Loading...
HomeMy WebLinkAboutFALMOUTH ROAD/RTE 28 PINOCCHIO PIZZA 1661, �N7LY01TT7R--'un_O;; i � BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli, M.D. BARN9TABLL F.P.(Thomas)Lee,. Mp Daniel Luczkow,M.D. Alt. 4' a °`•� 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 203 Issue Date: 01/01/2022 DBA: PINOCCHIO PIZZA & MORE OWNER: ANNA KRANIOTAKIS FAMILY PIZZA INC. Location of Establishment: 1661 FALMOUTH ROAD CENTERVILLE„ MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 42 OutdoorSeating: 0 Total Seating: 42 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, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: h I'~ ForO Initials: Town of Barnstable . , . , 7t( $ Inspectional Services E;�rp`� Public Health Division f Check# -Thomas McKean,Director 200 Main Street,'Hyannis,MA 02601 t Office: 508-862-4644 ;Fax: 508-790-6304 � al APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE I 1 14 7-1 NEW OWNERSHIP RENEWAL v NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: 1`D Le 4_�M yiA-41 l PZ&A CQ y)+f.Vvl I L M'16 O_Ue 3 2 MAILING ADDRESS'(IF DIFFERENT FROM ABOVE): SeLm C 0, a ba\re, — E-MAIL ADDRESS:s'a_ hy'1 StoLk i S Z 01 Mai . TELEPHONE NUMBER OF FOOD ESTABLISHMENT:) TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ✓ ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/_/ TO , i NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: 2— 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) �J 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 508-8624644 Q:Wpplication FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YE /NO D.O.B '� -L 59 OWNER PHONE #5()% --1—1 O �D q ADDRESS 3 Cie c I&ajn .Ewa Cti—,+6y-V rn f�- ®Z(V3 2— CORPORATE OWNER: 1p n>n a-, h,l S 1 lIj P 1 LZ� G i/1oC�'1i O �o Z?tee CORPORATE ADDRESS: 1 (O 1 C.f-n*eYi% PERSON IN CHARGE OF DAILY OPERATIONS: R n m a- 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.��'�,�p1,�,n 1 e:fi�-k..� 1� / q '/`�� 1:S`tQ,p " T��¢, �� ,,/ .•�:. /2.C� 2.�(�iph i Chr j S�OI�IS Co / 1 2(0 t� _71 fO SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. i ? 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.usthealthdivision/applications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application Forms\FOODAPP REV3-20i 9.doc 4 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. NSTABM =' Paul J.Canniff,D.M.D. 9dlA a5 � 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: 203 Issue Date: 01/01/2021 DBA: PINOCCHIO PIZZA & MORE OWNER: ANNA KRANIOTAKIS Location of Establishment: 1661 FALMOUTH ROAD CENTERVILLE„ MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 42 OutdoorSeating: 0 Total Seating: 42 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: oFt For Office Use Only: Initials: Town of Barnstable Date Paid ' Amt Pd$d-5D_ I ■UMSfABLE, : Inspectional Services MASb `0� Public Health Division Check# i°r6n Ma9 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 NEW OWNERSHIP RENEWAL .V �e NAME OF FOOD ESTABLISHMENT: Ril n-a-V-r In i oiak�s Fami�IU P i az-a.�-n p ino eC o:P zzu, ADDRESS OF FOOD ESTABLISHMENT: lo(0 I f7a� ryt p p y4-Vv IW 0j,Cemt e.y-V i (` e 024a S L MAILING ADDRESS(IF DIFFERENT FROM ABOVE): SkLM C E-MAIL ADDRESS: S 0.Ch r i S tfi0,k 1 S 2 Cq m c,i TELEPHONE NUMBER OF FOOD ESTABLISHMENT: S( 08)G TOTAL NUMBER OF BATHROOMS: a WELL WATER:YES NO X-...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE:y '- OUTSIDE: 0 TOTAL: Lf-N SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LI ENSING 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 FonnsTOODAPP 2020.doc ` OWNER INFORMATION: FULL NAME OF APPLICANT fk n VX P- k011 1 o-Ok U s SOLE OWNER: S NO D.O.B 3 a SGl OWNER PHONE —0 3'1 9 17� ADDRESS3q BCIdaYI L—A-YlC CQY1i P✓V11� M I� O (O�Z. � CORPORATE OWNER: 'A n to cL- 1=r-ar►l o+y.ki S f h1 i I u Pj 2Z,cL T7), L CORPORATE ADDRESS: 1W I�pG� , l�e I'1+>°✓ fIr b PERSON IN CHARGE OF DAILY OPERATIONS: A-nn-o, K...r Ak)I O,aY S 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.s+ e-pm-en 're 1+k e. is / 9 / 2-q 1. +C ehtn Ye K2 (al 2. "1 e, Ch am P h!�j 11/ 2-0_?"D SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.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.3 V each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Apphcation FormsTOODAPP REV3-2019.doc a Town of Barnstable BOARD OF HEALTH & John T.Norman Board of Health Donald A.Gaudagnoli,M.D. Paul J.Canniff,D.M.D. a , 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: 203 Issue Date: 12/10/2019 DBA: PINOCCHIO PIZZA & MORE OWNER: ANNA KRANIOTAKIS Location of Establishment: 1661 FALMOUTH ROAD CENTERVILLE, MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 42 Outdoor5eating: 0 Total Seating: 42 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: C�r AtYv� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: L A For Offlee Use Only. Initials: Town of Barnstable [ SE`i Date Paid �:7 Amt�Pd$ wwsrASLe. Inspectional Services 6 39 � Check# S Public Health Division �i1 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 i a. NEW OWNERSHIP RENEWAL V NAME OF FOOD ESTABLISHMENT: •P 1 n0 ce-yil 0 'p 1 ZZq 4, mI-im 1 " ADDRESS OF FOOD ESTABLISHMENT: k (0(0 I FGl M U VI�'1'� lera �i1 �-t:1�V� ls�- m ) d�'(a a Z MAILING ADDRESS(IF DIFFERENT FROM ABOVE): SGIMt E-MAIL ADDRESS: C(�IChY 1 Z; �S OV A YYIGLII - Q1�'Yl TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (S0�)-1+1 I - cI-1'7�1 TOTAL NUMBER OF BATHROOMS: oZ WELL WATER: YES NO, Ck ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: 4a OUTSIDE:0 TOTAL: �a 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? IJ IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? W- 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 s OWNER INFORMATION: FULL NAME OF APPLICANT l-n VICE hl 6-"l DA7/,Us SOLE OWNER: &NO D.O.B 3 a ISCI OWNER PHONE # EO Cl ADDRESS 1Q(p IMtly&+h P-00-A , 0 t of?if(V l �lA {�� � b2(0 3 a CORPORATE OWNER: P-f-)nrk k f"117"3 -q7&VY1I I,4 io►ZZ.Gc, CORPORATE ADDRESS: t U(D 1 f ib (Y-)y Vt,+IA P-pCka C9 n+t V vi -L M ft 0[jo 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 i a 0a I 6� 11 /m ;;-01c SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.usthealthdivision/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 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:Wpplication FormsTOODAPP REV3-2019.doc rtHSI Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board Of Health Donald A.Gaudagnoli, M.D. BAWNSTABLL = John T.Norman 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate by' 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: 203 Issue Date: 12/20/18 DBA: PINOCCHIO PIZZA & MORE OWNER: ANNA KRANIOTAKIS Location of Establishment: 1661 FALMOUTH ROAD CENTERVILLE MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 42 OutdoorSeating: 0 Total Seating: 42 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: -- _ - --------- --- - ---- - - MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: I FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: r a E " Town of Barnstable For O • Initials: o� • Date Paid Amt Pd$� MAS& Inspectional Services 9`b 039. "�� Check# '°rEo► � Public Health Division Thomas McKean, Director \A uj�ffd I,3 cO 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 11_Ind�Q L�_� NEW OWNERSHIP RENEWAL x NAME OF FOOD EESTABLISHMENT: 41.1'0 io P j'ZZ�t p61� ADDRESS OF FOOD ESTABLISHMENT: I (D(o I at M Q LA-t h (Z tDA6 : Co n+e,(Vi i(.L 02-( 3 Z MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �X me-) E-MAIL ADDRESS: S 0.C h Y-1 S tA-K 1 S 0 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: , D$ "77) TOTAL NUMBER OF BATHROOMS: 9 _ WELL WATER:YES NO X .. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: Lf 2 OUTSIDE: 0_TOTAL: `-f c. 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)? l 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) 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:\Application FormsTOODAPPREV2018.doc a PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT rl n -k-C n S SOLE OWNER: &NO D.O.B C1 OWNER PHONE # 5-0 ADDRESS-3 ri &61 A cl_h Is e . 0-,e-r1*erV 1 I U- (Yti 02-6 3 2- CORPORATE OWNER: PMnA--14Ani Q FADAFEDERAL ID NO. : V y-33&5 IX6-7 S "h 1 e) CORPORATE ADDRESS: Ile I 1 fiX4(Y)rM*1n eWdCl1.t'1�-f�ry 11'1 L 1YL C? PERSON IN CHARGE OF DAILY OPERATIONS: _f 1rtV I--- tom{kni 6TL(1j S 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. S C0J+ K&r+, Ih I l 20 la I 1. S��- �h�Yt ��` .F a / a- / a 1 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openinp-!! 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. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec. 3l't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPPREV2018.doc `oF� rokti TOWN OF BARNSTABLE . HEALTH INSPECTOR-s Establishment Name: Date: Page: I( Of S-' OFFICE HOURS PUBLIC HEALTH DIVISION 80019:30A.M. BARNS'rABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified e,y: �•� HYANNIS, MA 02601 M-8 -FRi.62-4644 508 No Reference R-Red Item PLEASE PRINT CLEARLY iOrFo May° FOOD ESTABLISHMENT INSPECTI N REPORT t Name cJ Date t T f Inspection l i otne Address- l�Cp ' l rV 1 Risk Food Servi -Re- coon XAA4 ; i ` Level Retail Previous Inspection cal Telephone Residential Kitchen Date: Mobile- Pre-operation "1 (� Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP ^ Ila jL lIn: i+, Other Inspector -��T, Out: ' ` ' i/✓-/ 1f Each violation checked re uires 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 590.009(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 �Zi�/!/ 1 r t , .41 ❑ 1.PIC Assigned/Knowledgeable/Duties F­] 13.Handwash Facilities N�t e ti' 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 �X p FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 123 ❑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 A/ (� p p ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Adv � -isories elic 1` it �- - _# 3 Violations Related to Good Retail Practices Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items F`{ t 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. F] Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspectioA 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. (FC 4)(590.005) cited in this report may result in suspension or revocation of the food 25.Equipment and Utensils B=One critical violation and less than 4 non-critical violations 9 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 ) aggrieved y y 9 g, q C=2 critical violations and less than 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of Y� y (FC-6)(590.007 a rieved b this order,you have a right to a hearing. Your request must 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 violation,4 to 8non-critical violations=C. . 29.Special Requirements (590.009) within 10 days of receipt of this order. Print i gnau e 30.Other PATE OF RE-INSPECTION: Inspector' 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N 11 � #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen-1 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 L 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) jDe-.onstrationof Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Coaling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11- Person-in-Charge Duties 1 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 i 7-101.11 Identifying Information-Original Containers* 590.003(C) Responsibility of the Person-in-Charge to Other* a 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 Se azation-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* ( ) q 590.003(G) Reporting by Person in Charge* - Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR ° 3-306.14(A)(B)Returned Food and Reservior of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) _ P - - 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3=201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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 E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11. Drinking Water from an Approved.System * Eggs Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective uinoot 4-602.11 Cleaning Frequency of Utensils and Food _ Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source- - _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing ContainingFish,Meat,Poultryor 3-201.15 Molluscan Shellfish from NSSP Listed _ Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* 10 Proper,Adequate Handwashing Ratites-165°F 15 sec* ing' P 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 RegulatoryAuthorily 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 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 3-201.17 Game Animals* 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) 3-202.11 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Lu 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. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S: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 tNE Oki TOWN OF BARNSTABLE _ HEALTH INSPECTOR'S Establishment Name: - Date: Page: of 2. p OFFICE HOURS PUBLIC HEALTH DIVISION 8:00=9:30A.M. BARE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS.�A ,e3q•n e HYANNIS, MA 02601 MON.-FRI.508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT dip. Name �' '� i'( _ Date .t,l I Tyne of jype of Ins ection Utine ALL Address / rGl� I/lJ _ C►�' --Risk oo e-inspection Level Retail 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 i Inspector Out: (: f Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. ;.v Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ _ 7`-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 l `•� I S f � .I� ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 1 )tiig EMPLOYEE HEALTH PROTECTION FROM CHEMICALS /v /� O aey ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 1 ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals .V1 FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures tQ !�b� `J�.( (� i 0 �r/��,� ❑ 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 �J 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 �/ I f� Z`� ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY I� ,� - ��` ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories I lit laf 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. I ❑ Embargo g ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=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 ) 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 = 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non- �' I violations C. 30.Other DATE OF RE-INSPECTION: Inspector'srSiature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N ✓//✓I natu Print: Si#Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC 9 Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? y N ___- ^- ..�.-.o-.�..._ -»-.�.., •r.•-_--.. .._-• �. ... -..r .-.. _.... `..r..--.` ". < -� -.-.-. � ._---.�_. ., -:. .._.... .� _,_. -..+-.t. �+-tires..._..4�..._, s r --+_ ,.....- .r. .-..a- e t •. . _ ,� 1.� r,� ,r-___.......-. �._...--�_.,,-..� � _ - - 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 3^202.1.2_ 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 75 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers*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* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* P g 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 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 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) I 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 1590.003(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 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 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* g8 - - Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff"i-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 3-401.11(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 10 Proper,Adequate Handwashing g' P �Y 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 k2-301.14 .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* .12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( )3-201.17 GameAnimals* 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* 1 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 Commerciall Processed RTE Food-140°F* (Blue Items 23.30) 3-202.15 Package Integrity ( ) Y 3-101.11 Food Safe and Unadulterated Prevention of Contamination from Hands ( ) g Critical and non-critical violations,which do not relate to the foodborne * 12 3-403.11E 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 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 * 5-204.11 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. oFi ►,� TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: ®�- Date: MA(/Page: of- P. tio* 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 HYANNIS,MA 02601 MON.-FRI. No Reference R Red Item PLEASE PRINT CLEARLY 508-862-4644 rFD MAC r�,FOOD E TABLISHMENT INSPFECTION REPORT R Name D e T e of Type of Inspection g TROU'Address //KZXA If - isk Fo d Servl evel oTelephone Residential Kitchen M r/AW Mobile Owner HACCP Y/N Temporary e Caterer General Complaint 41 Person in Charge(PIC) Time Bed&Breakfast HACCP I Other Inspecto Each violation checked requires an explanation on the narrative age(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 IV 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 Lu ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations no�r Critical(C)violations marked must be corrected immediately. (blue&red items) ok 0 1 W 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 4 non-critical violations 9 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)(59U.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than19n-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 must28.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 l vio ions. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. n,4 to 8 non-critical viola = 30.Other - DATE OF RE-INSPECTION: I s 4 tor's i e nt: 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 Waft Service Provided Grease Trap Size_ Variance.Letter Posted Y N Dumpster Screen Y N B Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) r 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 Contamination 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* Storage*- Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G) Reporting by Person in Charge* - 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR. 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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.b11 - 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. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 3-401.I IA(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* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff°eye 1/12001 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 401.I1(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs 4-702.11 Frequency r f 3- 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* 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 1 p 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. * 2-301.14 When to Wash* 3-401.11 A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Wild Mushrooms ( )( )(b) practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices _ 17 Reheating for Hot Holding 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g• g g 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 al violations,which do not relate to the foodbome * 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 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 5-204.11 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* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S.590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. O °F. rqr TOWN OF BARNSTABLE, . HEALTH INSPECTOR'S Establishment Name: Dater Page: of q OFFICE HOURS r PUBLIC HEALTH DIVISION 8:00-9:30 A.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 MON.-FRI. �p ,679.a a HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 'FO11P' p FOOD .STABLISHMENT INSP OO REPORT AA Name Date oe of f Inspection N' PratinniAl Routin" i s ect'�pn Address Risk od S , J p n p Level Previous �ie ,i n Telephone Residential Kitchen Date: i 1 Mobile Pre-opt a ion Owner HACCP YIN Temporary Suspe Il�ness Caterer General Complaint Person in Charge(PIC)' Time Bed&Breakfast HACCP Other Inspectorfin MA Each violation checked requires an explana i n the narrativ page(s)and a citation of specific provisions)violated. Anti-Choking 590.009(E) Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) 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) ❑ J 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 Asa Public Health Control NO ❑ 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 1 ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories w l Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) 1 `�Ia Corrective Action Required: I I I f r J-_ ❑ 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 Susp i C N Official Order for Correction: Based on an inspection today,th Items o E Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 6=One critical violation and less than 4non-critical violations 9 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 9 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 FacilityFC-6 590.007 aggrieved b 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 ( )( ) y 9 9 q violations observed,7 to 8on-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 n,4 to 8non-critic viol ns=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: s i at e P' 31.Dumpster screened from public view ) l Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's 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 1q 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 890.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 7-102.11 590.003(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* 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* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q � -- 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 AdulteReserrated or of 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* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.1](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 E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective iiuzoor 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 rf 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 StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* 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 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 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 3-501.14 Cooling PHFs Made from Ambient 24.- Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location-and Placement* (B) g 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: F IMF ro TOWN OF BARNSTABLE- HEALTH INSPECTOR's Establishment Name: ' / Date: Page:. of - �� OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAKOF CORRECTION Date Verified MASS. MON.-FRI. �p ,639,aim HYANNIS,MA 02601 508-862-4644 No Reference R.-Red Item PLEASE PRINT CLEARLY 'FDN1P` 6)OD ESTABLISHMENT INSP C ION REPORT Name �i T o e o ectio I g ne �IL I� Address Risk , �# od Se pectio Lj tj IN� t Level Previou Date I s 11 g Telephone Residential Kitchen t : Mobile Pre pe la Owner HACCP Y/N Temporary Suspect Illn'ss r Caterer General Complaint - Person in Charge(PIC) Time Bed 8 Breakfast HACCP ' In Other i Inspecto I 4 II Each violation checked requires an explanation'on the narraU a ge(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ i 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 i II ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals y FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating O . ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control A ❑ 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 �D D6 ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations' v � Critical(C)violations marked must be corrected immediately. (blue 8 red items) Titms Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately orwithin 90 da s as determined b the Board of Health. Overall RatingY y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,t checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure C] Voluntary Disposal El 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 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 4von-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 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critic viol ons. If 1 critical refrigeration. viol 4 to 8non-critical violati s= 29.Special Requirements (590.009) within 10 days of receipt of this order. �°:tt a aA. 30.Other DATE OF RE-INSPECTION: Ins SS) to 31.Dumpster screened_from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y natur Print: #Seats Observed Frozen Dessert M PIC's Si achines: Outside Dining Y N 9 - 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 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) r 590.003(C) Responsibility of the Person-in-Charge to Other* g 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* 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*- tensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* 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 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 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 L 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. 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°16 F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* g8 Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef c&v 7/1n001 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 of Equipment* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-,(D)in cater- Sources* Ratites-165°F In 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 3-001.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* L240 2 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 4 When to Wash* 3-401.11 A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )�) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Eatin Drinkin or Usin Tobacco* * Requirements. Reeeiving/Conditlong. 8 g 3-003.11(A)&(D) PHFs 165°F 15 sec3-202.11 PHF's Received at Proper Temperatures* 2 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 * 12 Prevention of Contamination from Hands 34A3.11 Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 3-101.11 Food Safe and Unadulterated (E) g 6 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 3-501.1 A Cooling 3-202.18 Shellstock Identification 4( ) g 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 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 1.009 3-502.11 Specialized Processing Methods* 130. 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 Rem in the federal 1999 Food Code or 105 CMR 590.000. `pp THE Tqr, TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: Date: U� .Page: . of q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. i eAaNSTAsLE. - 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 ,• More.-FRi. No Reference. R-Red Item - PLEASE PRINT CLEARLY- 508-862-4644 'FDN1 FOOD ESTABLISHMENT INSPECTION REPORT Name Date c of o ec ion O outine Addres Risk ood Service pection Level 4as7gr Previous Inspection ZA 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 Inspect o Out: �L-4 & Each violation checked re uires 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) Lea "Zol ❑ 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 ' �-+ 7 , ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Ha rdous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures \ ❑ 5.Receiving/Condition ❑ 17.Reheating, V ❑6.Tags/Records/Accuracy of Ingredient Statements F] 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) ray ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY r ❑ 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency Closure El Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4non-critical violation's 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.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 if: no hot 27.Physical FacilityFC-6)(590.007 aggrieved b 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 ( ) g9 y 9 9 q 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 violation,4 to 8non-critical violations=C. - 29.Special Requirements (590.009) within 10 days of receipt of this order. 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' Sign ture 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 14 Food or Color Additives Law Cooled to 41°F/45*F Within 4 Hours* 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination _ * * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302:14 Protection 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* fY 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 7-201.11 Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* 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 Reared or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated -- Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 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 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.. l 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* 3-401.11 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 - Equipment*ui ment* - gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef ctiw 11112001 4-602.11 Cleaning Frequency of Utensils and Food - Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(d - ide in cater- - * - Ratites-165°F 15 sec* in mobile food,tempor and residential Sources [:To: Proper,Adequate Handwashing g' 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. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* 3-401.11(A)(1)(b) All OtherPHFs-145°F15sec 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 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C CommerciallyProcessed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Critical and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 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* 1g 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[0 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 * 5-205.11 Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 - 590.004(J) labeling of Ingredlents' Supplied with Soap and hand Drying Devices 27, 1 Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 f HACCP Plans 6-301.12 Hand Drying Provision 129. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. '~ 1 GQt r °FVE or TOWN OF BARNSTABLE . HEALTH INSPECTOR•s Establishment Name: Date: �c GG Page: of ti ' PUBLIC HEALTH DIVISION OFFICE HOURS 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 ORRECTION Date Verified MASS. fir. MON.-FRI. 039,A 0 HYANNIS,MA 02601 508-862-4 No Reference R-Red Item PLEASE PRINT CLEARLY , 'FOM FOOD ESTABLISHMENT INSP CTION REPORT Name f Dat i ( e of T do t, Ah 10 Routine Addressk,(P Risk od Service n Level a aI 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 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) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 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 ❑ 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 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. Fii ❑ 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 B=One critical violation and less than 4non-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 6ncn-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 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 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address i 8 non-critical violations. if 1 critical refrigeration. violation,4 to 8ncn-critical violations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. = 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view . Permit Posted? 2,44 Y N Grease Trap Previous Pumping Date Grease Rendered Y N 's nature Print: I #Seats Observed Frozen Dessert Machines: Outside Dining Y N C 9 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* r 3-501.15 Cooling Methods for s 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 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 3-501.16(A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* 590.003(F) Responsibility of A Food Employee or An 3-302.15 ._ _ Washing'F'ruits and Vegetables 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 Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions*590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and P 4-501.111 Manual 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 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game * e ecrive 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) Pork and Beef Roast-1 1 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) 155 Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 1p Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commerciall 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 fuodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsticed 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 5-204.11 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 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced=.Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* -S.,590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.0 0., 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Town of Barnstable of THE 0 Department of Health,Safety,and Environmental Services r/�'p�0�111� DARNt�TADLE,I Public Health Division Sir L_7�) 9 MASS. �Alf039. Aim 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A. McKean, RS, CHO FAX: 508-775-3344 Director of Public Health June 24, 2016 Ms. Kristen Terkelsen Physical Therapy Solutions 1663 Falmouth Road Centerville, MA 02632 Dear Ms. Terkelsen, am in receipt of two additional letters from you dated June 23, 2016 and June 24, 2016 regarding the proposed nail salon and its wastewater discharge flow at 1667 Falmouth Road, Centerville. On June 21st, I responded-to your second letter and on June 17th I responded to your first letter. As indicated in both the June 17th and June 215t letters, the existing septic system has a capacity of 1,869 gallons at Centerville Plaza, 1661 through 1675 Falmouth Road, Centerville. In the past, 1,815 gallons per day (GPD) of discharge was permitted at this site. This site is therefore grandfathered; each unit is restricted so that the overall wastewater discharge flow does not increase beyond 1,815 gallons per day which is the maximum wastewater discharge allowed for this site. There is no extra capacity available above 1815 GPD due to the Saltwater Estuary Protection Ordinance which restricts wastewater discharge flows to 440 gallons per acre per day. The nail salon is restricted to 108 gallons per day maximum discharge as approved by Brian Dudley of the Massachusetts Department of Environmental Protection (DEP). This is based on two employees and 20 customers/pedicures per day. If this business expands into another unit with additional employees and additional pedicures/customers, the proposed wastewater discharge will have to be reviewed and recalculated in regards to the number of employees and pedicure customers by a professional engineer, prior to the issuance of an approval of a building permit. The wastewater calculations were not based on a washing machine nor were they based upon the number of pedicure chairs. The engineer's calculations were based on number of employees and the number of pedicures/customers per day. To the best of my knowledge, this will not be a public clothing washing business. The applicant informed us this will be a nail salon. If any other changes are proposed within this plaza (i.e. a new use, change of use, additional seating at a restaurant), the proposed use would have to be reviewed by a professional engineer at the applicant's expense and the wastewater discharge flow would have to be recalculated prior to the issuance of an approval of a building permit. 2ioEniias cerely, 2- McKe n Cc: Paul Canniff, D.M.D, Ed Pesce, P.E.. Q:IMPICenterville Plaza Terkelsen Jun2016 First Property Mgmt, 1046 Main St.,Osterville,MA CFNTERVILLE PLAZA -Wastewater Design Flo -) It.,�01'1)irxqk. Ce� rzl/lC� -e WASTEWATER DESIGN FLOW CALCULATIONS- 22 April 2016 Unit Use/Area Title 5 Design Flow Address d 1661 Pinocchio Pizza fast food 36 seats X 20 d/seat 720 1663 PhysioTherapy Associates 2,400 SF office X 75 g pd/1000 sf 180 1665 Office Ba side Builders Showroom 909 sf office X 75 gpd/l000 sf 1667 Proposed IN-ail Salon` " r - _ 2 employees X 15-gpd 30 Pedicures:'20 customers/day X 3 gal _. 60 245 sf office X 75 gpd/1000 sf (offices 41'84 __- IN space and toilet area to be dedicated from adjacent unit#1665 1669-1671 Centerville Pie Restaurant 16 seats X 35 d/seat 560 1673 Centerville Cleaners 1,500 sf total 80% Storage & 20% Retail = 300 sf x 15 50 d/1000sf + 2 employees x 15 gpd 30 1675 - Rt. 28 Convenience Store 2,600 sf retail X 50 d/1000 sf 130 TOTAL 1,811.4 GPD EXISTING APPROVED TITLE 5 DESIGN FLOW (May 2006): 1,815 GPD EXISTING TITLE 5 LEACHING CAPACITY INSTALLED (May 2006): 1,869.2 GPD PESCE ENGINEERING &ASSOCIATES, INC. Phone 508-743-9206 451 Raymond Rd., Plymouth, MA 02360 Fax 508-743-0211 • • CENTERVILLE PLAZA -Wastewater Design Flow WASTEWATER DESIGN FLOW CALCULATIONS- 22 April 2016 Unit Use/Area Title 5 Design Flow Address - (gpd) 1661 Pinocchio Pizza (fast food) 36 seats X 20 gpd/seat 720 1663 PhysioTherapy Associates 2,400 SF office X 75 gpd/1000 sf 180 1665 Office Ba side Builders Showroom) 909 sf office X 75 gpd/1000 sf 68.2 1667 Proposed Nail Salon 2 employees X 15 gpd 30 Pedicures: 20 customers/day X 3 gal 60 245 sf office X 75 gpd/1000 sf (office 18.4 space and toilet area to be dedicated from adjacent unit #1665) 1669-1671 Centerville Pie (Restaurant) 16 seats X 35 gpd/seat 560 1673 Centerville Cleaners (1,500 sf total) 80% Storage & 20% Retail 300 sf x 15 50gpd/1000sf + 2 employees x 15 gpd 30 1675 Rt. 28 Convenience Store 2,600 sf retail X 50gpd/1 000 sf 130 TOTAL 1,811.4 GPD EXISTING APPROVED TITLE 5 DESIGN FLOW (May 2006): 1,815 GPD EXISTING TITLE 5 LEACHING CAPACITY INSTALLED (May 2006): 1,869.2 GPD PESCE ENGINEERING &ASSOCIATES, INC. Phone 508-743-9206 451 Raymond Rd., Plymouth, MA 02360 Fax 508-743-0211 Crocker, Sharon From: McKean,Thomas Sent: Friday, June 10, 2016 12:46 PM To: Crocker, Sharon; Stanton, David; Desmarais, Donald; Miorandi, Donna Subject: FW: Seating Restrictions at Centerville Pie Company Attachments: SCAN-FILE_1of1 jpg; CENTERVILLE PLAZA- WW Design Flows - 22 April 2016.doc -FYI - -----Original Message----- From: McKean,Thomas On Behalf Of Health Sent: Friday,June 10, 2016 12:45 PM To: 'tboduch@verizon.net' Subject: RE: Seating Restrictions at Centerville Pie Company Good Afternoon Karen, Every unit in this building is restricted, not just this one unit. This particular establishment added additional seats without first requesting permission from the Board of Health and/or Health Division,as required by the Licensing Board. However,we worked with the professional engineer, Ed Pesce. Attached is the chart he submitted which allows Centerville Pie to increase the seating from 12 to 16 . Attached is the State of Massachusetts Title 5 sewage flow table, which requires us to use 35 gallons per seat as the wastewater discharge flow rate. This is based on both kitchen and restroom wastewater discharges together. There are two issues here: -The limited size/capacity of the septic system; and -The site location within an Estuary Protection Zone which restricts the wastewater discharge flow to 440 gallons per acre per day. However, 1,815 gallons was previously approved;therefore this site is grandfathered for this higher wastewater discharge flow. As you can see from the attached chart, each unit is restricted so that the overall wastewater discharge flow does not increase beyond 1,815 gallons per day which is the maximum wastewater discharge allowed for this site. Pinocchio Pizza is restricted to 36 seats maximum. The nail salon is restricted as shown in the attached chart and as reviewed and approved by Brian Dudley of DEP. (See copies of his a-mails below). The applicant has the option of requesting a variance from the Board of Health; however the Board has been very strict in regards to enforcement of both Title V and the Saltwater Estuary Protection Regulation for many years. Sincerely, Thomas McKean 1 ----------------------------------------------------------------------------------------------------------------------------------------------------- April 26, 2016 Hi Tom, I had a good meeting with Brian Dudley yesterday afternoon at his office in Barnstable. Brian reviewed my approach and wastewater flow calculations and has endorsed my methodology. He found it reasonable, and asked that you contact him if you have any questions. Thank you Tom, ED ------------------------------------------------------------------------------------------------------------------------------------------------------- April 22, 2016 Good Morning Tom, I dropped off some hand notes and drawings on Thursday and attached is an updated wastewater flow table showing the proposed nail salon and office space changes shaded in Blue. The highlights are: 1. The nail salon will have just 2 employees (husband &wife) 2. They expect to do manicures and pedicures' 3. They are estimating 15-20 pedicures (max) per day—so I used 20/day (10 per employee) 4. The pedicures will be done with a special chair(manufacturer's cut sheet attached), which uses water—the basin in the chair holds about 4 gallons, and they only fill the basin about half way(since the customer's feet take up some of the volume)—but I used a volume of 3 gallons/pedicure as a worst case estimate. 5. The Salon is proposed to occupy a unit that does not have a toilet, so they are planning to use the connecting door to the adjacent unit(#1665)to gain access to a toilet,which can be separated from the rest of#1665 by a locked door. This space also has some room for an office, so I have used that 245 SF in my calculations (for office flow). I left copies of floor plans to better explain this.So overall the proposed nail salon use does not exceed the existing septic system capacity, as shown on the attached table. Please review this, and let me know if the proposed tenant can proceed with their plans. Thank you, ED -----Original Message----- From:tboduch@verizon.net [mailto:tboduch@verizon.net] Sent:Thursday,June 09, 2016 4:05 PM To: Health Subject: Seating Restrictions at Centerville Pie Company I Hello Tom. Karen Boduch here. I have stopped in to the office a few times to speak with you, but unfortunately, have missed you. I wanted to voice my opinion and strong disagreement with a recent restriction that I understand was made by the Town of Barnstable Health Dept. at the Centerville Pie Shop. Z i Apparently, one of the inspectors had the owners remove from the restaurant, a table that would accommodate a party of three. The reason, as I understand it to be, is because of the relationship to the number of patrons that might use the restroom with regard to the size of the commercial sized septic system.This makes no sense to me at all. All this has done is to create-for the same number of patrons being served - just having to wait in line longer for a table because now,they are down to seating for only 16. Very frustrating for customers and not good for business.There appears to be neither any gain nor logic to this restriction especially when, clearly, not every patron uses the restroom. In fact, if one were to measure patron restroom usage, I am confident the study results would indeed be lower than speculated. Additionally,the staff was told that the same restriction was levied on Pinocchio Pizza who currently enjoys seating for 40 yet is primarily a take-out business. However, when speaking with staff at Pinocchio Pizza,they say no such restriction has been made to that business. Further, it is also my understanding that a nail salon will soon occupy the unit next door to Centerville Pie Company. What will be the guideline be for that business? I I ask that you kindly look into this matter and do your professional best to restore those three seats to that restaurant to better serve the community and to also prevent the BOH from appearing to unfairly single out the Centerville Pie Company.This is a restaurant is well known as having become an icon and staple of Centerville Village that is owned and operated by people who are compassionate, compliant and who give back to the community ten-fold,to say the very least. Thanks for your time, hope to speak with you soon. Take care, Karen Boduch (cell: 508-728-8710) 3 -I 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION ' 15.203: continued MINIMUM ALLOWABLE GPD FOR GALLONS SYSTEM l> TYPE OF ESTABLISHMENT UNIT PER DAY DESIGN (3) COMMERCIAL(continued) Factory,Industrial Plant, per person 15 Warehouse or Dry Storage Space without cafeteria Factory,Industrial Plant, Warehouse or Dry Storage Space with cafeteria per person 20 F Gasoline Station per.island***** 75 300 ]j with service bays per bay 125 c:,? ***** Plus flows for bays,if any Kennel/Veterinary Office per kennel 50 Lounge,Tavem per seat 20 Marina per slip 10 500 t f Movie Theater per seat 5 per Non-single family// washing 400 g Y P g automatic clothes washer machine Office building per 1000 sq.ft. 75 200 Retail Store(except supermarkets) per 1000 sq.ft. 50 200 Restaurant per seat 35 ' 1000 Restaurant,thruway per seat 150 1000 service area Restaurant,Fast Food per seat 20 1000 ; .I Restaurant,kitchen flow per seat 15 11. [for sizing of grease trap only] i Service Station per bay 150 450 $] ;�; [no gas] Skating Rink per seat 5 3000 Supermarkets per 1000 sq.ft. 97 Swimming Pool per person -10 Tennis Club per court 250 { Theater,Auditorium per seat 3 _l Trailer,dump station per trailer 75 a' 'G 1 (4) INSTITUTIONAL Place of worship without kitchen per seat 3 with kitchen per seat 6 Correctional Facility per bed 200 Function Hall per seat 15 Gymnasium per participant 25 i Gymnasium per spectator 3 Hospital per bed 200 ' Nursing Home/Rest Home per bed 150 Public Park,toilet per person 5 waste only I � • { 4/21/06 310 CMR-510 CENTERVILLE PLAZA -Wastewater Design Flow Comparison WASTEWATER DESIGN FLOW CALCULATIONS- MAY 2006 , f Unit Address Use/Area Title 5 Design Flow d 1661 Pinocchio Pizza fast food 42 seats X 20 d/seat 840 1663 PhysioTherapy Associates 2,400 SF office X 75 d/1000 sf 180 1667 Ba side Design & Remodeling Office 1,200 sf office X 75 d/1000 sf 90 1669 Light Speed Mortgage 2,400 sf office X 75 d/1000 sf 180 1671 Cape Cod Chicken fast food 16 seats X 20 d/seat 320 1673 Kelle 's Music 1,500 sf retail X 50 gpd1000 sf 75 1675 Rt. 28 Convenience Store 2,600 sf retail X 50 d/1000 sf 130 TOTAL 1,815 GPD WASTEWATER DESIGN FLOW CALCULATIONS-JANUARY 2015 Unit Address Use/Area Title 5 Design Flow d 1661 Pinocchio Pizza fast food 42 seats X 20 d/seat 840 1663 PhysioTherapy Associates 2,400 SF office X 75 d/1000 sf 180 1665 New Thai Restaurant fast food 10 seats X 20 d/seat 200 1667 Vacant Office 1,200 sf office X 75 d/1000 sf 90 1669-1671 Cape Cod Pie fast food). 16 seats X 20 d/seat 320 1673 Centerville Cleaners 1,500 sf total 80% Storage &20% Retail = 300 sf x 15 50 d/1000sf + 2 employees x 15 gpd 30 1675 Rt. 28 Convenience Store 2,600 sf retail X 50 d/1000 sf 130 TOTAL 1,805 GPD EXISTING APPROVED TITLE 5 DESIGN FLOW(May 2006): 1,815 GPD ,EXISTING TITLE 5 LEACHING CAPACITY INSTALLED (May 2006): 1,869.2 GPD PESCE ENGINEERING &ASSOCIATES, INC. Phone 508-743-9206 451 Raymond Rd., Plymouth, MA 02360 Fax 508-743-0211 f \ J III • 1 fJ �- 7/� CENTERVILLE PLAZA -Wastewater Design Flow Comparison �O -7 /0 V 0 ,e,#, WASTEWATER DESIGN FLOW CALCULATIONS- MAY 2006 Unit Address Use/Area Title 5 Design Flow d 1661 Pinocchio Pizza fast food 42 seats X 20 pd/seat 840 1663 PhysioTherapy Associates 2,400 SF office X 75 d/1000 sf 180 ✓//1 ll 7 1667 Ba side Design & Remodeling Office 1,200 sf office X 75 d/1000.sf 90 ` 1669 Light Speed Mortgage 2,400 sf office X 75 pd/1000 sf 180 1671 Cape Cod Chicken fast food 16 seats X 20 d/seat 320 1673 Kelle 's Music 1,500 sf retail X 50 gpd1000 sf 75 1675 Rt. 28 Convenience Store 2,600 sf retail X 50 d/1000 sf 130 TOTAL 1,815 GPD WASTEWATER DESIGN FLOW CALCULATIONSCANUA�RY 2015 Unit Address Use/Area Title 5 Design Flow d 1661 Pinocchio Pizza fast food 42 seats X 20 d/seat 840 1663 Ph sio herapy Associates 2,400 SF office X 75 d/1000 sf 180 i 1665 ., New Thai Restaurant fast food 12 r 10 seats 20 d/seat 200 1667 Vacant Office 1,200 sf office X 75 g pd/1000 sf 90 1669-1671 Cape Cod Pie fast food 16 seats X 20 d/ at IV, 320 f/ O c v»''-c o . 5 �' a o ewSe_ = Z/ o 7 1673 Centerville Clea rs 1,5 sf total 80% Stor e &20% Retail = 300 sf x 15 50 d/1000sf + 2 employees x 15 gpd 30 1675 Rt. 28 Convenience Store 2,600 sf retail X 50 d/1000 sf 130 TOTAL 1,805 GPD EXISTING APPROVED TITLE 5 DESIGN FLOW(May 2006): 1,815 GPD EXISTING TITLE 5 LEACHING CAPACITY INSTALLED (May 2006): 1,869.2 GPD PESCE ENGINEERING &ASSOCIATES, INC. Phone 508-743-9206 451 Raymond Rd., Plymouth, MA 02360 � v Fax 508-743-0211 cp— -s Jo J 4-5 Fick �310 lit cWo o I eD P -7 1-e, jp A)o4 W7 II'A Yo 3F 9� � � ����-�) � as �� _ � � , go 306 + Z— C�o ,JL j 4yl P-r-C, f A-t 2 o c-) sF Rai x ooc,5F T s (Iris, ("I C, . 'j • . ill Alicia Carter Po Box 874 Intervale,NH 03845 Monday, April 10, 2006 To Whom It May Concern: -3 .rjq I am writing.this letter out of concern,hope, disgust, and loss of faith. On April 1 st my family and I were having lunch at Pinocchio Pizza in Centerville,Ma. This has een a �t =' long time tradition for us. I can remember going there when I was a little girl loving ` it, now my son feels the same way. Unfortunately,this has all changed for some very unnecessary reasons. While having lunch on Saturday April 1st,the sprinkler in the dining room exploded. This happened just after we had received our pizza and barely got to eat one piece. At first when it happened I expected to be covered in water,but that was not the case at all. We all were covered with black spots that looked and smelled like oil. I grabbed my four year old son and ran outside. He was very shaken up by this entire incident. We stood in front of the store and I tried to wash all of this'black stuff off of his face and told him that the fire department was on their way. f have tried to teach him that fire fighters are there to help—and I kept telling him they were coming to help us and make sure we were alright. When they arrived they went directly inside the building and took care of everything.. There were two or three trucks and many fire fighters. We stood there covered in this junk for about 30 or 40 minutes. My son continued to be very scared and traumatized. I have no idea where the workers of the restaurant disappeared to or the manager and owner. We never saw any of them and no one came to see if we were alright. After about half an hour the fire fighters were just cleaning up inside and one truck left,I decided to go inside and say something. I was and still am extremely upset and disappointed that not one person came to see if we were ok. Not the fire fighters,the restaurant employees,owner of the building, or the manager of the restaurant. I went to the door and stated that I had a four year old that just got covered in this stuff and not one person has come to check on us. One fire fighter responded with"How were we supposed to know you were in here",well my guess would be the fact that we were standing in front of the building, covered with black spots and very shaken up. Another fireman asked me if we needed an ambulance. Thank God we didn't,but if we did I would have taken care of it myself—it was quite obvious that they would have left us there and never checked. r After I went inside a couple of firemen came out and started talking to my son to see if he was ok. One of the fire fighters followed me outside and very rudely stated"we did ask someone in your group if you were all ok",this was certainly not true. I did see one of the firemen talking to one other lady that was in the restaurant,but it was no one that we knew or were with. One of the fire fighters said there was just a small amount of oil and the rest was water. I understand that these things happen and sometimes there is nothing that can be done... But this certainly does not excuse the fact of negligence on the part of all these workers. I work in a hotel and I cannot imagine the person in charge not checking with your customers to be sure each one of them is alright when something like this happens. In my opinion(and I could be wrong),I thought the restaurant workers should have checked on all of the customers and taken their names, addresses,and phone numbers. (The cook of the restaurant did come out and take our names,but this was only after I went in and said how upset I was.) The fire fighters should have assessed the situation on the inside while someone else checked on the individuals who had evacuated the restaurant in the event that someone needed an ambulance. And who knows where the owner of the building and manager of the store were! I guess all of these people were more concerned about the building than the people. I was always taught that buildings and restaurants were replaceable,people are not! I am hoping by writing this letter that all of these workers who shirked their duties, remember that people are more important than structures! I really would have expected some compensation for the pizza that we had just paid for and never ate,and also for our clothes that are completely ruined. My son is now afraid to go into a restaurant and has asked if fire fighters are really there to help the people or the building. I have tried to teach him that they are there to help people,but when something like this happens and their last concern was the people; I am beginning to wonder myself. How can I teach my child something that is not true? Sincerely, Alicia Carter CC: Barnstable Patriot Centerville Fire Department Town Clerk Public Health Pinocchio Pizza l Health Complaints 05-Apr-06 Time: 2:45:00 PM Date: 4/1/2006 Complaint Number: 18729 Referred To: DAVID STANTON Taken By: DAVID STANTON Complaint Type: ARTICLE X- FOOD Article X Detail: Business Name: PINOCCHIOS PIZZA Number: 1663 Street: FALMOUTH ROAD\RT. 28 Village: CEN!TERVILLE Assessors Map_Parcel: 209-087-001 Complainant's Name: COMM FIRE Address: Telephone Number: Complaint Description: SPRINKLER WENT OFF IN RESTAURANT Actions Taken/Results: DS WENT TO SAID LOCATION AND MET WITH OWNER OF PINOCCHIO PIZZA. THE RESTAURANT WAS CLOSED DOWN. SHE HAS CONTACTED LANDLORD-ANDREW WITTER (508)420-0299 X13, OF 1 ST PROPERTY MANAGEMENT OF OSTERVILLE, WHO HAS HIRED A CLEANING COMPANY AND NOTIFIED INSURANCE COMPANY. THE FIRE DEPT. REMOVED AS MUCH WATER AS POSSIBLE. THE SPRINKLER SYSTEM WILL NEED TO BE CORRECTED. THEY HAD JUST HAD THE SPRINKLER SYSTEM SERVICED A WEEK BEFORE. THEY WILL RE-OPEN AFTER THE CLEANING COMPANY HAS CLEANED IT ALL UP. SEVERAL PHOTOS ON FILE. NO FURTHER ACTION REQUIRED. Investigation Date: 4/1/2006 Investigation Time: 3:05:00 PM 1 am Logged In As: Parcel Detail Tuesday, April 4 2006 Parcel Lookup Parcel info Parcel ID 209-087-001 Developer Lot LOT 1 _. _..... . ,,,..._ _.. m. _._._.... Location 1663 FALMOUTH ROAD/RTE 28 Pri Frontage;200 Sec Road( Sec Frontage village!CENTERVILLE Fire District IC-O-MM Sewer Acct Road Index 10522 Owner Info Owner DACEY, BRIAN T TR Co-owner CENTERVILLE PLAZA TRUST Streetl 1 P O BOX 95 Street2 City ICENTERVILLE State MA Zip!02632 Country USA - Land Info ....... 'Acres 1.19 Use STORE/SHOP A zoning 1HB Nghbd C115 ..._..... ......_.._ ....... ......... ......_.. -- ......_ Topography 3 Road! utilities Location - Construction Info _ .... ...........__ ........ _.. __ ... Building 1 of 1 Year­,_. _._. .. _. __ Roof _ �,.. —....:__ AC€" _. Built 1983 Struct Type Effect 13566 Roof ._": ."v .. . ^.µ................. Bed Area ... Cover Rooms p _. ._..___.... ....,.�_,..... Wall . Rooms . . . Style .Shop Center L P ._�__._. ... . Total Model Ind/Comm � Rooms ..... ......... ...... ............ ..... ......,......... .................. Grade Average Int Bath Floor Style? Stories Kitchen Fy, Style i Ext.......... Heat � Bath L..._ Wall MASONRY Fuel split __._ . .., . Heat3 _ Found-j Type? ation§,...... Permit History Issue Date Purpose Permit# Amount Insp Date Comments 2/1/1991 B34177 $15,000 CE REMOD' 11/1/1990 B34063 $7,000 CE EQUIP 6/1/1990 B33828 $25,000 CE REMOD' r II,9/1/12 I I624357 I$300,000 6/15/1*2:00:00 AM ICE NEW BLNow II Visit History .......... Date Who Purpose 3/7/2000 12:00:00 AM Gary Brennan Meas/Listed Sales History . ...__ _. Line Sale Date Owner Bock/Page Sale Price 1 1/26/1998 DACEY, BRIAN T TR 11186/300 $1,260,000 2 7/15/1982 HAIDAS, JAMES G &CONSTANTINE V TRS 3515/49 $260,000 3 5/15/1981 FITZPATRICK, $150,000 4 HAIDAS, CONSTANTINE V*M792 11186/294 $0 - Assessment History ...... ......... .........__ ......_.. _ ......... .... ....................... ......... __ ......... ...................................... ......... Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2006 $1,547,500 $0 $15,800 $386,800 $1,950,100 2 2005 $1,334,700 $0 $15,800 $386,800 $1,737,300 3 2004 $832,500 $8,700 $15,800 $386,800 $1,243,800 4 2003 $698,600 $8,600 $15,800 $297,500 $1,020,500 5 2002 $698,600 $8,600 $15,800 $297,500 $1,020,500 6 2001 $698,600 $8,600 $15,800 $297,500 $1,020,500 7 2000 $538,500 $8,900 $15,800 $196,400 $759,600 8 1999 $538,500 $8,900 $15,800 $196,400 $759,600 9 1998 4 $538,500 $8,900 $15,800 $196,400 $759,600 10 1997 $721,400 $0 $0 $186,500 $907,900 11 1996 $721,400 $0 $0 $186,500 $907,900 12 1995 $721,400 $0 $0 $186,500 $907,900 13 1994 $794,700 $0 $0 $234,000 $1,028,700 14 1993 $794,700 $0 $0 $234,000 $1,028,700 15 1992 $768,700 $0 $0 $260,000 $1,028,700 16 1991 $1,028,800 $0 $0 $367,400 $1,396,200 17 1990 $1,028,800 $0 $0 $367,400 $1,396,200 18 1989 $1,028,800 $0 $0 $367,400 $1,396,200 19 1988 $559,900 $0 $0 $282,600 $853,700 20 1987 $559,900 $0 $0 $282,600 $853,700 21 1986 $559,900 $0 $0 $282,600 $853,700 Photos 6643 Falrn©uth Road, Centerville.. -Pin6c6Wd8t �a. Sprinkler head went off. ,D r a� A ' 2006 .y 1 J r A y � w�.. 1 � e er PP'R 1 2006 r s A PPR 1 2006 it. n APR 1 2006 o . __ ..-ter• PRR 1 006 1 Y- 1 r �� s PiE ler head went off. DS a. ' " 1 2006 w. r Y'F I J i S Z T b 51 1 �w 1 ME, i zip P I r - Flkta t 1 uA- r art. 7f - � n - Y.a �bl I APR 1 2006 , . t - - - .' v o- _. ,. . ;. - - -: : _. : .'.. `. x .r ! . . s .. i„Sr w. :, ... ... ._:i : I ;, r - ., .. ,. .. r .. ♦ : . .: ♦ .♦ , ' " i • _ r, . . , < 444 'r - :: / :. .. r • _ ,. ,•. a: .I . i✓ .r i Iw: ; , t ! , - - c , , r , 'a , :, } -' ,. } : ' L... : !. 1 . -x ,. !, t 1 r t ;• .. :,. ,: s ,. __ _—. L _y _ �. - Y y -. _ i - i , , - : .. 4 , }{ !. c t. i .. , .. - .: r M+ ,. S } . w t ` ' :! :q . , 1. {: , 9 V ;: e ;:: F. ,. } .., ,: a} .:. i Y .. .1 t., 1. i...,., Yr" : f. . I-- �' . , ! , : r, 3 , .. t. e}rJIF'�' /p..liee '�.}: . >. x 1 f ...a.ii l 3.i ,T..! ,�` S.M Amw.I : ,lM b,pl. iM .. :: , p. i a .-, -, .sr ... :.. ,. : : : .. }' i . WAt t' tG _ , ' � , !_ t . ... t ...__... L. ._. :. :.. , , t t � .. - _ ....._ ::.._-..5._.....-k.: ».�r.a-_�:.w.._. . ... .. —fir."...a+_�+. 1. h-- .r•Y.,' - �.,.—...,..,•.. ..,_ _....,.«._.,.. -... ._:.:..�t.,.�...,..... i .-. _ ( t - r , ' t` � � ,. ,.., 1 ♦. {{ 3 f ,; , : . . ___ _ x _ _ _. r. t 4 ,_ p ' a 1 _ : 1 <, , I° �h Y i .. :. ! 1. (� /x : 'r 1 .. .. . � /} 1. 1' f 7" } , { 4 k r - 3,., o - i.. _ : .. , `� is .. _ r < i , _ _ ,.. , I t 1 I b k t .: . t : 1 i.. , { , .: j ,_. r a: _ ., -- .err, ,, .,�:. ,-,;,-c* 1 :a. -. ,... ... - } .w r 1 , - :. } ,. •`.- } - i _ , _Y... : .. .. -... f ::..„ t -! I t ,.. , ': .. :.. p l , t • ') ,.. , _ _ < . .? .. } ... Y i a - G . I , t - - . . ;_ : f ..' \ :. . _ f e —�---} a , r � Y - , . , . , , Y r _ . .' . _ `+, , - >, ".. . �' - ... j [i, , ,- 1 \ _ - _.. ' - y �� , , . _ - f G , , . , , ,, _m_ _ _ , r :. R . : , a { ,,. , :. .,. 1 - , - r r. } „ . , . .. , ..,: s e _ , w ., _ ' ""` \ , ' , , ,, y - .s , a .. , :. .. .Y.. .. .: :r`.. : ,- 1. :e ..::. ,. :::. '. a ,. 1 1. 4, _ .:'art. . a .. 6 s... ,.... - t fi ! r f _ _ .. - .w .. .-... '� « ,< t: :_ _ y , } , ...+_ , 1. .. , ,D , :. :. ' , a ? - ., .:,.. :: - y. ! _ , ,.: -,. .:: 1.. ,.. ri :. ::� :.. . n : .. «. #//,, . . , : *✓. .,. , .:. , :: . .. i x :Y r,r . . .:;:. , r , . . , Y . : . r , - + .��. as „ .r. - ,�. , 9 ,: . ,.. - y __ w: t� f. .. _ } t _ . , 1 t , ,., ,, a .. . .. _ , Yi 8Y PPfitr7Ei3 _ "$CAIg �, OAAWN':BY. I'i. Cx _. :. - ,' r CfAYE: , _► . . , Y , a „. - - ,. Y * .� yrr.,� ,.: 'K a l -._ i - r , _ . . , RA IN NUMBE , c D W G R r _ a , _ : „ : ' -k.,�•— fi M I . iYHtFJ7E0 ON 420 CHA R N LLLi : - / :.;. _. CNXRRETTE'PRO OR �. VE :. d -,.. �::.' .. ,.. ..: -.,: ,. .,:.: .,,;:. _ ,,:.. .,. _- . .. _ ,- -_ ,. 1:e, , , . .. ' ' rr' ,. - ., ._ : . ' i < Y - .. „ ., l i I q _L✓ s i . , F 5 to- 4 � I r pt JP r U/? Al65 s F G-r J ; 1 1 , q R ta, } Ao MC , u Pvor�i' < t - OT 9 Al r / s r fi a r ..:... �: � t �'✓; ,t E .t Peon-} d r� � t t L vF s UIF ,{Jt� r c?f7 pfF i 5�31.,4,t} (,1,u t`� :. .. F 0 �. G_ - m 1 - � t lv Gr ,f -, 'ram t d - .,f +tr All 'o"7ep--I, , h 1' T . Al -- _ it �< ._ 7 �,� ,Si 7 - M bE-- lam` r