 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �F THE ro TOWN OF BARNSTABLE_ HEALTH INSPECTOR'S Establishment Name: Date: Page: of P� 40 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSrABLE. - 200 MAIN STREET 3:30-a:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified m A.. g MON.-FRI. '� ,e39. �• HYANNIS,MA 02601 R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT sos-ssz-asaa No Reference Narn Dat ly ne o T sec ion l utine ood o O� Address 6 �(� k O Se�n ion /-7, /4� --Z_VIA,L L/lt vel Retail Previous Inspection lel Retail Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint /^^ Person in Charge(PIC) Time Bed 8 Breakfast HACCP In: Other v CGS � Inspector Out: 1 rV Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. C Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ J Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ t FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities �J l n VNI�1- EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives v�_ ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardouk Foods) W ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating t 1 ❑ 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 Critical(C)violations marked must be corrected immediately. (blue 8,red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance . ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo EmergencyClosure Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ ❑ ❑ 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 400n-critical violations )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to Boon-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dump ter screened from public view hc� 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 `'� v W V► �J ""� _ 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.) e FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 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 of Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-.Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 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 590.003(F) Responsibility 7-202.11 Restriction-Presence and Use*of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* _ 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3.-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* I Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B). Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501,1-11 Manual Warewashing-Hot Water 7.206.12 Roden[Bait Stations* Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and * 3-201.13 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* _ Saniti ation 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-I55°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from,an Approved.System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef ril 11112001 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* *- 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130*F 121 min Eggs* 4-702.11" Frequency of Sanitization of Utensils and-Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Chemical Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail * 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 3-201.17 Game Animals g g Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands _ Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 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* F1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities, 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 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. `pFT ro�, TOWN OF BARNSTABLE .HEALTH INSPECTORS Establishment Name, Date: Page: _ _ of OFFICE HOURS PUBLIC HEALTH DIVISION a:oo-saoA.M. ` BARNSTABLE. ` 200 MAIN STREET s:so-a:so P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MONA ,639. �e� HYANNIS, MA 02601 No Reference R--Red.Item PLEASE PRINT CLEARLY 'FDN1P�p FOOD ESTABLISHMENT INSPECTION REPORT 508-8624644 Nam Date a of Type of Inspection er outi Address Risk d Service el s ection Level Retail ection L ' Telephone UU Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness SjjS Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: C C � 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) ❑ C Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 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 l Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations V Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑Embargo ❑ Emergency Closure Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical 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 26.Water,Plumbingand Waste if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations l than 9 non-critical. If critical ' water,sewage 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must ons and non-cr no c g back-u p,infestation of rodents or insects,or lack of violations observed,7 to 8 non critical violations. if 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address 29.Special Requirements (590.009Y P ) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view r 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 1 I Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods * 19 . _ _ PHF Hot and Cold Holding_ . 2-103.11-- Person-in-Charge Duties - -- 3-302"14 Protection from Unapproved Additives Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F _ 15 Poisonous or Toxic Substances "590,004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying g Information-Original Containers* 2 590.003(C) Responsibility of the-Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 1307-102.11 Common Name-Working Containers* * _ _ -Applicants 7-201.11 Separation-Storage*3-302.11(A) Food Protection* * 20 Time as a Public Health Control 3-302.15 Washing Fruits and Vegetables Use 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by-Person in Charge*. 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-30fi.14(A)(B)Disposition 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 ofAduIterated or Contaminated � � - Food' 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 - - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(1-)) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 ;_ Shell Eggs*,- Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef°d-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 12 t 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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g� P arY 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. violationsrelatin to good retail * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 g g 590.004(C) Wild Mushrooms ( )( )( ) Good Hygienic Practices practices should be debited under#29-Special 3-201.17 Game Animals* 11 y9 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* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11,' Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashin Facilities 3-501.14 A g 3-202.18 Shellstock Identification* g ( ) Cooling Cooked PHFs from 140'F to 70°F Item Good Retail Practices FC 590.000 in 3-203.12 Shellstock Identification Maintained* Within Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402. Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(4(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 1.008 HACCP Plans 6-301.12 1 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 1 Conformance with Approved Procedures* S:590Forrnback6-2doc '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: `gyp I-HE Toro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: - Date: l ge: of v ~a OFFICE HOURS PUBLIC HEALTH DIVISION - 8:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A Ma AS. q. `0$ HYANNIS,MA 02601 sos esz�Rsa4 No Reference R-Red Item PLEASE PRINT CLEARLY lFDN1P`p FOOD ESTABLISHMENT INSPECTION REPORT / Name 141A1���. Dat e o Type of Inspection l O s Routine L Address Al isk od Se Re-inspection eve Previous Inspection Telephone Residential Kitchen D - Mobile re-operation Owner �c)/ Cy N�/ HACCP Y/N Temporary r Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspecto Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ c Action as determined by the Board of Health. Allergen Awareness 590.009(G) \t^. FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands p ,c A _/Y` .,Ca ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS /ham Wp,r.IYw ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives v,` L Coe ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foos !Jo ❑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(H P) ,.�. ❑ 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 f Critical C violations marked must be corrected'ct d immediately.( ) blue&red items) Y to s ( ) Corrective Action Required: Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspe ion Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspectionfd items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, g 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 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6npn-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 8non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. 'n,� violation,4 to 8 non-critical violations=C. 30.Other O E- SP TI �0�_ �ryY1:U Inspector's Signature Print: 31.Dump ter screened from public view (��I ,��i� / ^^ C Permit Posted? Y N Grease Trap Previous Pumping Date 1 Grease Fired ', #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's ASjre Print: Self Service Wait Service Provided Grease Trap Size Variance letter Posted Y N . _ roAl /o 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 L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods. 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 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* Time as a Public Health Control 20 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits Restriction-Presence and Use*its and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements -590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual 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 Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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 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-155°F 15 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-Immediate 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 Pathogens* Eff rnw 11112001 590.006(B) Water Meets Standards in 310 CMR 2?0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 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 191 min* Fggs* _ 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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 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. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A g 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 1590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F P Tags/Records:Fish Products 5-203.11 Numbers and Ca pacifies* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients[0 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S..590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000." *Denotes critical item in the federal 1999 Food Code or 106 CMR 590.000. oFt ►qi TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-5:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M., Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 019. .0� - HYANNIS,MA 02601 - MON -FRI. No Reference R Red Item PLEASE PRINT CLEARLY. 508-862A644 ' 11 FOOD ESTABLISHMENT INSPECTION REPORT Name Dat ' e of Type of Inspection er Routine Address Risk od Service,, R ection Level3 P on Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness AA Caterer General Complaint Person in Charge(PIC) Time Bed 8 Breakfast HACCP In: Other Inspectb a Out: r ' Each violati n checked requires an explanation on he narrative page(s)and a citation of specific provision(s)violated. f Violations Related to Foodborne Illness Interventions and Risk Factors(Red Itemsl Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ a� FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 2 lln� i. 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.Times Ac s 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 r ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY e ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No 4v� El 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 ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 9non-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 anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 29.Special Requirements . (590.009 Y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature 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' ig' lure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N \ v v Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15. Cooling Methods for PHFs Cooked and RTE Foods.* PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* 19 Contamination from Raw Ingredients 15 590.004(F) 590.003(C) Responsibility of the Person-in-Charge[0 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* Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 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 Wafer From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 I Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.1IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg-a-mrzoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and AutMidhority 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 97 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165'F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 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 13 Handwashin 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Cade and 105 CMR 590.000 3-202.18 Shellstock Identification* 9 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 4.11 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* 5-20 * 5-20 .11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1,0108 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 *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �p THE rpm TOWN OF BARNSTABLE . _ HEALTH.INSPECTORS Establishment Name: Date: Pag_e: of _ _ OFFICE HOURS ., . PUBLIC 2 0 MAN STREEETSION 3:00-s:30 A.M. BARNSTABLE. :30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified y MASS. g MON.-FRI. 4i"rEn Mn+>�0 HYANNIS,MA 02601 sos-as2 asaa No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT luA Name Dat � of Tyne of Inspection e a' �inspecti;n Address isk o Service e lon Telephone Residential Kitchen Date: Mobile Pre-operation Owner . HACCP YIN Temporary Suspect Illness n" 6 Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. AA ri- Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items l Anti-Choking 590.009(E) ❑ 40 Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS r1 ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives rL ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals L Ir FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Food ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 1, ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding _ PROTECTION FROM CONTAMINATION ❑ 20.Time 11s a Public Health Control - ❑ 8.Separation/Segregation/Protertinn 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 'Me IeN Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations -� Critical(C)violations marked must be corrected immediately. (blue&red items) O Correctiv Action Required: 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 ❑ Emplo stnctlon xcl i Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 6=One critical violation and less than 4nori-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=.F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9_non-critical. If no.critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility .(FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8rion-critical violations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N -Grease Trap Previous Pumping Date Grease Rendered Y IN #Seats Observed Frozen Dessert Machines: Outside Dining Y N ; I s Si tur PMt:,, ` Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 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 15 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 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* Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140*F* 2 Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control ( ) Responsibility Employee 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 590.003 F Res onsibilit of A Food Em to ee or An 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(i l) 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 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 8 Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts 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 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y * Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* Equipment i•y 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* ' 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* i * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g• P mrY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under . Game and Authority Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* RegulatoryAuthor/ty 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. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* Blue Items 23.30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F Conveniently Located and Accessible Within 2 Hours and From 70*F to 41°F/45"F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* * 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F%45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures I 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 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 *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000: of t"E rw�. TOWN OF BARNSTABLE - HEALTH INSPECTOR'S Establishment Name: Date: Page: of v` do OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARN57'ABLE. ` 200 MAIN STREET 3:30-4:30 P.M. I Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified A M63 I. HYANNIS,MA 02601 - sos-862�R644 No Reference R-Red Item PLEASE PRINT CLEARLY , FOOD ESTABLISHMENT INSPECTION REPORT Nam ( Dat ype of Tyne of Inspection Routine V `�t�" Address G ( Risk I Fo Re-inspection ` Level a Previous Inspection ' Telephone Residential Kitchen Date: Mobile F re-o eration " Owner HACCP YIN Temporary Caterer General Complaint A- (0%--c Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other �a V� Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. .�j Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590. 9(E) ❑ 1� Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 59 .009(F) 1 Action as determined by the Board of Health. Allergen Awareness 5 .009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands i. 1.PIC Assigned/Knowledgeable/Duties i ❑ 9 9 ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 04 Y� ❑ 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 Fo ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ° ( � ❑ 5.Receiving/Condition ❑ 17.Reheating ` L ❑ 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 t ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories e Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: -3 l` t-t/l Kai Dr` Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. O ❑ Voluntary Compliance ❑ Emp n ion a-in Em ension C N Official Order for Correction: Based on an inspection today,the items El Embargo ❑ Emerge ure o ntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical 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 if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically o la 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 i non-critical. . f 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 anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) Y p 30.Other DATE OF RE-INSPECTION,• Inspector's Signature Print: 31.Dumpster screened from public view a f�ru jP (J�+� ` Permit Posted? Y N Grease Trap Previous Pumping Date `' ! Grease Rendered Y N #Seats Observed - Frozen Dessert Machines: Outside Dining Y N PIC's Si re c 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* 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 7 5 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 7-102.11 Common Name-Working Containers* 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation-Storage** 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* P g 7-202.11 Restriction-Presence and Use* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y * P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products 4-501.112 Mechanical Wazewashing=Hot Water Monitoring 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3 401.1 I(A)(2) Comminuted Fish,Meats&Game ning Pathogens* Effect-11112001 M 4-602.11 Clea Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3 401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g. P �' 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 [he 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. 5 Receiving/Condition 2-401.1.1 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-102.11 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMIZ 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 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 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. yoFINE row TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name- Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 659- .0� HYANNIS, MA 02601 sos sz 4s4a No Reference R-Red Item PLEASE PRINT CLEARLY rFON1P`p FOOD ESTABLISHMENT INSPECTION REPORT NameLe 17 Date T e of T,yoe of Inspection O.oerafiew{s1 Routine < Address Fi2�kQ "_ Re-inspection [(e Retai Previous Inspection Telephone Residential Kitchen Date: CV Mobile re-operation Owner HACCP Y/N Temporary u s gni --3t Vk V- Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Ig' v. kA,\ In: Other Inspector Out: Iv` �r 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) ❑ J\ 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 �' 0 ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures N ❑ 5.Receiving/Condition ❑ 17.Reheating cJ L Q ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling o ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding j -PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control 1' ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) (� , J " ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY v al - ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restri tion/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Sus n- ion C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more 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 von-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 violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials. (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address 29.Special Requirements within 10 days of receipt of this order. violation,4 to Snon-critical violations=C. p q (590.009) Y P 30.Other PATE OF RE-INSPECTION: Inspector's Signature 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 Papature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violation 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 Assi ent of Responsibility* 8 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours* ( ) gnm * 14 Food or Color Additives 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.l l(A)(1) Raw Animal Foods Separated from 3-202.12 Additives 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances - 3-501:16(13) Cold PHFs Maintained At or Below 41'F/45'F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7 7-102-101.11 .11 Id Common Name-Working Containers* 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* . Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130'F* 7-201.11 Separation-Storage* Applicants* I 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* 3-302.15 Washing Fruits and Vegetables 7.202.12 Conditions of Use* Applicant To Report To The Person In Charge* 3-304.11 , Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR ' 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and,Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A_B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH.. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155*F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145*F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* . Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* ery a"°e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155*F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec* � aces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165`F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145`F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* 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. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165*F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140'F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140'F to 70'F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'17 to 41'F/45'F Item Good Retail Practices FC 590.000 * 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 3 402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibili Operation and Maintenance Temperature Ingredients to 41°F/45'F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention ty' P Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 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 HEALTH INSPECTOR'S Establishment Name: Date: v't� Page: of �tNe rp�aj OFFICE HOURS '° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. snnNsrne E. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MON.-FRI. �639 �0 HYANNIS, MA 02601 - " No Reference R-Red Item PLEASE PRINT CLEARLY 508-662-4644 �brFOMP`' FOOD ESTABLISHMENT INSPECTION REPORT Name Dat Type of lynp of Inspection - O er Routine Address460 Risk &7 od Servic' - n c Level Rexall Previous Inspection Telephone Residential Kitchen Date: � 41 Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness G �C Caterer General Complaint Person in Charge(PIC) Ti Bed&Breakfast HACCP (� In " Other Inspector Out: s Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. C ✓ �-i Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ J Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS Puzi y ✓ I ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives .CSC �. ❑ 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 In- r^ ❑ 5.Receiving/Condition ❑ 17.ReheatingL4j ❑ 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 S ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations -5 cz ' Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ® ❑ Voluntary Compliance ❑ Employee a clu e n S duled ❑eEmergency Suspensi C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ oluntary Disposal'' A❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=•F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 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 8non-critical violations. If 1 critical refrigeration. within 10 days of receipt t of this order. violation,4 to 8 non-critical violations=C. 29.Special Req irements (590.009) Y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.DuyVY screened from public view Zsk Permit Posted? N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sign Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N V Dumpster Screen? Y N , Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 6 Crosscontamination 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 15 590.004(F) 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 Anima]Foods Separated from Each 7-101.11 Identifying Information-Original Containers* °F* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(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 3-306.14(A)(B)Retained Food and Reared or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004A-B with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) Compliance 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* 4-501.112 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 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- mme is sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved S stem* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 111/2001 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* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Contact Surfaces of Equipment 3-401.11(B)(1)('2) Pork and Beef Roast-130°F 121 min* Eggs* Shellfish and Fish From an Approved Source 8g 4-702.11 Frequency r f ces of Equipment* 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* Sources* Ratites-165°F IS sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstoek 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 ni 3-201.17 Game Amals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practiceRequirements.srho ld be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's'Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * Blue Items 23-30) 3-202.15 Package Integrity g g 3 403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstoek 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstoek Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstoek Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* ; 8-103.12 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. oFtr.�,r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: `. of p� tip OFFICE HOURS PUBLIC HEALTH DIVISION a:oo-ssoA.M. ' BARNSTABLE, 200 MAIN STREET - 3:30-a:so P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS, MA 02601 5oON.-FRI No Reference R-Red Item PLEASE PRINT CLEARLY 'FON1A�` FOOD ESTABLISHMENT INSPECTION REPORT Name Date f e of T of Inspection - Op er outine Address / Risk Service✓ n t Level e a Previous Inspection I,, � < Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ }} Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ f r" Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ r� t FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands 1,94 AIL - ❑ 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 /`-'F- Critical(C)violations marked must be corrected immediately. (blue&red items) L_J Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. (I ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 590.005 B=One critical violation and less than 4 non-critical violations 25.Equipment and Utensils (FC 4 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590,007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N I►'�/b #,Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signaldre 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* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45'F Within 4 Hours* 15 Cooling 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501. g Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Chazge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15 Poisonous or Toxic Substances 590.004(F) i EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g o 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F � * 7-201.11 Separation-Storage*Applicants 3-302.11(A) -Food Protection* 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** 590.00411 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.004(11) Variance Requirements 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 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 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 3-801.11(D) _ Raw or Partially Cooked Animal Food and * 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and 3-201.13 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 1 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 Equipment 5-101.11' Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 sec* aces 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 3-201.15 Molluscan_Shellfish from NSSP Listed Chemical* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec 3-401.11 C 3 Whole-muscle,Intact Beef Steaks 145°F* kitchen o erations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* ( )( ) p 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. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165`F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140'F to 70OF 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction*, 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402. 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 Records,Creation and Retention* Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 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. `pp THE row TOWN OF BARNSTABLE - HEALTH INSPECTOR'S Establishment Name: ,`I�Q Date: 5 /oPage: of �v 1p OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �b 6;. .0� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY prFO MP'�° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Dat_ /5 Type of Type of Inspection /J O 'on s Routine 1 r Address C Risk pod Servi Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile re-o er n Owner HACCP Y/N Temporary uspect Illness Q} Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other O Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ R FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands �1 ❑ 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 TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 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 IL e� ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. oluntary 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 F] Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report when signed below b a Board of Health member or its agent 24.Food and Food Preparation (FC-3 590.004 P 9 Y 9 A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations.9 or more non-critical violations, )( ) 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 B=One critical violation and less than 4 non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewa a 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must g 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 within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. Requirements (590.009) within P 30.Other DATE OF RE-INSPECTION: nspector's i nat Pr 31.Dumpster screened from public view LoTalrfw - Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N �, #Seats Observed Frozen Dessert'Machines: Outside Dining Y N PIC's�ature Print: s_ Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N /J 1 Dumpster Screen? Y N N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 79 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 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 Identifying Information-Original Containers* Other* y g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F Applicants* * 7-201.11 Separation-Storage 20 Time as a Public Health Control PP 3-302.11(A) Food Protection 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 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Re or of Food*Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated ted or 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 * 3-801.11(B) Use of Pasteurized Eggs* g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and g- Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and * 3-201.13 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 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-Immmeme disate 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 Pathogens* EN give 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* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Contact Surfaces of Equipment 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* E s* Shellfish and Fish From an Approved Source gg 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,Poultryor 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,temporazy and residential 1Q 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 2-30111 Clean Condition-Hands and Arms* the a ro riate sections above if related to .Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave PP P 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* Other 90 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 es shoo 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. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity non-critical Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70'F 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* * 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 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 *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. Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT ; PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A). Assignment of Responsibility* $ Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 1 Separation-Storage*g 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* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS - - 3-202.14 _Eggs and Milk Products,Pasteurized* -501.114 -- Chemical Sanitization-Temp.,pH. L1$ Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.41(A)(2) Comminuted Fish,Meats&Game Pathogens* Effe°"°e innooi 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) Purk and Beef Roast-130-F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2). Ratites,Injected Meats-155'F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 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* p 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3403.11(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 23-30) 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items non-critical 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 $ Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Lug- 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 Cooling Cooked PHFs from 140°F to 70°F (A) g * 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 6 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 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 3-002.12 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 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* f 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* �( 8-103.12 1 Conformance with Approved Procedures* I S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.r *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `oF. ror� TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: jC'06'\CLk L�fu lc R jr Date: � Page: of OFFICE HOURS I ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. ennMASS Le. 200 MAIN STREET 3:MON.-0 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ,639. �0� HYANNIS,MA 02601 M-8 -FRI. �OrEO Mfi 508 862 4644 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT Name FnC �` C F� Date Tyoe of Type of Inspection s Routine j Address H� v") iv` Risk ood Sery Re-inspection �' Level a al Previous InspectionfX I Telephone Residential Kitchen D ` Mobile Pre-o eration I p 2 tL�fa Q M V Owner /`V HACCP Y/N Temporary ss ok-q AL fin Caterer General Complaint Person in Charg (PIC) ( Un Time Bed&Breakfast HACCP V. ly t V In: '�� Other f {- Inspector V\ _^ Out. v 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) ❑ -re Mof Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands l� t�V1, ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS v ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives m ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ,I Zvi ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags I Records/Accuracy of Ingredient Statements ❑ 18.Cooling _ f ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding ddl rP1( rn PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control n ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP V On A. W , U h ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY l pn ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories // Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) ( 6 UL, Overall Rating Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No Yes HE 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 ❑ 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 anon-critical violations. F=3 or more critical violations. n no critical violations observed, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing C_-2 critical vi tions and less than 4non-critical. If no critical 28.Poisonous or Toxic Materials FC-7 590.008 g and submitted to the Board of Health at the above address vpfati s b erved,7 8 non-critical violations=C. refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. 3 .Other DATE OF RE-INSPECTION: InVtor'sature P �� ✓i ` �r I 31.Dumpster screened from public view I J7 ,W ✓\ ,'jlr/} Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N \#Seats Observed Frozen Dessert Machines: Outside Dining Y N P 's , ture Print:a Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y � P�� 14�_,_ t-_ e��, J f N oF.Ne*q, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: qr•t rn UG It �H(A C K f�a,� Date:- j� �! Z! I Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. ~' BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. MASS, g. MON.-FRI. Item Code C-Critical Item DESCRIPTION OF VIOLATION/k-AN OF CORRECTION Date Verified �AtFO MP+ HYANNIS,MA 02601 50s-asz-asaa No Reference R-Red Item PLEASE PRINT CLE4RLY FOOD ESTABLISHMENT INSPECTION REPORT I { r Name h �= Date ) Type of Type of Inspection t D .e ion Routine / + p, ,r, l•.,t!.p,�l- rig✓',`/� j Address J CL( r Risk I (Food Service Re-inspection ( ' rw wr . yr Level Re al Previous I9spect1'on Tal/ I Telephone Residential Kitchen Date: S-,)2/1? \ I// Mobile Pre-operation J I r• r r 1r CA P Owner HACCP Y/N Temporary Suspect Illness ,- 1 Caterer General Complaint o ^u Utz' P t" I'A f r^ Person in Charge(PIC) Time Bed&Breakfast Ot eCP (RorM / 1 ra tr_ r It' r! In: /� Inspector `,vrI S Out: S�Hf. ry h o C -.203. �JAr.f,n r 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) ❑ r u �r t 0- O X cA x- r k nr J d + Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ / Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ rn rA FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands I l l ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities r i 7 0 1 c EMPLOYEE HEALTH PROTECTION FROM CHEMICALS i ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ' i 1 ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals ' I t FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 0 !n / r A A?✓ ✓ fn 0 1/i�1,n ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures p , + , ❑ 5.Receiving/Condition ❑ 17.Reheating J J p t ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 2 f V Gf fj?r I`' �� ' +7 FV t/n ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding vJ MA.4 1 e SP G fn.�G( ___ p J are w 0 PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control q I y tq + 'n+, r r.kl/l t 0 r( ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ..A ruv rd 2 011), ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP r ! ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY a thlve v P r 0/D Opir+ en tet 1prIl ti r 1 ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) !! Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No Yes i 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 ❑ 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 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils FCC 590.005 9 or more non••ciitical violations=F. ( )( ) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than 4non-critical violations j 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If - 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 water,sewage bpi k-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials FC-7 590.008 g C=2 critical violations and less than 4 non-critical. If no critical refrigeration. ( )( ) be in writing and submitted to the Board of Health at the above address violations observe/d�,7 to 8 non-critical violations=C. g 29.Special Requirements (590.009) within 10 days of receipt of this order. � r 30.Other DATE OF RE-INSPECTION: Inspector's Sign Yure 1 31.Dumpster screened from public view I Print: { G L G �r. i C'r / fe Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N < ' #Seats Observed 1 Frozen Dessert Machines: Outside Dining Y N PIC's Signa re Print: ;Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N I Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 19 PHF Hot and Cold Holding g 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. EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to * 2 Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers* A 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 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits Restriction-Presence and Use*its and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reted or of Food*Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 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* 4-501.112 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 Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* 4f3 ce�e uuzooi 4-602.11 Cleaning Frequency of Utensils and Food .animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Mears-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Poultry Meat, 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish, O'or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 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 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 5 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-,3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41'F/45'F 25. Equipment and Utensils FC-4 .005 3-402.4( Records,Creation and Retention - Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 6-301.11 Handwashing Cleanser,Availability 7 Conformance with Approved Procedures/ g Y 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. {f 0 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BA1LVJ1reBM Paul J.Canniff,D.M.D. MASS 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 306 Issue Date: 01/01/2020 DBA: BARNACLE SNACK BAR OWNER: BARNACLE ENTERPRISES Location of Establishment: 988 CRAIGVILLE BEACH ROAD CENTERVILLE, MA 02632 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 37 Total Seating: 37 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Variance granted for one toilet on site, Self-closing screens shall be provided by all opening, No more than 37 seats are authorized, this equates to approx. 6,picnic tables depending on size of tables. opt tp� For Offic • Initials: Town of Barnstable Date Paid` $� ,s lABNSTABF.B. : Inspectional Services E MASS. -� f6�9' `� Public Health Division check# 3a r.R �fD µPy A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 ' Office: 508-862-4644 Fax: 508-790-6304 ; APP ICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE D NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: 421l A)/vJf. FAi—fior n S," ackSt ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIE ERENT FROM ABOVE): V E-MAIL ADDRESS: CIS- #v e'r yov TELEPHONE NUMBER OF FOOD ESTABLISHMENT: w TOTAL NUMBER OF BATHROOMS: WELL WATER: YES_NOX ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: ACICI TO 10 /Al d)O NUMBER OF SEATS: INSIDE: 0 OUTSIDE: &C TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING.AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE _,IK2ETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE n) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc 1 L/ s OWNER INFORMATION: ` FULL ME OF APPLICANT UL A IIV IVAG Flrrr '/A SOLE OWNER: YES/® OWNER PHONE# ADDRESS P IS M 7;► CORPORATE OWNER: A/ • CORPORATE ADDRESS: a PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. 064 AJOU.94XI A" Al 2. r 21 2V! S GNATU A LI ANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openinE!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/ai)plications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. QAApphcation FormsTOODAPP REV3-2019.doc lr-- � Town of Barnstable BOARD OF HEALTH I, Paul J Canniff,D.M.D. Board of Health l Donald A.Gaudagnoli,M.D. BAmNsTh6Lr- ! John T.Norman MAS $ F.P. Thomas Lee Alternate ' u 9. 200 Main Street, Hyannis, MA 02601 Phone: (50$) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food'Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A,la permit is hereby granted to: i Permit No: 306 , Issue Date: 03/01/2019 DBA: BARNACLE SNACK BAR OWNER: ANTHONY NINIVAGGI 1 Location of Establishment: 988 CRAIGVILLE BEACH ROAD CENTERVILLE MA 02632 Type of Business Permit: FOOD SERVICE I I Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 37 Total Seating: 37 FEES , FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: iEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: -- MOBILE-FOOD: MOBILE-ICE CREAM: �� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: I r FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A,COMMON VICTUALER LICENSE Restrictions: Variance granted for one toilet on site, Self-closing screens shall be provided by all opening, No more than 37 seats are authorized, this equates to approx. 6 picnic tables depending on size of tables. i fr f•t �ff� i oFt►+e TAN Far Office Use Only: Initials; " Town of Barnstable ' , Date,Paid (V Amt.Pd$r i ? ' BARNurABLE, .,. „W Inspectional Services Gar-5�c� r'AA+°i� Public Health Division ' Check# T Thomas McKean,Director ,L 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 i APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE ' NEW OWNERSHIP RENEWAL X— NAME OF FOOD ESTABLISHMENT: 14wd&1 C I'D/ /y S!°S ��i►� ✓ ���'��S '�" w ADDRESS OF FOOD ESTABLISHMENT: Ong C.Arlo J At '6«f e'4 MAILING ADDRESS(IF DIFFERENT FROM ABOVE)- E-MAIL ADDRESS: JAC 1941AQAJ!C A CAI'""97 Jed TELEPHONE NUMBER OF FOOD ESTABLISHMENT: Owl I TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: V //�/9TO NUMBER OF SEATS: INSIDE: OUTSIDE: „ - TOTAL: 3 fi SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. r ***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? /V IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE _,,RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED &BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE 02) TOBACCO SALES ,— (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:Wpplication Forms\F00DAPPREV2018.doc F i i 1 i L PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT -rom / /I�[���/��1J<•-I SOLE OWNER: YES NO )�OWNEF PHONE ADDRESS PO�4 Iq3 ��CS�I7rJ1 Oa 7a- . CORPORATE OWNER: 1j FEDERAL ED NO. CORPORATE ADDRESS: Lira I 1W IIA, A&LA, PERSON IN CHARGE OF DAILY OPERATIONS: AI 111l1 I i 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 All en Awareness Expiration Date w _ CC � e 1. IV 7 1.�� Q z.eA �iwi t ( ` L�/Ir i t ! k SI NATURE A LICANT DATE I I ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. Prior to opening!1 Please call Health Div.at 508-862-4644 to schedule your inspection, Please call at least(7)days in advance, ! FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http•//www townofbarnstable,us/ilealtlidivision/applications-asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. { ) I NOTICE: Permits run annually from January I st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COhIPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st r I 1 t. Q:1Application Forms1F00DAPPREV2018,doc I ` � t i PERMIT NO: TOWN OF BARNSTABLE ISSUE DAT 281 BOARD OF HEALTH i 04/01/201 PERMIT TO TABLISHMENT ` In accordance :ati ga �a hority of Chapter 94, ermit is hereby ranted to: Section 395A and _ 4er � �� ectr�>€'�t►�e e� . �� Y g BARNACLE ENTERP IA C _; ARNAC T , RAIGVIL ,•f..CENT itR�� 02632 Whose place of business is �, ti� _� Type of business and any Je!tf s: ISH ., _twkR 'r. AN E - BLE P _ Too operate a food establil-hoept i ,the _ _ r. g. RESTRICTIONS IF ANY: Only&tc�oo�r S�eat g. JunL�1�4� nance for 2 eats ith the following conditions: the resta jaj wi€►�onl be en dur the flours that the Crraigv Ile Beach bith -m cities are open when using seatiniaVthe`,�stlis� ` SEATING: 20 ANNUAL% Aff TEMPORAZI SEASONAL: YES t^i ! lf • 4 1D OF HEALTH � `' E s D.M.D., Chairperson RETAIL FOOD STORE: . u J.Canniff, p FOOD SERVICE ESTABLISHMENT: d J ichi Sawayanagi RESIDENTIAL KITCHEN FOR RETAIL SALE' A, .' � onald A. Guada noli,M.D RESIDENTIAL KITCHEN FOR BED+BREAKFAS'f� � g Q MOBILE FOOD UNIT: re TOBACCO SALES: FROZEN DESSERT: I Thomas A. McKean, RS, CHO CATERER: Director of Public Health f NOT VALID'UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE I f I 4 I I F I fHE Town of Barnstable �pt (, Regulatory Services Gt'w I ZIvY axxsrnsi e, MASS. Richard V. Scali, Director BARNSTABI,E 9 $ Ib (�• 0 3 5`JfPELE-C,NiE0.`n.1E•CfIt11R•M'tRN r15 �plED �A� n a;r ns nns ass zo ax s mans u t Public Health Division f(.� Thomas McKean, Director �Dg 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: 3'a 7'I NAME OF FOOD ESTABLISHMENT: BAwAdr- nprl sox % V ADDRESS OF FOOD ESTABLISHMENT: QI ou I IIt MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: 13J9,2�/ �®69indQ S A NIT TELEPHONE NUMBER OF FOOD ESTABLISHMENT: W)`mil- lJgq 9 NUMBER OF SEATS*: INSIDE: D OUTSIDE: 0),5' TOTAL: a1� * Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: Q TYPICAL HOURS OF OPERATION MON-FRI: TO DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) d&n IF SEASONAL: APPROXIMATE DATES OF OPERATION: El I /?TO >O / /S / I0 ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE DETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO, MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) Q:\Application Forms\Foodappldoc ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? &Mit `f CONTACT INFORMATION: FULL NAME OF APPLICANT_ 119,0 I V SOLE OWNER. YES ADDRESS h 193 kjggr 0 jSAyj j PHONE # 0 — IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 416- kQP7 STATE OF INCORPORATION: FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL s BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) G 1. I EXPIRATION DATE: �/ 4 / _ 2. t 7/11 �GAET EXPIRATION DATE: EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON _THE CERTIFICATE*** LIST THE NAME OF YOUR CERTIFEkFOOD ALLERGEN AWARENESS TRAINED STAFF. '75 . 1. EXPIRATION DATE: J / Fj / SIGNATURE OF APPLICANT AND DATE Q:Wpplication Forms\Foodapp3.doc l_ I l rRNO: TOWN OF BARNSTABLE ISSUE DAT BOARD OF HEALTH 04/01/201 PERMIT TO QT � `TABLISHMENT In accordance ti y `ga a ,horny of Chapter 94, a r; Section 395A and 'eh ecth�h he ermit is hereby granted to: fl �� R_ ANTHONY NINIV CA ARNACL k pRAIGVIL •*.CENT ��L ,1N1 02632 Whose lace of business is f .E a B L z F< LISHM , Type of business and any Testis: R , t rt I M. _ . To operate a food establiih6ent irf the MWBIlLE x f RESTRICTIONS IF ANY: Vanarcepra ed!or one t i " II be pro ide y all pening,No more than 37 seats are ah iz th a es to rcl. pi nibles deendingon siz o leg. rp L� SEATING: 370 ANNUAL t a SEASONAL: YES TEMPOR : 5'' 1 - � E E s OF HEALTH - r rL RETAIL FOOD STORE: Canniff, D.M.D., Chairperson FOOD SERVICE ESTABLISHMENT: b I .'� eaL hi Sawayanagi RESIDENTIAL KITCHEN FOR RETAIL SALE: 4. �' ,. D .nald A.Guadagnoli, M.D RESIDENTIAL KITCHEN FOR BED+BREAKF r xa a cp. t r MOBILE FOOD UNIT: TOBACCO SALES: FROZEN DESSERT: �"" - _ "' '^ Thomas A. McKean, RS, CHO CATERER: Director of Public Health I NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS'LICENSE i I { i F l E i t i F I i , j j THE Town of Barnstable o„ Regulatory Services 2� I BARNSTABLE, * Richard V. Scah, Director MASMASS. BARN TABLE 9 039. BAR`iSTABIE•C'_NiJtv'1E•OCPJ •H'tf11 15 �A�fpMp2lA` Public Health Division YARBUNSMLLS'639-20 4Vr_iBNNSTME Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: 3'a NAME OF FOOD ESTABLISHMENT: RfijeO "Vkri SOS .01 ADDRESS OF FOOD ESTABLISHMENT: ' c:.I'Cl t 4 u _� Ed MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: -rdz smo&g-6M ®("6 m ear.+. u o TELEPHONE NUMBER OF FOOD ESTABLISHMENT:-7-- _ ,770 w NUMBER OF SEATS*: INSIDE: 0 OUTSIDE: 3S' TOTAL: * Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: SE so TYPICAL HOURS OF OPERATION MON-FRI: 81: ! TO DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) )&& IF SEASONAL: APPROXIMATE DATES OF OPERATION: '57 VTO /©/ l / /9' ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE ' : R TAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO, MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) Q:Wpplication Forms\F•oodappldoc I 0 5 ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? I 19 r IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? ?1►VI� '�a � GIGS CONTACT INFORMATION: F FULL NAME OF APPLICANT I�� �/� �//4(�y-1 SOLE OWNER: YES /0 ADDRESS 'A /q3 �egT f-1�/A-�IV 1S�avr� PHONE # C ) - 3"tV IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: I IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. -453Z rn 7 STATE OF INCORPORATION: /YI FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) T . � I. 'DU1I l/�l 1 U�lf� EXPIRATION DATE: r/ l //I I 2. R t r EXPIRATION DATE: EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** LIST THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. 1. nEXP WATION DATE: F-/ /7 3 /)7/ SIGNA OF APPLICANT AND DATE Q:\Application Forms\Foodapp3.doc 1 t� Town of Barnstable Regulatory Services swiwsrna�e. Richard V. Scali, Director � BARNSTABI,E NUss i639. �0� t+�s�ro�nsr`Eiu�s�'�iw of�eawi"siae Public Health Division 15e 201%4 Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Of6ce: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: NAME OF FOOD ESTABLISHMENT: 13 AR N nd z- EWeypie i s rz ADDRESS OF FOOD ESTABLISHMENT: E-MAIL ADDRESS: '7r1•l�$14J��1 }[,I E®eoyneasT N�'i TELEPHONE NUMBER OF FOOD ESTABLISHMENT: Uago - 3 00 NUMBER OF SEATS*: INSIDE: OUTSIDE: 34' TOTAL: 3S� * Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: SF ffSO1J R L TYPICAL HOURS OF OPERATION MON-FRI: & "M TO 9:ii9 '1 DAYS CLOSED EXCLUDING HOLIDAYS(I.E. MONDAYS) JVOJU� IF SEASONAL: APPROXIMATE DATES OF OPERATION: J/ TO �D/j/j ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE ><RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO,MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) ***REMINDER*** IF OUTSIDE_DINING, YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? SQ _ IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? 2 V f-ob SCwo-s CONTACT INFORMATION: , FULL NAME OF APPLICANT low MMitJAbGi SOLE OWNER: YES / T0O ADDRESS R0$ 193 yAj UN IS,DOr7 PHONE# Cgt c)W -134p IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 4-S &,0 7 STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) 4$6hu\ `% vouloki EXPIRATION DATE: 5 / d /� J2• EXPIRATION DATE: EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** IST THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. e 1• ( 0 I XPIRATION DATE: All SIGMUIIE OF APPLICANT AND DATE Q:Wpplication Forms\Foodapp2.doc PERMIT NO: TOWN OF BARNSTABLE. ISSUE DATEI 1 306 BOARp_QE-.HE—A 12/28/2016' I� PERMIT TOJ0P`E�=E= Q1�STABLISHMENT If In accordance with -iU]I#ionl�"ato5pkSRr�atli4rity of Chapter 94, I� 6 Section 395A and Chapter Al ec�ian�r�f t fit IpI ads yp yMIt is hereby granted to: ANTHONY NINIVAGGk= DIQ BA.RNACLE SIACCAF .y { Whose place of business is: , 38 'trRAIG1LJ H� !LCU�, MA 02632 � Type of business and any res.frid idrvs: F O _t r� TABLISHMENT Y _ To operate a food establisFanient:_in the _ T _ - - LE Pf RESTRICTIONS IF ANY: TEMPORARY-.�ERIVIIT ISSUED UNTILBVA`Rf3br HEALTH HEARING OI`i5U E t4,2016. SEATING: 0 ANNUAL: SEASONAL: YES TEMPORARY: j F',E S bARb OF HEALTH RETAIL FOOD STORE: f., $2�.00t- `; `.� �tr"li. UI'J. Canniff, D.M.D.Chairperson FOOD SERVICE ESTABLISHMENT: ichi Sawayanagi RESIDENTIAL KITCHEN FOR RETAIL SALE: 'tom c::-<•. tl ,'` RESIDENTIAL KITCHEN FOR BED+BREAKFAST c ti �=- -, �..,, ��onald A.Guadagnoli, M.D MOBILE FOOD UNIT: '"�. _ ? r } ee eS: TOBACCO SALES: FROZEN DESSERT: ``�- -�_- �- Thomas A:McKean, RS, CHO CATERER: Director of Public Health NUMBER FEE 396 THE COMMONWEALTH OF MASSACHUSETTS $100.00 TOWN OF BARNSTABLE Barnacle Enterprises Inc d/b/a, The Barnacle Thisis to Certify that........................................ ............................................................................................................................... 988 Craigville Beach Rd , Centerville, MA ........................................................................................................................................................................................................................ IS HEREBY GRANTED A COMMON VICTUALLER'S:LICENS.E Centerville, MA insaid.........................:........................................:.............:.........................::.:..............................and.at that place only and expires January 15,2017 unless sooner suspended or revoke&,for violation of the laws of the Commonwealth respecting the licensing of common victuallers. This license is issued in conforinity with the authority granted to the licensing authorities by General Laws,Chapter 140,and amendments thereto. HOURS: 11:00 AM-9:00 PM RESTRICTIONS: In Testimony Whereof,the undersigned have,hereunto affixed their official signatures. NOTVALID ........................•••........... unless issued in �__ conjunction with a ... ...... Licensing r Authorities Food Service Permit .....e` V °... ......................... Af ® % ............................. .. . .. .......... Issue Date: April], 2016 THIS LICENSE MUST BE POSTED IN A CONSPICUOUS PLACE UPON THE PREMISES. , s� 306 BOARD OF HEALTH PERMIT TO OPERAOD ESTABLISHMENT In accordance with 1 0mu thority of Chapter 94, Section 395A and Ch to 1 I cti e s ermit is hereby granted to: Mir1 ANTHONY NINIV l� R LE SNACK BAR Whose place of business is: IGVIL` ,` C MA 02632 Type of business and any r srlJ - ABLIS To operate a food establisi ent in he BLE RESTRICTIONS IF ANY: TEMPO .R` E MIT IS _ ARINGb3 1 2016. SEATING: 0 ANNUAL a� 5I! k" o I a aZc.s5�Y&= maw a A:+ dF stCE�vca€ � SEASONAL: YES TEMPORARY: � y � .EEs ItOFHEALTH RETAIL FOOD STORE: Chairperson FOOD SERVICE ESTABLISHMENT: " f�� In Miller, M.D.1 k ' RESIDENTIAL KITCHEN FOR RETAIL SAL P U J. Cannlff, D.M.D. E RESIDENTIAL KITCHEN FOR BED+BREAKFA �. -0 J ichi Sawavanagi MOBILE FOOD UNIT: Mlail TOBACCO SALES: u FrO FROZEN DESSERT: �'�* �� �.�. Thomas A. McKean RS CHO CATERER: � � Director of Public Health I i i i I • Town Of Barnstable Regulatory Services °* Richard V. Scaii,Director BARNSTABI,E g Public Health Division ��u a ,� 1639-Z1114 'Thomas McKean,Director 200 Main Street,Hyannis,MA 02601y Office: 508-862-4644 Fay 508-790-6304 . to APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT � DATE: °10 ®/ NAME OF FOOD ESTABLISHMENT: �7 Y& ��� P�'��� ADDRESS ®F FOOD ESTABLISHMENT: 6 90t V i LL. l3E_ &k -/a E-MAIL ADDRESS: CC W, P1 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ago - NUMBER OF SEATS': INSIDE: OUTSIDE: �� TOTAL: ,30 *Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMI ER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: L TYPICAL HOLM OF OPERATION MON-FRI: Sf TO DAYS CLOSED EXCLUDING HOLIDAYS(I.E.MONDAY.S� IF SEASONAL: APPROXIMATE]DATES OF OPERATION:_9/1 04TO /0l 1S'I I t ***REAENDER- * SEASONAL ESTABLIS]ELMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE ,RETAIL FOOD BED &BREAI£FAST CONTINENTAL BREAKFAST *IF SEATING: ALSO,MIDST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTIFALLEWS LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACMES CATERING OUTSIDE DIl G (OYER) I ***RENflNDER*** IF OUTSIDE DINING YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING?_L_ IS AN AIR CURTAIN PROVIDED AT WATTSTAFF SERVICE DOOR(S)? / /�`y � CONTACTINFO °RMATION: FULL NAME OF APPLICANT i SOLE OWNER: YES " ADDRESS PHONE# IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. �{G"SS" �S 7 STATE OF INCORPORATION A FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E.SERVSAFE.) 1. EXPIRATION DATE: r/ 2• �� )q` 4O2 EXPIRATION DATE:/; 74,9 EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMN[EDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** LIS IIE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. I. I �/ •! IRATIO DATE: J / // M SIGNA O AP CANT AND DATE ,1 QAApplicadon FonnsToodappldoc PERMIT NO: TOWN OF BARNSTABLE May 31, 2014 306W Q BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to: ANTHONY NINIVAGGI D/B/A: BARNACLE SNACK BAR Whose place of business is: 988 CRAIGVILLE BEACH ROAD , CENTERVILLE, MA 02632 Type of business and any restrictions: FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY: TEMPORARY VARIANCES EXPIRE PRIOR TO OPENING IN 2015 UNLESS OWNER HAS COMPLETED THE FOLLOWING ITEMS: MUST ADD WASHABLE SURFACES TO TWO WALLS AND CEILING IN BACK ROOM;TILE FLOORS AND ADD A PREP SINK IN BACK ROOM. SEATING: 0 ANNUAL: SEASONAL: YES TEMPORARY: F E E S BOARD OF HEALTH RETAIL FOOD STORE: Wayne Miller, M.D.,Chairperson FOOD SERVICE ESTABLISHMENT: $200.00 RESIDENTIAL KITCHEN FOR RETAIL SALE: Paul J. Canniff, D.M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST: JUniChi Sawayanagi MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: December 31, 2014 FROZEN DESSERT: Thomas A. McKean, RS, CHO CATERER: Director of Public Health C� ��0 Y Town of Barnstable � 3 Qo °FINE r Regulatory Services a 0 Richard V. Scali, Director BARNSTABLE . t BARNS"LE, * e.nxsrne�•®rteiwue•mam•xraxaa_ (//icy MAS& Public Health Division �� ���� � �/ 9$ i659. ,�� ins-zain iOrE Mai a Thomas McKean, Director 575 ` 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISE3MNT DATE: ' / �- I �^/ NAME OF FOOD ESTABLISHMENT: !;���&40 �� �f/ < S>S ADDRESS OF FOOD ESTABLISHMENT: cfa V hL E-MAIL ADDRESS: Q 'Of'- I TELEPHONE NUMBER OF FOOD ESTABLISHMENT: - NUMBER OF SEATS*: INSIDE: D OUTSIDE: TOTAL: / * Note: If indoor seating provided, see.Licensing regarding Common Victuallers License TOTAL,NUMBER OF BATHROOMS: nn /� ANNUAL OR SEASONAL OPERATION: TYPICAL HOURS OF OPERATION MON-FRI: �: OD TO l : 00 DAYS CLOSED EXCLUDING HOLIDAYS(I.E. MONDAYS) D!�I IF SEASONAL: APPROXIMATE DATES OF OPERATION: S l 1 / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD.SERVICE ✓RETAIL FOOD BED & BREAKFAST CONTMNTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) ***REMINDER*** IF OUTSIDE DIKING, YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? -4=- IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOORuJdS)?C — CONTACT INFORMATION: FULL NAME OF ICANT CDD� ` M m l (l G SOLE OWNER: YES /NO ADDRESS .W J� �} /U 1 rt OL 7 PHONE # A C 20 - IF APPLICANT IS A PARTRSHIP, FULL NAME AND HOME ADDRESS OF ALL; PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL-IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH 'OF THE CERTIFICATES' LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) EXPIRATION DATE: 2. EXPIRATION DATE: EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMllIEDLATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMIENT ON THE CERTIFICATE*** LIST THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. FXPIRATION DATE: C/ / SIGNATURE F APPLICANT AND DATE i QAApp[ication Forms\Foodapp2.doc i 1 License Period: 1t (—� n �J]- I a®B r �� l5 (I V `�, �?NAr Anniir.3tlon 1 J Tow '.( i Date: Sta F� newel "� ''� ' v APR 14 2016 UCEN ��� - T ansfer rF I TOWN OF BARNSTABLE3Anlend The undersigned hereby applies for a License to conduct business in the Town of Barnstable in accordance with the Statues of the.Commonwealth-of Massachusetts and subject to the Ordinances of the License Authorities. 1 NO BUSINESS MAY OPERATE WITHOUT A VALI® LICENSE ON THE PREMISES $ Name of Applicant/Corporation: / 1S& Business phone# i ,,l i Address of Applicant/Corporation: dR 1 //lz bell Phone# p Email Address: f� .._ o �'� Federal ID# lasti:¢digij�.ON4Y D/B/A: Map/Parcel# � Business Address: Property Owner T®A► o pI I Business Mailing Address: �//� 3�. Length of Lease o Name of Manager: LYVAff A11A11U,4A4,1 Manager's Email e ( ps ,t/g7- License Type: 49d V1er #41,1.0/2 ❑Annual XSeasonal Hours of Operation. -F1q#7 ®.�.®® Pr1 Entertainment: Yes 5C No If yes,the entertainment license application form is required ONLY if previously licensed. New applications must be filed separately. NOTICE.Any misstatement in this application or violation of the applicable town ordi,iances,bylaws or regulations shall be considered sufficient cause for refusal,suspension,or revocation of any and all licenses. I warrant the truth of the forgoing statement u the penalty of pe�u . Signature of applicant: For Town use only USE PERMITTED WITHIN THIS ZONE?❑YES []NO R.E.Tax Paid G.Mgmt Notified Cons Com Notified Yes❑ No[] Yes❑ No ❑ Yes 0 No ❑ Special Permit Granted YES❑ NO ❑ Attach Comment Attach Comment Attach Comment If yes,include with application Approved Floor Plan on File YES❑ NO❑ Fire District Police Dept. Town Clerk j Date 'Date Business'Cert Filed Occupancy Number Number of Units or Rooms F---] Comments: Comments: Yes❑No❑ Seating Capacity ...................•••• Board of Health Grease Trap last pumped: Building/Zoning Date pate F--I Date: Comments: CommentsT (must show proof of pumping) �tu)OD" 1 V-1 3 LC 0()4 I G � r N n _ •j- o �� � � r,1 d 41 I1 n p C) S'614L �' I � C s a f rk�r i I I � s i II I I I i I LI r Hartsgrove, Elizabeth From: The Barnacle <thebarnacle@comcast.net> Sent: Monday, July 25, 2016 4:59 PM To: Hartsgrove, Elizabeth Cc: wthensley@msn.com; Ells, Mark; Flynn, Margaret; Anderson, Robin; Gallant, Therese; FredChirigotis1 @gmail.com; Smith, Tracey Subject: Re: The Barnacle, 988 Craigville Beach Rd Good afternoon Yes, looking forward to it. ' �1 Thank you, ,. The Barnacle Tony&Carolyn 774-470-2166 508-280-3400 C On Jul 25, 2016, at 4:29 PM, Hartsgrove, Elizabeth<Elizabeth.Hartsgrove@town.barnstable.ma.us>wrote: Good afternoon, I am confirming that we are still scheduled to meet tomorrow morning at 10am at the Regulatory Services building located at 200 Main, to discuss the Barnacle. See you in the morning -Liz From: The Barnacle [mailto:thebarnacle@comcast.net] Sent: Monday, July 18, 2016 9:45 AM To: Hartsgrove, Elizabeth; wthensley@msn.com Cc: Ells, Mark; Flynn, Margaret; Anderson, Robin; Gallant, Therese; FrecIChirigotisl@gmail.com; 'The Barnacle' Subject: RE: The Barnacle, 988 Craigville Beach Rd Good Morning Elizabeth, As the owners of the property at 998 Craigville Beach rd. Carolyn and I want to thank in advance for taking the time to sit with us next week to discuss next steps. Would 10:00 am Tuesday 7/26 work for you? If there anything you want us to prepare and bring to this meeting please advise. Thank you! Tony& Carolyn Ninivaggi The Barnacle 988 Craigville Beach Rd 1 I Centerville, MA 02632 774-470-2166 From: Hartsgrove, Elizabeth [mailto:Elizabeth.Hartsgrove@town.barnstable.ma.us] Sent: Friday,July 15, 2016 12:00 PM To: wthenslev@msn.com; thebarnacle@comcast.net Cc: Ells, Mark<Mark.Ells@town.barnstable.ma.us>; Flynn, Margaret <Margaret.Flynn@town.barnstable.ma.us>; Anderson, Robin <Robin.Anderson@town.barnstable.ma.us>; Gallant,Therese <Therese.Gallant@town.barnstable.ma.us> Subject:The Barnacle, 988 Craigville Beach Rd Good afternoon Mr. Hensley, I appreciate you taking my phone call and discussing the warning letter that was delivered on July 12`h regarding hours of operation and the parking on the property of The Barnacle. It was agreed that a mini-review should be scheduled with all related staff and you, sometime the week of July 25`h, to discuss all available options and the procedures on how to accomplish what is best for your business in the allowed uses. I look forward to hearing from you on the best date and time to meet, and if you have any questions in the meantime please do not hesitate in contacting me directly. Hope you have a great weekend, Liz Elizabeth G. Hartsgrove Town of Barnstable Consumer Affairs Supervisor 200 Main Street Hyannis, MA 02601 508-862-4670 <image001.jpg> 2 F 14 k � Ag t } t ll ^ e $ {3 414 N III l r i i �FTHE r Town of Barnstable Regulatory Service Director } Richard Scali � Regulatory Services i * BARNSTABLE, * Consumer Affairs Supervisor 9 MASS. $ Licensing Division Elizabeth G.Hartsgrove 639.C A 200 Main Street,Hyannis, MA 02601 www.towwbarnstable.ma.us Consumer Affairs Administrative Officer Assistant Telephone: 508-862-4778 Fax: 508-778-2412 Therese Gallant Margaret Flynn I HAND DELIVERED July 12, 2016 Barnacle Enterprises, Inc. Attn.: Tony Ninivaggi 988 Craigville Beach Road Centerville, MA02632 f l RE: WARNING-UNLICENSED EXTENSION OF PREMISE,988 CRAIGVILLE BEACH ROAD l It has come to my attention from an on-site inspection by Chief Zoning Enforcement Officer Robin Anderson on July 11, 2016 that The Barnacle, licensed'through the Barnstable Licensing Authority to. conduct Common Victualler operations at 988 Craigville Beach Road in Centerville, has: 9 Expanded its Take-out Only operation by allowing:vehicles to be parked on the premise F without having approval by the Building Commissioner or Licensing Authority, and •. Failing to apply for sign permits for additional signage on property'after being notified by the Building Department in June, 2016. In addition please be aware that your current allowed hours of operation on the license was legally noticed and approved by the Authority at a public hearing on June 9, 2014 for the hours of 11 am to 9pm. However, after reviewing your 2016 application, the hours of operation listed a on the application is for 8am—8pm, and noted on your Facebook page is from Sam—6pm. Therefore,this letter serves as written notice that The Barnacle is in violation of: §501-5. Physical premises of the Licensing Rules and Regulations: A. No licenses shall issue or shall be considered in good standing unless licensed a premises comply with all statutory requirements, including all applicable building codes, fire health safety, trash state and local tax obligations and other government regulations g g g and laws. (1 count — placing signs on the premise without proper permits issued by the ; Building Department) B. Any changes in the floor plan or any renovations of any kind may not be made without notification to the Licensing Authority and the approval of the Licensing Authority. (5 counts- allowing at least 5 vehicles to park on premise without approval from the Building Commissioner and Licensing Authority) §501-4. Hours of operation. Licensees are not permitted to have persons, including employees, on the premises except during the following hours: A. The hours on the license (1 count—opening for business 3 hours prior to approval and x closing at least 1 hour early without approval from the Licensing Authority) You are hereby ordered to immediately: The Barnacle Warning -Floor Plan Page I July 12, 2016 R s 3. l r 4 1 f a) Adhere to the approved floorplan approved by the Building Commissioner and Licensing Authority and the hours of operation according to the advertised and approved by the Licensing Authority; or b) Submit an application to amend the hours of operation and floorplan to accurately delineate spacing for vehicles on said property, which will be required to go before Site Plan Review prior to a Licensing Authority public hearing. f If either option is not administered within 5 business days of receiving this notice, a Show Cause Hearing will be scheduled as to why your Common Victualer license should not be'modified, suspended or revoked. Res ectfully Elizabeth G. IIartsgrove Consumer Affairs Supervisor Cc: Bamstable Licensing Authority r Richard Scali,Regulatory Services Director Lt`Murphy,CAO Gallant-Barnstable Police Department Robin Anderson,Zoning Enforcement Officer Enclosures: Photos of 988 Craigville Beach Road,Centerville 2016 Common Victualer License and Application a Floor Plan,approved by the Building Commissioner i Copy of Facebook Page,dated July 12,2016 j 1 t r q i { i l i 1 t I The Barnacle Warning--Moor Plan Page 2 Ittly 12, 2016 t { 1 t TO�iYN OF BARNSTABLE*=- i rLICENSING AUTHORITY :NOTICE OFPUBLIC ,• y�{ I NEW ANNUAL COMMON VICTUALLEjj LICENSE +'` y� The cBamsteble Ucensirg Authodty will-hold 8 pubpc hearing on Uie_application; of =Bamacle_',Enterprises 1 s Inc =d/b/a ,Th'e Bamacle; " { 988'yCralgvllle Beach I Road; Centerville Tony Ninrvaggl, Manager for.a'New Arinual i Common,Vctualler License;.; to tie operated,ll am to,9 :.extermc'Maximum number i ior-seats asapproved.by": the Building Coinmisstoner Seld hesnng_vnll beheld on-Menday Jgne 9 201. at ' 9:30 a.m.or,es;soon follovnng es.prac8cal In the Town:Hall Building 2nd sFloor Hearing Room 367 Main'-. Streel,j,. _Hyannis = ! Martln E Hoxie, Chairyerson!I Gene Burman, Paul Sullivan Dlck Boy :Ron Sempdnl t David Nunheinier,:+ BamstableLicensing s � Aulhonty;< The Barnstable PeMot tarp n s61no - C-�1r2 Vl �c.0 y� 233� vyoQ Jfv I C L c; L c..z U I I c.'v r ^ CQ ��^ 1 1 I 4 Ai pFTNETp� Town of Barnstable Barnstable Board of Health 0-AmwicaCity BARNSTABLE,+•.I!� 9 ,ASS. 0200 Main Street, Hyannis MA 02601 1i6gq. �m 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul Canniff,D.M.D. August 27, 2014 Mr. Tony Ninivaggi and Ms. Carolyn Ninivaggi ` The Barnacle 988 Craigville Beach Road Centerville, MA 02632 RE: The Barnacle Snack Bar,.988 Craigville Beach Road;;Centerv>lle Air Curtain acid Toilet Fadil Variances% l�Diztd'6.or Seatrn '.Authorized Dear Mr. and Mrs. Ninivaggi: You are granted variances from Sections 322-4 and 322-5 (6) of the Town of Barnstable Code in order to operate a food establishment, The Barnacle, at 988 Craigville Beach Road, Centerville with the following conditions: (1) A new handwash sink and a mop/utility sink shall be installed prior to opening for business this year. (2) Prior to opening for business in the year 2015, the applicant shall complete the following work: (a) finish adding washable surfaces to the two walls in the back room, (b) provide new tile floors, (c) provide a washable ceiling in the back room, and (d) add a preparation sink in the back room. (3) Self-closing screens (i.e. mechanical/automatic closing screens) shall be provided at all window openings utilized for serving food to patrons. This requirement is a condition of the variance which shall be provided in lieu of the requirement to provide both screens and air curtains as per Section 322- 5(6) of the Town of Barnstable Code. (4) At least one toilet facility shall be provided on-site for patrons. This requirement is a condition of the variance which shall be provided in lieu of the requirement to provide two separate male and female toilet facilities for male and female patrons per Section 322-4 of the Town of Barnstable Code. (5) A sign shall be conspicuously posted which states that a bathroom is available to patrons and indicating its location. , '!1 Q:\W PFILES\Barnacle'iariances2014.doc (6) No more than thirty-seven (37) seats are authorized. This equates to approximately six picnic tables, depending upon the length of the tables. (7) This variance is not transferable to another owner'or lessee of this establishment. (6) These variances are temporary and expire on December 31, 2014. This is due to several other conditions at this site which are non-compliant with the 1999 Federal Food Code and the Massachusetts State Sanitary Code, 105 CMR 590.000 (i.e. walls and ceilings are not smooth and easily cleanable, no preparation sink provided). The applicant is required to comply with all of the subject Federal and State Codes. The toilet facility variance is granted because the applicant testified she is unable to provide two separate toilet facilities for the patrons on-site due to physical constraints, due to the existing layout of the establishment and it's small existing size. Only one restroom is provided for patrons on the second level which is accessible without traveling through any food preparation areas. Also there are public restrooms provided across the street at the public beach. Although the outdoor dining regulations have been strictly enforced, picnic tables have been provided outdoors at this site for many years. Screens are currently provided at all the serving windows. The air curtain variance is granted because the Board is of the opinion that the self-closing screens (by gravity) at these windows should be sufficient to prevent a significant number of flies and other insects from entering the food preparation area indoors. Ve truly yours Wayr Miller, M.D. Chai �rran, Board of Health Town of Barnstable Q:\W PFILES\BamacleN,lpriances2014.doc �3C�L �J ���� )� ���e� ,I J u� f Food service window has screen with automatic_ closing system by gravity .which working very well . s� Front room service area cooking area-- Exi.st,ing hand wash ink { need automatics faucet) g � .dcnxb 1.e s nk Exi s t ing food prop s iris -- - - - _ Back Room -- Need new mop servic ink: ' rain grease tr is Need new han washi si kith aut t' fau in food prop room (this fall} Need new floo i in the ck room fall) Need ne in the back room (this fall) Need thermometer , .Need w ceiling Back rom (this fall) In -all re€rigerators needed good .attention to the .screen door back room 7/9./2©13 .It does not shut.vell treed repair) I F. _The Barnacle F 988 Craigville Beach Road Centerville, MA 02632 May 13, 2014 I Wayne Miller, MD Chairman, Board of Health Town of Barnstable Board of Health 200 Main Street Hyannis, MA 02601 i Dear Dr. Miller: This is to request permission to open and operate a food establishment with the same criteria granted prior owners. I We are the new owners, having taken possession as of May 1,2014. Repairs have already begun to improve the aesthetics of the building. Our intentions are to improve this property in the same manner as our adjacent property,The Craigville Beach Grill,974 Craigville Beach Road, Centerville,which we purchased over 10 years ago. We are applying for the variances listed on the attached application in an effort to improve the property in time to open and operate a food establishment prior to Memorial Day Weekend. Granting these variances will greatly assist us in reaching our goal to keep The Barnacle the landmark that it has become. Thank you for your consideration. j Kind regards, E Anthony Ninivaggi n InivaggiCarolY � enc. 4 I I 1 ��P THE rti DATE: ' FEE: * BARNSTABLE, 9 MASS 0 r �AlED.39. a, REC. BY Town �® Barnstable SCIiED. DAT&*D/ Board ®f Health 200 Main Street; Hyannis MA 02601 Office: 508-862-4644 - Wayne A.Miller;M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul J.Canniff,D.M.D. V_ARIA1lCE REQUEST FORM LOCATION qeg 6fAcIv®1f6 ,���U A� �,,� �� AProperty Address: yQ!� i Assessor's Map and Parcel Number: Size of Lot: Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: Ee Ee • Jr!jHPhone' a0'3�_ Did the owner of the property auth rize you to represent him or her? Yes No PROPERTY OWNER'S NAME _ ® CONTACT PERSON Name: Name: Address: �® ��,� Address: Phone: s � Phone: VARLUNCE FROM REGULATION(List Re,-.) REASQN FOR VARIANCE(Vay attach if more space needed) /iT'R0d1 VUL4 34n.# Ab l 1/9 F !ki r n9 11rra+K17 5 et f 2- j serge 3 )- oo 1 ehAawih Ao AV&-,tKf,4 #of Piwic. a 141 S9I�01h 1 D 41.0 Wt it, NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑ Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form O Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineers gistered sam-ttaapan -- Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Q') Signed letter stating that the property owner autho;zee you to represent him/her for this request -� ' Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicants gpense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals(same owner/itssee opl}1i, outside dining variance renewals(same owner/lessee only),and variances to repair failed sewage disposal systems[ my if no espaPion to' e building proposed]) --- � r'o� Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Cannifff,,,JD.M.D. C:_\cache\Temporary Internet Fi1es\0LKAE\VAP!REQ.D0C P 2 n t` ,h G /� - C{?MTO� .ALTH OF MASS'A4M G�SiMS BARNS ,MASSACWUSETrS Y,0=fheQn-sitAc apDisposalsS�emCon�hactvd( ) Reperst�d�V} Upgraded( ) Abndo>aed( }by at has been const maed in accordance with the pmvisiom of'rj6 5 and The for Disposal S.vswm Cocoa Pcrmii NQ�` a ---2 -- �' Installer Desi$ er 0 bedwoms Approved design Sow Al $Pd Tho im C of this petmoft J=U not be C eti as a tbai the sysmm. as d D pecbat 19 -- --- ---------------- - n� - 4 fi N M 6 AN LLL nNA l?n'vf'. �k ap4ii. =:. � _.. .' � ". :� ���, .:'..' .' 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I BREAKFAST KIDS PLATES Breakfast Sandwich .....................$4.00 includes French Fries One egg,cheese,2.pcs bacon on English Muffin or Toast Kid Hot Dog Plate r Muffin of the Day....................... 2.00 .......................$5.25 Grilled with butter $� Kid Grilled Cheese Plate.............$5.50 English Muffin with butter.............$1.75 Kid Mozzarella Stick Plate 3 pcs..$6.50 Toast with butter................ ..............$1.50 Kid Chicken Finger Plate 2 Ig pcs$6.75 Yogurt............................................$2.00 EnergyBar....................................$2.50 LUNCH Grilled Hot Dog ...........................$3.50 Tuna Melt.............:........................$6.50 Grilled Cheese..............................$3.75 Tuna Wrap with lettuce &tomato.....$6.50 Hamburger...................................$6.00 Chicken Ceasar Wrap .................$6.50 Chicken Fingers (4 pcs)..............$6.75 Grilled Chicken Sandwich .........$6.50 with lettuce; tomato &m yo Add Cheese.............50 Add Bacon.........$1.00 SALADS SIDES & SNACKS Tossed Salad.................................$4.50 French Fries - Small ....................$2.75 addTuna..............................$6..75 - Large....................$3.75 add Chicken ........................$6..75 Mozzarella Sticks (5 pcs) $ 75 with mariaara sauce Ceasar Salad.................................$4.50 Chips.............................................$1.00 add Tuna.................... .........$6.75 Doritos add Chicken : $ ..........................................$1.00 Smart Food......... ........................... 1.50 BEVERAGES Dasani Water................. .....$2.00 Minute Maid juices ...................... ....................$2.50 Cake, Diet Coke...........................$2.25 Minute Maid Lemonade.............$2.50 i Sprite, Fanta Orange....................$2.25 Nestea...................... Vitamin Walter.........._..................$'.50 lce� � �?ec...... .................,...._...$%. �O. � Monster Drinks............................$4.00. Hot Coffee .$2.00 I url d� u I Tl-f I �U s T L - P- iL L06 �L � v J c' �.C�rnr Town of Barnstable t Regulatory Services Department f aetsNsrnsrs, MASS. 6. 200 Main Street,Hyannis MA 02601 APPLICATION FOR OUTSIDE DIKING/SIDEWALK CAFE � h LOCATION Property Address: ?() v Name of Establishment: i✓6 : / k ( � S APPLICANTS NAME.: 7CIU1 /V_! 1 U/ (l%—� Phone# SEATING � FACILITIES/EQUIPMENT� Total#of Seats Existing . #.of Restrooms Provided Size of Grease Trap 1 Total#of Seats Proposed / Air Curtains(Yes or No) (Total means overall number of seats indoors and outdoors) Hose Bib '(Yes or No) d ak Screens (Yes or No) S Brief Description of Seating Arrangement,Type of Furniture Proposed,Hours of Operation,Projected Opening and Closing Dates 0 UTboo R H/C LTA- 13 9 S Uwe the undersigned certify that the above information which Uwe provided is correct. Uwe have read and fully understand the procedures as established by the Town of Barnstable in accordance with Chapter H, Article 8, Section 2 of the General B Taws and the Board of Health Regulation#14., and further understand that failure to compl th s 'd pro dares y result in the immediate revocation of this P=f Signature of Applicant(s): __ Date: Xdll�Z Date: EY PORTANT-PLEASE RENfEYBER TO INCLUDE: 3 Copies of the Neatly Drawn Sketch Plan of the Outside Dining Area Showing Separation Distances to Curbing,Trees,Rubbish Containers and any other Obstacles in Pedestrian Walkway 3 Copies of Pictures of the Proposed Outside Dining Location(Front and Side Views) 1 Copy of the Menu THIS SECTION BELOW IS FOR OFFICIAL USE ONLY Town Manager Approval: Public Health Division: Licensing Board Approval: Certificate of Insurance: License Agreement: Comments: i I BOARD OF HEALTH REGULATION,PART 11,SECTION 1.00,#14,.Requirements a through n (a) The applicant shall file a written request for outside dining or for an outside cafe on a form prescribed by the Town and shall submit plans of the proposed dining area. The seating capacity shaIl be determined by the Board of Health after a determination is made whether requirements "b"through"n" below will be met and after a visual inspection is conducted by an agent of the Board of Health. A replacement food establishment permit shall be issued by the Board of Health indicating"outside dining"is permitted and listing the overall seating capacity, only after it is determined by an.agent of the Board of Health that all of the requirements"a"through'V' of this Regulation#14 are met. (b) A menu shall be submitted to the Board at the time of application. } (c) The dining area must be appurtenant and contiguous to the restaurant property. The dining area must be mentioned on the described premises as in the case of a Common Victualler's License. (d) Sufficient restrooms,both for customers and employees,must be furnished counting the additional outside seating as required by the State Plumbing Code and Town of Barnstable Health regulations. (e) A grease trap shall be of.sufficient capacity,based upon 15 gallons per seat, as required by the State Environmental Code, Title V, and Town of Barnstable Health Regulations. A grease recovery device may be installed to supplement an existing inground grease.trap,after receiving the approval of the Board of Health. (f) All entrance and exit doors used by food service personnel and customers must be screened and provided with air curtains meeting National:Sanitation Foundation standards. AD windows or openings used for the transfer of food will be screened and provided with air curtains. Food cannot be stored or kept outside. All food must be prepared inside the facility's kitchen and kept inside until served. (g) A drainage system designed to eliminate odors will be required for all outdoor dining areas. Hose bibs with vacuum breakers must be available for washing down the dining area. (h) Trash dumpsters shaIl be situated no closer than 50 feet from an outdoor dining area. If such a dumpster is in the line of sight from the dining area,it must be hidden from view. The area around the dumpster and stockade must be kept clean and free of litter. Dumpsters must be closed with adequate covers designed to prevent entrance of rodents and birds and sealed to control odors. (i) The patio or.other ground surface must be of constructed of material readily cleanable and not susceptible'to dust,mud, or debris. (Brick,tile, and concrete are examples of acceptable materials). (j} Table tops must be smooth,non-porous, easily cleanable and durable;.and readily maintained in a clean and sanitary condition. (k) Food service personnel must constantly police the dining area for waste paper, garbage and other trash. Placement clips, cup holders and other such deices must be utilized to prevent blowing paper. Covered trash receptacles must be provided in close proximity to the dining area and must be emptied as needed to prevent overflowing. (1) Strict clean-up practices must be adhered to. Waitstaff and buspersons must clean up after each patron as in indoor dining. Each establishment must abide by all regulations contained in Article X, Minimum Sanitation Standards for Food Service Establishments, of the Commonwealth of Massachusetts, Department of Health Sanitary Code. (m) Outside food handlers must have easy access to handwash sinks and cleaning cloths. Facilities for preparation and disposal of sanitizing solutions must be accessible. I (n) Hair nets or other effective hair restraints,such as hats covering exposed hair, shall be worn by.all outside food or drink handlers. Beards and mustaches must be neatly trimmed. i ti� '�:,? �,. w .. � �_ �„ _, � . , +�_ .,, r r :,,? ... i-��� �`_,.;-. . .5� d t �i� r.,$ I����` w F, b • s A o. oa :d j a, i F fit;' v a . _ :� �,p;q�,r_ L_d6y � -"`ro_.,..,,. - 'y.is _:�, "? y �'� _ ^•-.. 7 � T � •. �tv�l"R`_�r � f a�' �4. `f 1 9 �• .:�3. � l... �? •� BARNACLE SNACK BAR 988 Craigville Beach Rd. Craigville i I� A; 1 5 M E A D No.2K2.153L &3 UPC 14537 omead oom • Made In UM wm . croa�a�r� L O CATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S .NAME A ADDRESS d UILDE R OR OWNER ; DATE PERMIT SSY: ED a . DATE COMPLIANCE`` ; ISSUED ' f l { l THE COMMONWEALTH .OF MASSACHUSETTS BOAR® F HEALTH NW/t .............OF...... ....................... Appliratiou for 14spuiial leorks Tomot.rurtinn Prrmit Application is hereby made for a Permit to Construct ( ) or Repair X an Individual Sewage Disposal System at: ........ ..._. ,_...... - K&Z............Lo...... -.. dress .............................................Lot No. /� Owner Address {A<ld.�.i�,....... . ........................... ---------------------- -.----------.--•-•---..------- ......... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No.1..............minutes per inch Depth of Test Pit.................... Depth to ground water_.__-___-__-__ ----.__. �T4 Test Pit No. 2..'_r_........_._minutes per inch Depth of Test Pit.................... Depth to ground water-_-_-_____-_-----.__-_ 0 ..........................................-.................................................................................................................. Descriptionof Soil........................................................................................................................................................................ x c.> x -----•-----------------------•----•--•----------------•--•------------------•-----•----•-- •-•- / ---------------------.--------.-. U Nature of Repairs or Alterations—Answer when applicable.______ .. ,�-j__...__64-Aew-, _e _-�,�'�rlp ' ems /------... -----•-- --------------- /.�fi_vt-... ---- /� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ued by the board of health. Signed. --•----- ..... Date ApplicationApproved By-------•-••--••--•---•--•-•------------------------•--•----------------•.............._......-- ••--••-••------•----D......--......... ate Application Disapproved for the following reasons:----•---------••---........................................................................................... -•--•--•------•-----••---•-•-•---•-----------•----------------------------•-•----•-------..........---._.._......_...._..............-------------------------------------•-----•--••---------.....------ Date PermitNo......................................................... Issued....................................................... Date ............. THE COMMONWEALTH OF MASSACHUSETTS /BOARD E HEALTH �y� Lf .�.' / .!...............0F..... ..... /./ --�lL...��_-----___-_-_---_____------- Appliration for Disposal Work, Tontrn.rtion rumit Application is hereby made for a Permit to Construct ( ) or Repair-' an Individual Sewage-Disposal System at: .........:.. . ._. r -------------------------or-Lot-No-•-------------------_-------------•---------- Location-Add dress . ✓ ......................•-•---....---•------------•---•--.._.__......... -----.....-----•.._.......------•---------•........... - W f�' Owner Address ASr!_jiQ0.4............................... .............•-•--------------•-•-•-••----..........-------------••-•---------•------------•--...... Installer Address UType of Building Size Lot............................Sq. feet I•-I Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `LI Other—T e of Building No. of ersons____________________________ Showers W(�I Other—Type g -•................•--------- .--------P--�- ( ) — Cafeteria ( ) Otherfixtures ------------------------------••-•-_.... ..•--•----••-----------•----•--•----------------------_----- ------ 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. 3 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........................ (1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fx --------------------------------------------------- --------------------------------------------- •--- -------------------------- •------- -- --•-•--•-•----•-•-- 0 Description of Soil......................--------•----•-••---------•--...--•--•--....----•--....----.-..---•------•------•------•-------...---------------------._._.._._.__...•--....._.. x V ---------------------------•-------------...----------------------------------•--...--------------------...-.•----------•-•-----------------------•-----•--•-•-------•-••------------...----._._._..__.. VW ---------------------------------------•---------------•---------•-------------------------------•--------•---------------------------- - ------- -- Nature of Repairs or Alterations—Answer when applicable__ r.�` ________9.�_ _ _ '/ �'� __e/._._. � 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 been sued by the board of health: Signed--• ...........mo d' " ✓- ,c%? _2�a. _ Date ApplicationApproved By.................................................................................................. ------------------ - Application Disapproved for the following reasons:-------•-----------------------•-------------•---------•-----------••------------•--•-•--Da�`•--••••----••- ______________•------•-------=---------•-----------------------------------_-•--------____-----------•--------•----------.............................................................................. Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. cc.+.t --..-.......OF....... ...................... (ardifiratr of fwontplittnrr THIS I TO CERTIFYThat the Individual Sewage Disposal System constructed ( ) or Repaired by-•---••••• • fQ 41C -.--.....,�----.h�/, �2t✓---•----•-------- - -------------------•-•-----________-__-----= ----•--------___-_----------- •------- R l Instal � at . E' "' .* `_��4' 1 has been iti-staled in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated.-.............................................. -- THE_.ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A A GUARANTEE THAT THE SYSTEM WI NCTION SATISFACTORY. _ DATE.-1_ . ......................... _ .. ..........................5..__._..._..- .... _____________.___._________...___.___.____......_.-............._. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....�.act..�..............OF.....: --��.__-r"�.. �?�f�,l�----..._..-----------......... ,,--•^� C FEE...................... DisposV1q orks Tonstnutionn aermit Permission is hereby granted........ _l• _P......... _ �__ to Construct ) or Repair ,A) an Individual ewa D- posal System at N Street as shown on the a tion for Disposal Works Construction Permit __________________ Dated... �'''�P �'/---------- Board of Health DATE ............................................... FORM 1255 A. M. SULKIN, INC., BOSTON �r Town of Barnstable Barnstable � o Board of Health a RAHNSfABM MASR g 200 Main.Street, Hyannis MA 02601 i639. �m 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul Canniff,D.M.D. July 1, 2013 Ms. Kathryn Gianno 309 Mistic Drive Marstons Mills, MA 02648 RE The Barnacle Snack Bar;988 Craigvlle Beach Road, Centervi<lle _,, `._, Air Curtain;and To>_let Facility„�ar>ances/Qutdoar�.Seatng$�uthonzed ;x:� , Dear Ms. Gianno: You are granted variances from Sections 322-4 and 322-5 (6) of the Town of Barnstable Code in order to operate a food establishment, The Barnacle, at 988 Craigville Beach Road, Centerville with the following conditions: (1) Self-closing screens (i.e. mechanical/automatic closing screens) shall be provided at all window openings utilized.for serving food to patrons. This requirement is a condition of the variance which shall be provided in lieu of the requirement to provide both screens and air curtains as per Section 322- 5(6) of the Town,of Barnstable Code. (2) At least one toilet facility shall be provided on-site for patrons. This requirement is a condition of the variance which shall be provided in lieu of the requirement to provide two separate male and female toilet facilities for male and female patrons per Section 322-4 of the Town of Barnstable Code. (3) A sign shall be conspicuously posted which states that a bathroom is available to patrons and indicating it's location. i (4) No more than thirty-seven (37) seats are authorized. This equates to approximately six picnic tables, depending upon the length of the tables. ti (5) This variance is not transferable to another owner or lessee of this establishment. (6) These variances are temporary and expire on December 31, 2013. This is due to several other conditions at this site which are non-compliant with the 1999 Federal Food Code and the Massachusetts State Sanitary Code, 105 CMR 590.000 (i.e. walls and ceilings are not smooth and easily cleanable, no mop sink provided, no preparation sink provided). The applicant will be I Q:\WPFILES\BarnacleVariances2013.doc 1 I P either required to comply with all of the subject Federal and State Codes and/or provide the Board with information relative to her timeline plans/goals to comply with the Regulations at the time of expiration of these variances. The toilet facility variance is granted because the applicant testified she is unable,to provide two separate toilet facilities for the patrons on-site due to physical constraints, due to the existing layout of the establishment and it's small existing size. Only one restroom is provided for patrons on the second level which is accessible without traveling through any food preparation areas. Also there are public restrooms provided across the street at the public beach. Although the outdoor dining regulations have been strictly enforced, picnic tables have been provided outdoors at this site for many years. Screens are currently provided at all the serving windows. The air curtain variance is granted because the Board is of the opinion that the construction and installation of automatically self-closing screen devices at these windows would be sufficient to prevent a significant number of flies and other insects from entering the food preparation area indoors. Ver ruly you ) Wayne iller, M.D. Chairman, Board of Health Town of Barnstable Q:\WPFILES\BamacleVariances2013.doe II I A(0 Ave C ITC (�o C. r C�,r-4 i'111 o / N U M", air w; �.. _ d�vlf� &f L-'PN 1�'� � I ' OF THE Tp� DATE Pv ti I „* BARNSTABLE, FEE 9 MASS. �a 1639. REC. BY W p'E°Mp�A Town of Barnstable SCAED. DATE: Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul J.Canniff,D.M.D. VARIANC RE UEST FORM LOCATION / //J `2'✓ J Property Address: (/ Assessor's Map and Parcel Number: Size of Lot: Wetlands Within 300 Ft. Yes Business Name: M E, Q No Subdivision Nam : 7 APPLICANT'S NAME: ki Pho e Did the owner of the prope au,tho ize y i t sent him or her? Yes No PROPERTY OWNER'S NAME / CONTACT PERSON Name: 4/4WOkAAN14, Name: Address: S (� Address: Phone: 5 �p<471 Phone: V ANCE FROM REGULATI N-gist Re,, REASON FOR VARIANCE(May attach if more space needed) SOP S&q 13 —q 110tits.1 e s) 11 - NATURE.OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑ Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4).copies of the completed variance request form. _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOTAPPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:.\cache\Temporary Internet.Files\0LKAE\VARIREQ.DOC MAIL-I N REQUESTS Please-mail the completed variance application form to the address below. Also include four. copies of engineering plans, house plans, authorization letter, etc. (see check-list below). In addition, please include the required fee amount (see fees at bottom of this page). Make $95.00 check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 Checklist _ Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) h ; i Completed seven(7)page checklist confirming review of engineered`septic system plan by submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage',regulation variances only) Full menu submitted(for grese trap variance requests only) ' $95.00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/lessee only], outside dining variance renewals[same owner/lessee only ,and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date ` 1 FOR FAXED REQUESTS' I Our fax number is (508) 790-6304. Please fax a completed application form. " Also, you must mail the required $95.00 fee. Please make the check payable to:-Town.,of .Barnstable. The check must be mailed to the address listed above: In addition';please mail four copies of engineered plans, house plans, authorization letter, etc. (see check-list below): - J Checklist _ Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by the submitting engineer or registered sanitarian _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to rep-esent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) $95.00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/lessee only], outside dining variance-renewals[same owner/lessee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page i The Barnacle Snack Shack 988 Craigville Beach Road Centerville, MA 02632 Board of Health Meeting June 18, 2013 Desire: To open and operate the establishment with the same criteria granted prior owner. Improvements: Many improvements have gone into the building structure, bringing the condition and standards of the establishment up much higher than prior. Variances applying for: Reason: 1) Toilet Facility Variance Have one toilet on first floor and one on second floor. 2) Air curtain variance Provides screened windows at f6od service. open & shut. 3) Mop sink variance Space limited. (1999 F.F.C. 5-203.13) 4) Variance Back room is constructed of wood walls and (1999 F.F.C. 6-201.11) ceilings. 5) ,Prep sink policy Space Limited. Request allowance to use (Policy# 2010-02) bay sinks. 6) Use of 37 seats (all outside) per septic design—prior owner's approval was described as four picnic tables and eight small (approximately three feet in length) L�Z G I I T r Town of Barnstable PYoEs"e r � Regulatory Services Barnstable Thomas F. Geiler, Director ALLAmexicaCity * snxNsrnsr.E, TA Public Health Division 7-007 639- Thomas McKean, Director 200 Main Street, Hyannis, MA 0260-1 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT, DATE: NAME OF FOOD ESTABLISHMENT: ry ADDRESS OF FOOD ESTABLISHMENT: MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S)- TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( ) NUMBER OF SEATS: INSIDE: �� OUTSIDE: TOTAL: TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: TYPICAL HOURS OF OPERATION MON-FRI: TO �CJ DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO /L ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: - PLEASE CHECK ALL THAT APPLY FOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) l ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING AND MEET ALL OF THE OUTSIDE DINING TERIA IS.WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SER CE DOOR(S)? CONTACT INFORMATION: FULL NAME OF PP CANT l� r SOLE OWNER: S 0. ADDRESS -21 PHONE # IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION' CERTIFIED STAFF (I.E. SERVSAFE) i EFFECTIVE JANUARY 1, 2004, AND ALLERGEN AWARENESS TRAINED STAFF EFFECTIVE; OCTOBER 1, 2010. EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS (i.e. ServSafe) AND ONE ALLERGEN AWARENESS TRAINED STAFF MEMBER. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** 1. l EXPIRATION DATE: / k1v/ . 2. Oros / 4 EXPIRATION DATE:/ L21 —m-s 3. EXPIRATION DATE: 4. EXPIRATION DATE`. SIGNATURE OF APPLICANT AND DATE Q\Health\Application FormsToodappl.doc °Fzr Town of Barnstable Barnstable ° Board of Health i �I MASS 9� i679, 200 Main Street, Hyannis MA 02601 ArEb MA1 A 2007 Office: 508-862-4644 FAX: 508-790-6304 Wayne Miller,M.D. Junichi Sawayanagi Paul Canniff,D.M.D. May 26, 2010 Mr. Roger Ghanem 323 South Street Hyannis, MA 02601 RE The�Barnacle Snack�Bar;�988 Craigville Be"ac�h�Rd,;Centerville� � A,�ti�"'��`.��°L" Dear Mr. Ghanem: You are granted permission to provide outdoor tables and are granted a variance from Section 322-4 Toilet Facilities at the food establishment, The Barnacle, 988 Craigville Beach Road, Centerville with the following conditions: (1) At least one toilet facility shall be provided on-site for patrons. (2) A sign shall be conspicuously posted which states that a bathroom is available to patrons. (3) No more than four(approximately six feet in length)picnic tables and eight small (approximately three feet in length)picnic tables are authorized. (4) This variance is not transferable to another owner or lessee of this establishment. (5) This permission is temporary and expires on December 31, 2010. Permission is granted because the applicant stated he cannot provide two separate toilet facilities to patrons on-site at this time, only one is located so as not to require patrons to travel through any food preparation areas. Also, although the outdoor dining policy adopted July 1992 is being strictly enforced, tables have been provided outdoors at this site for many years. Very truly yours, Wayne Miller, M.D. Chairman, Board of Health Town of Barnstable Q:\WPFILES\988 Craigville Beach variance The Barnacle May20IO.doc I /J L � ii cy E\L 9 _ J ? � F ' >`ep#•. - 1 t Ih ^ '•:� � •, � . ,?ii,,, : 1 17 i i.ii,'F4; ter• s,� �. 1-t s��y��;� �.. .?:� '�,� r��S: �` '" do ,• ,. -a ��_.,\ i ', ,. "k r �.'. ... ' . N � Mal �t ss ' � , uw.s.a�n + +nraav nA� � a pp. a!�D� r-t ti 'S - l 1F� !gyp;. s:w iY,�^'M+nx:�`. �c,.w4°"'ix+="'x2ts' w•m _ S�.., �-`.,^' ?�f�'��;{�.�a 1 .p9't�M .i { G. r f �'; -° ,• �` ;v u.: a !, -.'-''e'A•'+'�"t�� ! �':r r'"y`7 ay.�,e��'` '•ve ,�' 'F,. '" .a ..s �.�, ,,,-. '., � ._ ...:.: .: ,. ;; '�i+ -r- .. -�.`' ;r' V•, -�,�, ...' 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BREAKFAST KIDS PLATES Breakfast Sandwich.....................$4.00 Includes French Fries One egg,cheese,2 pcs bacon on English Muffin or Toast Kid Hot Dog Plate.......................$5.25 Muffin of the Day........................$2.00 Kid Grilled Cheese Plate.............$5.50 Grilled with butter English Muffin with butter.............$1.75 Kid Mozzarella Stick Plate 3 pcs..$6.50 Toast with butter..............................$1.50 Kid Chicken Finger Plate 2 lg pcs$6.75 Yogurt............................................$2.00 EnergyBar....................................$2.50 LUNCH Grilled Hot Do ..$3.50 Tuna Melt.............:............ Grilled Cheese..............................$3.75 Tuna Wrap with lettuce&tomato.....$6.50 Hamburger...................................$6.00 Chicken Ceasar Wrap .................$6.50 Chicken Fingers (4 pcs)..............$6,75 Grilled Chicken Sandwich .........$6.50 with lettuce, tomato&m yo Add Cheese ............50 Add Bacon.........$1.00 SALADS SIDES & SNACKS Tossed Salad.................................$4.50 French Fries - Small....................$2.75 addTuna..............................$6.75 - Large....................$3.75 add Chicken ........................$6.75 Mozzarella Sticks (5pcs) $5.75 with marinara sauce CeasarSalad.................................$4.50 Chips.................................... $1.00 add Tuna..............................$6.75 ....... Doritos..........................................$1.00 add Chicken........................$6.75 Smart Food_..................................$1.50 BEVERAGES Dasani Water................................$2.00 Minute Maid Juices .....................$2.50 i Coke, Diet Coke...........................$2.25 Minute Maid Lemonade.............$2.50 I Sprite, Fanta Orange....................$2.25 Nestea............................................$2.50 Vitamin Water................ ..............$2.50 iced Cod'ee.....................................$2.50 Monster Drinks............................$4.00 Hot Coffee ....................`................$2.00 i I �pIME r ti DATE FEE: * BARNSTABLE, Y y MASS. �AIED r3A9. Aim REC. BY- Town of Barnstable SCHED. DATE:((J Board. of Health 200 Main Street, Hyannis MA 02601 FAX: 508-79 Office: 508-8b0-6304 4- Wayne A.Miller,M.D. 30 Junichi Sawayanagi Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION Property Address: C �/��� 44— Assessor's Map and Parcel Number: Size of Lot: Wetlands Within 300 Ft. Yes Business Name: ` No Subdivision Name: APPLICANT'S NAME:-� NA qlM7' 00 Phone (� Did the owner of the property authort e you represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name:-.&M V Name: Address: U _J 1 dress: Phone: �.[l �17 Y/ � y Phone: VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May att ch if rn sp cc needed) .. r N/ c�i�, NATUR F ORKouse Addi ElHouse Re ovation ❑ Repair of Fail d Se "tic Sem Checklist (to be completed by office staff person receiving variance request ap ication) r�Please submit copies in 4 separate completed sets. , Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic.system plan by submitting engineer or"registered sanicanan Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request r Applicant understands that the abutters must be notified by certified mail at least ten days prior to meetmgjdate at applicant s expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals'[same owner/lessee otil), outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[ohly if no expansion tothe building proposed]) a M t Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:.\cache\Temporary Internet Fi1es\0LKAE\VARIREQ.D0C t ...,MAIL-1N ..REQ.UESTS Please mail the completed vanance .application form to the, address below. Also 1.1"include flour copies of'engineering',plans,:house, plans, authorization letter, etc. (see check list'below). In k addifion, please,include the;required fee amount.(see fees at bottom of this page). Make $95.0.0:check payable to ToW'n of Barnstable.. :Our,mallmg address Town of Barnstable .Public Health Division -200 Main Street Hyannis;°MA 02601 Checklist: Four(4)copies of the completed vanance request form _ Four(4)copies of engineered plans bmtttyed(e.g septtcsystem plans)vs: t — W `GorrtpI i*sevenz(7)page checklist confirming review of engineered septie system plan by submitting engineer or registered sanitarian Four(4).copies of labeled dimensional floor plans submitted(e g..house plans or restaurant kitchen,plans)" _ $tgned letter stahng,that the propertyt owner authorized you to represent hitn/her for this request `a Apphcant:understands that the abutters must be nottfied:by certified mail at least ten,days prior to meeting date at applicant's expense(for Title,V and/or local sewage"regulation variances only) — Full menu submitted or,grease trap vanance requests only) $95 OOruanance request apphcationfee(no fee for lifeguard.modification_renewals grease trap variance renewals [same ownedlessee only] ,« '} k outside dining vanance renewals[same owner/lessee only,and variances to repay failedxsewage disposal systems[only`if no expansion to the t butldmgproposed])n t i'• A. f Variancerequest subrni tted 0 least.15 days'phor to meeting date:;,. r t: � t FOR FAXEWREQUESTS Our fa`x number is (508) 790,6304. Please fax;a completed appl'lcation form.' Also, your must mail the required..$95 00 fee >. Please make the check payable.; to Town of i Barnstabl0 M 614'66 ,must:be mailed to the address Ilsted}above In�additlon please mail four coplesof engineered plans; house plans;P":authorization letter, etc.: (see checks llst belo7. w) r 71 x, �k.'+� ° k3 'F i1 , .:�. ,�4,. ` A. a, Checkhst t , �r ( l" �� t Four(4)copies of engineered"plan submitted(e,g septic system plans) � t ,Completed seven(7)page ct e&list confinnmg review of engttieeTed`septic system plan by the•'.'submitting engineer or registered sanitarian — s Four(4)copies of labeled dimensional floor plans submitted(e g house plans or restaurant kitchen plans) ,t, Signed letter saing that thepoperty owner auhonzed.you to t�epresen�h�m/her for thissrequest. 1 t Applicant understands thaCth`e abuttets must be'notified by certifed mail at least ten days prior to meeting date,at applicant's expense(for Title Viand/or local sewgulation variances only) l Full menu submitted(for grease trap vanance requests onlRA R�.z y) age re e 4 $95 00 vanance request application,fee (rip fee for lifeguard modification renewals grease trap variance renewals [same owner/lessee only]; g p Y [ Y,if,no expansionao;tht: outside dtmng var>ance renewals[same ownerhessee only],and vat lances to reparr failed sewa a dis.osal s stems onl building proposed]) s' '" _ ,Variance request submitted,at least 15 days prior to meeting date , For further assistance.on any item above, call (508) 862-4644 p Batik to Main Public"Health`Division. Page : Town of]Barnstable pFIKE Tp Regulatory Services Bamstable yyP .tip, 4 Thomas F. Geiler, Director �; ay BARNSTnsr.,E. � Public Health Division 2007 p'ED'i1°�a Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT, DATE: NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: L MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS: INSIDE: Mls `OUTSIDE: TOTAL: j TOTAL NUMBER OF BATHROOMS: I ANNUAL OR SEASONAL OPERATION: C' i TYPICAL HOURS OF OPERATION MON-FRI: : TO DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) 4/11 IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO L 3 15 i 1 ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES `V FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) l ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING AND MEET ALL OF THE OUTSIDE DINING.CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? ISAN AIR CURTAIN PROVIDED AT WAITSTAFF SER CE DOOR(S)? ' CONTACT INFORMATION: FULL NAME OF PP CANT Adh&n 0(ft SOLE OWNER: S O ADDRESS PHONE # (1�k -_� IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION' CERTIFIED STAFF (I.E. SERVSAFE) EFFECTIVE JANUARY 1, 2004, AND ALLERGEN AWARENESS TRAINED STAFF EFFECTIVE OCTOBER 1, 2010. EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS (i.e. ServSafe) AND ONE ALLERGEN AWARENESS TRAINED.STAFF MEMBER. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** 1. h I EXPIRATION DATE: / /;W7 L J� 2. / l/ EXPIRATION DATE:9/ 3. EXPIRATION DATE: - / / 4. EXPIRATION DATt: / / SIGNATURE OF APPLICANT AND DATE Q1HealthlApplication Forms\Foodappl.doc oF� r Town of Barnstable Barnstable 0 Board of Health AFAmedcaUty * BARNSTABLE. 9 MASS. 200 Main Street, Hyannis MA 02601 1639. �0 AtEp�,l A 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul Canniff,D.M.D. May 26, 2010 Mr. Roger Ghanem 323 South Street Hyannis, MA 02601 RE: The,Barnacle Snack Bar, 988 Craigville Beach Rd, Centerville Toilet Facility Variance and Picnic Tables Allowed Dear Mr. Ghanem: You are granted permission to provide outdoor tables and are granted a variance from Section 322-4 Toilet Facilities at the food establishment, The Barnacle, 988 Craigville Beach Road, Centerville with the following conditions: (1) At least one toilet facility shall be provided on-site for patrons. (2) A sign shall be conspicuously posted which states that a bathroom is available to patrons. ' (3) No more than four(approximately six feet in length)picnic tables and eight small (approximately three feet in length)picnic tables are authorized. (4) This variance is not transferable to another owner or lessee of this establishment. (5) This permission is temporary and expires on December 31, 2010. Permission is granted because the applicant stated he cannot provide two separate toilet facilities to patrons on-site at this time, only one is located so as not to require patrons to travel through any food preparation areas. Also, although the outdoor dining policy adopted July 1992 is being strictly enforced, tables have been provided outdoors at this site for many years. Very truly yours, Wayne Miller, M.D. Chairman, Board of Health Town of Barnstable Q:\WPFILES\988 Craigville Beach variance The Barnacle May2010.doc II C1s2 v L�Jlc XY - S � S a `fit` 5 . rrkw - / �J 0 J c � _ ll Cuu�.omer 60ce, hR 0� Customer Service Report ff`N'V°I R`O•N-M EN TA•L System Owner System Location Barnacle Snack Bar Barnacle Snack Bar 988 Craigville Beach Road 988 Craigville Beach Road Centerville, MA, 02632 Centerville, MA, 02632 (508)-304-2851 x (508)-304-2851. x Barnacle Snack Bar CCLS i. Approx.Gal. 0 Custom Clean Customer Home Number in Household 1 2 3 4 5 6 7 8 ZabebFilter System Type Tank Size 1000 22 20 18 16 14 12 12 12 .. T5, Frequency 1250 22 20 18 18 16 14 12 12 Previous Service Oda 1500 24 22 20 20 18 16 14 14 t' $e&Ace Date-. Build Up 2COO 26 24 22 24 20 18 16 16 MON 05/06/2013 CAT Depth Below Grade " Teed PIiamw Serv�ce5!. . .� C,,( / Score From Table Description Quantity Unit Price Ext Price Subtract 6 for Garbage Disposal Commercial Pump Greas4 1000 .1600 $160'.00 Subtract 5 if System is Older than 10 Years Commercial Pumping 1500 .1484 $222.60 Add 8 for Seasonal Use Fuel Surcharge. Commercial 1 39.5000 $39.50 Add 5 if System Additive is Used 9 Net Score: Score Frequency Less than 5 Every 6 Months Subtotal $422.10 6 to 15 Every Year Tax $0.0 0 16 to 23 Every 18 Months Total $422.10 Greater than 24 Every 2 Years Tank Observations: Potential Solutions: Payment Details "❑System Operating Fine We suggest these 4 keys to keep your system healthy: Payment Type In$oioe 1)Regular Servicing 2)Bacteria"Boost"at time of service Credit Card f3)Use Wind River Bacteria Additive Card.#: a• 4 Use a filter ❑Ycessive Solids Utiliz .Wind River Bacteria Additive Security Code envy Sludge Intro,uce additional bacteria via Wind River Boost Program Ex Date Utilize Wind River Bacteria Additive p U Tee Missin /Broken Re air/Re lace Tee 'PHigh Liquid Level Could be an indication of system in hydraulic failure. Terms: Due"ice Receipt I Suggest a system evaluation and/or a custom cleaning. Call the office as soon as possible at 978-841-5017. 0 Distribution Box Issue We observed the following issues: )qj L�. /d�j qf 1 / El Missing Filter Use of a filter is one of the 4 keys to keeping our system health cvt 0Other IV -,The observations and solutions identified may require additional treatment.Please call our Customer Solutions Specialist at.978-841 5017 for additional information,or call our Customer Service line at 800-499-1682 with any questions. p/✓t - ✓ �U Tech Notes: Q _ 4 Remit Payment t0l- . Suite 110, Hudson, MA 017 l I o_ .� rime Arrive "Time Left Tech Initials Customer Signature uin_nn, n+ f Town of Barnstable �P�opTHe Totyo Barnstable Board of Health AS-AmMcaC V It�t* BARNS'TABLE. MASS Q \ �a m 200 Main Street, Hyannis MA 02601 O i639' � m ArfD MA'S% 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul Canniff,D.M.D. May 26, 2010 Mr. Roger Ghanem 323 South Street Hyannis, MA 02601 RE: The Barnacle Snack Bar,988 Craigville Beach Rd, Centerville Toilet Facility Variance and Picnic•Tables Allowed Dear Mr. Ghanem: You are granted permission to provide outdoor table's and are granted a variance from Section 322-4 Toilet Facilities at the food establishment, The Barnacle, 988 Craigville Beach Road, Centerville with the following conditions: (1) At least one toilet facility shall be provided on-site for patrons. (2) A sign shall be conspicuously posted which states that a bathroom is available to patrons. (3) No more than four(approximately six feet in length)picnic tables and eight small (approximately three feet in length) picnic tables are authorized. (4) This variance is not transferable to another owner or lessee of this establishment. (5) This permission is temporary and expires on December 31, 2010. Permission is granted because the applicant stated he cannot provide two separate toilet facilities to patrons on-site at this time, only one is located so as not to require patrons to travel through any food preparation areas. Also, although the outdoor dining policy adopted July 1992 is being strictly enforced, tables have been provided outdoors at this site for many years. Very ly yours yn Mi er, D. C ai an, Board of Health Tow of Barnstable Q:\WPFILES\988 Craigville Beach variance The Barnacle May2010.doc �F THE Tp� DATE: U FEE: 9�C * * BARNSTABLE, * e, y MASS_ o 16 q.� REC. BY.plfD MA'I a` Town- of Barnstable SCHED. DATE: V7 J Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-700-6304 JunichiSawayanagi Paul.[.Canniff,D.M.D. 0 VARIANCE REQUEST FORM`:,. LOCATION Property Address: - -Ce a-,-� j/ L r Assessor's Map and Parcel Number:` �d 5� Size of Lot: Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: rJ !t.✓t Phon �59l ��4 2 it ` Did the owner of the property aut ze you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name: r Name: ® Address: - Address:lsz�l'r ✓0"t ST-• G3 ^. Phone: ��b Lih a L Phone:�S� COY j `7 efT77 VARIANCE FRO REGULATION(List Rees) REASON FOR VARIANCE(May attach iLmore.space needed) &2 ,�o h NATURE OF WORK: House Addition House Renovation ❑ Repair of Failed Septic System Checklist (to be completer)by.office staff-person receiving variance request application) Please submit copies.in 4 separate completed sets. Four(4)copies of the completed variance request form 4;i��Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same omier/lessee only],, outside,dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASONTOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\cache\Temporary Internet .Files\OLKAE\VARIREQ.DOC MAIL-IN REQUE S Please mail'the completed variance application form.to the address below. -Also include four copies of engineering plans, house plans, authorization letter, etc. (see.check-list below). In addition, please include the re uired fee amou nt (see fees at bottom of this page). Make $95.00 check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street_ Hyannis;. MA 02601 Checklist Four(4)copies ofthe completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor,plans submitted(e.g)house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by cer tifiedmail at least ten days prior to meeting date at applicant's expense(for Title. V and/or local sewage regulation variances only): Full menu submitted(for grease trap variance requests only) $95.00 variance request application fee (no fee for lifeguard modification renewals,grease trap variance renewals [same owner/lessee only], outside dining variance renewals [same owner/lessee only ,and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prier to meeting date FOR FAXED REQUESTS. r Our fax number is (508) 790,6304. Please,fax a'completed application farm:_ w , Also, .you must mail the required $95.00 fee. Please make the check. payable to: Town of; Barnstable. The check must be mailed to.the address listed above. In addition, please:mail . four copies of engineered plans, house plans, authorization letter,etc. (see check-list below):, Checklist Four(4)copies of engineered plan submitted(e.g..septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by the submitting engineer oi•registered sanitarian Four(4)copies of labeled dimensional floor plans:submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her forthis request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at.applicant's expense(for Title V and/or local sewage regulation variances.only) Full menu submitted(for•grease trap variance requests only) $95 00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/lessee only], outside dining variance renewals[same owner/lessee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior=o meeting date For further assistance on'any item above, call (508) 862-4644 Back to Main Public Health Division Page Seafood Plates Sandwiclies Flares ow served n•id,h'rrr,edr fries aril!,vtioa rnt,qa Fried IIaddock/Flounder t i h Sand,►u u Shrimp Plate lfantbul1le, vith Preaeh r ie Scallop Plate 1/`L Ib llan►burker ,+dd:Frown rtIt" f Whole(Taut Plate Grilled Chicken Brea � uuti st ., r,eu,,rrh !, w,la Irje,, I ('Inur Strip Plate 'FIRM S:indwiclt with FrC„(•(r.(rirs Calanliwi Plate Chicken'lendel'ti,t•i!!r(a'rn,'!a ti;,•. Ovster Plate ;r ineri !lnt Il„„ I Seafood Rolls Salads Scallop I Ron i�ohster Roll Garden Salad Shrimp Roil Crab Roll with Feta Cheew C'ca itekur,Salad Whn Grilled Chicken h (`►;�,�,Roll with Roll , irh(frilled Chicken ,uuh Grilled Shrimp Clam Strip Role Side Orders Broiled Dinner Onion Rings Frenclt t�vies Rruri'ed clhrnecs.+err•r•<(,rith rirc pilaf arttl enle,elrta, C'urI y Fries 11addoct.oeCora Chicken Wings Scallops New FlIgIand C'Ittnl Chowder Grilled Shrimp Coleslaw Beverages Seafood Sides Sodas Iced'ren Iemomide Iced Coffee Whole Clans Frappes Scallops Vanilla,Chocolate,Coffee,Mocha►•Illark lvirllc,Mrasvheny shrimp (.hint Strips QvNters Ice Cream Calamarl 5oflt.Serge Iee Cr+•71T, " "-X?bq"ura7%w, WOUCu„hnJ ke els X_ .:h•FA.dr n Q � a • a jCC1r2 vtCcv u�yoe J �� c\ a s S 5 L -� L_ 06 �Z L OG Y- U C> _ _ 1 Town of Barnstable QFTHE TOwti Regulatory Services Thomas F.Geiler,Director j '�9. �' Public Health Division rFD 39. 14 Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 26, 2001 1 r �O PrR 0Y Mr. Wayne Chasson p AU_5 VA4 16 Linda Lane Centerville, MA. 02632 s Re: Barnacle Snack Bar Dear Mr. Chasson, -Your are granted permission to provide outdoor tables with the following conditions: (1) At least one toilet facility shall be provided onsite for patrons. i (2) A sign shall be conspicuously posted which states that a bathroom is available to patrons. I (3) No more than four (approximately six feet long) picnic tables and eight small (approximately three feet long)picnic tables are authorized. (4) All other regulations of the Board of Health and of the State Sanitary Code for Food Establishments, Article X, shall be strictly adhered to. i (5) This permission is temporary and expires or_December 31, 2001. Permission is granted because the applicant stated he cannot provide two separate toilet facilities to patrons onsite at this time, only one is located so as not to require patrons P Y q P � to travel through any food preparation areas. Also, although this outdoor dining policy adopted July 1992 is being strictly enforced, tables have been provided outdoors at this site for many years. Town of Barnstable oFt"E'O�ti Regulatory Services Thomas F.Geiler,Director x BAMSrA • x 9 MASS. '� Public Health Division 039. ♦0 '°lEn nna'�°i Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 26, 2001 Mr. Wayne Chasson. 16 Linda Lane Centerville, MA. 02632 Re: Barnacle Snack Bar Dear Mr. Chasson, Your are granted permission to provide outdoor tables with the following conditions: (1) At least one toilet facility shall be provided onsite for patrons. (2) A sign shall be conspicuously posted which states that a bathroom is available to patrons. (3) No more than four(approximately six feet long) picnic tables and,eight small (approximately three feet long)picnic tables are authorized. (4) All other regulations of the Board of Health and of the State Sanitary Code for Food Establishments, Article X, shall be strictly adhered to. (5) This permission is temporary and expires on December 31, 2001. Permission is granted because the applicant stated he cannot provide two separate toilet facilities to patrons onsite at this time, only one is located so as not to require patrons to travel through any food preparation areas. Also, although this outdoor dining policy adopted July 1992 is being strictly enforced,tables have been provided outdoors at this site for many years. ` I 4 . It is the.opinion of the Board of Health that providing one toilet facility onsite on a trial basis this year will be beneficial to patrons. Sincerely yours Sumner Kaufman :M.S.P.H. Acting Chairman I �- ram G�iGt��c TvaE Tp� DATE: .� °" O FEE: BARNSTASLE, y MASS. $i6 4� 39. ,® REC. BY dip- " Town of Barnstable S CHED. DATE: Board of Health 367.Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION Property Address: QIq 4 1 C- Cf f n Assessor's Map and Parcel Number: 22 b d S Size of Lot: • 26 Wetlands Within 300 Ft. Yes Business Name: l'U No gSubdivision Name: APPLICANT'S NAME: /0 f}y,� fy/ C/7`�� GJ Phone 1'0 a 7 75- '716 6 Did the owner of the property authorize you to represent him or her? Yes No . PROPERTY OWNER'S NAME CONTACT PERSON Name:114A,)-V 50a7- Tic?()S7' Name:41UT�yICC ��" �7`/ -.-��SeJ Address: L t 4 L j Address: ��? L 1 ti'Q!� Li I a" Phone: 7 -7 j >j 0 7 7 Phone: ,>C y 7 71 7 VARIAINCE FROM REGULATION(List Re,) REASON FOR VARIANCE(May attach if more space needed) NATURE OF WORK: House Addition House Renovation El Repair of Failed Septic System Checklist(to be completed by office staff-person receiving variance request application) _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen.plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date.at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) _ Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only],outside dining variance renewals(same owner/leasee only],and variances to repair failed sewage disposal systems (only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Q:/WP/VARIREQ f The Barnacle Menu 988 Graigville Beach Road -Centerville, MA. Grilled Hot Dog $2.25 Hamburger $3 .00 Cheeseburger $3.25 PB&J $2.50 Grilled Cheese $2.50 Chicken Sand. $4.50 Tuna Sand. $4.50 Seafood Salad $6.50 Fried Clam Roll $5.95 Fish Sandwich $4.95 Onion Rings $2-.65-- French-Fries $ 1 .55 / 2. 15 Cup o' Chowda $2.99 Soda $ 1 .110 / 1 .50 / 2. 10 Ice Cream $ 1. .75 / 2. 10 Frappes $2.65 N N S - 15 i t L_ C)6- Log - c� c� J o l c= c 2cltrn Z J Et 1 M47 20, 1993 Town of Barnstable Susan G. Rask, Chairman Board of Health 367 Main St. Hyannis, MA 02601 Dear Madam Chairman, Please consider this letter a request to allow outside seating and a variance from' the criteria in Regulation 14, Town of Barnstable Health Regulations requiring toilet facilities onsite for use by outside patrons who are not served by the employees of the food establishment. The Barnacle Snack Bar is mainly a take out facility for the patrons of Craigville Beach who frequently return to the beach to consume their food and beverage. Picnic tables provide seating for those patrons who are waiting for orders to be completed or who prefer to consume their food and beverage before returning to the beach. Craigville Beach restrooms are available to all within a hundred yards of the Barnacle. The Barnacle Snack Bar has been serving Craigville Beach and the area in this manner since 1951 . Also, since the regulations were adopted in 1981 the Barnacle has changed ownership three times without any restrictions noted on its permit to operate a food establishment. I feel that granting this variance would not be inconsistent with past procedures and would not create nuisances to public health or to the environment. Further, the employee restrooms are available to all individuals in case of emergencies. Thank you in advance for you consideration. Sinc-erely, Car s I . Mariscal T Barnacle Snack Bar 988 Craigville Beach Rd. Centerville, MA 02632 'yO�YN[TO`I The Town of Barnstable Health Department t ""'T"` ' 367 Main Street, Hyannis, MA 02601 riva Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health OUTSIDE DINING BY PATRONS WHO ARE NOT SERVED BY EMPLOYEES OF FOOD ESTABLISHMENT If the employees of the food establishment will not be serving any food or drink to patrons seated outdoors, the Board of Health has empowered the Director of the Health Department to grant permission to place seats outdoors if certain criteria are strictly adhered to. The following are some of the criteria that must be met prior the placement of any seating outdoors : (a) Notification of the Barnstable Health Department Director. (Telephone 790-6265. ) (b) Tables and chairs furnished by the food establishment shall be located at least ten ( 10) feet from the property line, sidewalk, and public access ways (parking lots, etc. ) . (c) A divider, such as a small fence, shrubs, etc. , must mark the designated setback. (d) Sufficient restrooms, both for customers and employees, must be furnished counting the additional seating as required by the State Plumbing Code and Town of Barnstable Health Regulations. If the employees of the food establishment will not be serving any food or drink to patrons seated outdoors, the Board of Health of the Town of Barnstable will waive the following requirements of the attached criteria list: (e) (9) (n) (o) Thomas A. McKean Director of Public Health PART II FOOD ESTABLISHMENT REGULATION'S ECTION 1.00 REVISED SUPPLEMENT TO MINIMUM SANTTATION STANDARDS FOR FOOD SERVICE %tet ESTABLISHMENTS AN o�`�* ADOPTED 2/21/75, BECAME EFFECTIVE 2/26/75, •REVISED 7/19/78 Dsn>trrur, BOARD OF HEALTH 'eb rbT& \� 397 MAIN STREET HYANNIS, MASS. 02601 REVISED SUPPLEMENT TO MINIMUM SANITATION STANDARDS FOR FOOD SERVICE E STABLISHMENTS Adopted February 21 , 1975 The following regulations are promulgated the Town of Chapter Barnstable Board of Health, in accordance with the provisions 111, section 31 , as amended, of the Massachusetts Gennt eral Laws,provi and are being adopted to supplement, clarify gm of Article X, Minimum Sanitation Standards for Food Service Establishments, of the State Sanitary Code. Applicants shall refer to the State Sanitary Code for basic requirements. REGULATION 3 - FOOD PROTECTION 3.1 All food served buffet style shall be enclosed in such a manner to prevent contamination REGULATION 10 - PLUMBING Grease traps must be provided at restaurants, nursing homes, schools, hospitals, bakeries, or similar establishments as determined by the Board of Health. The capacity of the grease trap shall be calculated by the kitchen flow rate of 15 gallons per seat, or chair, per day but in no case shall be less than 1000 gallons. This applies to es- tablishments connecting to Town sewer, or establishments with on-site sewage systems. REGULATION 11 - TOILET FACILITIES All food service establishments shall provide adequate, conveniently located toilet facilities for its' employees. Each food service establishment with a seating for iesgforpemployeesacity of othatf areyseparate patrons shall provide toilet acilitdies from the toilet facilities provided for patrons. Separate facilities must be provided for male and female employees and male and female patrons. Each food service establishment shall be provided with adequate, conveniently located hand washing facilities for its' employees equipped with hold and cold or tempered running water, hand cleansing soap or detergent from a dispensing unit, and sanitary towels or other hand-drying devices. Common towels are prohibited.ion areas hand- washing facility shall be located in the food prep The hand wash sinks in the restrooms for patrons, or employees, can- not be considered as the hand wash facility for employees , but are required for all toilet facilities. REVISED SUPPLEMENT TO MINIMUM SANITATION STANDARDS FOR FOOD SERVICE I ESTABLISHMENTS (cont'd. ) REGULATION 14 - VERMIN CONTROL Outdoor cafe-type restaurants will not be permitted in the Town of Barnstable. REGULATION 22 - MOBILE FOOD SERVICE Push-cart type food service vendors will not be permitted in the Town of Barnstable. Mobile food units shall operate from a commissary, or other fixed food service establishment that is constructed and operated in compliance with Article X, of the State Sanitary Code, and Town of Barnstable Health Regulations. Mobile food units serving foods not packaged for individual servings and/or involving the use of utensils shall provide a potable water system under pressure. The system shall be of sufficient capacity to furnish enough hot and cold water for food preparation, utensil cleaning and sanitizing, and handwashing. A double compartment sink must be provided for washing and sanitizing utensils. A separate hand wash sink must also be provided. Mobile units garaged outside of the Town of Barnstable must furnish written certification from their local Board of Health verifying that they operate from a licensed food service establishment. REGULATION 23 - VENDING MACHINES Any establishment with vending machines dispensing food or drink must be licensed by the Board of Health. PENALTIES Any person who shall fail to comply with an order issued pursurant to the provisions of these regulations upon conviction is sub- ject to the same fines prescribed in Regulation 39.2 , of Article X, of the State Sanitary Code. INVALIDATION If any section, paragraph, sentence, clause, or phrase of these rules and regulations should be decided invalid for any reason whatsoever, such decision shall not affect the remaining portions of these regulations, which shall remain in full force and effect; and to this end the provisions of these regulations are hereby declared severable. This regulation is to take effect on the date of publication of this notice. TOWN OF BARNSTABLLEB�OARD OF HEALTH A n J a Es h a j /Chairma bert . Childs A. W, Mandelstam, M. D. 7/19/78 a � Barnacle Menu 1993 ' Grilled Hot Dog 1 . 55 - Hamburger 2. 30 Cheeseburger 2 .55 Grilled Cheese Sandwich 1 . 95 BLT 2.55 Tuna Salad Sandwich 3 .75 Seafood Salad Roll 4 . 65 Fried Clam Roll 4 .55 Ham Sandwich 3 . 10 Ham and Cheese Sandwich 3 . 50 Peanut Butter and Jelly 1 .95 Salads Fresh Fruit Cup 2. 25 Garden Salad 2 . 65 3 Fresh Chicken & Garden Salad 3 . 95 Seafood Salad 4 . 25 E French Fries sm. 1 .25 reg. 1 .85 Onion Rings sm. reg. 2.25 Sodas sm. 16oz. reg. 20oz. lge. 32oz. .95 1 . 35 1 . 75 Coke Seven Up Root Beer Diet Coke Orange Lemonade .Ice Cream Cones sm. 1 . 45 lge. 1 . 85 Chocolate Strawberry Vanilla Chocolate Chip Orange Sherbet Frozen Yogurt Frappes 2....33 : Novelties Italian Ice 1 .25 Sports Bar 1 . 50 Ice Cream Sandwich 1 . 50 Frozen Fruit Bar i2 . 35 Popsicle ! . 60 Hoodwich ! 2 . 35 Mineral Water Coffee,Tea . 80 Milk .80 Iced Coffee, Tea 1 . 35 AM PIAQc ,0F_ dnrravf;1., � I,ONK IS M0 7- IM P0C,A07 IS MIOINOM OF e` TV)EEO Aµ07 .•."A&Z t3E&IOP106 or U. - REA hit T 2 I ov. � I juci a y I WON tl�F l7 I Naj• ItBLE j AMR t � 1 I I 5�r1 t'ti Eu T t? LF PATF lei {; ------------- T N seat ng authoriz d 'ndo rs or outdoors, due to SEATING: NONE FEE RETAIL: FOOD: $100.00 MILK• TOWN OF BARNSTABLE BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NO. 326 JANUARY 1, 1993 In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and. Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: CARLOS MARISCAL D/B/A BARNACLE SNACK BAR Whose place of business is at 988 CRAIGVILLE BEACH RD. , CENTERVILLE MA Type of business and any restrictions FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE Permit Expires DECEMBER 31, 1993 BOARD OF HEALTH: :• Susan G. Rask, Chairman Joseph C. Snow, X.D. Brian R. Grady Thomas A. McKean Director of Public. Health i :� P �- � 2I3i/93 �t sa : ` �oT �¢n�s o ,usw nw�:�� TOWN OF BARNSTABLE F TH E t0� OFFICE OF : DABa9TeDL BOARD OF HEALTH MAN& 0 1639. `� 367 MAIN STREET am HYANNIS, MASS.02601 June 1, 1993 Carlos I. Mariscal The Barnacle Snack Bar 988 Craigville Beach Road Centerville, MA 02632 Dear Mr. Mariscal: You are granted permission to provide outdoor tables with the following conditions: ( 1) At least one toilet facility shall be provided onsite for patrons. ' (2) A sign shall be conspicuously posted which states that a bathroom is available to patrons. (3) No more than four (approximately six feet long) picnic tables and eight small (approximately three feet long) picnic tables are authorized. (4 ) All the tables and seats shall be removed whenever the Town Beach bathrooms are closed to the public. If separate male and female toilet facilities are constructed onsite, this condition #4 may be removed. (5) All other regulations of the Board of Health and of the State Sanitary Code for Food Establishments, Article X, shall be strictly adhered to. (6) This permission is temporary and expires on December 31, 1993. Permission is granted because the applicant stated he cannot provide two separate toilet facilities to patrons onsite at this time, only one is located so as not to require patrons to travel through any food preparation areas. Also, although this outdoor dining policy adopted July 1992 is being strictly enforced, tables have been provided outdoors at this site for many years. i w It is the opinion of the Board of Health that providing one toilet, facility onsite on a trial basis this year will be beneficial to patrons. Sincerely yours, Susan G. Risk, R.S. Chairman Board of Health Town of Barnstable i SGR/bcs I Aw Nj N \ \ �`- s s 5 �' U C -F 7p.0 k� � � � Lj �fF �FiTr�E Tp� DATE: 1�5�G G G C * FEE: * lA M LE MASS. * �S 2 9 ASS. $ �AlED-39. Alm REC. BY Town ®f Barnstable SCHED. DATE: Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORIM LOCATION Property Address: l� V`i L 7 Ct� g u Assessor's Map and Parcel Number: Z2 b b S Size of Lot: Z�' Wetlands Within 300 Ft. Yes Business Name: �'C�Ty l ' ?j� %lC)� 1 I �i-I -,1VJJ A e2-6— No Sub/division Name: APPLICANT'S NAME: &)�q 11-i Ali (./] ��CJ Phone 6 7 75 7 76 Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name:/'14%,-)-V 5(`C77' 7-, (O S-r Name: I C), ya 121 Address: L f o`-'A) ri L, 71+L Address: /6 L % to D A Li I A'C Phone: j 7 Phone: 36 7 VARIANCE FROM REGULATION(List Reg) REASON FOR VARIANCE(May attach if more space needed) NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑ Checklist(to be completed by office staff-person receiving variance request application) �— Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) _ Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only],outside dining variance renewals[same owner/leasce only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Q:/WP/VARIREQ - _ I The Barnacle Menu 988 Graigville Beach Road Centerville, MA, Grilled Hot Dog $2.25 Hamburger $3.00 Cheeseburger $3.25 PB&J $2.50 Grilled Cheese $2.50 Chicken Sand. $4.50 Tuna Sand: $4.50 Seafood Salad $6.50 Fried ClamRoll $5.95 Fish Sandwich $4.95 Onion Rings $2.65 French-Fries $ 1 .55 / 2. 15 Cup o' Chowda $2.99 Soda $ 1 . 10 1 .50 / 2. 10 Ice Cream $ 1 .75 / 2. 10 _ Frappes $2.65 6_1� 7f-f V)jooQ r 0 - LC LC L nz lJ J J CA � V r� t 2 0 C vJ ,�- �{ The Town of Barnstable Health Department 367 Main Street, Hyannis, MA 02601 rr Office 508-790-6265 Thomas A. McKean FAX 508-775-1144 Director of Public Health June 6, 1995 George Linardos, Jr. Linardos Children's Trust P.O. Box 488 Centerville, MA 02632-0488 RE: BARNACLE SPN: 14-95 Dear Mr. Linardos: I am in receipt of your letter dated May 1, 1995. According to the notes of the February 23, 1995 site plan review meeting, the size of the leaching field was requested. Dale Saad stated she did request the information from you. Without an evaluation of the existing system, one cannot determine whether it can accomodate additional seating. On May 18, 1995, the Health Division finally received the actual leaching facility dimensions from Bill Robinson, a certified on site sewage disposal system inspector. The system can handle 740 gallons per day which limits the seating capacity to 21. Thus, the Health Division cannot approve more than 21 seats at the Barnancle without a larger leaching facility. If you should have any questions, please telephone me at 790-6265. Sincerely yours, 71 Thomas McKean, R.S. Director Health Division May 1, 1995 , Cb Town of Barnstable Health Department Attn: Thomas McKean 367 Main Street -9.9 Hyannis, Massachusetts 02601 RE: BARNACLE 8 SPN: 14-95 Dear Mr. McKean: In response to your comments/questions concerning the above referenced, as addressed in your correspondence to Carol Ann Ritchie dated April 18, 1995, please be advised as follows: Per our telephone discussion prior to your correspondence, it was agreed, or at least from my perception it seemed, that the issues being brought up concerning flow diffusors, etc. were not part of the requested information and/or concerns raised at the two site plan meetings attended by your office concerning the Barnacle. During said telephone conversation I understood that all that was required was to have Mr. Robinson, or some other septic inspector, fill out the old style report, approximately five pages of check list type questions, to confirm that the existing system can handle the proposed. changes to the building. After reviewing the notes from said site plan meetings, I do not find where the requested information in your 18 April letter is set forth. Please advise if I missed something. If you should have any further questions concerning the above, please feel free to contact me at (508) 790-8448. Very truly yours, George Linardos, Jr. on behalf of the Linardos Children's 'Trust c: Carol Ann Ritchie file L as �a D2.t3 b Gir) c5z2- oggq � tq q 0 "Iax �dl Lo con a.0 C w uen Lo o ro o^ of n S.e C�cQ�csecP U{a, a o C cQ e� c l- s b.e��, '� a.�-K s4On A- o 0 � 2t 3 n- �i� wzO o cJ �z cr,�►vz ,�.d .rn � Q�P 40 S�l i�q aeAA I � I,pp( .e" C4 C/,4,L9 4h �,��o set , ty)U-r� C� L - ems_Assessor's office(1st,Floor): ,.. �• I7$r�0$v$T(i�� ��,�^ r q Assessors maq and ibt number , oC o��e :Q 0 `� Board of Health(3r�floor): ;; a: I F. 114STALLED IN oi THE Sewage Perki number �' l 9ov I " i ■��TH���"� !!` wii Engineering Department(3rd floor): �J� f ENVIRONMENTAL CC'5'.. •.,�� i DiDl17�DL i ' House number s! F ? TOWN REGULATIOIw '00 630• Definitive Plan;Apprord by.Planning Board 1g '�o r►r►.- APPUCATIO PRq�CESSI D 8:30-9:30 A.M.end 1:00-2.00 P.M.only ' A p p R 0 Y f , _ � stable Cons mmisalT OW. OF BARNSTAB r ! 4 BUILDING: INSPECTOR Signed — Date APPLICATION FOR PERMIT TO ,� , l _ DGRNER, TO TYPE OF CONSTRUCTION WOOD j?ftftt-fE MARCH 5, 1990 19 90 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora permit according to the following information: 98a3 CRAIGVILLE BEACH ROSD, CENTERVILLE, MA Location PfopOsod Use MAKE FLOOR AND WATT SPAOR AVATT A RT F FOR ST0gA(`F AND OF TrF' SPACE Zoning District RC- Fire District �`� ^ bi xm , ANASTASIA MAKRIS Name of Owner Address 7 PARKSTnF DR, BOSTON, MA 02130 TO BE DETERMINED Name of Builder Address Name of Architect Address 2, NO CHANGE Number of Rooms Foundation HAT,F MASONARY Exterior P!F.flAR R14TNrT.r Roofing PINE, NO CHANGE Floors Interior __ r7NFTNTSHFn Or.�:• :;::..;. .:... .ENO ng Plumbing NO Fireplace Approximate Cost �D D Area s Diagram of Lot and Building with Dimensions Fee • O dZ/ Ivor `t?h,x:.c.,L& o,,. �os�vn A A• C7 21 3 V SUBJECT PA RCEL: MAP 226. LOTn , P c�nn ABUTTERS:. 2p- MAP 206 PU4num L{, 0�,2(ob LOT 122- RICHARD AND SALLY PlkESSA g,L �- eeja.sS", �� Q I h a..�• �k.uru�. - 5$fo S� NOR�OOD, MA O Zo to,;., a�-v bJ LOT114— ROBERT MORAN la�ruzQke,�YYI A b 2(, 3 2 12 7 LEE DRIVE C CONCORD, MA 01742 LOT 94— TOWN OF BARNSTABLE Bosun nY/!d- O 2�O 9 367 Main ST HYANN IS, MA 02601 aft-c.cY.Z�tc.$C 1. MAP 226 As4 la^d 61721 LOT 6- ANTHONY AND KRYSTYNA cELENCHOWSKI P.O. BOX 458 t BOSTON, MA 02102 drER � � E LOT 7— CAPE COD FIVE I P.O. BOX 10 WEST ROAD ORLEANS, MA 02653 :... LOT 8-1— DENISE .j ND SANDRA NEMAN BROOKLINE, MA D . I ' "��LLcui r..• ,eu.i° LOT 8— — ST EVE TRAINOR • •-�� � ��„��� RANDOLPH, MA "• q"• :••.o LOT 13— TOWN OF BARNSTABLE nr 367 Main ST si.. ,�A e• 1�`L� . i ,_ `1 HYANNIS, MA 02601 4 1,, �QA'►l.Q,l' LoA.lS6� '•. D 94 MAC, `P•O 'box 55 a Du�lt I�IO � �� k-A- bi ?o s Lr $^2.wC N N BE4C01 R040 t{4C, 4446c Q{{ IE'•C,., �Q��QassA- a Qe4t-Ua h.Q.Qe ft4 0 2h, 2- SUBJECT PARCEL: MAP 226. LOT ABUTTERS: MAP 206 LOT 122- RICHARD AND SALLY PRESSA NORWOOD, MA LOT114- ROBERT MORAN 127 LEE DRIVE C CONCORD, MA 01742 LOT 94- TOWN OF BARNSTABLE 367 Main ST HYANNIS, MA 02601 MAP 226 LOT 6- ANTHONY AND KRYSTYNA ZELENCHOWSKI P.O. BOX 458 BOSTON, MA 02102 � EN1 LOT 7- CAPE COD FIVE P.O. BOX 10 ��o•° ,� WEST ROAD ORLEANS, MA 02653 A.... LOT 8-1- DENISE AND SANDRA NEUMAN BROOKLINE, MA �! :-•�u�.. I ��• LOT 8-2- STEVEN TRAINOR -•� ( w ��� _ i ,, 8•z RANDOLPH, MA :• i �a I `' "^"•° LOT 13- TOWN OF BARNSTABLE ,,. 367 Main ST "'• ; , _ i `1 HYANNIS, MA 0260194 I►tiel', 1l[ loo .c. 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F .r��Z 715tt��l�l+s� YYrNP^Ry -_c .�'�.�r�-xr-.1+;�;�xai?!,Y.v'•T c•Z.:ey_ ;�.dyr'.•g�,1�.._ ! _�+� z. �, 'I'', 310 CMR 10.99 Forth 2 �-- Flle No. A DI A—9 0 012 Barnstable Clt Commonwealth ! pTown i )AR79TAXI, of Massachusetts , MAea Makris pp i639 \'� Applicant E� �OYAf" 03/13/90 ;r Date Request Filed, Determination of Applicability Massachusetts Wetlands Protection Act, G.L. c. 131, §40 TOWN OF BARNSTABLE BY-LAW, ARTICLE XXVII From Barnstable Conservation Commissinn Issuing Authority To Anastasia Makris Same (Name of person making request) (Name of property owner) 7 Parkside Drive Address Boston, MA. 02130 Address Same This determination is issued and delivered as follows: ❑ by hand delivery to person making request on (date) X3 by certified mail,return receipt requested on Apr i 1 19, 1990 (date) Pursuant to the authority of G.L.c. 131, §40,the Barnstable Conservation C'_nmmi siai nn has considered your request for a Determination of Applicability and its supporting documentation, anq has made the following determination(check whichever is applicable): Location: Street Address 988 Craigville Beach Rd. , Centerville, M_A. 02632 Lot Number: 5 May Number• 226 1. ❑ The area described below, which includes all/part of the area described in your request, is an Area Subject to Protection Under the Act.Therefore, any removing, filling, dredging or altering of that area requires the filing of a Notice of Intent. 2. C The work described below,which includes all/part of the work described in your request,is within an Area Subject to Protection Under the Act and will remove, fill,dredge or alter that area.There- fore,said work requires the filing of a Notice of Intent. Effective 11/10/89 2.1 j" 3. ❑ The work described below,which includes all/part of the work described in your request,is within the Butter Zone as defined in the regulations,and will alter an Area Subject to Protection Under the Act.Therefore,said work requires the filing of a Notice of Intent. This Determination is negative: 1. ❑ The area described in your request is not an Area Subject to Protection Under the Act. 2. ,,E( The work described in your request is within an Area Subject to Protection Under the Act,but will not remove,fill, dredge,or alter that area.Therefore, said work does not require the filing of a Notice of Intent. 3. L The work described in your request is within the Buffer Zone,as defined in the regulations,but will not alter an Area Subject to Protection Under the Act,Therefore, said work does not require the filing of a Notice o1 Intent. 4. ❑ The area described in your request is Subject to Protection Under the Act, but since the work described therein meets the requirements for the following exemption,as specified in the Act and the regulations, no Notice of Intent is required: Issued by Barnstable Conservation Commission Signature(s) This Determination must be signed by a majority of the Conservation Commission, On this 19 th day of April 19 90 ,before me personally appeared Elisabeth Eaton Clark ,to me known to be the person described in,and who executed, the foregoing instrument, and acknowledged that he!she executed the sa a is!her free act an eed. October 28, 1994 N tary Ic My commission expires This Determination coos not relieve the applicant from Comoying with an Diner applicable teoeral.state or local statutes,ordinances, Oylaws or regulations.This Determination anal)be valid for three years form the Date of issuance The applicant,the owner,any person aggrieved by this Determination,any owner of land abutting the land upon which the proposed work is to be Done,or any ten resioents of the city or town in which such land is located,are hereby nwifieo of their right to request iris Department of Environmental Protection to issue a Superseding Determination of Applicaoilny,providing the request is moos by ceniheo mail or nano Delivery to the Department,with the appropriate tiling tee and Fee Transmittal Form as provided in 310 CMR 10.03R)wiinin ten Days from the Date of issuance of this Determination.A Copy of ina request snail at ins lame time be sent by Conifieo man or nano delivery to the Conaarvation Commission and ins applicant. 2.2A i 310 CMR 10.99 Form 1 OF TH E!0 Rie No. �d DED : = Commonwealth I+ss�r9T►aLX Cdy To wr ' of Massachusetts Applicant .. OMAYk. Request for a Determination of Applicability Massachusetts Wetlands Protection Act, G.L. c. 131 , §40 TOWN OF BARNSTABLE BY—LAW, ARTICLE XXVII 1. I,the undersigned, hereby request that the Barnstable Conservation Commission make a determination as to whether the area, described below, or work to be performed on said area,also described below,is subject to the jurisdiction of the Wetlands Protection Act, G.L c. 131, §40. 2. The area is described as follows. (Use maps or plans, it necessary,to provide a description and the location of the area subject to this request.) Location: Street Address 988 CRAIGVILLE BEACH ROAD, CENTERVILLE,MA Lot Number: LOT NUMBER. 5, MAP 226 3. The work in said area is described below. (Use additional paper,if necessary, to describe the proposed work.) I WOULD LIKE TO CONSTRUCT A STAIRWAY TO THE SECOND FLOOR. THESE EXTERIOR STAIRS WOULD REPLACE A SET OF INTERIOR STAIRS WHICH ARE NAROW AND STEEP. THERE IS NO PRACTICAL SOLUTION TO MODIFY THE IdERIOR ACCESS TO THE' SECOND FLOOR. THE EXTERIOR STAIRWAY WILL BE LOCATED IN THE REAR OF THE BUILDING, AND WILL MEASURE 12X 4 FEET INCLUDING A LANDING. SIMILAR ACCESS .TO THE SECOND FLOOR OF THE ABUTTING PROPRTY (LOT 6) IS EXISTING. IN ADDITION, THERE ARE TWO SETS OF EXTERIOR STAIRS It; THE REAR OF THE BUILDING STANDING ON LOT 7 also on MAP 226. Adda�r► n : :� MeR� �o Q�dP ,ed. a &4 o ( uea.M (OC461 k' . Effective 11/10/89 4. The owner(s)of the area,if not the person making this request,has been given written notification of this request on (date) The name(s)and address(es)of the owner(s). ANASTASIA MAKRIS 7 PARKSI E DRIVE BOSTON, A 02130 5. 1 have filed a complete copy of this request with the appropriate regional office of the Massachusetts Department of Environmenta l Protecti on MARCH 13, 1990 (date) DEP Northeast Regional Office DEP Southeast Regional Office 5 Commonwealth Avenue Lakeville Hospital Woburn, MA 01801 Route 105 Lakeville, MA 02347 DEP Central Regional Office 75 Grove Street DEP Western Regional Office Worcester, MA 01605 State House West, 4th Floor 436 Dwight Street Springfield, MA 01103 6. 1 understand that notification of this request will be placed in a local newspaper at my expense in accor- dance with Section 10.05(3)(b)1 of the regulations by the Conservation Commission and that I will be billed accordingly. .�i( ` Name ANASTASTA MAKRT$ Signature bW a Adaress Tel. (617) 522-0899 1.2 No. OJ Fee UU� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS s ftplitation for -Mispo$al *pstrm Const rtion hermit Application for a Permit to Construct( ) Repair(_,�Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No. C�b C.MRSYaveXr S6 Owner's Name,Address,and Tel.No. �" `c1 Assessor's Map/Parcel ,� �q� a ��1 \�y�r� cz> Installer's Name,Address,and Tel.No.a1 WCA- e Designer's Name,Address,and Tel.No. CS Type of Building: '(�jMfc1Q�`t'`�G\ pill Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building G\ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 0 z. c, Lti� n Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal sgtem i!d accordance with the provisions of Title 5 of the ronmenta Code not to place the system in operatir•1.>I l�a Certificat f 1E Compliance has been issued by this Board o ea r► Signed D` ' Application Approved by Dafe Application Disapproved by Date tZ t1f for the following reasons co Permit No. 6 —0 e) O Date Issued —_ 7—/ s No. d �I U J U Fee R. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS s 2ppYication for.)Disposal 6psteut Construction i3ermit Application for a Permit to Construct( ) Repair(v Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. q C cG`ty,\'e 1�1, cc Owner's Name,Address,and Tel.No. c �/ Ln Assessor's Map/Parcel -Q ��'I 1�p Installer's Name,Address,and Tel.No.1Je X C'06. WCC�e Designer's Name,Address,and Tel.No. I" Type of Building: �rntcYUcY°G\�' l Dwelling No..of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building C1xrCccs r.� No.of Persons Showers( ) Cafeteria( ) 4 Other Fixtures Design Flow(min,required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) , Date last inspected: Agreement: f The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in 4-,,- accordance with the provisions of Title 5 of the f ronmental Code an not to place the system in operation until a Certificate`of Compliance has been issued by this Board of eat{{ w // Signed ) Date Application Approved by ) _o Date '— t/ R Application Disapproved by- � Date for the following reasons G Permit No. G�I 11 Date Issued -2 - 7— t� ---------------------- ------------------------------ ------------------------ ----------------------------------------------------_---- S, ��^ TH E COMMONWEALTH OF MASSACHUSETTS' p �i BARNSTABLE, MASSACHUSETTS' F (r hf< < f-eirp ��` �` fay Certificate of Compliance V o o f S IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) � v , Abandoned( )by IJCS ch��n ram^ , �lr��e l 1. rks— at G`�F C cr:'ra�l����P �,� \�(j has been constructed in accordance with the provisions of-mile 5 and the for Disposal System Construction Permit No. ated Installer Designer #bedrooms y1� f r Approved design flow / gpd The issuance of this permit sliall not be construed as a guna�}ra/ntte/e that the system will ctibn as d/esigned..Q �! O Date L l��' � � fly i l i (3'/t/Cp( Inspector -------------(��1/��------:�// © ----------------= No. J o / C/ Fee ' v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal *pstem Construction J)ermit Permission is hereby granted to Construct( ) Repair( Y)" Upgrade( ) Abandon( ) System located at C, C CT�i r,�lu� \�e_ (xrr ;� a-\ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must-be completed within three years of the date of this permit. Date 2- -7//�� Approved by ' y RfeE�EO r APR A.BPEAKM ? 2 199 COI1t1lI1I31l01I Commanweafth of Mass et1500FBARNST 15 Way ��. PH �(Ty�fPTAB(f Executive Office of Environ I Affalis HmAch,MA 0®8+16 Department o! 4, ti~ Environmental P WORM P.wale Aftoww Ae�q 7rady Carte bee Prul Qslitrvcl e•r u. ma 001010 uIrwhe C�mnY•Mnp ., p,j BU68URFACE SIy1VA0E DISPOSAL R6'!'@1i!INBPicanoN PURM PART A rf8E1 GT'.4/�C//GGc lCtao.0 CATION ; �Ar Add"" G,-^�/4r trl GGC/ ^sue! . CeN�I Addtrees of Otte;Date si lnaiseoflonr g leg/9 C A, _ COS 'Af a q HAtaa 01 t <If titfteseny �, o. .3nX /yam . ssepeotor. �4n3 fI. 3P�.4rcr`�av OmtPrmy Nam•,Address and Telephone,Nurnbarr, �/.�o✓, ? , %9wr I eartlfy slut I ha.•Pereonslly inepMed the Aewage dJspo•a1 system At this address and that the information reported below,is tM,&Connote etd wmP"w Y of tAe time of inspection. The inapection was performed hosed on C/ my tra6tittr and experience in the,proper A►nctioa and , annums1i! tltl�lte aewaae dj•fr►ul gateau. The•ytem: Conditienaliv passes Ya•ds Further EvAlustion By the Locei Approving Authority IaeP.etars AI 17 �daattara G� �� ] Date: 5 I? r/ �/7 The System IMMUr Abell submit a mpy of this lttspAetion repo"to the Approving Authority within thirty(30)days of complitiAll this leapettlon. 2t the system is A•hared Amen or has a design flow of 10,000 gpd er grwttsr,the impactor and the aystan owner shall submit the report to the appt01069%regional office of the Depaminent of Envoonwatrtl Protection. The ortBf W should be ant to the ortem owner and copies sent to the buyer,if applicable and the approving aatltarity. e IN6PiffiCTiON 80MAIAAY: Chock A.8,C,or D; Al QV2?W P tot r k"Not hJud W intbtmation whkh indimteo that the atom viol Ltea any of the,railyn criteria IN dented in 310 CM1 15-303. A"lailu•a criteria red""tied ere indicated below. 21 Blr'd71tM CONDITIONALLY PAISM A-r - One or more system aersponents nerd to be replaced or ropaired. The"sm upon oodtpletion'arthe raplsoett ent or repair,posses , Ldiesta!re a•,or act determined(Y.N,or ND t. Describe b•ais of detartuir&ilea in W ateta as. If"not deteratiSAd",espWp Khy soil The septic tank is metal,(recited,structurally unsowd,shows Substantial infUtrstion Or eaRltration..or task r>tiluse is !at"ti'tebjP theB ard ofH�syno h sill pass insP•etion it the eaututg septictanM i replaced with n yoetforrnir►g septic tank as apppyb (revised lifO/OS) l ' 'l onWb t sum • 80110 ,MaegehueeMe021Qs a PRA tstIr)300.10d61 • toblom"a(617)3W"" rq.ted a k4W W Pope, . f• j` r Ir r J� v r t i M BUNDUR At2B ABWAGO DIMSAI.SVSTSM INBP89M(W FORM PART A C1�TIRCA'I'ION(asnlMttidl PMPV"y Address: Date Of Irnp"Itonr 91#TIT=CONDITIONALLY PABNEB(watieued) Bewa`e Wimp or breskout or high statie water lava)abeavved in the dWnUtien hot is due to brokea ter obrmcted pip,(si or due to a broYsn,ettttcd m"even dietributioa boa. The system will pas leapactiop it(.0 spp�at the Hoard OI Hawth): breltsa pips(e)art replaced Obstruction is r' 'Nod distWtien box is Iwalled at,repleim d The QMW l4gWrM Pumping more than four tuner a year he to broken or obstructed plpe(0. The Qetam will pew inspeetta►1(With approval of the Board of HeaNhl: bMkah pipets)are repeated obstruction Is rww d CI FURTHUR EVALUATION 18 RZRUIRED aY THE BOARD OF ABALTH; ('.nndllimu Will wkteh rtgnire further @Valuation by the Board of}laalth in order to deternaina;l the sysrem is f"g to PMWd tn0 public hw$h sally and the environment. I) BVIITW WILL PA88 UNLF,AR DOARD OP R'I;ALTB DWMMIN>Z$THAT THE BYBTR>rI 18 NOT FUNCTIONINO IN A MANNER WHICR WILL PROTECT THE PUBLIC MWALTI1 AND BAVM AND THE ENVIRONMEMh Coerces or privy b within 60 fast of a surface water, _ Cesspool of prwy is within 50 feet of a bordarian vegetated wetland or a daft marsh. 2) SYSTEM WILL FAIL UNLZ119 THE BOARD OF HEALTH(AND PUBLIC WATER 81PPWZPq 1P'APPROPRIATE) DWM MINFA'MIAT THE BYSTEM 18 FUNCTIONING 1N A MANNER THAT PROTECT THE PUBLIC HEALTH AND BAi'C'f"C AND THE ENVIR0NMZNTc The sydem has a septic tsak and call cbompt(cn"m and 11 withbl I00 feet to s at48"water supttlt or tributary to a auface ester supply. — The system has a sortie tank and and sbeorption eyetsm and b within a Zone I of a'ubw watt supply well. 'Cho gstem has a septic teak sad soil abeorptice System and it within 60 feet of a private water"Jy WOU, The system had a septic tank and soil absorption"stem oaud h )eu than I00 fast but 50 feat or more(eta a private water dvrply Well,unlau a WOO wale►analysis kn 16Uferas bacteria sa+d valetUs areanie eortpoanda indicates tbat the well le des from pollution from that facility and tM presence of ammoais nitrogen and nitrate estrogen is equal to oI has Clla11 b ppttt i!l aTgB.tt (rtv(aed 11/03M) s SUBSURFACE SEWAGE DISPOSAL 9YOrEM INSPECTION FORM PART A CERTIFICATION(continued) O wolferiy aaareeae 98¢; C�i Qw+eer. 41Cy V1L4g!5- Z6-ACW ;eo,J c�'.4•G w� '9t. C-1 re"�(0J �a4 72(Sf�9 L Date of Inspewtim. 3/Z`S //;7 D1 SYSTEM FAILat Aj I have determined that the system violates one or more of the following failure criteria as detlned in 310 CUR 15.303. The bob far this determination is identired below• rho Board of Health shuuld be contacted to determine what will be Maury to corms the failure. Backup of sewage into facility or system component due to an overloaded or clogged f)A13 or cesspool, Discharge or ponding of effluent to the surface cf the ground or nrrface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or eeupool. T Liquid depth in cesspool is leas than T below invert or available volume is lose than 112 day flow. Required pumping more than 4 times in the laat year NOT due to clogged or obstructed plpe.(s). Number of tithes pumped Any portion of the Soil Ahsorption System cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply, ,_,_, Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. i Any portion of a coespool or privy is Iwo than 100 feet but greater than 60 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis far codorm bacteria.volatile organic compounds,ammonia nitrogen and nitrate nitropa. 71 LARGE SYSTEM FAILS: 6QThe fo OWWR criteria apply to Inge systems in addition to the criteria above: N(/�7 The system serves a facility with a design flow of 10,000 IN or greater(Large Systems and the system is a significant threat to public httaltb and safety and the environment because one or more of the following eon6tiono atilt! the system is within 400 feet of a surface drinking water supply the syrotam is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(interim Wellhead protection Area(IWPA)or a mapped Zone 11 of a public water supply well) The owner or opermor of m v such system shall bring the system and facility into full compliance with the groundwater Imainient prop m requirement#of 314 CUR 6.00 and 6.00. Please consult the local regional office of the Department for further information (revised 11/03/OS) 9 e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPILOTION FORM PART 8 CNRC UST Property Addrum Owosr. ,Date of Iaepeotlont Check if the following havo Seen done: —Pumping isfortnation was requested of the owner, occupant, and Board of Health. _None of the eymm components have been pumped for at least two weeks and the system has been receiving normal now rates during that period. Large volumes of water have nct been introduced into the system r9cantly or m part of this inspection. Al built plats have been obtained and examined. Note if they are not available with MIA, _The facWty or dwelling was inspected for signs of sewage backup. The system don not rec¢ive non-eanitary or industrial waste flow U!'6e site was inspected for eigno of breakout. n. — 1 system oanponsnts,exeluding the Soil Absorption System,have been located on the tits. septic tank manholes were uncovered, opened,and the interior of the septic tank wMs inspected for condition of bafllee or Me,material of construction,dimensions,depth of liquid,depth of sludge,depth of stunt. hs sirs and location of the Soil Absorption System on the site has been determined based on existing information or � ap tad by non•intrusive methods.e tac 1 ty owner(and occupants, if difhreni from owner)were provided with information on the proper maintenance of Srb Surfees Disposal System. (revised 11103/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Prbparty Add CR'A/4r4!�'/C.C. 3tFAC A-e ��.) CV--4/G7 Date of InepsoHoe: Ce�TeG 0 j / FLOW CONDMON9 LIF,BLDENTW. /�(� balm Qow:��gaIlens Nmmber of bedrooms: Nwnber of ew"nt tesidenis: Garbage grinder(yea or no):_ _ L►uedry connected to system(yes or no):_ Seasonal use(yea or no):,,,_, Water meter readings,if available: Last date of orupaacy: OOMM LAC IAL/INDUSTRIAL• Type of edabllshment;._ ,jA j&,- Deslgn tlow:_pUow/day Grease trap Dreamt:(yea or no))OF-S Industrial Wane Holding Tank present:(ycs or no)6P Non•eanitaey waste dhcharpil to the Title b system:(yes or no)NO Water motor rmdinp,if available: Last date of oocupamy: OTHER:(Describe) Let date of 000npancy: GENERAL INFORMATION PUMPING RECORDS and nource of information: System pumped as part of inspection:(yea or no)RJO If yes,voltam pempsd: aallone Reasom toy pumping: TYPE OF fflom Aeptio tenlVdbstributlon bo:lsod absorption system Biwa a Pool Overflew esapool Privy Shared system(Pe or no) (if yes, attach previotu inspection recor(s,if any) Other(espiain) APPROXIMATE AGE of all components,date installed(if knowni and source of information: Sewage ad6re detected when arriving at the site:(yes or no)!�p trevised 11/t)]l95) g SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(ootttlnucd) Property Address: Owner. Date of Inspection: SEPTIC TAN10 Z- (locate on site plan) Depth below grade: " Material of construction:_concrete_metal_FRP_other(eaplain) Diamasions: Shtdp depth:_ Distance Aram top of siudge to bottotu of outiet tee or WM.:3 Z Scum thickness: DUtance fwin top of scum to tap of outlet tee or baffle: /y Distance from bottom of scum to bottom of outlet tee or bane: Comments: (recommendation for pumping, condition of inlet and outlet tees or babies,depth of�uld level in relation to outlet invert,structural integrity, evidence of leakage,etc.) !C"c9 f-7 Ad "�"r %J Al doCG' A"OcJ 7-A A-) G c:>0 /02..E-c 4 s 7- GREASE TRAP:_ (locate on site plan) Depth below grade: dVI Material of coestruetion —concrete_meta]_FRP_ether(mplain) Drmensfome: Q Scum thick"W:_ e�o_ Distaw Flom top of scum to top of outlet tee or bable:� Distance from bottom of scum to bottom of outlet tee or baffle: Comments: i (recommendation for pumping,condition_of inlet and outlet t se or battles,depth of liquid level in relation to nittlet insert,structural integrity,. evidence pf kaksge, ete.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPRCTION FORM PAS?C SYBTKM INFOR MA"ON(eantinups!) OwMer,y Addtrs.a� � 'j G/C/li/C�v/C.4 1� F�C1� 7Z_'O.f eYe 4/Cq ll rum 1-14. Date of IMP"tioe: ` ('U`S .3 CAC TIGHT OR HOLDING TANK:6? (locate on site plan) Depth below grade:,_ Material d cotutruction:_oonetrte`meta!_FRP—other(explain) Dlmaeatotur . Capacity: gailoru Design AM ssllons/day Alarm love): Comments: (condition of Wet tN,condition of alarm and Aoat switches,etc.) DI&MBLMON BOX- (locate oil site pl") Depth of liquid Ievel above outlet invert comments: mote if level and distribution is equal,ertdente of solids carryover,evidence of leakage into or nut of box,ate.) PUMP CBAMBRA,k (locate on site Puti) Pumps is working order.(yes or no) (note condition,of pump ahaniber,condition of pumps and appurtenances,etc.) (revleed MOM) 7 A. o SUBSURFACE SEWAGE DISPOSAL MTBM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ProP�Y Addreast Owner. Date of InspeotloD: SOIL ARBORPriam svBTrA (locate an site plan,if pouibls;mtcevation not wAdmd,but may be approdmmted by aoa•latrusive methods) If not datermined to be present,explain: ; Type: loaehing pit&, number: leeching chambers. number:—L---� AlZ_, 578ni(5'-- I'Air o leveling galleries,number:_ leaebing trenches,number,length: leaching Relds,number,dimentionu: Overflow cesspool, number:_ -- Comments:(note condition of Roil,signs of hydraulic failure, level of pending,condition of ve tion,etc.l CU .,. OMPOOI.9: (boats on site plan) Number and configuration: Dopth•tep of liquid to inlet invert: Depth of solids layer. Depth of acorn layer- Dimensions of tewpool: Materials of eanatn lion: Indication of groundwater; Mow(oaaspod muss be pumped as part of Inspection) (lnnnnents:(Rote condition of soil,signs of hydraulic railure, navel of poll".Condition Df vegetation,etc.) PRIVY: (locate On site phinl Metariala of oonatruetion: biim&nrione: Depth of solids: Commemta:(Dote condition of soiL signs of hydraulic failure, level of ponding.eomdition of vegetation.etc.) (revteed 11/O's/OS> g SUBSURFACE SEWAGE DISPOSAL8Y9TBM INIIpEMON PORAl PART C SYSTEM INFORMATION(oonttnued) Prop"Addy+ - 1769 C C4/C7 !/�C.C.� � ,�Cf� TG'Cl� j `• d Dale of le"eetlan SJMMCN OF SEWAGE DISPOSAL SYSTEM: ine)ude tie@ tc At ieeet two perleanenl refereneee tsndniarhe or 1anchmerke locate ey+welts within low R � o a G D I i f i 3Z ' -- �-- e S' DEPTe TO GROUNDWAM Dep*to Wvundwetn.-_-2 feet 6el co..-) 66 i it s method of dearmtWim or epprorimati on: iV U.2 O e-t,77 p eo l - L (revised 11103/95) o ai-* ti"3AY• r, l . f Rr w' �•;-Q,".' 4�W " ' Y a p�,� ��� k,lW d "Ri ,: �'�q, �'..'J •ilat t� ,r a.iy.,xr fir" 4,1. 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Property Address BARNACLE REALTY TRUST Owner owner's Name information is CENTERVILLE MA 02632 2/17/2014 required for every page. Cityfrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your y cursor-do not DAVID J BURNIE v use the return Name of Inspector key. NEIGHBORHOOD WASTE WATER Company Name 350 MAIN ST Company Address WEST YARMOUTH MA 02673 City/Town State Zip Code 508-775-2820 SI-386 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and#flak the; information.reported below is true, accurate and complete as of the time of theitispection.Tfie insction was performed based on my training and experience in the proper function and fm4aintenan e,of or Bite sewage disposal systems. I am a DEP approved system inspector pursuant to Section"IS,�8yof Title 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fairy, C '`:�I n f' g ,J : -3 t,f ❑ Needs Further Evaluation by the Local Approving Authority , y r •• 2/18/2014 Ins o4Signa4tu, Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the.future under the same or different conditions of use. tsins•3113 Title 5 orfidal Inspection Form: Sewage Dispose)System•Page 1 of 17 Commonwealth of Massachusetts a= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 988 CRAIGVILLE BEACH ROAD Property Address . BARNACLE REALTY TRUST Owner Owner's Name information is required for every CENTERVILLE MA 02632 2/17/2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: CONDITIONAL PASS. SEE BELOW B) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. if"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): THIS SYSTEM IS A CONDITIONAL PASS. PLEASE NOTE THIS SYSTEM WAS CONSTRUCTED IN 1984. BOTH THE GREASE TRAP AND THE SEPTIC TANK ARE LEAKING,.THERE IS NO DISTRIBUTION BOX AND THE FLOW DIFFUSORS HAVE ROOTS IN THEM. IT IS UNKOWN AS TO HOW ROOT INFESTED THE CHAMBERS ARE AS WE CAN ONLY VIEW THE INSIDE OF THE CHAMBERS. THE ROOTS NEED TO BE CUT OUT t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 2 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 988 CRAIGVILLE BEACH ROAD Property Address BARNACLE REALTY TRUST Owner Owner's Name information is CENTERVILLE MA 02632 2/17/2014 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ® Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): GREASE TRAP 8r SEPTIC TANK ARE BOTH LEAKING. ROOTS ARE IN THE LEACHING CHAMBERS AND NEED TO BE CUT OUT. ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ® obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ROOTS C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the.environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Mae!Ir spectian Form:Subsu face Sewage Disposed System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System,Form-Not for Voluntary Assessments 988 CRAIGVILLE BEACH ROAD Property Address BARNACLE REALTY TRUST Owner owner's Name information is CENTERVILLE MA 02632 2/17/2014 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis;+performed at a DEP certified laboratory., for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria.Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No El El clogged of sewage into facility or system component due to:overloaded:or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface-waters due to an overloaded or clogged.SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert.due to an.overloaded or clogged SAS or cesspool ❑ ® Liquid:depth in cesspool is less than 6°below invert or available volume is less than '/Z day flow t5ins•3113 Tide 5 Official brpedm Forth:Subsurface Sewage Disposal.System•Page 4.of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 988 CRAIGVILLE BEACH ROAD Property Address BARNACLE REALTY TRUST Owner Owner's Name information is required for every CENTERVILLE MA 02632 2/17/2014 page. cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the.system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes'or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200.feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 l Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not ifor Voluntary Assessments 988 CRAIGVILLE BEACH ROAD Property Address BARNACLE REALTY TRUST Owner Owner's Name information is required for every CENTERVILLE MA' 02632 2/17/2014 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No r I ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? i ❑ ® Were as built plans of the system obtained and examined?(If they were not available note as N/A) ' ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding.the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,'depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption.System(SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: COMMER Number of bedrooms(design): CIAL Number of bedrooms(actual): . DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): l t5ins•3M 3 Title 5 Offidal Inspection Form:Subsufaos Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments lug 988 CRAIGVILLE BEACH ROAD Property Address BARNACLE REALTY TRUST Owner Owner's Name information is required for every CENTERVILLE MA' 02632 2/17/2014 page. City/Town State Zip Code Date of Inspection D. System Information Description: COMMERCIAL SYSTEM ' VACANT Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): YES Detail: SEE COMMERCIAL SECTION i Sump pump? I ❑ Yes [0 No SE Last date of occupancy: D ate AL Commercial/Industrial Flow Conditions: Type of Establishment: BEACHFRONT SNACK SHACK Design flow(based on 310 CMR 15.203): UNKNOWN Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): , UNKNOWN Grease trap present? ® Yes ❑ No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes. 0 No Water meter readings, if available: 2013=37,000=102GPD 2012=22,000=61 GPD t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 988 CRAIGVILLE BEACH ROAD Property Address BARNACLE REALTY TRUST Owner Owner's Name information is required for every CENTERVILLE MA 02632 2/17/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: UNKNOWN Date Other(describe below): SEASONAL General Information Pumping Records: Source of information: 5-6-2013 GREASE&SEPTIC Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): 1500 GALLON GREASE TANK t5ins•3113 Title 5 Official hspec hon Forth:Subswface Sewage Disposal System-Page a of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form-Not for Voluntary Assessments 988 CRAIGVILLE BEACH ROAD Property Address BARNACLE REALTY TRUST Owner Owners Name information is required for every CENTERVILLE MA 02632 2/17/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: INSTALLED 1984 PERMIT ON FILE AT BARNSTABLE HEALTH DEPARTMENT Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 48"feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: 10+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): OK-AS TO WHAT WE CAN SEE Septic Tank(locate on site plan): 41 Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) SEPTIC TANK COVERS ARE NOT WITHIN 12"OF GRADE If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No y Dimensions: Sludge depth: t5ins•3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•_Page 9.01'17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 988 CRAIGVILLE BEACH ROAD Property Address BARNACLE REALTY TRUST Owner Owner's Name information is required for every CENTERVILLE MA 02632 2/17/2014 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle TANK LEAKING Scum thickness TANK LEAKING Distance from top of scum to top of outlet tee or baffle TANK LEAKING Distance from bottom of scum to bottom of outlet tee or baffle TANK LEAKING How were dimensions determined? TANK LEAKING Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): THE SEPTIC TANK IS LEAKING AND NEEDS TO BE SEALED i Grease Trap(locate on site plan): 6" Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: TANK LEAKING Scum thickness TANK LEAKING Distance from top of scum to top of outlet tee or baffle TANK LEAKING Distance from bottom of scum to bottom of outlet tee or baffle TANK LEAKING Date of last pumping: 5-6-2013 Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •'' 988 CRAIGVILLE BEACH ROAD Property Address BARNACLE REALTY TRUST Owner Owner's Name information is CENTERVILLE MA 02632 2/17/2014 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): BOTH GREASE TRAP AND SEPTIC ARE LEAKING. BOTH NEED TO BE SEALED Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Of ial Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments V.`�. 988 CRAIGVILLE BEACH ROAD Property Address BARNACLE REALTY TRUST Owner Owner's Name information is required for every CENTERVILLE MA 02632 2/17/2014 page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert NO DISTRIBUTION BOX Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): USED A SEWER CAMERA AND DIDN'T FIND A DISTRIBUTION BOX. HAND SKETCH ASBUILT ALSO DID NOT SHOW A DISTRIBUTION BOX Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: LOCATED AND VIEWED USING A SEWER CAMERA. FOUND ROOTS IN FLOW DIFFUSORS t5ins•3/13 Title 5 Offidet Mspechon Form:3ubsurtace Sewage.Disposal System-Page 12 of V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 988 CRAIGVILLE BEACH ROAD Property Address BARNACLE REALTY TRUST Owner Owner's Name information is required for every CENTERVILLE MA 02632 2/17/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: EST. 4 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): VIEWED WITH CAMERA. DID NOT FIND ANY STANDING WATER BUT DID FIND ROOTS. ROOTS TO BE CUT OUT. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '' 988 CRAIGVILLE BEACH ROAD Property Address BARNACLE REALTY TRUST Owner Owner's Name information is required for every CENTERVILLE MA 02632 2/17/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: , Dimensions Depth of solids F Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l r t5ins•3f13 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 988 CRAIGVILLE BEACH ROAD Property Address BARNACLE REALTY TRUST Owner Owner's Name information is required for every CENTERVILLE MA 02632 2/17/2014 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 LOCATION SEWAGE PERMIT NO- VILLAGE INS A LLEN'S l_NAME 1: ADDRESS BUILDER OR OWNER � r 0A T E PERMIT (-$S#k E 0 :Z.. O A T S c o M P c:r U.t p�s.s .E 3f n ly 717 I 1 7 � 1 j i i i , i i I I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •� 988 CRAIGVILLE BEACH ROAD Property Address BARNACLE REALTY TRUST Owner Owners Name information is CENTERVILLE MA 02632 2/17/2014 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 86"feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: HEALTH DEPT.ABUTTING TEST HOLE 86" ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: ABBUTING PROPERTY TEST HOLE SHOWS WATER AT 86". BOTTOM OF LEACHING 1S APPROXIMATLY AT 78" LEAVING A SEPERATION OF 8" PLUS OR MINUS. DOWN CAPE PLAN DATED JANUARY 3, 2008 Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Offictai hupection Forth:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official- Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "< 988 CRAIGVILLE BEACH ROAD Property Address BARNACLE REALTY TRUST Owner owner's Name information is CENTERVILLE MA 02632 2/17/2014 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I ' TOWN OF BARNSTABLE /��^/l�' , LOCATION CrA:JViVIC' &&ICJ, ff0 SEWAGE# (� ((�/'/ 7 VILLAGE G ei, f-v v,'l/C. ASSESSOR'S MAP&LOT �p INSTALLER'S NAME&PHONE NO. 1 A a L.9 A✓ kf 4-e- SEPTIC TANK CAPACITYd-te�,V /-p-120 1 S'o �m f?G Z LEACHING FACILITY:(type) (size) G-A KN o w�— NO.OF BEDROOMS BUILDER OR OWNER f?6,n2 e-G l-e 04e4P4 %/- .5'r PERMIT DATE: L 2 6`/// COMPLIANCE DATE: .3! !/p' Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Z Feet Private Water Supply well and Leaching Facility �(If any wells exist on site or within 200 feet of leaching faciliy) r Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) NA Feet Furnished by1.�7�iilG /D/�t/J"Y /-�s� `?P�le J .3S LOCATION SEWAGE PERMIT NO. VILLAGE d /Z 1. INSTALLER'S NAME i ADDRESS 7&v B U I L D E R OR OWNER :"~' -0ATE PERMI;Ty�l;SSY;ED . . , ;, •D,A T E C 0 M P:L I AWN C E ;t,l S S`U E D, x " 00 4 s