Loading...
HomeMy WebLinkAboutDUNKIN DONUTS - FOOD DUNKIN DONUTS 16,Z O�FALMOUTH RD!- Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BATRINSTABLE = F.P.(Thomas)Lee,. S'&' 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 312 Issue Date: 01/01/2022 DBA: DUNKIN DONUTS #312 OWNER: CAPE COD ENTERPRISES LLC Location of Establishment: 1648 FALMOUTH ROAD CENTERVILLE„ MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 20 OutdoorSeating: 0 Total Seating: 20 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: Qn 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: f IME r� Town of Barnstable For Office Use Only: Initials: in ti Rd �ASAa Inspectional Services �An E 9 Public Health Division Check# D MP a Thomas McKean, Director1��f Z� 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 12/27121 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Cape Cod Enterprises, LLC DBA Dunkin' ADDRESS OF FOOD ESTABLISHMENT. 1648 Falmouth Rd, Hyannis, MA 02601 V� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Go Couto Management Group,169 Main St,Stoneham,MA 02180 V E-MAIL ADDRESS: office@coutomanagement.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O8 ) 771 - 5366 TOTAL NUMBER OF BATHROOMS: 2 WELL WATER: YES_NO V ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V SEASONAL: DATES OF OPERATION: . / /_ TO NUMBER OF SEATS: INSIDE: 20 OUTSIDE: 0 TOTAL: 20 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? I. 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) i —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 4) i ***,SEASONAL,MOBILE&NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 1 QAApplication Forms\FOODAPP 2020.doc S f l i • I OWNER INFORMATION: FULL NAME OF APPLICANT Salvi Couto SOLE OWNER: YES ED D.O.B 3/7/1979 OWNER PHONE# 781-279-0290 ADDRESS 169 Main St, Stoneham, Ma 02180 CORPORATE OWNER: Cape Cod Enterprises, LLC CORPORATE ADDRESS: 169 Main St, Stoneham, Ma 02180 PERSON IN CHARGE OF DAILY OPERATIONS: Jazmyn Murphy 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 e Lvta4-�w� I rD a narsc � '�7=P� 1, Jazmyn Murphy 7/ 9 /2023 2, Sushma Thapa 4/ 25 /2023 J-QzM,A NW(�V)4 as- ,;z--�, ! 12 /27 / 21 SIGN 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 muss: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.3151 each calendar year: IT 1S YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. QAlApplication Forms\FOODAPP REV3-2019.doc BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. *' xsrAW� Paul J.Canniff,D.M.D. F.P.200 Main Street, Hyannis, MA 02601 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: 312 Issue Date: 01/01/2021 DBA: DUNKIN DONUTS #312 OWNER: CAPE COD ENTERPRISES LLC Location of Establishment: 1648 FALMOUTH ROAD CENTERVILLE„ MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 20 OutdoorSeating: 0 Total Seating: 20 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: i For Office I Initials: Town of Barnstable Date Paid Amt PdPd$_ : BARNS TABU; Inspectional.Services Public Health Division Thomas McKean,Director a 3 200 Ma:in'Street,Hyannis,MA 02601 } Office: 508-862-4644 Fax: 508-790-6304 4 APPLICATION FOR PERMIT TO OPERATE A.FOOD ESTABLISHMENT DATE 11/16120 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Cape Cod Enterprises, LLC DBA Dunkin' ADDRESS OF FOOD ESTABLISHMENT: 1648 Falmouth Rd, Hyannis, MA 02601 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): c/o Couto Management Group,169 Main St,Stoneham,MA 02180 E-MAIL ADDRESS: office@coutomanagement.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O8 ) 771 - 5366 r j TOTAL NUMBER OFBATHROOM`S:. 2 WELL WATER: YES_NO V ... (ANNUAL WATER ANALYSIS REQUIRED) i ANNUAL: V _ SEASONAL: DATES OFOPERATION: //_ TO_/_/_ NUMBER OF SEATS: INSIDE: 20 OUTSIDE: 0 TOTAL: 20 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LIC-EeNaG 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 OUTSIDEDINING?' 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 i _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:VWpplication FonnsTOODAPP 2020.doc i OWNER INFORMATION: FULL NAME OF APPLICANT Salvi Couto SOLE OWNER: YES NO D.O.B 3/7/1979 OWNER PHONE# 781-279-0290 V s .ADDRESS 169 Main St, Stoneham, Ma 02180 CORPORATE OWNER: Cape Cod Enterprises, LLC CORPORATE ADDRESS:. 169 Main St, Stoneham, Ma 02180 PERSON IN CHARGE OF DAILY OPERATIONS: Jazmyn Murphy 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. Jazmyn Murphy 8/ 25 /2022 1. Jazmyn Murphy 7/ 9 /2023 i 2, Sushma Thapa 4/ 25 /2023 11 . /16 / 20 SIGNATURE OF APPLI:CAN - 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 Barnstab.le.must notify theToum by fax or mail prior to catering event. You must complete a catering notice found at.http://www.townofbariistable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. i NOTICE Permits run'annually from January I st to Dec.3151 each calendar year. IT-IS YOUR RESPON81BILITYTO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. 'I i I I 1 I 0Application F6fms\F00DAPP REV3-2019:doc i i t i j I °p 1NE i TOWN OF BARNSTABLE. _ ..HEALTH INSPECTOR'S Establishment Name: - Date: Page: of J l 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 `� M63. `0� HYANNIS, MA 02601 508-8 -FRI.62-4644 No Reference R-Red Item PLEASE PRINT CLEARLY plFU Ma•1° -8 FOOD ESTABLISHMENT INSPECTION REPORT Z Name ��)(j Date Type of T of Inspection p outine Address Risk ood Servi p /,,, Q .M 1�, �`�n/ Previous Re-inspection V , Level Previous Inspection Telephone Residential Kitchen Date: , Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint �r Person in Charge(PIC) {� Time Bed&Breakfast HACCP (l ` In: �Y , Other Inspector y��/v Out: Y Each violation checked req Tres an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ // 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) ❑ ? )' 2� &I FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands �` d ❑ 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 an 1713.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals uf� 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 ✓� �(�� �Q �l.J h�1�1Z a- ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling Y ( `'� ❑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 ///CC C ' ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories ) �I/�J`v`� �e'�Q� "� Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violation 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 Volunta Com ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items F] Embar checked indicate violations of 105 CMR 590.000/Federal Food Code. go ❑ Emergency Closure ❑ Voluntary Disposal Other: ❑ 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.Equipment and Utensils B=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) g violation,4 to anon-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector' Signat 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 PI & �gnature 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.) I FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 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 R uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) � 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washin Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E). Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 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 AnimalConsum Foods Tat 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* 8 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g * Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-1 1 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-40 1.11(A)(2) Ratites,Injected Meats-155 155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- * Ratites-165°F 15 sec* in mobile food,tern or and residential Sources 10 Proper,Adequate Handwashing g' P Game and Wild Mushrooms Approved By * 3 401.11(C)(3) Whole-muscle,In[ac[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. * 2-30L14 When to Wash* 3-401.11 A ] b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items non-critical 23-30) 3-202.15 Package Integrity 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* F 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 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Fom7back6-2doc *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�Her TOWN OF BARNSTABLE H �THiNSPECTOR's Establishment Name: Date: Page: of, _ OFFICE HOURS °^ PUBLIC HEALTH DIVISION 800-9:30A.M. BARNWABLE. • 200 MAIN STREET 3:30-430 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date=Verified MA- MON.-FRI. HYANNIS,MA 02601 soa-862-464a No Reference >R-Red:Item PLEASE PRINT CLEARLY "'e°rAaya, FOOD ESTABLISHMENT INSPECTION REPORT Name ) .'� Date Tvoe of T ns c ion �D / , h S /� z C ice` j. outine Address / / V Z/%r/r�`` �( Risk ection Level Retail Previous Inspection Telephone.-. Residential Kitchen Date:' Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness p� Caterer General Complaint Person in.Charge(PIC) Time Bed&Breakfast HACCP �. Other Inspector 9 Out: 40 Each violation checked requires an explanation on the narrative page(s),and a citation of specific,provisions)"violated. L_ _ Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) .Anti-Choking 590.009(E) ❑ ��% � _ y p hazard and require immediate corrective Tobacco 590.009(F) ❑ % Q/ rl �� Violations marked may pose an in health ha � � ... Action as.determined by the Board of-Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands �,•,/�j ❑ 1.PIC Assigned/Knov✓ledgeable/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) rr ❑4.Food and-Water from Approved Source ❑ 16;Cooking Temperatures. t/(J (AJ �✓ '. ❑ 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 Handwashng CONSUMER ADVISORY ❑ 11.Good Hygienic.Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations i 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. El Voluntary,Compliance ❑.Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑'Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:,: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9.or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than 4raon-critical violations 9 26.Water,Plumbing if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot and-Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Ph sical Facility C=2 critical violations and less than 9 non-critical. If 1 critical refrigeration.critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of y y (FC-6)(590.007) aggrieved by this order,you have a,right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical 29.Special Requirements (590.009) within 10 days of receipt of this order. violation non-critical violations C. 30.Other DATE OF RE-INSPECTION: 41nspecSig lure Print//31.Dumpster screened from public viewPermit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N#Seats Observed Frozen Dessert Machines: Outside Dining Y N tune Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y. N Dumpster Screen? Y N ..--- ..- r. -r,_.-. ��-r�.w�.•--- �z„n ..._ .:Y.^�"-."- - lY..�.:s..rn . .Y:. sue, .. .. . '., � F � �- .,� ..-. �.`.�r.srr.._._ -.:"-"`�.:�i..�a n�r•�rv�.��., r -, __tip ._ _-y _ .. .... - _ -..1^ .. Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives 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 $ 590.004(F) Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to . .. Other* ...Contamination from the Environment ( )3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and 7-101.11 Common Name-Working Containers* 3-501.16 A Roasts Held At or Above 130'F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage*7-202.11 Restriction-Presence and Use* 20 Time as a Public Health.Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers.-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition of 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 y 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 Shell Eggs* Sarutization Temperatwes* TIMEfrEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY * Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* _ 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* ( )( Pathogens* B 590.006(A) Bottled Drinking Water* 3-401.11 A 2) Comminuted Fish,Meats&Game g s e ecri�e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanrtization 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,Sniffed PHFs SPECIAL REQUIREMENTS,,- 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne 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 Other PHFs-145°F 15 sec practices should be debited under 4129-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11 A& PHFs 165°F 15 sec* $ Receiving/Condition ( ) (D) 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3 403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following o the Food Code and 105 CMR 590.000 6 Tags/Records:Shellstock � $sections f 3-202.18 Shellstock Identification 13 Handwashing Facilities : 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 596.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Supplied with Soap and hand Drying Devices -Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Forrnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF� ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of y OFFICE HOURS :x RARNS�TAR�E. PUBLIC 0 MAIN STREET HEALTH DIVISION 8:00=9:30A.M. 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ' 9, �0� - HYANNIS,MA 02601 MON.-FRI. No Reference R Red Item PLEASE PRINT CLEARLY p p, 508-862-4644 'FO1AP` FOOD ESTABLISHMENT INSPECTION REPORT Name /%�f 1.Y` �//✓✓� �.�jfZ Date' // --TOYS[a of oute Qf Inspection Address (il 1 f isk od Service Re-i ction ' 11 Level e a 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 Inspector In: V Other / p Out: 4, I'Lehe 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) IAIYQ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives - ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B- 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 One critical violation and less than o 6 non-critical violations non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to =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 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 9 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's (gnat re Pri 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' atur Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N L Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* S Cross,contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * 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 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Infonna[ion-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge[0 7-102.11 Common Name-Working Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F * 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reted 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 or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources' 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* I Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs- mme is sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eH crfve tiuzom 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 temporary and - ide in ca[er- Sources Ratites-165°F 15 sec* * ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail shouldpractices be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.11 Package Integrity Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* 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 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Fonnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `oF� royti TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: Date: 3 1( Z ( Page:_�of 2--- OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARl'�-rABLE. - - 200 MAIN STREET 3:30-a:3o 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 p'FDN1A`� FOOD ESTABLISHMENT INSPECTION REPORT 508-862-4644 Name / -� Date3 d-L Type of of Ins c ionRoutine,)I�VW lc�t Address ,, ,1, vJ Risk Food S spection o Level ad Previous Inspection �) `-bj Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time U _ Bed&Breakfast HACCP In: 2`- (7rV) Other LL�� `` '' f� Inspector sj Out: `� h a O S V- Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ I _ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ ` led KJ cf « es Action as determined by the Board of Health. Allergen Awareness 590.009(G) g,- u _"�9, „ & O mu id FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands O� ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ,li✓`VAR ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals ` FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) �p N ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures -l Z`Ll Q_o ' 1�( � �' b ❑ 5.Receiving/Condition ❑ 17.Reheating G� 7CC✓✓ L QA ' ❑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❑ ❑ liC�lJ'Q a/ 11.Good Hygienic Practices 22.Posting of Consumer Advisories t/�^'��C�r is Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations L� Critical(C)violations marked must be corrected immediately. (blue&red items) 1 al 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 Embar o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ 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 4 non-critical violations 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F.is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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 8non-critical violations C. 30.Other DATE OF RE-INSPECTION: Inspector's Sign��/�. Print: 31.Dumpr screene d from public view Permit Posted? v/ Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signatum Q^� 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.) 1.. 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) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 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* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical/ Sealed Container*' Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 183-401.I IA(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg - Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ep ctim 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 Source3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- , 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Ars* Regulatory Authority m 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* .11(A)(1)(b) All Other PHFs-145°F 15 sec* Other es sho9 violations relating 9 good retail 590.004(C) Wild Mushrooms* 3AOI 3-201.17 Game Amals * 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under t129-Special ni 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ 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) 3-202.11 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11 Remainin Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated B) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 3-501.14 13 Handwashing Facilities Cooling Cooked PHFs from 140°F to 70°F i (A) g ConvenientlyLocated and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 * 5-205.11 Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(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' Conformance with Approved Procedures* S:590Formback6r2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `oF.Heror TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: A)W(A_�_V OA4(/f ) Date: �l Z( Page: Z- of 4• OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BABNS'rABLE, ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified M639. `0� HYANNIS, MA 02601 508 8fi2-4� No Reference R-Red Item PLEASE PRINT CLEARLY -ArFD MP+p FOOD ESTABLISHMENT INSPECTION REPORT Name Date j 11 ,fie of T ction .` (� r g outine r q �i(" D�l Address (��� I Risk Food inspection (. ( - l� Level etail Previous Inspection /h Telephone Residential Kitchen Date: _j,2 Mobile Pre-operation �I tt Q� Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint t 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) ❑ AAA JaAA ` Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ ,( 14 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 kg (/� ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded D�."!Tcxic Chemicals / 1 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 • .Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,checked indicate violations of 105 CMR 590.000/Federal Food Code. F] Embar o 9 ❑ 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 9 ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations re if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. . f critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to Snon-Critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. ` 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print• 31.Dumpster screened from public view 3/1 c�zl 1 Permit Posted o Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signa a Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According t- 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each .7-101.11 Identifying Information-Original Containers* 2 590.003 C Responsibility of the Person-in-Charge to Other* g g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* ( ) P Y7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130*F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* * 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use 590.003(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) 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 ofAdultereted or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Pe 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 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* 163-401.11A(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* Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.1](A)(2) Comminuted Fish,Meats&Game Pathogens* Ef cti-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory � 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to . 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 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 practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 343.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11 Remainin Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated �) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 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 3-203.18 Shellstock Identification* ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F TagsiRecords:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 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 1105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. OF THE roe," TOWN OF BARNSTABLE HEALTH iNSFECTORs Establishment Name: POLn Date: - Page: of OFFICE HOURS i AR'N" LE. PUB2 0 LIC HE N ST ALTH RETSION 8:00-9:30 A.M. 3:30-4:30 F.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified . 9qp Meyy.a m� HYANNIS,MA 02601 M- -FRI. 5088 62-4644 No Reference_ R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPCI rFn MP'� REPORT ON Name Date Tyne of Ins ction Routine Address Risk Food Servi Re-' ecti e revio ,I cin e ' lIi Level eta il Telephone Residential Kitchen Date: i Mobile Pre-op t � Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In' Other Inspector Each violation checked requires n explanation on the narrative p 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) ❑ n on eof AA 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 C 1716.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 1717.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding 4 � PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control i ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 1 � ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories I.tJ Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) .�rR 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,th ite s ❑ go Embar checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency Closure Voluntary Disposal ❑ Other:❑ 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations if no critical violations observed,4 too 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations If critical water,sewage 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must ons and less than 9 non-critical. no cr 9a 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 ti anon-critical violations. If 1 critical refrigeration. ' ation,4 to 8non-critical vlolationyKV. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: I for Ignatu e c 0 n t: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N I '�1 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 Assi nment of Responsibility* 8 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours* ( ) g14 Food or Color Additives 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202:12'* Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to _ Other* g g 3-501.16(A) Ho[PHFs Maintained At or Above 140°F* 7-102.11, Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F* 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 I1 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* - 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* -_-. - REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for 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 * 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* P" - 3-701.11 Discarding or Reconditioning Unsafe Food 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY * - Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.f6 Ice Made From Potable Drinking Water 3-401.11A(1)(2) Eggs-Immediate is sec Animal Foods That are Raw,Undercooked or 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11' Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate S90.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Elf c i-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source _ _, 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* 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 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. g 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 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 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 Labeling of Ingredients* Supplied with'Soap and hand Drying Devices 27. Physical Facility FC-6 .007 590.004(J) 9 9 y' ty 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 jmii HACCP Plans 6-301.12 1 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 wAh 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 °p(ME Tp� TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name:TOD io Date Page,: of .. q. '• ' PUBLIC HEALTH DIVISION OFFICE HOURS8:00-9:30A.M. BABN57'ABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MON�p Ma3q.s�0� HYANNIS,MA 02601 - 6 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHME TFn MAC T INSPCTON REPORT -8N Name Date e o �e of Inspection g Routine /IV I I J a L2_1_5 Ply Address / Risk Food Servi Re-inspection t ' Level i Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary. Caterer < General Com Person in Charge(PIC) Time Bed&Breakfast A (q Other � Q Inspector r4 Out: 0111 '' Each violation c ecked requires an explanation on the narrativ 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 ❑ 9 9 ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑,5.Receiving/Condition ❑ 17.Reheating Eli.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) ? 11 b D Corrective Action Required: ❑ No El Yes Non-critical(N)violations must be corrected immediately or Overall Rating V within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency Closure. ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 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 4non-critical violations g ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than i non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8non-critic violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violatio =C. 30.Other DATE OF RE INSPECTION: InspVia r' t: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' Prjatr-� q• 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.) I FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 3-302.14 Protection from Unapproved Additives 9 Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41 590.004(F) i 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* 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 Re uirements 590.003(G) Reporting by Person in•Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q _ Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 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 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 Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202:13 Shell Eggs*, Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 4-501.114 Chemical Sanitization-Temp., H. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY - Pasteurized* P P 3 202.14 Eggs and Milk Products, i 6 p 9 p * Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water 3-401.11A(1)(2) Eggs-155°F is sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* ' Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg°'i"11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155'F 15 sec* 590.006(B). Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact 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 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 IS sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 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 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 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 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C)- Commercially Processed RTE Food-140°F* (Blue Items 23-30) * 12 Prevention of Contamination from Hands 3403.11E Remainin Unsliced Portions of Beef Roasts* Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification g Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F 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 wth Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 - Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* -103.12 Conformance with Approved Procedures* S:590Formback6 2doc 8 *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. A51 -/ oFTNe ro TOWN OF BARNSTABLE HEALTH wsPECTOR s Establishment Name: a ° �S✓� Date: Page: of OflOFFICE HOURS PUBLIC HEALTH DIVISION '1 1 r 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 MASS.�p'F+DeN�1qP.`pie HYANNIS, MA 0260 CI MON.-FRI. No Reference R-.Red Item PLEASE PRINT CLEARLY 508-862-44 FOOD E T BLISHMENT INSP REPORT Name Date Tvoe of Type of Inspection Routine Address Risk Food Servi Re-inspect- n Level Re Previou ti Telephone Residential Kitchen Date: I Mobile tGeneral oOwner HACCP Y/N Temporary pCaterer Complain Person in Charge(PIC) Time Bed&Breakfast I Other Inspector <7 t ' r,1-11Z!5�� U�z 046Z�9! Each violation checked requires an explanatlon on the narrative p 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) ❑ , FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 7 ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals to FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) n 9 ❑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 q4fil9 ❑ 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 ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories -44 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations I�r_ ` Critical(C)violations marked must be corrected immediately. (blue&red items) ` lCJ f�' 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,t e to checked indicate violations of 105 CMR 590.000/Federal Food Code. F] Embargo Emergency Closure Voluntary Disposal Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,-results in an F. 25.Equipment and Utensils FC 4 590.005 B=One critical violation and less than 4 non-critical violations g ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical ,olat- ns. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-critical violatio s=C 29.Special Requirements (590.009) y P 30.Other DATE OF RE-INSPECTION: Ins ect is ture rint? 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC s 'Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted- Y. N c.., Dumpster Screen? Y N J Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties � 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140'F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* 20 Time as a Public Health Control Applicants* 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reted of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or 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 F9 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 Warewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 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 * egecnw 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 E2-301.14 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 10Proper,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 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* Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* 3 401.11(A)(1)(b) All Other for H-1 olds 15 sec practices should be debited under#29-Special 3-201.17 Game Animals* 11Good Hygienic Practices 17 Reheating for Hot HoldingRequirements. $ Receiving/Condition Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165`F 15 sec* 3-202.11 PFIF's Received at Proper Temperatures* . 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* 1 3-403.11(C) Commercially Processed RTE Food-140'F* (Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the 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 g 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 Handwashin Facilities 3-202.18 Shellstock Identification* 13 g 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41'F/45'F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 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 Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 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. HEALTH INSPECTOR'S Establishment Name uI JtAin Z0001 Date: kdo�/1 g1 Pa 1NE rok� TOWN OF BARNSTABLE _ HE OFFICE-HOURS 9e: of PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p 63q•p�0� HYANNIS,MA 02601 _ MON.-FRI. No Reference R-Red Item. PLEASE PRINT CLEARLY AFC MPS 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORTOJ Name D��k.� pdnU�,� Date814,111 Tyoeof T oflnsn_ec•o O eration s ou Ine r Address b y� Fc,Jrmau (A cj r61 Risk odServl Re-Inspection SA w �/- caa �0b Level Retail Previous Inspection 17 Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness I �(� Lid' Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP g iD r k, In: Other Inspector an $U�n Out: 1 Mach.11,14 Won S o - � -t eed-io Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. ! � �7G` Q, v Ct'r Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ lI TD ��� Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ LA�tk I r�c v r� 6 Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ - W k n ! Dur FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands J-}p ra V �'/1 V ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities c3 EMPLOYEE HEALTH PROTECTION FROM CHEMICALS GI I I GUQ ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY �� Q ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories LD�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 Pwithin 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 4non-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 (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 8non-critical violations C. 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's Signature '� Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501,14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45'F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12-- Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 590.004(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* 2 Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se * 3-501.16(A) Roasts Held At or Above 130°F* 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 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*590.003(E) Removal of Exclusions and Restrictio * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR- 3-306.14(A)(B)Resumed Food and Rated or of Food 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP ns Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations , 3-201.12 Food in a 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 * Equipment 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E1iP0h°e inrzom 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf aces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-Ql.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Chemical Stuffing Containing Fish,Meat,Poultry or 590.009 ( )-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed * (A)-(D) Violations of Section 590.009 A * 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 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* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 3-201.17 Game Animals* Ell Good Hygienic Practices 1 Reheating for Hot Holding practices should be debited under#29-Special 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 PreventingContamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g 3 403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the odborne f° * 12 Prevention of Contamination from Hands 1 Remaining Unsliced Portions of Beef Roasts*3�03.1 E e 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and ound in thea risk ctors listed above,can be found f 8 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- * 1S Handwashing Facilities 3-501.14 3-202.18 Shellstock Identification (A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 :004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 - 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures I 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 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. `oF1HEr TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: �V Page_: of �i( 1 OFFICE HOURS o' PUBLIC : 0- :30. .M. B ARNSTABLE. 200 MAN ST EET 3:30-4:30 P.M.P Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified M63q. �m� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item, PLEASE PRINT CLEARLY AlFO M�n 508-862 4644 FOOD ESTABLISHMENT INSPECTION REPORT Name . Da Tvoe of section on (-Routine Address 411 Risk o;51 ervi Re-Inspe oIn Level Previous,Inspection Telephone �- -7 ( r Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary. Suspect Illness Caterer General Complaint Person in Charge(PIC) 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 // ❑ 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 ❑ ❑ ® �(1�J✓J 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 lZ Critical(C)violations marked must be corrected immediately. (blue&red items) C� 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 IN Official Order for Correction:Based on an inspection today,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ ❑ Emergency.Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations.,and no.more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F 25.Equipment and Utensils FC 4 590.005 B=One critical violation and less than 4 non-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations.observed,4 to 6 non-critical violations=B. 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 28.Poisonous or Toxic Materials (FC-7)(590.o08) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dump er 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 Igna Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N t � Dumpster Screen? Y N Ll 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) 1 Assignment of Responsibility* 6 Cross=contamination 14 Food or Color Additives Law Cooled to 41"F/45"F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 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 A[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* 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 1 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°P 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 Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Reared or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ). P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical/ Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of 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) Battled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg°"°e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 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 A 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 Authority Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Aut 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* Ell Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* Blue Items 23-30) 3-202.15 Package Integrity* 3-403.11(C) Commercially Processed RTE Food-140'F* Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Convenient/ Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* y Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000: /t_?°F, r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date.' I� Page: of OFFICE HOURS C HEALTH AR E. PUBS 0 MAN STREET 3::30-0.-4:3:30 P.M.A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ASS r HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY a 508-862-4644 rFD MP�a FOOD ESTABLISHMENT INSPECTION REPORT Name 991 vne of T s ectio ' O r outine P ` L Address � Risk od Service ction 1 r Level Previous Inspection51 Telephone Residential Kitchen Date: M1, Mobile Pre-operation pr Owner HACCP Y/N Temporary Suspect Illness (%�/L 11f ; Caterer General Complaint v Person in Charge(PIC) l Time Bed&Breakfast HACCP r Lkg 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) ❑ C.� 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 U EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ` ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives rp ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Haiandous Foods) rv`c,--c ❑ 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 � o� ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY \XI1 ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories bm 9 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations I - ' 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, ems checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more-non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 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= critical violations and lest 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 violation,4 to 8 non-critical violations=C. 29.Spec/Reirements (590.009) within 10 days of receipt of this order. 30.Othe DATE OF RE-INSPECTION: Inspector's Signature Print: {�^31.Dumeened from public viewPermit Posted? 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 _ _.,__- ._, e. ., _ " ..^-^'Y. a.y+.A. y` '`g'�A. Lr _...',_....,f, `7��-.+r.�..-v t ......�.. z _ ___ _.. ..,. _ � .. .. ..... .-.. �...,t........-, t... • .-v .. .-., _ - . - - ... ..-.. _- • Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45'F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3`202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF.Hof 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 * y-590.004(F) 7-101.11 Identifying Information-Original Containers * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge to - - 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 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 * ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions _ Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 "Food and Watek From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* - 4=501:111- Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-80L11(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 _ 1� 7-206.13 Tracking Powders,Pest Control and 3-20133 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* I . _ _ Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg ' Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg ctiw 1o12001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets-StandardsFishFrom 310 CMR 22.ou Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and- 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Poultry or Meat, 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish, 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Game and Wild Mushrooms Approved By - 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* - 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* _ - 3-40L11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under 929-Special 2 401.11 Eating,Drinking or Using Tobacco* * Requirements. $ 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-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* 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 Labeling of Ingredients* Supplied with Soap and hand Drying Devices (J) 9 9 ,.,,F 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 w•, 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:590Fonnback6-2doc *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. 'i, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes' application for �Bi5po5al 6p5temc Con5trurtton Permit Application for a Permit to C tut a' grade( ) Abandon( ) ElComplete System ❑Individual Components Location Address or Lot No. 16`j� 4r'�o� t or+ Owner's Name,Address and Tel.No. Cep ru�'lI� Mare�I R. Assessor's Map/Parcel O q�(y/ a»23a , dto"s Ins ller's�j�lame ddress,and Tel.No. Designer's Name,Address and Tel.1 Io. �v[ �igf�LO Sv�cn kngI$I ,H o INc, Ao T3©x 6 Type of Building: Dwelling No.of Bedrooms PO4 Lot Size 4,6 a C Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures .0 5eJ-4 a�rzvr � Design Flow(min.required) j'D gpd Design flow provided q, 99- and Plan Date yla/bfd06 Number of sheets Revision Date Title se t e.. 3 f aoqned e ZoaW Ranns. e Terri;ll /1,45_511 Size of Septic Tank Type of S.A.S.�8) noo a,l�n�ac� eLta,mr6e'rs�z1S X s�9.5, Description of Soil Va 4„ r,// t ?'%29",44U, e�/�� .r 6,4 ,rp,,d�-fv�le„� �oav st 4_,JCL l",D&,.c yrll-sy-,6rowry C E Ca n�T Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction d maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 o the Envi in ntal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boarl o Heal Si m Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued ¢ _ rT[ 47 Nj Fee computer:Entered in com .4, TH MMONWEALTH OF,MASSACHUSETTS P Yes PUBLIC HEALTH DIVISION -DOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for !�i!gpozal gpp!tem Corgi,5truction Permit Application for a Permit to Cq•ny uc�t( fi Rrpai�( �)U,U grade O Abandon O ❑ Complete System ❑Individual Components l V 1 t Location Address or Lot No. /�4 �4/n�our�o a e(' Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 2 O O 9/ Installer's�Iame, ddress,and Tel.No. Designer's Name,Address and Tel.No. 1TnC. pft,CA (A S� GUI. C�;�P.v1!le MA /5M) 1�F-.3399 ,..L Type of Building: Dwelling No.of Bedrooms AIA Lot Size 4.6 d2 G sgti ft'' Garbage.randes,.�.....)_ /V0ge Other / T e of Buildin � / No.of Persons Showers( ) Cafeteria( ) YP $ t nn,rhNrc,a Other Fixtures SD 5eaff I<'-5s� arcaw4 Design Flow(min.required) 1. D 4 gpd Design flow provided gpd t Plan Date 9 /��00(c, Number of sheets Revision Date Title J` � 5v-p ew 1),o9.,gale a- /499 X2,"ouM Size of Septic Tank -7 ,� �A Type of 9.A.S. /�� .S'o® da �Pae 4 �ia.rrdrrs IDS sC,�y S') Description of Soil 6- ,,?y'/�J-,(a•ie,- /0B'/�Q r//&( Y,�/`ow-2?rown aems,. Sa.d.rt w r,>ii/`R-r!'>4 - VX -� /y ef-lb Yp N!j?""a -Yo- A,s1 (oarSC S�NCfW Co U��Pt' �1�'���:1� �4%Nr /t7 Y/t S./�// Y,N/�ul',Uro�/�7 I nArSP Se.arX e 4 t � Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Z T Agreement: The undersigned agrees to ensure the constructio�Apd maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 Nhe Env�efimental Code and not to place the system in operation until a Certificate of Compliance has been issued,by this Board of,Heal / � / / n'` t S ed Date , i Application Approved by 407111,Y p >rrr�.�'a_/ ' �9:C.�t�i /�` Date ��/� //r Application Disapproved by: r 1. Date T r V for the following reasons ell Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance 1 THIS IS TO CERTI-YY,that the n-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by (( �A1V/ t� at l G,9 S fr,1..A4�1 oa cX Cc-ydP/`y,l�e has been �c/onstru ted in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer / #bedrooms Approved design flow / i gpd The issuance of this permit shall not be construe/dlas a guaranttlel'e�that the system i11 functiony,/,G s dde'L gned.l Date /�f!1 r7�r .if 1 t' �/�/ ��yF1f// Inspector �/� / .� ----- -------=-------------- ---- No/ � Fee THE COMMONWEALTH OF M_SIS ACHUCE''_TS � PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS =i!gpo!5ar 6p9tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upg ade ( '/)� Abandon System O System located at t 6 98 F'o/r,»,v �i ©c �n �r r�,%l'e {nl��Gl l.r✓JAVI� 1 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction mu. ,be co leted within three years of the date of thisfp�t: Date //J // Approved by / J .r TOWN OF BARNSTABLE LOCATION IC048 VAIPA ANN (Z.17 SEWAG_ # �' ,q VILLAGE C60TC-k1\XkIC, ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY /6-00 6, 5,666 �306 y c,, t/0 L LEACHING FACILITY. (type)/8~;o 4 aV(,15(1,S (size) '71.6- $ d•" NO.OF BEDROOMSL SCs1TS i OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: i . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility l-e! Feet j Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist n within 300 feet of leaching facility) Feet FURNISHED BY C ,y ) ' I i /• - • I Ci i � QD. 00 0 G © `� Cyr•1 CO m VO 6 w N cA I p 2 d TOWN OF BBARNSTABLE ¢ LOCATION 1"/U�/7 �v SEWAGE# 0 (J� VILLAGE ASSESSOR'S MAP&LOT ?O'f—Of 3 INSTALLER'S NAME&PHONE NO. ° O Z S-4yC, (� SEPTIC TANK CAPACITY — fJ er E Ih . p LEACHING FACILITY:(type) (size) .S /� 3 a' NQ.OFBEDROOMS Jv1 B>_TILDEROR OWNER ,/�E3✓/1�jiJ� Q / T PERMIT DATE: v COlyIPLIANCE DATE: f�AU D Zs� S Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of 14aching Facility Feet � Private Water Supply well.and Leaching Facility (If any wells exist / IA14 on site or within 200 feet of leaching facility) . Feet %ge of Wetland and Leaching Facility(If any wetlands exist - within 300 feet of leaching facility) Feet Furnished by 1- vu Afek) DaXOT;s ; c 6P 62, s J AsBuilt Page 1 of 1 r v.- - . ,• .-•: era •� �/1^'r'� N OP SARNSTABLE LOCATION/4QR` &L9 /� T.�/Zf �Dls vjrtc,e i o�' n �� SEWAGE ' /39 T VILLAGE ( �fe!✓i��p_ ASSESSOR'S MAP & LOT;?d Gam INSTALLER'S NAME & PHONE NO. �i�I/�✓fd /7,S- a840 SEPTIC TANK CAPACITY G,% /oac) ildo LEACHING PACILITY:(type) ` /QOC' (size) v/1 10A117 NO. OF BEDROOMS PRRIVATE WELL OR ±LI_d WATER BUILDER OR OWNER 0o yAn DATE PERMIT ISSUED: /U • c(,� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ✓ 1��$ f�iv �toc7U CX4/ o. 1000 y A(. 0 o ys r o loon ynl, �,8sx G.% N•�o c'ovcrs fo 9rAdae £x;s4;n� fix$ 0 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=209003&seq=1 4/24/2019 r NAP# �fhip.uP . JLK Iry I� S T X AP, Cp XF t�.G, �,ac,, L.Fft�, ta,,A C�Fht Pu a, r i �I /� L. C • i f 7ILE % \ r. lu fog C'�f.Y►,�E, �JA(L La�� I Q PAIN, II�QN SyM$oc— '4f z- _ ,, . ,. . _ _ — L�ii� ✓i �` gad - BOpRp OF HEA • • • 'TOWN OF BARNS P.O.BOX 5�2601 �ANNIS,t�iA / RECEWEI) DEr,- 1 1 1991 "FAWN DEPT. TOWN OF BARNSTABLE , T'wh.bf Barnstable Regulatory Services . o� Thomas F. Geiter,Director � s�R�isF�Hss. MASS- Public Health Divisino `erg' Thomas McKean,Director 200 Main Street,Hyannis,NIA-02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: ©C� 9 ) 2C0 7 Designer: o t, v A�1 6 �i C Installer: - - — co Address: r? 7ke� Yell Address: S� M �a� VJ 62G-73 On of 12 Oho f -1(/CQ was issued a permit to install.a (date) (costa er) septic system at I(o A a tp`LYKOU Ct-\ %20 C C—N i 00%Lc -based on a design drawn by \ (address) VL,W.vb�w'Eju6 1IaC. dated `5Jzl10 G-Vl S'/2110 (designer) )C I certify that-the septic'system referenced above was installed S tantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. A, u I L-t k j i-r-'Ct��© Q��. �p�� 10 lW/6-7 I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. ZN OF-M,g Ss'gQyG o PETER d+ cSULLIVAN a CIVIL w (Installer's Signature) No.29733 O � AP �FCIs �� (Designer's Signature) (Affix Designer's Stamp Isere) PLEASE RETURNN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF C0NMPLLANCE NVILL NOT BE ISSUED UNTIL BOTH THIS FORM' AiND AS- BUILT CARD ARE RECEn ED BY THE BARN STABLE PUBLIC 1: EALTH DIVISION• THANK YOU. Q:HealthlSeptic/Designer Certification Form j-7Ze 3eoc,. 04 o.e. I wand � # w Z' ►..i ' Rs �Or::ri-1 /�i � r � _... d,P� r yT fPwell) 60a�se. . 4,0 . : C'a2rSe NZ �Jo, `¢� I �p,ow e. El. is 2Io0 ) P // #- Ig 1' Y PA � /T Oc Z,5= 4j:3 Si�Gs: Zx3.�¢x J6 X . Lv�f. 2 K :.7BS"`� /lo ._�/ K / 20/' �.S-C c`i i�•Yi ra rq,S ,�f-in 8S¢S,F / o. 75V . YAW �IIKI.• : 1 '. jOl .,. - - �-~, -- ,42�~ .; ; �7/b :c:e<-,c, f�u✓r{�' �� .�i�?C?t���.. Of ��<'v/4'�!'�r, '4•�y ����i,`,�oF ��.�: r / .r' ' r�pr,<<I�l'P� P� l •r��, � ,F y ./i.e �. Ar� ifJ< i►' • s Us� /SCO ya/• grease /-t :�,v moo, ICY /ell.) 1 3 � u " � z • anc/ �► � ' o � w�:,G��.-c/ Peas�d�,•e. vv/ C-/,47, a/.4L• KV /Vd N ra- 57 1-7e /V'�� ��sT- :mac c.� �7BE3E.lTS.. JGr� '�P•r '. ! ` /Z/c 7-o4Z-Z- x1ie5D L'�` wo,2 :113 . fi +•7 ` ,., e G l/�7 I•r Cl/ �Jh��9 `:,, �/ r� ' � t�As�.� �;.�}, �„� It r"fr,�"�'���, .t , r I'CIG�I000/ L�V®YIe W/-e�PO/ , 1 �r ;13� L '. {' /�~/.Y.�r.+ JYG. � •� �OCO St; y��W�/., S. , i':.Srtr Jrr. � !t•51i. ,AFt(It.,y�� � � i :SA�i, .Ss ,• g T',� r 1,4� _� ��3,yfJ!'/���+/ i.' �yj yi. � i .L_. �._ •+ TO :, J74V48,0 , Ih✓'i �+r/a�y t �q�+•��p��qT✓,.i fs3 LA z`✓r� syi 1 . 47, y ryGl�iy /.�. -r'ey•7S e `�"'.r�NjVipp��rt�..¢�5�' � "•�,� X'"^`wy Yy Mtp 'kf' L/(� � ' .. ' —" ".VI r •^1 Y4 lF i ..i ..4 j q Fl�ii'A� Y�Y.F�Y'.�/'� �� .+lti S 7 • ,1Cae,?�s.C�-rv�I�sa�( B: rbzJ{ r :, ' �1 fi XL.4 n+ jil lIx.u,.c„� :• ^oy� t7�wKr ; ' 23GI'/IG7�y �u1�°/VV/ /+cecY dyh r i rty+ G�t3iilLmg+mzr' Tdji� j�(�1J /iU :G°�itl +�' T wiG <rkvcrt�znzai'Cttflt ' ;"'1�/�cG `t ; / r�Fi�Jitle� L'/fJTt� �'O�ihvW! 54 vRu;P13cK STl"• C'Bii17c`,�1/�G[ /�.Q�S � �° '� ��1s7�?`t♦♦j S 1 AR'f�1(iI1TI7 'K?M• i-y�{/, eCl._' ��� �iGl� i!�✓ in CT. (ram` R''T �� �•. Rl:SiTY,kP1.5 • ^ r • � � � r�. i �< i•,•' i k �.,+.r' l 1 ( �• R'Z�rj Mw�^ .�. 'Y i' � .Lt+ t� �� i r • TOWN OF BARNSTABLEJ OCATION 2f" Z. SEWAGE # / VILLAGE : 4,, �!r�- ASSESSOR'S MAP Cz LOT? - INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY _.--- - � LEACHING FACILITY:(type) (size) 1 ci z, NO. OF BEDROOMSf PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: f k DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No e f �, ��9/S d 8 L G �,� �, Cf C'�----- � � .� �. ���� �.�' TOWN OF BARNSTABLE LOCATION�(p� /(Q/(Q _�/p60-$(p 9-1 ZT SEWAGE#,�O 1'— �5 VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. d-1 6 C4AJ Q SEPTIC TANK CAPACITY EX-sTD-)5 (quo !i.4 LEACHING FACILITY:(type) (size) /06� 3/6 1�=J0 ie NO.OF BEDROOMS /N�/� A?T K V L S hApe OWNER /"IA�L'C/ PUy/AA rl PERMIT DATE: / COMPLIANCE DATE: A Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY /Co5Y /&&° llR5v Ito 6;" 63 77 I TOWN OF BARNSTABLE 't LOCATION I(rq 8 �AkOw h Q-D SEWAG #(,�'-M-4`t4 VILLAGE C60TiEkZ\XkIG ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. Afd 6q/ 1(Q SEPTIC TANK CAPACITY 16'00 G,T- 5"$06cji4,( 5,T. 30adSs4 /�C. LEACHING FACILITY:(type)18-61"41 laCJW6J1S (size) 77-5- X JS x d` NO`OF BEDROOMS 5'0 54C4Tf PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility !� Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) �� Feet Edge of Wetland and Leaching Facility(If any wetlands exist n within 300 feet of leaching facility) // e/� V/ Feet FURNISHED BY 0/4 iCJ� P 03�3" 1 Y �3=�►°�'c� 63 toto OW ton { �(o TOWN OF BARNSTABLE tj LOCATION i �/aGyt�tG �r'f G /Z SEWAGE #_� �`� VILLAGE -✓- ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. /����� �"� SEPTIC TANK CAPACITY 00& � t LEACHING FACILITYAtype! v Lz1y ' _ (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER_ BUILDER OR OWNE VV d �l DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: .-) Id VARIANCE GRANTED: Yes No r �o `4 '771W 14 LOCATION 5EW PERMIT UO. kc _ __II�1ST-I�LI.ER-�5.1J�ME_�_ ADDRESS i BUIL.D.ER 15_ntJ/_D.t�AE_/-_ DATE. -PER[-1T-- DATE, COMPLLAM- CE .— �e boo �C'�.I � '9s Now—. TOWN OF BARNSTABLE LOCATION 1C39 Feat n&-7411 A SEWAGE# °Z a +3 - 3 7 2- VILLAGE Ceey4e 1/j fie, ASSESSOR'S MAP&PARCEL aOci 101.3 INSTALLER'S NAME&PHONE NO. �'.`t ��`�G E, �✓�o�i Q�S LC.C,o u08-977477 SEPTIC TANK CAPACITY /c�(X) C9�► l C,r� o dip + 7,5(0 LEACHING FACILITY:(type) 6,d Le-,-hsj dwrdk+(size) NO.OF BEDROOMS .33b c,P ti-ao OWNER oa,j Shop PERMIT DATE: 11t (Z0 13 COMPLIANCE DATE: 6 I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility�ncct, cc� a Feet Private Water Supply Well and Leaching Facility(If any wells exist on /c?® site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility.(If any wetlands exist within 300 feet of leaching facility) 1 Feet FURNISHED BY o, Donki, Tod ezh a �; bowis 1=®ocA sFxaPs . �' `�' 4 ,1633 40 o t: 1 PNT p) S3 P6/ /fin• ; �� G f _ -?�� ,� 60 y e rl ,.y 4° / e�x�Q-G • _.,__ ,c��SE,c�T ��_e�1�E• ' ' -: Iley e-z- �G.4IJ IALI ltJG f' /'/ ��=�PG'.� O�'a► 'c'D'NG. G�W/7� r3t�i Of h'►/��v>1��. ; 4 , /)l ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD`- F HEALTH _ L. dcJoF..... ..:.,.. ..5 ............. Appliratiun for Uispusal ;arks Tonutrurtiun Vrrthit Application is hereby made for a Permit to Construct (.Y) or Repair ( ) an Individual Sewage Disposal System at• 0 zlleoc ! �. ... -•... .............................. ... --••- -•---- ationdd�s 41 Owner A dress - Installer Address UType of Building Size Lot-.` '�.. ;,�--. t �-, Dwelling—No. of Bedrooms..__-_-._.�•--•-•--•..................Expansion Attic ( ) Garbage Grinder (/ © aOther—Type of Building , _ _..._... No. of Dersons............................ Showers ( ) — Cafeteria A' Other fixtures .... .. __....__.. - W Design Flow.............. ...................gallons per pi;-m-sR per day. Total daily�flow.......__..1-�7.-5-0.........._gallorp. � Septic Tank—Liquid capacity allons Length_._. _ _.. Width.....�f�.'........ Diameter................ Depth....... _ . . x Disposal Trench— No. .................... Width------- _ .__..-__ Total Length.................... Total leaching area_...-..-. --_-.-.-sq. ft. See age Pit No..__. •�_-_ Diameter....._. .. De to below inlet-- ... svoo � P g �••----- �• -•-••- P � Total leaching area z Other Distribution box (><) Dosing, k ,/� % p - - Percolation Test Results Performed by._..(/G.°.[.�.�. ? '�!C��e.l ....... Date....-':�--.7 ..0 a Test Pit No. l................minutes per inch Depth of 1'est Pit........ Depth to ground water-_�4� 44 Test Pit No. 2....q�---____minutes per inch Depth of Test Pit-------- Depth to ground water......41116--1X , - ------- •--_----- ............................ l Desch ri Soil �K ..�r �. _. d- s 81.... , - --- -•------- - V ... .... ...... .......---•-------------••--••--•...------........------•--•--.....-•----•------------..............._......_..•-•-••---•--..__...•-----------•--••-------------•---------•---- ------ W U of Repairs or Alterations—Answer when applicable....................................................------------.---.------.-.---------------.. LPL OF ment: undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with _ R. , the ions of c� of the State Sanitary Code— The undersigned further agrees not to place the system in t8883l fermi until a Certificate of Compliance has b i ued by t Ze bo d of health. / !U is ��4. �� S ed.. � -"`-.�------------------- r / T Date StNNAL cation Approved By..... .. • ............................................ ! Date Application Disapproved the llowing reasons:--------------- , � ......................•-•-•-----........--------- ......---- ....................................................................................... •-•--------•--------------------•- -------•--•- • Date PermitNo...............................................% Issued Date ---- ------------ THE COMMONWEALTH OF MASSACHUSETTS f "'777 BOARD OF HEALTH ............................... ..........OF................-.................................................................... rrti tr of f�uutrlittnrr TIFY T e n vidual Sewage Disposal System constructe ) Rpaired b i..... • / sta r • at has been installed in accordance with the provisions o � �ff _tate Sani tar v Code s de in the application for Disposal Works Construction Permit No... .........r_... ............ dated_...?.. _:�" ....... ................... THE ISSUANCE Of THIS CERTIFICATE SHALL NOT BE CONSTRU D &S A GUARANTE THAT THE SYSTEM a��-,SATIIFACTORY.DATr---- ...---. Inspector.... ti i ! 6 No.....................••- .F THE COMMONWEALTH OF MASSACHUSE­TTS BOARD OF HEALTH Apphration for Disposal Works Tattutrurtion prrntit Application is hereby made for a Permit to Construct ( *or Repair ( ) an Individual Sewage Disposal System at: Loca wn• dress ---------------------- 1,6 7� r AdS dd es's .. Owned f_�. teasY .......... j f-:'y ....,.r.� .... ---------------- /`'r�:-•-,a«. / // „cam Installer / A dress � U Type of Building Size Lot..... 4 .Sq'4e4 .�,..,�. Dwelling—No. of Bedrooms..............vrrn........................Expansion Attic ( ) Garbage Grinder ( �O a Other—Type of Building .... - ��,._ ..... No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures . ��T -------------------------------------•---••----•-•-•-----------•-•-----•---•---..----- W Design Flow................... .-. - ._.___gallons per per• day. Total daily flow................ _!'-_ ........gallons.! WSeptic Tank—Liquid capacity___ �•tapons Length-•_-__.-` 4.Width........{ _� Diameter................ Depth.........Vl... x Disposal Trench— No. .................... Width.......--.1....... Total Length.........._......... Total leaching area.................... ft. 1 e 3 Seepage Pit No........ Diameter..•.._... . Deptn below inlet..... _��Total leaching area..._ tl. f �� J z Other Distribution box ( Dosintank Percolation Test Results Performed by......... .� - Date....... - Test Pit No. I................minutes per inch Depth of Test Pit.........__f.`.,De.pth to ground water....... 44 Test Pit No. 2........Z....minutes per inch Depth of Test Pit-------------f_.Depth to ground water........... a ............................•---............................-••-•-................. -••-•............_...--•••-•-•••...............-----...... .. O DescriptioA%f Soil..............Z ._ ...... " s i'/---Xi =r � �` � y -. ------------- c.� == ........ ------------------------------ _ -----------------------••--•-------•-•-------------•- W .. x ... Lj--- - = - - ----------- U Na e[cd"Repatrs or Alterations—Answer when applicable..... U -----••-----------•--------------•---------•--------- ent: undersigned agrees to install the aforedescribed Individual Sewage.Disposal System in.accordance with `e ° ns of Ane State Sanitar Code— The undersi ned further a rees not to lace the s stem to eati 1 ntil a Compliance has been issued by the board of health. g p y $ THWICK N .. Date /ST ``� n Approved By......................................................_........................................... FS`SfONAL E t. Date ication Disapproved for the following reasons:................................................................................................................ ..........-•---•----.._..---••--•----.....--••..............•--••---•--.......--•---.....•--•..._•---••••.----•.--••---•-•............---•----..._•-----......-•-------....------...---•--....._....... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF IvIrdifirate of Tompliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bY-•-•---•••-•-•--•---------------•--••----------------------•--------------•--------•_---------------------------------------•------------------------------------------------ Installer at__.... has been installed in accordance with the provisions of Ar jelees fie State Sanitary Code as described in the application for Disposal Works Construction Permit No. ...................................... dated................................................. THEFit— CE THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEMF N ION SATISFACTORY. DATr••••• ..-•-------�--••-----------------------------........... Inspector.------- ------ -•----------------------------...---••-------•--••---•----......-- TOWN OF BARNSTAB LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&LOT 20°J— / O�3 4,7-0 INSTALLER'S NAME&PHONE NO. f" AXO 7� Z S-Cr"% SEPTIC TANK CAPACITY lam"` O 4. .. • LEACHING FACILITY:(type) (size) NO.OF BEDROOMS IVI AeTl lln91(p 11D IF - O�v1N�Q/CIa / BUILDEROR OWNER 0 Q / Y PERMIT DATE: COWLIANCE DATE: �-�U•O Z. , / S Separation Distance Between the: �G Maximum Adjusted Groundwater Table and Bottom of 0-aching Facility Feet NL� . Private Water Supply well and Leaching Facility (If any wells exist (J D on site or within 200 feet of leaching facility) Feet fk dge of Wetland and Leaching Facility(If any wetlands exist \ within 300 feet of leaching facility) Feet Furnished by R i 1 � 62, Igo t'p� 63 20 tl I, kc C _l,d �y TAB /�1-e s --H 1� P n-� i 7 w. 60H L4 i�'(f� Ii NI�W IGN Lt U NOTE THIS SCHEMATIC IS FOR REVIEW PURPOSES ONLY AND DOES NOT GUARANTEE COMPLIANCE WITH ANY APPLICABLE CODES AND LAWS, NOTE: EQUIPMENT MARKED WITH AN ASTERISK (+) ARE NON-TYPICAL MILLWORK ITEMS THAT SHOULD BE REVIEWED WITH THE RESPECTIVE DUNKIN' DONUTS CONSTRUCTION MANAGER FOR USE, CONFIGURATION, SIZE, FINISHES, ETC.,PRIOR TO SUBMITTAL FOR DESIGN 'APPROVAL. r� H 14V H L L L r-, g c;, PL_PA,N - - i i I FLOOD ZONE: Zone C x See Note 4 250001n0005a�ei No, . �•• d �x (op.) F.G. EL. 55.0' vent Revised: Aug 19, 1985 k • s EL.47.10• 165• OVERLAY DISTRICT: c AP - Aquifer Protection District * +` T_og V. 52.0' ==== I L 0 0 0 0 0 ZONES. bie5aaiai Proposed : r t14R4slZf! , ' . . 00 �C4500 Sepik Tank 3,000Gal D-BoxQ OOO Area' (m)n.) 87,t20 SF(R.P.O.D.)got. 49.0' Fron a i(Sse Note 9)) Pump Chamber H-20 t e (m n �0• Leach Chambers Width gmin) 1 0 b • , 4 (18) 500 gallon Setbackks: e Bedding, "T''s, 'U"s, H-20 g Front 20� Side 10 ' dt Batiels ►f Encountered Remove de Replace N KK Rear 10' EL.4Z 75' as Per Title 5 Ali unsuitable Sous Within 5'of See Note 11 the Outer Perimeter of The Sysltem il8 Area (min. 4 ,004 SF Front, a Omirtg ?0 Test Nole El. 41.5' Width min) 180 o rdoundwater, Setbacks. Groundwater•at. 25 From Front 60' - • , PROPOSED SEPTIC SYSTEM PROFILE roe car contour Map (1992) Side 30• NOT TO SCALE t Rear 20' Location Map 1"=2,000±' ASSESSORS REF.: Map 209, Parcels 013 PERC TES T. 10,287 Design Data- PERFORMED BY PETER SULLIVAN, PE GENERAL NOTES: R 1MTNESSED BY: DAVE STANTON 1. Water Supply For This Lot is Municipal Water. Restaurant Flow: :50 seats BARNSTABLE BOH Loaated lh The Front of Building. Daily Flow = 35 x 50 seats = 1,750 gpd SEP 30, 2004 2. Location of Utilities Shown on This Plan Are Approx. With No Garbage Grinder. At Least 72 Hours Prior to Any Excavation For This Septic Tank Design TEST HOLE — PT Project the Contractor Shall Make the Required Septic Torok: 1,750 d x 2005' = 3,500 d PERFORMED BY SULLIVAN ENG Notification to Dig Safe (1-888-344-7233) P gp gp SEP 30, 2004 J. The Contractor is Required to Secure Appropriate Use A New 5,500 Gallon 2-Compartment EL, 51.5 Permits From Town Agencies For Construction Septic Tank. Defined by 7his Plan. Leaching Area o"-e nu 4. Risers With Cl Rims and Covers to Finished Grade 1,750 d 0.74 = Z365 SF Required a LAYER toYR 5/8 5o.g Shall be Provided as Follow: Grease Trap -2, 9PSeptic Tank - 2, ,p Pump Chamber - 1 S A.S - J. Sldewall Area: = 417.88 SF g=24 YELLOW-BRN COARSE SAND One 36 X 48 Aluminum H-20 Access Door, or Bottom Area. = 1987.5 SF COBBLES Approved Equal, to Finished Grade Shall be Provided ` Total Provided= 2405.38 SF 8 LAVER IOYR 6/8 Over the Pumps. 24"-48 BRN-YELLOW COARSE SAND ` COBBLES 44.B 5. All Structures Buried => Three Feet or Subject A�, '�j• "°"'^°'w°g°t°ted'''"° Leaching Chamber DestoQ C LAYER 10 YR 5/4 to Vehicular Traffic to be H-20 Loading ti Proposed 4'PVC Pipe 48 YELLOW-BRN COARSE SAND 6. Se tic System to be Installed in Accordance With n All Pipes to be Schedule 40. pp ys V loox W1th Perforations 310 CMi? 15.00 Latest Revision and the Town of Reserve Area Downward Full Length of Use (18)-500 Gal. Leaching Chambers (25x79.5') Barnstable Board of Health Regulations. Natural Vegetated Ana i o�b � Leaching Chamber In a Washed Stone Field as Shown. PERC TEST 7. Ail Piping to be Sch. 40 PVC. v d - 48 LESS THAN 2MINAN 44,8 - �.� 8. Wherever Sewer Lines Must Cross Water Supply Check: (2.405.38 x 0.74) = 1,779.98 gal (OK) No GROUNDWATER ENCOUNTERED Lines, Both Pipes Shall Be Constructed of Class 150 Pressure Pipe And Shall.Be Pressure Tested To TEST HOLE — TP Assure Watertightness. 0 10.0iv�, ', 9. Septic Tank Shall Be 5,500 Gal. 2- 5 O , PERFORMED BY SULLIVAN ENG A SEP'30 2004 Compartments. The First Compartment Shall Have 0 � A Volume Not Less Than 3,500 Gal. And The Second i, AT GRADE EL 5115_ _____Comoortment_Nnt Less Than_A Volume of_1,7 0,rci ' O • O \ - '" "" "*"" ' " "' ^� '-to.H/gh'Water Aform Sha►!Be Located in The Guiding \\ \\ _ o'-s FILL Served And Powered By A Circuit Separate From ---- • , Proposed 3.000 Gat 50.8 The Circuit For The Pump. `\ - ' PumpCha of A LAYER 1oYR 5/8 11. Inlet Tee's Extending a Minimum of 10" Below the Y For"Mah 9'-24 YELLOW-CO COARSE SAND g Proposs8-�i,.S Proposed � COBBLES Flow Line Shall Be Provided. Outlet Tees Extending , 19- 500 Gd a Minimum of 14" Below the Flow Line Shall be 8 LAYER tOYR 6 8 -awinb°'s H_?° "-2D ! Proposed 5,WO Cal 24-48 BRN-YELLOW COARSE SAND Provided, and Shall be Equiped with Gas Baffies. __-__�_____ _ _ _ Sepik Took 12. Note Well. It is the Contractors Res onsibi/it to __- ---- -- Dk+turbed Area i3---` `'``.� Remove Exhtthil H-20 COBBLES 8 P Y (5)too y,l C LAYER 10 YR 5/4 Confirm the Compatibility of the Existing Electrical - Be Loomed �� Lsaeh �� 0 48"- 120 YELLOW-BRN COARSE SAND Service with that of the Pumps. --- ----62}----- _Q=Boz _ _ - Exlsthg 3,000 Gd 41.5 _ - - -------- ----- '`' - -__ - - - Septic Tank H-20 - ---- Be Abandoned NO GROUNDWATER ENCOUNTERED 1 a,-x�s• 0.0'Min sear. + ` Be D dedCam To ad—a -----► MIN F•deeL swe t lao.t O O s p edes«u°iato%011" 1 1 ( i lo Existing 1,500 Gal. e-o' I 1 X _���^ 90 a men Two R..Jh O cn - --------- e ° ge ° a an �� Pump Chamber Plan View Detail �9 Not to Scale _ o r .�cS� vp aed. Aftwrhwm e•-ao sf.cf Aoow aoer ar o,"ee,. aen,eeaa n Ar A s or -Z umwy araner i i d uedtsim aoet a 4o A...L a ru"..M a AQ M ham' _ r iw a-r UP.Aho _____---- ---- Cross Section Of Chamber ` Not to Scale t _ 3000 Gallon - _--_---_- _ Q Pump Chamber Section Detail ---- pop ___----- Not to Scale PL I AN VIEW r LOT AREA: �\ SCALE: l — 30 , Add 5,500 Gal. S tic Tank As Required Revision: & Pump Date 05/21/OT harnber Details PREPARED BY: PREPARED FOR. 7tle: Sullivan Engineering, Inc. MARCEL R. POYANT Septic System Upgrade 7 Parker Road P. o. Bar. 659 1648 Falmouth Road (508)428-3344 /428-31151ax 282 BARNSTABLE ROAD o PSuIiPE�bol.com Barnstable (Centerville) Mass. ' Field: MD HYANNIS, MA 02601 Draft: DO Job Date: Cale: Review: PS Drawin 9812D SEP 21, 2006 As Shown I i .... .......... 41 X��, S/I ­ 79A PIT S-;? S3 7 7e7l, A,4 77 ot ve "A 6p, yo, %jo led "Q. ____7.7-7 7 ;xe, -5�k4r' )re> 11V e v'T 2-T 2, '7- 4-Z 72 711� lz �/�,—­ —/ - - NA, AJ Z-4C J" Cf. -2 Ae� �T 1'�' 4 4,z `7 -77 20 'd, 2r- 4e) 0 :�.-oc jo A)e P.4 4r 77': Af ii;,,�, lei 177 -jo le 7e- A FT 0 J, T Ti _jf V ?I u 40-1 L "Ik "IV, 7 4L J�l k �So 77 1�5 "W7 '24 40 4 Q IT 'o -.5 MjTW _,0 .0� je� .4 W, I a4. ------------------ 'o GENERAL NOTES 1 GENERAL CONTRACTOR SHALL REFER TO WRITTEN SPECIFICATIONS FOR ADDITIONAL INFORMATION NOT CONTAINED IN' THE DRAWINGS. G. 3 COMPARTMENT SINK, T S SPRAY 112 12 2, GENERAL CONTRACTOR SHALL PROVIDE ADEQUATE BLOCKING AT SHELVI' LLJI Q 13AGEL BRACKET, POT RACK, HAND SINKS, MOD SINK FAUCETS, TIME CLOCK. GRAB BARS, LAVATORIES, HAND DRYERS, HAND -4 �:14 41 MIRRORS, PAPER TOWEL DISPENSERS, SOAP DISPENSERS, OTHER ACCESSORIES, ETC. -N SINK r�,IOVE THE EQUIPMENT AND EQUIPMENT LAYOUT. P_ NEW BAGEL OVEN 3, REFER TO THE *K* DRANNG(S) FOR INFORMATION REGARDING 4" A,F.F. OR SANDWICH STATION, TOP OF BLOCKING 9 4'- HOOD BY CAPTIVE 4, GENERAL CONTRACTOR SHALL INSTALL 2� x 8" BLOCKING F AIR ALSO BLOCKING FOR.VDU MONITORS. OF ICE-\ 5. ALL TOILET WALLS AND OFFICE WALLS TO HAVE ALUMINUM FACED FIBERGLASS INSULA70N, 6. HANDICAP REQUIREMENTS- (EXIST KITCHEN T HIMSELF WITH THE HANDICAP REQUIREMENTS FOR THE (EXISTING) A. THE GENERAL CONTRACTOR WILL ACOUAIN 4'-0- C LR APPLICABLE STATE AND THE AMERICAN DISABILITIES ACT (ADA) AND INSURE THAT THIS FACILITY Wil LL -,EOUIREMENTS: ACCESSIBLE' THE FOLLOWING IS A PARTIAL UST OF P iAl: A� 41 1. AISL*ES MINIMUMI .36" WIDE.' 2. CURB CUTS PROVIDED AT HANDICAP PARKING SPACES. 3. MAX. SLOPE OF 5,10 OR 1:20 IN ALL PARKING LOTS AND ON SIDEWALKS, ALL 07HER AREAS V�!ITH GREATER 03 SLOPE WILL BE CONSIDERED A-RAMP. t6 2 4. SID -0" WIDE. z EWALKS WILL BE A MINIMUM OF 4' AND 19" ABOVE THE FLOOR ON 5. RAMPS HAVE TO HAVE A MAXIMUM' SLOPE OF 1:12 WITH HANDRAILS AT 34 'v' zoc L-JL--JL BOTH SIDES AND TO EXTEND BEYOND..THE 'TOP AND BOTTOM OF THE RAMP A MINIMUM OF V KIT$ �a_m 8'-0" ,FINISHING . 6. ALL DOORS WILL HAVE A MINIMUM OF V-6" CLEAR ON THE LATCH (PULL) SIDE OF THE' DOOR. (EXCEPT IN ov) <z =.O 0 CERTAIN STATES "ERE IT WILL BE 2'-0-) 7. DOOR MATS AND THRESHOLDS TO BE A MAXIMUM, OF 112" HIGH. HALL EXIS77, .1 w ...V) 24 BASKETS 4 BASKETS S. DOOR HARDWARE SHALL BE MOUNTED BETWEEN 36" AND 42" ABOVE FLOOR. COL on 9. DOORS TO HAZARDOUS AREAS TO HAVE KNURLED HANDLES. (EXISTING� 1112 BASYET Ur 6, A- DON s BAKERY 0 Nu T� 10. TOILETS. METERING FAUCETS. V HAVE�LEVEER' HANDLES, SPRING FAUCETS OR SELF '---FILLER I BAGELS A., LAVATORY TO SJ f t i B. A COAT HOOK 54" ABOVE THE'FLOOR WILL BE-MOUNTED ON THE BACK SIDE Or- THE HANDICAP 6 Mi STALL DOOR. 18" FROM 'THE CENTER LINE OF THE FIXTURE TO THE WALL. THE SEAT C. LOCATE THE WATER CLOSET N WILL BE 17" TO 19" ABOVE THE FLOOR TO THE TOP OF SEAT, u I Li�t FROM, THE WALL _J V, GRAB BARS, 1 1/2 A D. PROVIDE TWO 42" LONG x 1 1/2" OUTSIDE DIAMETER PENNED m V 1_�� SERVING AREA FROM THE WALL AND ONE ADJACENT TO AT 12" FROM THE WALL 33"-36" <_ NTH ONE BEHIND AT 6 PARALLEL TO AND ABOVE THE FLOOR, WHEN A TANK PREVENTS THIS LOCATI ON OF I REAR GRAB BAR x INSTALL GRAB 'BAR 3' ABOVE THE TANK. CE OF 30" IN (o 4 -6 COFFEZ TH KNEE SPA FILLER 6'--0" COFFEE. 2#-B 2' E LAVATORY TO BE MOUNTED 32" ABOVE THE FINISHED FLOOR TO RIM VA CASH CASH r­l WIDTH AND 27" IN CLEAR HEIGHT. M I UTILI I Y N/I F. INSTALL MIRROR 36" ABOVE THE FINISHED FLOOR (TO BOTTOM) AND 72- TO TOP. c; co ww_z 0 G. DISPENSERS TO BE MOUNTED A MAXIMUM OF 42" ABOVE THE FLOOR TO ALL OPERATING OR o la::�Lo. DISPENSING SLOTS. tv ADJOI NG '19" TO CENTER LINE ASO�T THE FLOOR� (EXISTING) L_j H. TOILET PAPER DISPENSERS MOUNTED PASSENGER LOADING ZONES., RAMPS, AND SIGNAGE, SHALL CO PLY WITH 11. ACCESSIBLE PARKING SPACES H LL TENANT,�' 1 7= THE (ADA). I I I, > Aj "MEN" OR "WOME� 3) %vio S REQUIRED WITH RAISED LETTERS AND IN BRAILLE INDICATIN (EXISTINC 12, ON TOILET DOOR(S), SIGNAGE 1 99 LAIR SIGNAGE REQUIRED IF BUTTONS PROVIDED. SELF- OUNT S' CENTER AFF OPENING SIDE OF DOOR, SIM! SPACE M SERVE ERIAL NECESSARY FOR THE COMPLETE INSTALLATION OF CEMENT BOARD BACKING 7, FURNISH ALL LABOR .AND MATE 11 COOLER FOR F.R,P, AND CERAMIC TILE. TOILET o. O.S SYSTEM AS SHOWN 014 ELECTRICAL DRA)61NGS OR, AT MINIMUM THE 8. GENERAL CONTRACTOR TO PROVIDE FOR P. X LOCATED BEHIND OFFICE DESK UP WALL TO GATE FOLLOVANG CONDUITS: A) 2 112" I,D. FROM 4 x 4 x 3 JUNCTION BO LINE CHASE UNDER SLABTO BACK WALL. PROVIDE #1 J� ABOVE CEv ING; 8) FROM A HUB LOCATED IN THE FRONT 2 1/2- I.D. CONDUIT WITH 2'-0- SWEEPS AT ENDS. Tr-IRVINATE ABOVE THE CEILING. C) 1" 0, CONDUIT FROM BEHIND USE 2'-0" SWEEPS AT BOTTOM TO SIDE NEAREST ul LET P WALL TO ABOVE CEILING (E X i S TI N'3), THE DRIVE THRU CASH STATION U S SS THAN V-13" RADIUS. REQUIRED SO NO WIRING BENDS LE FPAME WALL IF WIND01W BEHIND PROVIDING CHASE A'S #2 AND D) 2"W ELECTRICAL E30X 6*-0" A.F.F, WITH 1' CONDUIT IN WALL TO ABOVE CEILING, CENTER 32" X 32" X 3/4" 2 -UNIT.- PLYWOOD BLOCKING IN WALL FOR VDU , 75-0", AND ONE (EXISTING) NOTE THAT THE MAXIMUM CONNECTION, LENGTH BETWEE� V15U(s) AND ITS DEDICATED CPUAS ro4___ 0­0 TELEPHONE JACK IN OFFICE 70 BE AN ISDN LINE. NOTIFY DUNKIN' DONUTS IF NOT REGIONALLY AVAILABLE. LOCKED 9, NOTE: ALL POWER OUTLETS FOR P.O.S, DEVICES ARE DEDICATED CIRCUITS WITH THIRD Wi R Er cr OUND VARES, RUNNING BACK ISOLATED GROUND. AN IG IS AN INSULATED WIRE, SEPARATED FROM ALL OTHER GR TO THE BUILDING MAIN OR COMPLEX POWER PANIEL. STORAGE (EXISTiNG) < NEMA 'STANDARD L5-15R I.G. FOR THE RECEPTACLE'AND PLUG. JADPLEX OUTLETS: (I.E., HU8BELL IC-5262. IG-5362 OR, EQUIVALENT). USE OF IG DUPLEX OR 01 A 4 I-A71ONS'ARE DETERmIN E-D. 10. GC. SHALL NOT PROCEED NTH CONSTRUCTION UNTIL V.D.U. LO., 11, IF BOLLARDS ARE REQUIRED, G.C. WILL PROVIDE, 6*95 CONCRETE FILLED PIPE AT LOCATIO14S SHOWN ON SITE PLAN. -21 PARIS WHITE, AD�1011' ING i N, i BOLLARDS 3'-0" ABOVE GRADE AND SET 87 ALL BOLLARDS PRIMED (1) COAT, PAINTED (2) COATS P it, I SALES /AAVREA IN CONCRETE TO AT LEAST 3'-0" 13ELOW GRADE. MA TENAIN71,11 (20 SEATS) E RESPONSIBLE FOR REVIE�VlNG EXISTING HVAC EQUIPMENT AND rl 12. OWNER'S MECHANICAL CONTRACTOR SHALL 8 TECT APPROVAL MODIFYING AS REQUIRED BY NEW HEATING & COOLING LOADS. SUBMIT SHOP DRAWINGS FOR ARCHI OF BEFOREOP BEGIMNiNG WORK, DERING EQUIPMENT OR E ' N COOLEIR(S) BEING USED AND ALLOW SUFFICIENT ,SPACE. L REA H, 13. GENERAL CONTRACTOR TO VERIFY SIZE"O. J6 14, DIMENSIONS SHOWN ARE TO THE FACE OF FIN!SP 15, THESE PLANS ARE BASED, ON MINIMUM ALLIED DOMECO CORPORATE DESIGN REOUIREMENTS, 'THE STRUCTURAL DESIGN, FOOTING DESIGN, ADA COMPLIANCE AND GENERAL, BUILDING REQUIREMENTS HAVE BEEWEVALUATED To MEET % ALL ADA STATE AND LOCAL CODES. IN cn f-I z �Yl V) o /1v UJI --Jl V) _j LAJ z C5 VE S I I B"U LF DOOR SCHEDULE , FRAME FINISH ----------- WAR REMARKS TYPE MAT R FRAME DETAIL THRESHOLD HARD E 14AX., MARK SIZE ERIAL DOC INT FLOOR PLAI\I. SET NO. NO. IN x H. FINISH EXT 3"-O"x 6'-E!" SOLID CORE HOLLOW P-30 . SEE NOTE SCALE: 114" V-0" ACTORY METAL 2/A2 NONE #2 MED OPENING 2" SPRING HINGE, 1 1/2" x,4 1 I FRA LAMINATE 3'-0 x 6-8"x C. SOLID CORE HOLLOW P-30 < T METAL 1/A2 NONE #5 UNDERCUT 1 2" BIRCH St-22 2 1 Z/4- HOLLOW P-30 UNDERCUT 112- 3'-O"x V-8"x SOLID CORE 1/A2 NONE f3 3 1 ,3 4- BIRCH ST-22' METAL' HOLLOW P-3 UNDERCUT 1/2- WOOD 2 NONE 0 2'-6" x 6'-8" x 'E' I/A ST-22 �4 LOUVER METAL- 1 3/4" 3'-O"x 6*-8' HOLLOW p HOLLOW P 30 -30 WELDED FRAME 4/A2 ALUMINUM f6 P, 22 5 . 1 3/4*7 .'D METAL -221 METAL J x 8 x SOLID CORE HOLLOW P, UNDERCUT 1/2- z -0 -30 3' BIRCH S7-22 MFTAI 1/A2 NONE 4 __j L (VOSGES REAR) > ELIASON EASY SWING 3/4- DOOR WITH FORMICA PL-28 BOTH SIDES. SIZE- 35 3/8"x78 1/4"x3/4" FOR 36"xBO' FINISHED OPENING. 0 TION BLACK KYDEX KICK PLATES BOTH SIDES, SEE SOURCEINFORMA M < O� 0 /117 IVES 698 826D i 160* VIEWER GLASS 7__)._lAx, 5" PEEP HOLE LIGHT MAIL 0 SLOT 0 fy OFFICE < E' Ivl A X, EO. /E01 EO. UJ ONLY /EO. 'o t ---KICK GATE POST NOTE J PLATE SHEET END POST 70 BE" 1 1/2' x 5-0� S�S. P OST-. DRILL SLAB 24" DEEP FOR POST AND SE T IN 8 c D T 0 1 L E T DE-FAIL "POUR-A-POCK' OR EQUAL. FORM 3//- WOOD POST AROUND MET 1 POST. FINISH, PLYWOOD iAL S%CALE- 1112" V-0" ALL S�DES/TOP WITH,PlAM P!-8, FINTSH POST WTH S.S, POS7 it,) CENTER. TYPES 3" SQUARE DOOR FILE -'00789 RE550 IT DATE: Ol-Z22/03 ' DRAWN BY: J.R. �clm. M. FEUTI o, 2 .� -- I . ti- 4 I 1 L..r q - f- 000, G.1 V) Z 2 , r� O x iJr t Q _ r 1 N n w E c t M-A , rti N tJ? i i r- N) IF I 9 i I k ✓' {� v Z v 1 a o , 1 I / a i i Z Z : W W O O O O N h _tl 4. r a a a a W 17 a a r r r V t r I • � d 4 t v+ T V) to N � f i 3 � 3 _ to tTJ t 9 V) P Z Z Z Z La. iL � W W W r t > 1 :lf O0.0 Oa aO aO Ef l] Et o Si Q2 v2_<) <2_ W w .d- oC1 Otr7 Ort05 ' W'• WJ GaGO in U vdQ O O O mo t a c - II � 0a C1 :� 7 ^ , co _ O .. U U tp W w � w W tL W t1 t �. m +4 r m w 1 Z , C_ 2 Fs W _ w t... Q W t.J U f *'� U to N W w w w t � N ii J J ¢ 1 ¢ d d < Q w a a a a I t w ; U W w Gt w > tx a a J v O 00 J - a J a a _ A A to Ln to '.t�? O O O U U '4' U O [•- to d 4 ►- w ! a Q 4 ¢ ti d I U t Z 7 v N) tZ Q U 1 i F- m ►- O r Y 2 � a � W w a v o w w c� >- o U 0. r � t2 Q M M M tl A W a 9 CZ' J J J J W � .: N W w a W W O O W : W W U W W , a a w W 4 J w tO a c W (, U -) U J i W Q 2 r p W W 1.t1 A. t1 0. tl fY 0. � r- U J W w W ._,., _ U U J c� 0. w S W� W O O O {1C tY to a : c U o tY N .� Q Q U a � � J .- (n � i X d a O _. V1 to to G� X r r �' U r< r r r C W X t�c.) U d U , W W W W - X x a x a � r J < a < r w � a s Q tr tx tY m J t] A W W W ZS w W N r r r r J w w � a 3 tL U w H w r GL Q 9a J J 2 U J d Lj a U a v x U U c W � t3. a _ w w a rn (�1- !- I O O V) w O U W W W r1 W O J z w W G II U 1 N : 4 C] ., Q Q a O O c O U U U U U W t0 Cf V`S c CL U LY V w I r , ...... W W W Q tp , 3 3 t a t0 to to Cr0 c m cry w r ,rj c c .� c \ rn _ m v o IY to m 4 w ) U O ,1 4 tY L>: Z f � O Ci O O O Cr� tY __ I <n to O d : an � s� w zz O N N J � U> N N .t�'., d � O M N ¢ !L r .- T • N M,�r� d : U O W .. l I O U U U U t W Z N 1 a i ! m a W ; a r N I 1 Ln c to tr vi -�W W w W r ty \ to tf? N s , 1 o to J J J J O qJ � � (D tD tp - -' Z ;:.. Z..� _. _ f- � a CL�•Ln In W r r W W W N d Q O n-_ Q Q o 1111 a 4 Q Q _ _ r Q a < < c CO< Q d a 'Y ta.R < G 6 � f W W 4 g � �W W d LL W w 11 J J rY - W W W J J .•+ W W W W W O w W w O w W O _ z z 1 _ CII z z z a¢ Q Q ¢ z z �� z z Z z z 3.,.E.J O i o a o I ! <0 0 0 0 0 0 W C= O .. I P O O ,o O i 1 N LC) d 1 t N) yy 0 O w { Y Id jjj 1./ � �_ ,ter I LJJ n h v5 O tt)N - O! ,✓;,."i i N t7, to N , � P. e- N tD to N f I e ■ , O O O O O JG, r r r .- rN Nr• NN CV N N N N) CN \O I N iN O .- .- r- � to O O O O O OO O Or o c o N 0 Osr O O 04 O O �st N r N N fJ N \> N N N O ON . O N N N O N N _ �w d� I O co e O O O O O N O OOO o7 a O N N N N N - •- N N O E R N CL w D. • t t z t t { t a �: t r N C7 'Itt70 w _ w Z W r 3 J \ t0 j34 i 2 cq M '. -,.-^ .. t r ,...: ! t , '"••d`T.1C /,t-.,g-,,�... ,.. _ 3 "`" �: i' . _ t ;-- s :. 9 : t t s t t 'co 47 � tKOF 7� i 1 _ ` w � 9 _ \ y 'd �! M � : _ ca m w i U r h r- w . - N N .. in O •F. 4 1 .- rn, _ , m O an r v rt m ua n cts r Ln I I Z I N h tq Ct_ W ` O z c� Q 9 w `` W e .d- w 0 _) c cc, m 0 LC) x (Al z t2 N N x d 1 V Z U O N O O r N W O m w . d a a _ 0. 'x) i r O r _ 1 x ,O ti.J v O O Q rt \ C1 a C� Q l9 ��•• Z �/y N C] A Q A O , t'� r I Q r N Z. t.Lj i p O 1. a _ ' .. O N O a CN d t'- t R t t t t7 r f O A A CV W !� N W N W u7 O O J w o m m v to�t K7 � x O N O N)N} p A _ 5 z � J M i N N , r, NI C.a Nt rh v �er ) Z �O O •, _ t0 O a o r\ CL O g Lj- O D W w F x X O o to z �1' _ z z z z � z z z N n z o z 0 0 'o L� O N to Q o x O o o z to Z O N O -- M t O ,1 � V7 N 1 W _ _ A tY A 2 U � M'X X O ti Q a¢ x x x 3 a ¢ ¢ ¢ c N) � U U Q Q _ N x CC O Co 0 Z O a >o t- m Q o 0 o O N o d to d Y LD m J 3 3 � ¢ � w 2 1 _ N 'J r 2 'S st e- d r t/) _ U J O ? O J N to n o r N N .A J N) N ( N 1 n z l C o I r E V r r U7 .- N Y� N � zJ O O to 1 i1) O O O N1 r• 'S O to 0. �a � 1 _O LL a a a d a a t c _ o 3 m m .-.. CJ r ro fi "r` <Q r 'y' © O z U h tl t t S' O A Q J O c'd' .- Q Z N .- 4 +t x s O .-� O O Q O = (n h to to O L� Z N l ( tr h tt O N W t x x x '?t I O O 1 O A s . x C7 W to r (O cp M s- O O tII cA U A N) 3 W O cO .- rn [ cU t . 1 \ to N N Lt) P ffJ SD U W O : t I s � X CD s t to m N tir h Ll: LL` d' c NY t r (A C6� l : Q' n LLJ 1 N N V tD h Ca t!7 O O 1 N) a N a �� N) tr A O O O N t .- r I 0. 1 � O m N O i t l Q r r 1 ra h m ,m 0 1 N) r� � tx .� � U :o v' J J w.t' r3s O a i t N v i w W s 2 I w W w W W W W P P U S �t r C9 U to N z d _ ca �a I J Lt to v to n aL N G a t _ a. W o w ct> ,. w v N) O U w 1 �t t0 O 1 � W r` 1 2 _ � A Q U Q P- .- I _ M A U N r9 �t '� O O co D F N N N N , u) � +7 tra n tm m a � > Q d a a c a a a N a •� ca h a a U U tt �t d t *' �' w N s Q ¢ va cn o W rn to a O a n to v M O p a z r• I s : Z ' W A a I ! Q' L Z Z Z A _ , 9 a CC a CC 0.J J > W Q. z t� WW a F- I-- I v t rn d w w J J J r V} b� I ca O _ O to O J O ; U _ a a r r F-) r a _ z ¢ a e' r d O O O W ' a •�t w Q w W to to w Q 0 Q t,. A _ ¢ a z z z 1-- w x r r w z z r 0 t- 1- r r O LL. I C] ,. < U v i a o 1 Z � w W w 1 Q O O Z ,W c U t W O iJ J 0 ?r ?i 1-- lL 4. tt 0 O Z .r _ ._ O c J J -A � m R .�. W Z . c c � :� w f- � o o � R � J J �� W �d tX 0. - O a m� r r r _ J l � r ._ � Q a Q tx a a ► c a o _ � W a w W O a to O ,� b a tr o o w O � � t t O c� � O O t� O c a d d � O O w a O c o G o 0 0 0 0 0 0 0 0 _ _ c, o w o _ v u _ _. o t� V) V Z z z _ o r _ o a J o _ w ca z tag a � a o 0 0 o m O m R a o tL w W z z J _ Z Z a r r tr r m r m r r ►- Z w Q A 1 r r c f r r r r r r w 4 tL r r r a z z z z z z z z c > c� W s > +- d r r r r r r a o z_ J r r _, r r z r m z z z r N cn > > > w r r z z - z ' __. r r to z z w cn an .� _ a _ fr � � � � m � (Y Le m o x J x � z r �' �-' r � tx' � � � � cn ut cn e • ' Q sn to cn (n v? u7 V) to cn N V) to z c Ln cn V) to v) to z J J J N to to N O J O O O O O O O J Li w LC O m Z z V) 2 3 . ■ - a O - O - } Q �` O O "! O O O z `s W O tx 2 c W W W W w W O ? ) ? ? O w W Q O w W W a > a LY tz 0 0 0 0 0 0 0 0 0 0 < v o w a 0 0 w c� 0 0 0 0 a 0 © 0 r r r z -> W a J w x x x x o W o O o w W Q w Q O a a d a o c Q o o 0 U v G) c� t� U v v d a m c� m m r �- r v c) U m m A w U U o w U U m U o n A l a cn CL A A .z tn' P P +n w v -, J ., J J J J z a A d m m m W V) m m ca m a a Q ¢ V1 cr LY o G� to w cn o Z 3 3 3 U U s J a 0. tL m m m m 4 W tL •ter. _ W Q U et M C?N N m :) N vs w m U. x x C F }- r d Y c? ii `. 4 ^ z cn to to �' `` ,. tt c� U 0 0 m w W , a a a Q¢ N N O O Q O m z O r r r to J : Z t a LL-- W r _ : . tn J N . . _ : Z F- .^. L t'Y >, to _� , F- � o w t- z w z - c W w S W W .-. tY a a '2 W , W Z [C .� O J t Q a /� d� `` C� r W z z z z w c z z o a _ !- z IL �i.t w V') 4d �•. a d' Y J J 0 0 0 != a ca V W .t a J J 0 o W o _J J K J T Lr_ c <r to a f�1 w _ z m m m tx J C Z C9 r Cl. W W C c c c N J M. . F.J _ ,. r r � � F w w w� r W a. to _ 2 2 W r 2 �. ,r r r J W C7 O d W w J Z fbi. 4 d 1 Q s 2 m r Vl 2 2 o I z tx Q a r r r � a Q 0 w w w .,. z i Z W _ W z z z a � tk c r V, U i.. 3 r w w f 1 i.� r r w r 2 o ®C w _ cn J ?r W Z +.. v VI O VJ V) V) {n >O V) O O O Z to _ W J u) O to P Z(!) ..I a V s J 4J W V) ca W J a d d tz w U c r r C9 Y r m � - � d"- r w U y U z � X d cn tx m tr a o to to W Y Y A o U w 3 ¢ a ,L z z a tY tr _ W W c 0. wLLJ C} z � >o m to v) a CC m ,. n c w a a Q v U 1L �` O U w' W L>, La. ���JJ Z U J U a v W � ? > w o W F' a � W s c _ N �.v v Lr 2 o r a z G O _ _ _ _ W pp m _. O O 9 J c m !1 0 o Y a C1 a_ w U O �tr" .+t � ,z J {,�,�w Z O Z l J C! Z «. W O O d In 6/J m _ Q ,Q. O V`O 0. 0. 0. to r: 2 Q r t1 U r- >- W r J F � o Q O LL O Z 1 G') Q i ! r � z i O � W Y- W>- w o w r tr? th' vi t� _ J tY _ � � V1 CI) to {�,� t,.� �,,1 �,J N in J t0 t7 Q >O U > 7 > >a W W W 4 �...... 4 a a a ¢ t0 r t` V) VI to V) C c a Y J O ti _ , O J O O W J t,19 o p _ z U w N r J tx z w ►- w Q d Q i +- F N .t � z W r r r r< , r = a a a r r tx tr r ct z z � 'z a r r c� �d W z _ _ o U c� c�J O 0. - - - J 0. ::: W J fY d W O !� _ _ _ U U t].. J r x -,. O d Z� Z !'., a W ¢ r r � r � rn c, � t� N � � a !� W r <S!i W tII m �° � W O O O O �. W I-- LL 1 i I \ � 'S Z _ d � Q J I - Z 7 Z m O ¢ Q O a s o O 0 o a U cn w o ►- .. a Q � 4! r cn _ _ _ z � z z a w a 0`)_ a f_ U? a7 V) t!' (n W.a. � U _ < tx Ca V) r� i. La. a O o O O O O _tn l Le \ \ LLJ - - F" O O _V) V �«�, �q U Z i 3 z U _ t- r C _ Z to I A O o = to r r r 1= W ¢ a 1 w_ _ it _ r J o Q A O u w w a c� t7 .,. _ o Y) .�., .� � _ 9 r t� z v cn a d a a I°- a .- "�L3 A d c z �, ¢ � a m m w r w _ to rn m A _ fn .r II_ W ` . Q d d a z � _ z Y U A w w t�. o z n A ,._ W _ r_ z Ln m z ,� o _ W Y � o W w _ r r #- r 2 LL Q.. N Z O (� t� O t�fi a _ fn _ O r r r U U U U w Y z tx tx U G O C9 A r z Z Y st c� ca c� tat a A r r' r V7 Y Y sti Q tk !� U Z a _ a O Y Z d. ¢. Q � CL' J � tY J a J '' • ii +•- r r _ C,3 � cn to 0 U a) J o w L.�.! r �C � z z . , 1 � > t,. w ua w � to cn to cn z z z z_ w tx � v a w Q z J J to to fn fn LY m m Lr v _ Z Z d ¢ `r O z Z Z z. t7' w w t>r U o f- r U _ a tx a W r z d tY c�0 0 z _ o ►- _ d r Cr- a LL ?^ J L� >- U p.- _ d:: w w c U Y Y Y Y � O Z J �`' it O � J ,.r"'....:_ o W w la- t- C� W W w � � � � ...,i O ¢ Q r Ur O ; U ¢ o o W w _ Z w 5 S 5 to.�_ � � S y z W m v w o I z w 3 z z r � I Q w W 2 .. z z z W ' 0. w w w c9 _ -t a J W Q U Z < O O W W W W = Ir c 2 1 .s c 0. t CC J r w O t7 ti to _ o c� c) ! I U c a, a c Lr_ to Y _ J J J _, J _, W r w _ _ r W tY w to to F � U U w .. Lr ¢ z tr � Ir �� O t'a. to Z a N J > •. � } w W ►- Z �. _ a w O t0 `✓ (n o 0 o O ¢ a ca i U v v c,) m c � o O a) m ca � c �' c� U c� � ut �' _ m a ca o z .� w W W w to m � _ W C9 J a __ T J J ta,P o a Q _ O 0 c m _ w m O O O o U W w W t,a A _ z g 2 _ U a = U w to U U J t, O = 2: r 7 Z F r p p p a w W m iY _ G U _ _ ti 'SC Z ¢ O O W O W A m m o m Lr a 5 5 > e 3 1 _ 3 2 2 = 2 Q rr z z m m [ w 5 S S 5 q to w 's 2 t7 O p� a O ..,.> r O t� w W 4. . Q o = 2 Z 2. 2 w W � GJ � __ V) to �, W to V) 2 W W w W r _ .! Q t(l p J U C3 y Z Z W G`) V3 a r O O to ro to r m W + I..s ,.® W t� aC, _ _..l 4� C7 N V) in to fl O � � W U Q w Z 2 Z Z LC tY LC CC W � CC tY rz t:t: V) � � a J V) V) fr t!D to F•- � V) W _... Z r }- [t] a Q _ ..,�.. r [� ?_ r d A W w Z (� r r z z r Y U Lr- a r r r 5 O r r 1- Y a U O t- > > w O O 0 i._ UM ti � J v 1- L LL �C '� �`' r r vy r d d C;3 a w w w w ►- mo o _ r . }� W w W, w w W Y d o O 1 � a � m tr J tx tY O t�. �o W w W r r r Z Q !� Q "°�. O . w d } > e t t t �r R ,� O J ? U U - O w 7' po .: Z .. W w W Q a _ a O Z ��`g� tt � to N cn (n J J J J : W W CJ E _ s r II _,. C t7 W _ Q Q Z tY m to tY O O 1� 2 (n (n (n (� O O Z Q Q _ to (n Cn V) t� W W LY Z O tY 2 r r (y_ O •� .p t�'�C 1 O t? W W _ > c O O O (n t3 � d r F- tp Z IL 4 CL. < Y : w Ll. a Q Cd r r r J J a r w od v v o F a a tY r r o Y Y Y II v) to tx (� o C1 U ..�. W w w �1 _ Q Q Q <z Q w w w w l;a► z coQ� w '¢ L- 00 0� o� ocy tt z Y _ � r r f- t�. m ca n w V� a� x� w I Y 2 �j W C� Ua to r U cR cn W U _ . V) O O O U Q _ Z .. O d _. .,.J V) u) (n V) V) Y W W f- r r O N N N N .- r` .- r r Q d a 0. U _ 6 U U U V) t!1 to U tL �._ O V) to w << w tL 2 S 2 2 a ? m m W a ¢ U Z \ W W w w t+7 t/) w W W W Ca O O Z. N c tY. Q' K m ►.- `� \ W r O '� J LLJ a a Q in a = t, pp Z V _ cn _ I a a _ Ld F- W U �'�' c( a... Q a. d Q y 0.. U Q Y Y Y Y , V) -• -) ,W Q O W !Y Q a 0. W W W W w d A O O G J V) V O U '3 rr W g .z m II�� w w w w w J 0. w W w Gi z W co f�3 m a to C O U C., x x x x x x x x x _ � r w 0. CL ?r �r V) W w w to Z d . W J J J :. W t7. W r.. Z N Y J � �1 LcJ - - m _) 2. z ta) W :... tY J J � m m W ty lL ... 4. W U U J J fn 4. W ^Li t.._ U U U W W � a ¢ a ¢ 0. C>: !r a J ._ W O > W W t- J _. O O d _ J �w w Y tL Q N J 7^ to W W w a r r r w r r !n m d 2 J Ln Q' m O S r U Q O O O _w is tl 0 4 _O Z U W W W w W W Q. r !-- i- Q O �,. W li lL a t : t p n. m r r d E a t' J d ¢ c t i ' _ c t Z z x � _ �. O w cx tr. z a _ � � r- o a O o ca , _ m m Q a w cfl O v N �? O O O O '� a s O o 0 0 t? to w z O o o O O w W w w ,n ¢ Q d W N n m c cr m > > �' w O m o m m a o tin a ca t `t O ,,, x O a p a 'd d O 4. O > > z z t7 y d O r o O Z 7 U O O O O O O 1! U U U U - Z v J O J O O O O O O N A O tl O t- a r c LC a _ Vy (� N {/1 O O U U C� U 2 �} O U Q U U U U _ _ _ _ p 2 m m 2 N) N G] m W m O O O O G7 W W V r (Q t') N O M CW � M .- 3 U t7 W 0 t� W W W W W U m 3 m .- r- U a s t Q (!1 V) U r r F- !-� U w (a7=> rt z> O 0 IZ y F- I ,'Q a d Q Q V d .4 i Z 1 Q Q Q Q Q Q Q a d a s Q a a a 1 ¢ Q ¢ a Q a c` a a c a Q d a s a s a Q Q a _ I � a' a a c a a Q a c a a s '; z Q \ \ � w q , 7 5 � - d Z Z N Z Z r- Z N Z N Z =- Z Z Z N) N) N) Y(� r t`r) r .- Z 7 Z .e... Z Z Z r- Z Z Z Z �i Z Z r- r 7_ r- M .- .- N N .- r e- N r d r- Z '- s- �-• r- s•- Z Z T Z tD .M Z Z Z Z Z' r �- Z Z '- Z Z Z Z Z Z Z Z Z Z Z .- Z Z 2 Z Z Z Z Z Z .- e- r r- r .- r s- t70 .- Z Z � Z Z Z r Z Cr M w , I tl WWD is 5z z SHEET t QW w z t a a.. w w c� ca d a Q a.- N .- ¢ m U a Q M C a Qm U 0 N W Q !t: ca d r w o o m a A tl_ an U Q m m D d Q r '- r- x r _ O r- r � N N N N M "'�# tf)' tI5 O O N L O O d to O .- N7M ') O o .- .- r- ,- to O O O � O M 0 0 O O r- O .- Nto r O M v e- .- to h O O O O F- � O � N to OO ON O N fJ .- � N! N N N O M O O f- N) O O O Z O O O O O O O O tI) O O O O O O C7 O O C3 O O r- r e- r {1p N N f t N `d P l� tIJ 00 tYJ O O 010 O 1010AW1010 r '- N) ro N) N) M M N) N) W) n f` O OO Cv N N N N N N CN CN N N w O O r +- N N N " N n n n n M to n -t <! ([) in w i0 CD 0 to CC) tC) O � N M tU (D !� U© O O O.- r r r .- N N N N N N N N N N N N N N et st �t et st a d st t* et et �" �t "It U) 1!) if) tf) u-) to L) tt) to «) 0 0 0 to 0 to to to to to to it) tr7 Lo to to o to (A - cp O ua O 1- co p t)D t70 Z �N M 1r 300789 RE550 FILE DATE: 0 22 03 BY: B.J.C. DRAWN C.M. M. EU I A M ii�Y Y �fI ADDRESS DESIGN - REIAEWIED FOR CONFORMANCE ONLYr C APPROVAL FOR THESE PLA NS BY ALLIED DOMPCQ DOES NO T TItiPL Y THAT T 1648 FALMOUTH ROAD ALLIED DCMECO HAS REVIEWED THEM FOR CON_FORMITY TO APPLICABLE 0 C�.R REGUL G .,. CODES 0 7MA 026312 D AP, ROVF_Q f • f AS NOTED, Submit .Record Co .or Archives p APPROVED PY -� Q.pDISAPPROVEDASrOT Revise o ,d Resubmit. ` c- D INCOMPLETE INFORMATION:, Add req� s e ted infcrmalton and resubmit . ' Ua c Q Dote: f" 0 COUTO ' ALLIEC DO.,�ECG OSR MANAGEME-l" T ,. t t n Mane g DUNKIN7 "' 0 " C / o x L..j S Notes: 169 MAIN : T � 1 �S STONEHAM , MA O , BUILDING DA A _ MASS CHUSETT ABBREVIATION INDEX 'INDEX OF DRAWINGS ADA STATEMENT , 2c JCN A3 > 50 OCCUPANCY UPNCY AND GA. GAUGE Q.T. QUARRY TILE USEGROUP. - rr1 QH , I 0 AT . GALV. GA V!NtZ D Q TY• QUANT ITY I TY - _ Or- CO NSTRUCTION:RUC TI N. TYP E 5 B AC AIR CONDITIONING GY . 8Q. GYPSUM BOARD R.A. ALLIED DOMEC4 TYP ©x Cz Ti TITLE SHEET/ ARCHITECTURAL DATA mQC rcN. r7 A.D. AREA DRAIN HDAIJ. HARDWOOD RAQ. RADIUS IH BY CERTIFY THAT THt PLANS AND DRANI GS STORIES. � I y F ,•m (X? O A.F.F. ABOVE FINISH FLOOR H D P H _R REF, 'REFRIGERATOR RAT O R FOR R T: iSD R0JECT WERE fl RAWN IN ACCORDANCE c c R A NCE - ALLOWABLE FLOOR AR A , 4 0o S.F �3 uG7 ALUM ALUv!NUM H.M. HOLLOW METAL RatNF. REINFORCING AlFLOOR PLAN SCHEDULE; DETAILS WITH ALL FEDERAL S TATE AND LAWS, ALTERNATE HO f� HORIZONTAL REV. REVISION ACTUAL FLOOR AREA. 1827 S.F. APPROX. A PROXIf.ATr__ HGT, HEIGHT REO Q REQUIRED A2 REFLECTED CEILING NGPLANfL�GEND, DETAI SINCLUDING, BUT NOT LIMITED T0, THE AMERICANS ,. , Y BID. BOARD D INSIDE E DIAMETER REsIL. RESt IANTSCHEDULE A,� FLOOR PLAN DETAIL; L, . „ - WITH DISAB ILITIES ACT THE _tl ADA I HE p A ELDv, SUILDtNG WS1L. INSULATION R . ROOM A4 INTERIOR ELEVATIONS; SCHEDULES DETAILS ACCESSIBILITY GUIDELINES AND ANY CTATE OR _ LOCAL OCCUPA NCY LOAD.8M. E3EAM INT. INTERIOR R.O. ROUGH OPENING l . C== , r r r 1 r T T JOINT SCH E r ,,,•tT. 8A5Ei�AGN � . �a scH�D. _DUL N OR: TAI�DARDS � � ACCESSIBILITY ODES- REGULA 110 S, S `� PERSONS PAN NATIONS SCHEDULE FIXED SEATS. 9 _ K1 EQUIPMENT L ELEVATIONS; _ TIA N, BE7WEEN KIT KITCHEN SEC. SECTION ! , ` SQUARE " K2EQUIPMENT SCHEDULE LE saT. BoTrG� LAM, LAk !rATEES.F. F 0T ,. 'EMPLOYEES: S P E PERSO NS _ SH .SEE .. e. , 22 I Y Date:- .'TOTAL N LAVATORY R L E Al �A0 C.L. CENTERL L T _ 4 OCCUPANCY: 2 PERSONS T T pNC 0 AL 0 CCU c !C SIM. SIMILAR ► �r ,a ,,.T. CERAM, , TILE LT. LIGHT E1 ELECTRIC LIGHTING iNG PLAN, LEGEND T HERE ARCHITECTS SIGMA U c C_G CEILING Ma� MASONRY SO NR YSPECIFICATION SPEC. SQUARE ELECTRIC POWER PLAN.` ELECTR IC C CLOS. CLOSETMAX.A MAXI UM CM CCv5TRJrTt N MGR. MECH. NEGHnNiCAL S.S. STAINLESS STEEL PANELBOARDS, ALEVATION, LEGEND EDULE S _ ERENCESCMU CON,'. MASONRY UNt M L. METAL STD. STANDARD P1 PLUMBING PLANS; ELEVATION; SCH AL IEDDMECCRr1 COLUMN MFR. MANUFACTURER STL. STEEL el - , �TRu CT. STRUCTURAL P1 U EING D ETA ILSLcoNG. CONCRETE MIN, MINIMUM CUSP. SUSPENDED FLAME SPIREAD. CO T. ccaTlN�our MISC. MISCELLANEOUS M 1 MECHANICAL L PLAN ALLIED DOMECQPECF ON BOOK CORE '2' 5 , ARCti r CONS-T. CONSTRUCTION M.O. MASONRY OPENING TEL: T LEPHO`,G FREEZER COREMAT MATERIAL: DEPT. DEPARTMENT M TD MOUNTED TNK. THICK M2 MECHANICAL DETAILS (ISSUED 1 31 98 N , ! T THRU THROUGH FREEZER METAL PANEL: 25 DTL. DETAIL N.t.i.. NOT IN COtvTRAC I, 9� T Trl£Z1F r SOURCE A ACCOUNT NATIONAL CC NA 0 .... P. TOP F PLATE w. R T. 0 0 L TE N FOUNTAIN N t'+UMv� D.F. DR.NKI � 0. ! S. P F NOMINAL T.O..., TOP 0 STEEL � T N hOk.IN L , DlA, DIAMETER ER OM BOOKLE T o ! INFORMATION RATINGS. �J!!t�<NS1G?�I N.T;S• NOT TO SCALE T.O.SL. T0, OF S�l+.B 'SMOKE ,, DEVELOPMENT c c c 7a.A ,.. . TREATED _, ED V�R LL (ISSUED3/6 /00) FREEZER L � ` �R,AT _ OR � A r DO?�„ O.Q. OUTSIDE DIAMETER b.0 ~ VINYL COMPOSITION BASE E Al�Li D D MECQ EQUIPMENT T FREEZER METAPh`v�EL. Q.S. DO-,','N SPOUT 0PJG. OPENING V.C.T. VINYL COMPOSITION TIDE _ ,,.._�.. DWG GRAViNa OPT. OPTIONAL VE RT VERTICAL S P E� I SPECIFICATION I N BINDER BASED ON THE FOLLOWING CODES W EA. EACHPL. PLATE A ✓.I.F. VERIFY IN FIELD _ L TE Q _L: ELEVATION P. .AM. PLASTIC LAMINATE A T E r ALTHOF �ASS HUSETTS BUIL DING NG CODE:V.Y .C. V1 YLwALL C VERl G ISSUED � 9T1 COMMONW W1 1 THEi C, ELECTRICAL PLUMB. PLUM . G E0. EQUAL PL�l,Q W.C. ` -' ,. . PLYWOOD d�/ WATER CLOSET 27 98 999 FDA * 780 C.M.R.F A FOOD CODE 11 " EQUIP , EQUIPMENT PR, PAIR WD-. WOOD _ 0� ZG EXtCT EXISTING PROP, PROPERTY WIG 149 TH Q�T (ISSUEDL 1999 ) , EXT. cXT ER!OR _. ., P.S.F. PER SQUARE FOOT WP. WATERPR OOFING F.D. FLOOR DRAIN P. PER SOtARE INCH NT. WEIGHT FIN, F1vlSH PTD. PAINTED 1hJM. WELDED 4fIRE MESH S:r l ALLIED, i1 V�7 FL. FLOOR PlC POLY VINYL CHLORIDE ORtDG F.O. FACE OF I SIGNAGE -iV THR . z FT, FOOT 0 J ... . FUP Nt RU R_ ! SQUARE : TY E FOOTAGE DIMEN SIONS N YES N0 O .. -..: — 4 NUMBER 0r D.T. WINDOWS PPYLON _ MflNU��IENT 40 S.F. 4 3 1 /2 x 9 —3 ,3/ _ J 4 — — A a BUILDIN,.� 0 S.F. 4 3 1 2 x 9 3 3 4 MENU BOARD -SIZE N SITE DIRECTIONAL SEE SITE PLAN BY; OTHERS AND OWNER CAR LENGTHS FROM.. D.T. WIN. STORE iDIMC DIMENSIONS: _ STACKING C# OF VEHICLES) SQ. FOOTAGE I-- GRAPHIC SYMBOLS SALES A ESCAPE LAN E E I PUBLIC AREAS! I ! T TI SYSTEM TOILETS 804 S.F. , ' la' AND DRIVE HRU MER S S EM I FINISH NUMBER R INTERIOR WALL Z t FI IS UMBE , R t� AND SMOKE pE�r'ELOPMENT RATINGS FO E 1 SECTION tiUMBEl� FLAMES E D RETAIL SERVICE 3 , 7 S.F.I t IF ATION• III 76 200 .1 N H ��ATERIALS INTERIOR F,NISN .CLASS IG CEILING FINISH _ U �0 21 KITCHENJ 706 S.F. ►- �-� _ ! SHEET NUMBER MATERIAL FLAME SPREAD SMOKE RESTRO0 S. NUMBER RATING DEVELOPMENT d �SECTION FINISHES BASEMENT N A 0 ' I _ r � 135 HANDICAP RESTROOMS 2 _C FIBERGLASS REINFORCED PANELS 75 TAIL NUMBER DETAIL m i _ 5 5 �— VINYL WALL COVERING H 1 © `uj i (DETAIL E . 301 PLASTIC LAMINATE30 200 TOTAL: 1827 S.F. SHEET NUMBER ENAMEL PAINT , JJl TRIM, DOOR DETAIL A I L WOODFRAMES, OOD SHELVING SESEATING:T . ` I NG. . : , - ti"t00D .STAIN NATURAL WOOD SURFACES) 5 R TIT KEY t ., PARTITION ION. , 5 '" t i GEAR SEALE R (NATURAL ih00D DOORS) . J MARK � 1 T .... —DOOROF TABLES AND TYPE 0 TABLES . 1t 2 3 _._...--.� TlCAL 'CEILING TILES AGcaus ICJ I P _ N N A STAND—UP COUNTER <. rJ PARTITION TYPE'-- DOOR . STOOLS N/A _ �.. : � B D100 OF F,ANDlCAP SEATS . COI UMN REFERENCE GRIDS SHEET.EQUIPMENT TAG ; TOTAL # fl SEATS. . 20 SEATS OR F DR AWING N0T`S INTERIOR ELEVATION INDICATOR FILE 300789 RE550 DATE: 01 Z22/03 B .DR AWN' ` Y• B.J.C. Ir C.M. M. 'FEU T u\j u U\\j 1 i i II III