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HomeMy WebLinkAboutKING'S GRANT RACQUET - FOOD L12 'S GRANT RAQUET LD KING RD ,COT. baal 0(0 4 �2► r oFtHE r Town of Barnstable Initials: �— Amt Pd$ �BARNSTAB Inspectional Services � MMM , �0 Check# A•F1659. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATENIJ c� WjeNAEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ,C\,(NQ5 G'(G"-\k Lo cC Q&- C\ O ADDRESS OF FOOD ESTABLISHMENT: 1Z m 6��� S Z6, C(YN\),A \\J\ MAILING ADDRESS(IF DIFFERENT FROM ABOVE):V-U J���\�.P'� E-MAIL ADDRESS: a: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (SITU)�q- .A5(0 TOTAL NUMBER OF BATHROOMS: I WELL WATER: YES NO 'k ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION: 5 /I/ZI TO I / 1 /Zf NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? ��� �i�d� a� C6UXNNe_( 4\J Cks IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REOUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QAApplication Forms`FOODAPP 2020.doc r ,X • a OWNER INFORMATION: \( FULL NAME OF APPLICANT CoQ( \-c\Qm `\ S ej SOLE OWNER: YES/(O D.O.B 1'2�—%\ OWNER PHONE# ADDRESS 5 \(0,\Q \1`\ ® vVv-N t,, l\ ®2S 1� V\< �CORPORATE OWNER: -\fNcisG<a-w �G.CS�y�c C�v �L) 1 �—� C G LJ CORPORATE ADDRESS: Z C)\Ck \ t1GS CLd C®k i M Ck PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 5hc &3L 2 / W /261S 1. Ta(NeN* S1nolck. fo /21 i20-0 2 Coin-r 1 Qd 2 / t0 i2025 �. A Z 2� SIGNATURE OF AP ICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. LQAApplication FormTOODAPP REV3-2019.doc BOARD OF HEALTH Town of Barnstable John T.Norman a Board of Health Donald A.Gaudagnoli,M.D. MAM uatvAt,�me.' Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 lF.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 237 Issue Date: 01/01/2020 DBA: KINGS GRANT RACQUETBALL OWNER: JOHN L. MALOY Location of Establishment: 12 OLD KINGS RD COTUIT, MA 02635 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 39 OutdoorSeating: 0 Total Seating: 39 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: CC�iA 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: bba o of tq`ti Town of Barnstable For Office Initials: RARNWABLE. : Inspectional Services KAM' Check# Qqq(o pa3o Public Health Division �. r U C ED MP Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 C Office: 508-862-4644 Fax: 508-790-6304 ri,? APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 2-UP-M20 NEW OWNERSHIP RENEWAL X NAME OF FOOD ESTABLISHMENT: 1\X)GS G'(aX--NV ` 0'CQ\3'f"k U ob ADDRESS OF FOOD ESTABLISHMENT: �2 d l` gdalro'\ ` `'\ �^ "�'�� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): P V (301 IS 3 W 1vl � i`�' 1� O`� v'� E-MAIL ADDRESS: KGC G�C,C�V TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: 2- WELL WATER: YES NO v ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: • SEASONAL: V DATES OF OPERATION: 5 / 1 /2OTO (U / I / Z Q NUMBER OF SEATS: INSIDE: '-�9 OUTSIDE: —1(0 TOTAL: S 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. ^1f1 IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? V TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q1Application FormsTOODAPP 2020.doc i Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. UARINSTA sUe. _" Paul J.Canniff, D.M.D. MA F.P. Thomas Lee Alternate 639, 200 Main Street, Hyannis, MA 02601 0. 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: 237 Issue Date: 01/01/2021 DBA: KINGS GRANT RACQUETBALL OWNER: KINGS GRANT RACQUET CLUB INC. Location of Establishment: 12 OLD KINGS RD COTUIT, MA 02635 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 39 OutdoorSeating: 0 Total Seating: 39 FEES -------- ---- - — � - FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: ------- - - - - --------- MOBILE-FOOD: MOBILE- ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: JS OWNER INFORMATION: FULL NAME OF APPLICANT COV'�� � e-� SOLE OWNER: YES/ D.O.B -20—' OWNER PHONE#11A�ZZ.� Z$ `V ADDRESS 1�G�k��V�� \�\\S ZN CORPORATE OWNER: CO yY CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: Co V 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 to / Zs 1.T0yT\-&ShGLdk CD / 2 ? Z /24 ZO ZO SIGNATURE OF 41PLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div, prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to'-catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. `OUTDOOR COOKING: Ou,'door cooking,preparation,or display of any food product by a food establishment is prohibited. ,OTICE: Permits run annually from January 1st to Dec.3I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:Wpplication FormsTOODAPP REV3-2019.doc � ► , Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. BARNMBM = John T. Norman toASS F.P. Thomas Lee Alternate j� 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections g p g Y hereby 305A, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is e eby granted to: Permit No: 237 Issue Date: 12/20/18 DBA: KINGS GRANT RACQUETBALL OWNER: JOHN L. MALOY Location of Establishment: 12 OLD KINGS RD COTUIT, MA 02635 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 39 OutdoorSeating: 0 Total Seating: 39 _ FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - - -- - - MOBILE- FOOD: MOBILE-ICE CREAM: CQ� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: q ��Tory For Office UsInitials: Tin Town of Barnstable 1� _ Date Paid Amt Pd$ ,s • SAS$ Inspectional Services Check# �`� .1 w Public Health Division Thomas McKean Director 200 Main Street, Hyannis,MA 02601 O a Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE,A/FOOD ESTABLISHMENT DATE{V }�®`� NEW OWNERSHIP RENEWAL �/ NAME OF FOOD ESTABLISHMENT: Qy�\Q<,� Gm(N— - %acao QA CV- `O ADDRESS OF FOOD ESTABLISHMENT:Q, 0\d lyymAs MAILING ADDRESS(IF DIFFERENT FROM ABOVE): &LNk E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (5UN - ty�t11 TOTAL NUMBER OF BATHROOMS: 2— WELL WATER: YES NO v ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: V DATES OF OPERATION: J/ I /Iq TO 10 I /_jI NUMBER OF SEATS: INSIDE: 39 OUTSIDE: Lib TOTAL: S SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? NO TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:\Application FormsTOODAPPREV2018.doc f ----- ---- --------- --- -- - ------ - !c PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT �( SOLE OWNER: YES NO <D.O.B OWNER PHONE ADDRESS t5`! CORPORATE OWNER: FEDERAL ID NO. : CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: CO��c�N List (2) Certified Food Protection Managers AND at least (1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date i. A \-rN / N /7 0 1. SCk�e.\- '3ha- �►5�..Ga / 2 / 202 2.SO-!LN,9 N S(1 LA / 14 /2blQ) \ 1 / 2 -0 SIGNATURE OF AP ICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec. 3l't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPPREV2018.doc p THE TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: 4 Date: ' v(Page:�_of Pyo OFFICE HOURS - F BAR E PUBLIC HEALTH DIVISION 8:00-9:30 A.M. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 MON.-FRI. No Reference R-Red;Item PLEASE PRINT CLEARLY PrFD MP'�° 508-862-4644 FOOD ESTABLISHMENT INSPEIPTION REPORT _ Name r Date A Z Type o T ns ec i n " ] ( outine _ 7a_ a Address Z ® , / � Risk Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) L't f Cp e Time Bed&Breakfast HACCP no �p� In:3,�p Other Inspector Out: e�,I w 1 � 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) ❑ uzed I ca- 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 E1'`PHandwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS vs C e7D�. ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives k,,, ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals , ,, L. FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) I r^, "� ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ►� ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 1 ooling ❑ 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) L_7?Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY T Cam, _Z ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories 6 , , Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) q /;/� �:1 Corrective Action Required: ❑ No Yes Non-criticaldays violations must be corrected immediately or Overall Rating V v 6 within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Ern genc 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 o 6 non-critical violations 9 r y 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 boon-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. y 29.Special Requirements (590.009) s o within 10 days f receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signatur Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N OFerr.- ...n'. ...,..•y :"-.Y....CY'- __ _ ". a ,. � -� _.-... ..-.r - �.:C -"�,-. .. �. -.w. .... .._,. . _.-..i^..s ,.'.^. ^._t°.. .��.r.. ..,5,... _ may. Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202:12- Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* - * 19 PHF Hot and Cold Holding 2-103.11 Person=in-Charge Duties - 3-302.14 Protection-from Unapproved Additives Contamination from Raw Ingredients 7 5 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * 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 3-501.16(A) Roasts Held At or Above 130°F* Require Reporting by Food Employees and Contamination from the Environment 7-202.11 Separation-Storage*Applicants* * P g 20 Time as a Public Health Control 3-302.11(A) Food Protection 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* _ .. _ 3-302.15 Washing Fruits and Vegetables * Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* * 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions _ 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition 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 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 1 g 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-OFF 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* Effective 11112001 4-602.11 . Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish.From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 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 y 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- - * - Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g� P ail' 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By * 3-401.1 1(C)(3) Whole-muscle,Intact Beef Steaks 145°F kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification-Present* - 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004 C Wild Mushrooms* 3 401.11(A)(1)(b) All 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 t129-Special Requirements. 5_ _ _...-_ Receiving/Condition 2-401.11. _ Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F15sec* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) t' Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 23-30) 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items Critical and non-critical violations,which do not relate to the foodboe 3-101.1-1 _ . Food Safe and Unadulterated* 12 non-critical 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 ( ) 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 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 1 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1 09 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF. ror TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: ► ( If Date: tl/ Page,;, of r/ P` tio OFFICE HOURS 8:0 BARNSTABLE. ` PUBLIC 0 MAN STREEETSION 3:30-0-4:30A.M.:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified :3 MASS. �. MON.-FRI. p .639• �0 _ HYANNIS, MA 02601 .. - 508-862-4644 No Reference, R-Red Item., PLEASE PRINT CLEARLY rFDN1Aya FOOD ESTABLISHMENT INSPECTION REPORT Name f is �( Dat� ,Z T e oe of Inspection rram�,,, t p� Routine IVv� It p�G _ Address 1 gA &0� Risk Food Service Re-inspection ll tf t - Level Retail Previous Inspection S Telephone Residential Kitchen Mobile Pgyet-�opera�tib�n Owner HACCP Y/N Temporary Susp4 ecfll�ess I S �� �,y Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP C `de-, , �-Q.. In: 2:30 QV% Other Inspector N godv Out: 3� 5- d„t �'� Each violation checked r quires an explanation on the narrative page(s)and a citation of specific provision(s)violated. I � Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ l t� ' , 1, �+ 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 CS S _ ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities v V 1 J 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 1V 30 sk Kot bee4,` � - ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling �� ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding ILI PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP i ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY C- ❑ 11.Good Hygienic Practices i �' ❑22.Posting of Consumer Advisories Violations Related`to Good Retail Practices(Blue Items) Tot I Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blu re e d items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overal Rating 41 ,within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Officialrder for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 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 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 g ature Print: 31.Dump er screened from public view r4A,4� 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 :-;...-�. ��•�,-.��..::.....x-t.� t_.p_ ,e.r� -.err •.:.--.,*.•_�...m....._.-=.,..k.-..,-.-.ti --.,.--.--:..M..�,•--"=-� ,�-.... .-_. _ ... ..,,-•----� < �..--..... „-� _.err..•..-,.. .Y- ,w .� - - -.... ^- -. ._-� ..----r. .. . :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 iq - 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.]1(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 Unapp66Led 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* 7-102.11 Common Name-Working Containers* 3-501.16 A Roasts Held At or Above 130°F* Require Reporting by Food Employees and Contamination from the Environment ( ) Applicants* 7-201.11 Separation-Storage* Time as a Public Health Control - - 3-302.11(A) - Food Protection* 20 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*Applicanf To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 - Variance-Requirements 590.003(G) Reportin by Person in Charge* Contamination from the Consumer 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q g _ 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR - 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated _ Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources ' - 9 Food Contact Surfaces I 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* 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* -' 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202:16' `Tee 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 roved S stem* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Equipment* Not Otherwise Processed to Eliminate 590.006(A) 1 Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E�crave 1112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B)-- Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source_ 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min Eggs* - - 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) 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 3-201.15 � Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(ll) Violations of Section 590.009(A) (D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g, P �' 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under _ Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to ( - - 3 202:18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g 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 3-203.12 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 * Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 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 128. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements '009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc t *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.00.0. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. HA`oF10KEroy TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page of OFFICE HOURS LIC HEALTH BAR E. PUB20 MAN STRDEETSION 0/, - . - 3:30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M.MON.-FRI.HYANNIS,MA02601 508-8624644 No Reference R-Red Item, PLEASE PRINT CLEARLY rF°Mm FOOD ESTABLISHMENT INSP TIP N REPORT of Name a e D T e f Tyne of Inspection - Routine Address O Risk F od Servlc Re-inspection Level etail . Previous Inspection Telephone y 6 v Residential Kitchen Mobile pera Ion Owner HACCP Y/N Temporary Sus s Caterer General Complaint Person in Charge(PIC) TipeBed&Breakfast HACCP Other t Inspector t: ..m Each violation checked requires an explanation on t1fe narrati: a page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Corrective . Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ n /M-5 " 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 H ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY <]/J ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violation ^�Critical(C)violations marked must be corrected immediately. (blue&red items) 12NZ O 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. g ®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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ® g ❑ g y �� ry P ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below bya 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 FG-4 590.005 B=One critical violation and less than Orion-critical violations g ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F n scored automatically o la hot 27.Physical Facility . (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. . f critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 n n-critic iolations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 violation,4 to 8rion-critic iolati C. � 29.Special Requirements (590.009) within 10 days of receipt of this order. , 30.Other DATE OF RE-INSPECTION: In I to 's Signature rint: 31.Dumpster screened from public view / Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N V #Seats Observed Frozen Dessert Machines: Outside Dining Y N P -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* $ Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) , 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F A 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 � Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11' Variance Requirements 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 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 17.206.12 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* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * 8g Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg cr;vr mnoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR.22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Cough[Molluscan Contact Surfaces of 4-702.11 Frequency Sanitization of Utensils and Food 3-401.1](A)(2) Ratites,Injected Meats-155°F 15 sec* f 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* in mobile food,temporary and residential Sources � g• Po aTY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and AntMid Mushrooms Approved By I 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[o good retail 590.004(C) Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec practices should ol debited under to g-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 1 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) 3-101.11 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.600 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked and Fr from 140°F 1 70°F Item Good Retail Practices LFC- 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 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility .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 1 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:590Formback&2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. HEALTH INSPECTOR'S Establishment Name: a Date: Page of THE TOWN OF BARNSTABLE. pp Tpk, ��='W'`�' I t" f q OFFICE HOURS P ° PUBLIC HEALTH DIVISION s:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION kVerified MASS. q MON.-FRI. HYANNIS, MA 02601 sos-ssz asaa No Reference R-Red Item PLEASE P NT CLEARLY 'FO MP�� FOOD ES-rAPLISHMEN3 INSP C ION REPORT Sf Name Date I T e o Type of Ins ep ction Routine Address isk c ood Servi- Re-inspection evel et ' _ Pre ' us Inspe it Telephone Residential Kitchen Mobile Pre-operatio Owner HACCP Y/N Temporary uspect Illness Caterer General Complaint Person in Charge(PIC) I Time Bed 8 Breakfast HACCP Other Inspecto u � O Each violation checked requires an explanation on the narrative pig (s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk actors(Red Items) Anti-Choking 590.009(E) ❑ > '� Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ > . I Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION a"4"!AGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 1 n / EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 4 ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding I PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control a ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY l _ (� ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories W 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. I ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no-more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot = or insects or lack of C 2 critical violations and less than 9non-critical. If no critical ' water,sewage back-u infestation of rodents , 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 9 P. 28.Poisonous or Toxic Materials FC-7 590.008 9 violations observed,7 to 8 nIiolat tiea(violat' s. If 1 critical refrigeration. ( )( ) be in writing and submitted to the Board of Health at the above address a 4 to 8non-critical violati•f�=C � 29.Special,Requirements (590.009) within 10 days of receipt of this order. A 30.Other PATE OF RE-INSPECTION: In ect s Si P•nt: 31.Dumpster screened from public view f Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's natur 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* $ 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* - 79 PHF Hot and Cold Holding Contamination from Raw Ingredients 3-501.16 B Cold PHFs Maintained At or Below 41°F/45°F g ( 15 Poisonous or Toxic Substances 590.004(F)) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying 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 Separation-Storage* Applicants* 3-302.1 * Protection 20 Time as a Public Health Control )(A) Food 590.003(F) ' Responsibility of A Food Employee or An 3:302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 1 590.004(11). Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ REQUIREMENTS FOR f 3-306.14(A)lB)Resumed Food and Reservior of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions I 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 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.1-I1 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Spro,rt-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) v Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* - Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Elf cri°e uiiaooi ' 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A) (D) Violations of Section 590.009(A)-(D)in cater'' Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 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* ( )O p Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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 596.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:She ustock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A)- Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. .Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 520511 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* - . Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004 Labeling of Ingredients* Supplied with Soap and hand Drying Devices (n 9 9 ( 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 5-301.11 Handwashing Cleanser,Availability PP I 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 1(6-301.12 Hand Drying Provision '• �"�� - 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging.Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. I�i °p INEA TOWN OF BARNSTABLE HEALTH,INSPECTORS Establishment Name: Date: Page:. of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNS'rABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MAC, g MON.-FRI. .639. �• HYANNIS,MA 02601 506-862-4644 No Reference R-Red Item - PLEASE PRINT CLEARLY �'FON1P�° FOOD ESTABLISHMENT INSPECTION REPORT. Name Date A ype of Type of Inspection y eti�2n�l Routine Addr Risk -inspectionLevel Pry s nspection Telep a Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness - Caterer General Complaint V 25, 7 - Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 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 lJ Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) 8/ LD ' Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 6=One critical violation and less than Orion-critical violations 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspensi re9on 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 violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. violation,4 to 8 non critical violations=C. w 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view tA A^A Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N s Si atur Print: Sign Self Service Wait Service Provided Grease Trap Size. Variance Letter Posted Y N \`p�/I Dumpster Screen? Y N 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 2-103.11 Person-in--Charge Duties - - - Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 --- - PHF Hot and Cold Holding - Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* - , * 7-201.11 Separation-Storage* 20 Time as a Public Health Control 3-302.11(A) Food Protection d U * 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence an se 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* i Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3,-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3•-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY * Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water 3-401.1IA(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.l l(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff air inrzoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155'F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS i 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165'F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 * (Blue Items 23-30) 3-202.15 Package Integrity (C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbore 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* O 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*. 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* - Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* Temperature 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 1.007 7 Conformance with Approved Procedures 1 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other < 3-502.12 Reduced-Oxygen Packaging Criteria* &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. op IKE row TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: t- G Page: of ' ti OFFICE HOURS ` AR E. PUBLIC 0 MAW STREET 3:30 4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. � MASS.9. `0$ HYANNIS, MA 02601 508-8 08-8 -FRI.62-4644 No Reference R-Red Item_ PLEASE PRINT CLEARLY iDlEO MP+° FOOD ESTABLISHMENT INSP CTIO REPORT Name Date?j Tvoe of T ns ectio ^ ORPIAilmgsI outine ,L Address lL Risk -Fo6d Se --Tnspection Level 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 -24 (.g* In: Other Inspector Out: C.� Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.0091(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals le 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) ," 47, ❑ 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: I ❑ No TO Yes Non-critical(N)violations must be corrected immediately or Overall Rating (� within 90 days as determined by the Board of Health. 'v"7 ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension Official Order for Correction: Based on an inspection today,the items C Ny ❑ 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 o 6 non-critical violations g 26.Water,Plumbing and Waste if no critical violations observed,4 to boon-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot t g (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage _ 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must back-up,infestation of rodents or insects,or lack of violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address (590.009 within 10 days of receipt of this order. violation,4 to Boon-critical violations=C. 29.Spy quirements ) 30.Ot PATE OF RE-INSPECTION: Inspector's Signature Print: 31.Duscreened from public view Permit Posted? N Grease Trap Previous Pumping Date Grease Rendered Y N nature Pr t: #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' i 9 Self Service Wait Service Provided e Variance Letter Posted Y N Dumpster Screen? Y Grease.Trap Siz N ®� Violations related to Foodborne Illness I Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) j and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT I PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* ! 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19- PHF Hot and Cold Holding _ 2-103.11 Person-in--Charge Duties- -' 3-302.14 Protection from Unapproved Additives - - - Contamination from Raw Ingredients 15 Poisonous of-Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F - - 590.004(F) * . - -- EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F p ty7-10211 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130. °F* Applicants* _ - 3-302.11(A) Food Protection 7-201.11 Separation-Storage* - - licants - 'I 20 Time as a Public Health Control * 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* - 590.004(11) Variance Requirements Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* 11 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ) Disposition of Adulterated or Contaminated - _ - - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources F.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 Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-80L11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* _ - Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - .- -'. . Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System Eggs Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg cd-1112001 4-602.11.- Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish.From an Approved Source _ - 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702:11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) 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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority � 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 1 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashin Facilities 3-501.14 A CoolingCooked 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 * Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient I 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 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. . _��L / � Fug � No..---.. ............. ,1......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEA ...............TH ;.. ...V....f .....OF,:........ .. ......... .... J�vvl;ttt of -for- Uiwiiai Warks Totui#rurtton Vanift Application is hereby made for a Permit to Construct (>q or Repair,( ) an Individual Sewage Disposal System at: al _ . l l �+ _ --------------_---------------•--- ------�--- ............ -• --••-=-----``" ocatio -Address � �n!-r: .�o. /-lY '2I�I/�/V�ddres., ........................ Installer Address Q Type of Building Size Lot----------------------------Sq. feet V Dwelling—No. of Bedrooms------------------__________________-_-__.Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons.-____---_._____-_-____.-._- Showers ( ) — Cafeteria ( ) aOther fixtures ------------------------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. Septic Tank—Liquid capacity_______-___gallons Length---------------- Width.-__---_.__.. Dia meter---------------- Depth--------- xDisposal Trench—No..................... Width-------------------- Total Length.................--. Total leaching area--------------------sq. ft. Seepage Pit No---------------------- Diameter..............:..... Depth below inlet.................... Total leaching area.._--.--_-______--sq. it. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------- -----------------------------------------------•---•-•----------. Date---------------------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water.._-___-.-___-_---__.--- GL, Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water__.____._-_______- ---. 1:4 -------------------------------•-••-...............................................................---- - ------------------------------------------ 0 Description of Soil----------------------------------------------------------------------------------------------------------------------------- ------ x U ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------- ---------------------------------------------------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable.-... - , i � . -- -C c��------ ------------------------------------------------------------------------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued bythe board of��� Signedr------- -------------------------------- Date .Pi....... � Application Approved By------ ... - - ------- � ��. .- . Dat� Application Disapproved for the following reasons______________ ----------------------------------------------------------------------------------------------------------••-•------•-----••----••-----......------------• ---•------- --•--------------- -Date PermitNo........................................................ Issued....'. - ----- ly ---•----•-- // / Date No..-- ................. F>s.1........................ THE COMMONWEALTH OF MASSACHUSETTS -BOARD QF HEA TH ... OF......... Apphraatiun fur Ui_qpuittl Worko TomUurtiun Prrnait Application is hereby made for a Permit to Construct or Rep it ( ) n ndividual ewa�e Disposal System at: --•- ss �r�•��--�---•-•-- /. cOA dare..................................... .. .......hrrw _ e , r ------------------------ af"p lt,�� / ddres; /�P A,,,V j ................. Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—TYPe of Building --••........................ No. of persons__________________---.---- Showers ( ) — Cafeteria ( ) P r Other fixtures ------------------------------ - W Design Flow............................................gallons per person per day: Total daily flow............................................gallons. P4 Septic Tank—Liquid capacity...........gallons Length................ Width---------------- Diameter......... ------ Depth........._..... xDisposal Trench—No..................... Width-__--_---_.-_----. Total Length-----._--_-__--___ Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area------------------scl. It. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed.by.......................................................................... Date-------------------------- ------------- W Test Pit No. I................minutes per inch Depth of Pest Pit..._.-_.____.---_- Depth to ground watef------------------------ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ------------------------------ .............................................................................................................................. 0 Description of Soil----------- --•---••-----•-•---•----------•----•---------------------------------------------•--•---•----...------•--------...........--------------.....---•----------- V ......................................................................................................................-----..--•--•••--••---•----------•-•---------------------..........-------------- ------------------------------------------------- . ..--••----•--•-•--•---•-•----•-----•-••-•-------•-..---- ---..._.... . - s U Nature of Re airs or ter= ' ns—Answer when applicable.--. -..5 �)..........-.1��Bt ..-a�.t/....f�''.!VA" . fvao I ------------------------------------------------------------ ------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary. Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board of h th. Signed--- ---- ----- -- - - .... .... --------- ---��--------- -------------------------------- / Date Application Approved B -d d' 1 ;� . -------- - ! � Y Dafe Application Disapproved for the following reasons:............ . -------• ------------------------------------------------=--------------=---------------------------------••-•-•-------•-'-----•--•--••-••-•-••--•-••----•-- ----------- --------------------------- Dd-te Permit No......................`.Z------•---•--.._.............. Issued.. -� =---A:f-•-----..---- Date THE,COMMONWEALTH OF MASSACHUSETTS �y�� BOARD OF HEALTH F. ...... f•• '.".(............OF......... �.. . W"rrtifirate- of Tnutphaturle TH SS TO CERVTF hat e Indivi al ew`ge Disposal System constructed �r Repaired ( ) by .............4.......................... E at.....•tw . .�!s has been installed in accordance with the provisions of Article XI of The State Sanitary CocI as de ribed in the application for Disposal Works Construction Permit No....... 1.. ................ dated.: . "j.:e --------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT`THE SYSTEM WILL4UNCTION SATISFACTORY.. DATE................................................................................. Inspector...................................................................---------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. . EA.LTH A. y�� ✓' 1�_ .� ..:.t..........OF.... .......... 4.�r...`." �.............. --... f . No. / FEE.-•,f 4--------•---- Bin l Workii tru ioat Mit . Permission is hereby granted.?./. -- ------ -- --------•- -•-- =.... -- A--- --------- to Cons t' �ror Re a' . ( ) an div' 1 Sew isp em _. at No.-- - ��.. ))) r - ."Street as shown on the application for Disposal Works Construction Pe No.-. _ ated--- 1_..'Z.`.. .._ . ...... i� B d f Health DATE----. ............/- ----*-� oar o eat FORM 1255 HOBBS & WARREN., INC.. PUBLISHERS .Y,ef No ..... YmB ................. Uv THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................oF......... .. -. '. - ................ ApptirFation for Dhip al Workii Ton.6trur#ion ranfit Application is hereby made for a Permit to Construct ( } or Repair ( ) an Individual Sewage Disposal . S stem at Location-A dress or Lot No. ............ .................................. -------------------------------------------•--------.----------- ............ .......... W s / Owner nos dress a ...............................------- ...... e ---••••• • ••• -.._--.------•. ---•-••. __..._... .....1=•. ••••••.......................... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.....�..`.....................................Expansion Attic ) Garba e Grinder ( ) pa, Other—Type of Buildingl:.���_ ...... No. of persons._q�4: . Showers ( Cafeteria ( ) a Other�fixtures W Design Flow. ..lT�4SP.�._:.__.__ __-gallons per person per day. Total daily flow----- ®. ...... ............gallons. WSeptic Tank—Liquid capacity ......gallons Length._t4.___ j. Width__..__.._.. Diameter................ Depth_, x Disposal Trench—No. .................... Width.................... Total Length........... -_ Total leaching area....................sq. ft. Seepage Pit No--------2 ...... Diameter...�t1.._ ��_. Depth below inlet...&............Total leaching area.71.6_...,sq. ft. Z Other Distribution box (✓j Dosing ( ) `-' Percolation Test Results Performed by- � - Date--3----•••••-• ..... aTest Pit No. l..../_�Z-.minutes per inch Depth of Test Pit...l. .__..._._. Depth to ground water._-� _ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ o � S! Z 1. -®-........ �.. De crl!ptio of Soil.... �••-• ----•- -••-.... ------------------- •----------•--•--------•--.----- W UNature of Repairs or Alterations—Answer when applicable-------------------------------------------_.................................................... ---•----•--•--•-------------•--•..•..--•---•-----------•----•-----------•--•--...----•------•-••--------•---••••••••-----------•-••-•---------••-•--•-----•-------••-----•----------............-•-•-••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i IT,1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ��,... �� . Application Approve -•-- -- -•-•• � Date Application Disapproved r e following reasons:---•--------------------•---------•--------------•-•-------------•----•-------....---••---•---------............ ..._•--•-•-•---•--•--•-•-•--•----•------•--------•-•-•---•--•-----------•...•••--------••-••-••----•••••. ---------------------------------------------------------------------------- Date PermitNo......................................................... Issued_....................................(................-- . Date r ` No.......V .................. Fxs. ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �D.t�.. f•1....................OF........f.A......................0 S / _ - =-- ....-.... App iration for Bis.VnBal Morkii TouBtrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S stoat: r Location-Address or Lot No. ... '.t .� u. r ,.,..... ................ ... ... ............... Ownerr.� -- �:... ..�. 1. ..................•---..._....... W V 'i V P Own.r.law �� �.- f-� �Lf�+ "'Y► ddress;I,,_ . C Installer Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms...........................................Expansion Attic ) Gar ge Grinder ( ) a`4 ,Other—Type of Buildin / ._..... No. of persons ' ._ Showers rthg •-•••--•-- person - ( ) — Cafeteria ( ) _Other.fix_tures ------ ---- ....... Design Flow. '.. % ....c.d Y gallons per person per day. Total doll flow..-.�../.U_ _.._......__•___._.. llons. P4 Septic Tank—Liquid capacity .gallons Length- �.r_-It... Width�_.��'Y�.f._ Diameter________________ De th�%�1___.._.... WP ,2 x Disposal Trench—No..................... Width.................... Total Length.......... Total leaching area...................sq. ft. Seepage Pit No....._.Z____--_-- Diameter.................... Depth below inlet... ?............ Total leaching area...+...........sq. ft. Other Distribution box ( Dosing.tank (.� ) /�} �` Percolafon Test Results Performed by.__ `�'S` ?._ _:.. '�"� _ -,` _:..._._t. '_ Date_ ..................._______________. Test Pit No. 1___` _.minutesperinch Depth of Test Pit___E_. __._._..__ Depth to ground water.'` "' " - �r4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ;. i �r-jl�yi. L ^ O �- Descr>pti of Soil :............................................ ---------------•-------••--•- U '�.. -•-----•--------•-•••••--•-----•--•-••--•-•....-•-•-----•-----•••----------•--•••-------•••-••--•----•-------•--••-•-------••-------- W g x. i°. V Nature of Repairs or Alterations—Answer when applicable_____________________________•-_--___--_-.__-_-_.--.___.___._-__--_-_-_-____-_.--__--......... Agreement: , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions o f2TTLE, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Complianc has been issued by the board of health., ...... ...12( ........... t� ...... Application Approv •--.... • ---......... ••--- -- ................. ----------•----------- Date Application Disapprove or e following reasons:-------•---------•----------------------------------------------------- ........................................ �r D ate 'i Permit No....._.. 1. .................................................. Issued.-•.................................................. °. Date 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ...........................OF...................................................................._._.............. C�p�ifirtt� ,af f�u�t�r�iaaatrp T S CERTIFY, That the I dual e Dis -stem constructed ( ) or Repaired by ........ - ------ / Ins al at......----- '..._ • ............ . .. ...... .-- -- . ---- ------ .--------------------------...-------------•-•---•----------------------. -------- has been installed in accordance with the provisions of PI f tate Sanitary Code as described in the application for Disposal Works Construction Permit No---- dated THE ISSU NICE F THIS CERTIFICATE SHALL NOT BE CONSTRUE® A GUARANTEE THAT THE SYSTER+I'VIL FUN ION SATISFACTORY. DATE---!/t_. .. � --._ ..•--------------•----•----------............ Inspector...----- -•-- ---------------•--------... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA `/ , ........ ...OF.............................................................--..__................. No..... FEE........................ Permii - •. --------•-•••• -- •---••...-------••••-•.............•-••......• to Co r o pair an In d S ' posal System �c r . ...... Street jj r PP P Construction,Per ated.. -----.. ._"•• as shown on the a lication for Disposal Works F ..... Board of Health ............ y, `FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Sent from my Verizon, Samsung Galaxy smartplione -------- Original message -------- From: "Bellaire, Dianna" <Dianna.Bellairegtown.barnstable.ma.us> Date: 6/19/20 10:03 AM (GMT-05:00) To: "Miorandi, Donna" <Donna.Miorandigtown.barnstable.ma.us> - Cc: "Bellaire, Dianna" <Dianna.Bellaire a,town.barnstable.ma.us> Subject: Kings Grant Hi Donna; Were you okay with Kings Grant? Can I mail the permit? Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The info.rm.ation contained in.this electronic transmission("e-nail"),including any attachment(the"Information"),may be confidential or otherwise exempt.from disclosure.it is for the addressee only.Tliis Information may be privileged and confidential work product or a privileged and confidential communication."I'he.Information tnay also be detiberative attd pre-decisional in.nature.As such.,it is for internal use only.The Information may not be disclosed without thee prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable.If you have received this e-mail by mistake,please notify the sender and delete it from your system. Please do not cope or forward it.Thank you for your cooperation. 2 Bellaire, Dianna From: Miorandi, Donna Sent: Friday,June 19, 2020 10:37 AM To: Bellaire, Dianna Subject: RE: Craigville Snack Will do!! Sent from my Verizon, Samsung Galaxy smartplione -------- Original message -------- From: "Bellaire, Dianna" <Dianna.Bellairegtown.barnstable.ma.us> Date: 6/19/20 10:33 AM (GMT-05:00) To: "Miorandi, Donna" <Donna.Miorandigtown.barnstable.ma.us> Cc: "Bellaire, Dianna" <Dianna.Bellairegtown.barnstable.ma.us> Subject: RE: Craigville Snack Let me know if you give Craigville Snack a thumbs up. I will mail their permit. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bella ire@town.barnstable.ma.us The information contained in this electronic transaiission ("e-mail"),including any, attachment(the"Information"),may be confidential or otherwise exempt from disclosure.It is for the addressee only.'Phis Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may'also be deliberative and pre-decisional in natire..As such,it is for iriternal use only.The Information may not be disclosed without the prior written consent of the Director of Public f lealih and/or the Town Attorney's Office of the.Town of Barnstable. If you have received this e mail by mistake,please notify the sender and delete it from your system.Please do not.copy-or forward.it.'I'liank you for your cooperation.. From: Miorandi, Donna Sent: Friday, June 19, 2020 10:25 AM To: Bellaire, Dianna Subject: RE: Kings Grant Yes sorry they are all set too many emails with tom and phone calls. I am swamped sorry they are okay Donna I Bellaire, Dianna f1 From: Soto, Kathryn Sent: Thursday,June 10, 2021 2:22 PM To: Bellaire, Dianna Subject: FW: King's Grant FYI From: Courtney Keyser [mailto:kgracquetclub@gmail.com] Sent: Thursday, June 10, 2021 2:02 PM To: Soto, Kath.yn Cc: jason.riverNay(-&comcast.net Subject: Re: King's Grant Hi Kathryn, Thank you for clarifying and consolidating the issues onto a list for us. We'll review and develop our plan. I'll be in touch and will get you the spec sheets for any new equipment before it is installed. Thank you, Courtney Sent from my iPhone On Jun 10, 2021, at 12:32 PM, Soto, Kathryn<Kathryn.Soto@town.barnstable.ma.us>wrote: Jason, I was informed that you had contacted Marybeth this morning regarding the emails between Courtney and myself. I want to address a couple things and document them in this email. Also to acknowledge that Courtney is in fact the owner of King's Grant and you are involved with food preparation. First I never stated Marybeth was my supervisor, I stated in an email "I briefly talked to Marybeth on Friday (another health inspector)". Second I also never stated you could not prep food on site. When I did the inspection I stated due to the issue with the hood that area could not be used. However,that was understood because Building and Fire had not approved it either. That was the only thing I stated could not be done. What I have been doing is keeping Courtney up to date in that I have been looking into this facility and asking questions to get a clearer picture. Courtney that is what I have done with the emails correct? Asking questions is my job and I ask questions to all businesses. I could just tell you no you can't do this or that but I have been trying to come up with a solution which you don't seem to appreciate. I have been researching for hours and getting.more information from another health inspector to make sure I give the right information. 1 ` This morning due to your conversation with Marybeth the health director has now been involved and this is the resolution that has been made. Due to the change in the kitchen and the use we are giving six months for the residential:equipment to be upgraded to commercial grade equipment. All equipment needs to be certified to ANSI standards (2013 Food Code 4-205.10) This will give you till the end of the season. The residential dishwasher is not acceptable and a commercial one will need to be installed instead. You have the option to either use the 3 bay sink (without the right side being used as a hand sink) or upgrade to a comrrrercial dishwasher before the six months are up. (2013 Food Code:4-204.113 and 4-301.12) In the meantime you need to have a maximum registering thermometer for the dishwasher to use it now. (2013 Food Code:4-204.112) You cannot prep food off site and sell it at King's Grant unless you have a wholesale license. If you are interested in this license you need to contact the state. You are allowed to prep food on site, currently you cannot use the griddle to cook until approved by all departments. The hand sink on the right side of the 3 bay sink is no longer enough for what you are making on site. A hand sink will need to be installed to meet code within six months. (2013 Food Code: 5-202.12) For the ice cream you will be selling see this section (2013 Food Code: 3-304.12)for how the scoop has to be stored. As far as shucking oysters where is that being done in the facility? What exactly is the setup for that? Courtney keep me posted during these six months once you decide what you want to do for the equipment and send me spe--s on any potential new equipment before it is installed. Reach out to me with any questions on this. Regards, Kathryn x Health Inspector Town of Barnstable 200 Main St Hyannis, MA 02601 508-862-4639 <image002.pn.g> The information contained in this elec conic transmission("e-mail"),including any attachment.(the„information"),may be confidential or otherwise exempt from disclosure.It is for the addressee only.This Information may be privileged and confidential work-product or,a privileged and confidential communication.The Information may also be deliberative and pre- decisional in nature.As such,it is for it ternal use only.T he Information may riot be disclosed without the prior written consent of the Director of Public Health and/or the'T.own Attorney's Office of the"town of Barnstable.if you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe!. 2 x M * lk Legend Road Names 02 2102 # A LAA Y�+ � pry, Uc'1406 #12 ,ems. Aw. 0221054-1 �r'''��p r _ i t 1 Map printed on: 1/10/2020 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026ot 0 42 83 an on-the-ground survey.It may be gener4lized,may not accurate relationships to physical objects on the map 508-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale: 1 inch= 42 feet cartographic errors or omissions. , gis@town.barnstable.ma.us 1/10/2020 ShowAsbuilt(1700X2200) ,` TOWN 0 STABLE LOCATION � .G\U 1�E n } ric SEWAGE ifi � VILLAGE �=+1 "i ASSESSOR'S MAP&LOgIl- CI� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) - (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 within 300 feet of leaching facility) Feet Furnished by I o E3 Orl vo 1 n J ob �-c.►��4' tea,.�� https:Hitsq ldb.town.barnstable.ma.us:8407/Home/ShowAsbuilt?mp=022106&sq=1 1/1 E Parcel:022-106 Location:12 OLD KINGS ROAD,Cotuit Owner:MALOY,JOHN L JR TR Parcel Developer lot: Road index 022-106 LOT 110A 1154 . Location Fire district Secondary road gig 12 OLD KINGS ROAD Cotuit MAIN STREET(COTUIT) Village - Interactive map Cotuit 7,_ 1 Town sewer at addressNo � . Asbuilt septic scan 022106 1 V_Owner: MALOY,JOHN L JR TR Owner Co-Owner Book page MALOY,JOHN L 1R TR JOHN L MALOY JR FAMILY TRUST 25632/32 Streetl Street2 12 OLD KINGS ROAD City State Zip Country COTUIT MA 02635 V_ Land Acres Use Zoning Neighborhood 3.14 TENNIS CLUB RF C107 Topography Street factor Town Zone of Contribution GP(Groundwater Protection Overlay District) Utilities Location factor State Zone of Contribution IN r_ Construction - y_ Building 1 of 1 Year built Roof structure Heat type 1950 Gable/Hip None D - Living area Roof cover Heat fuel 1080 Asph/F GIs/Cmp None 207— Gross area Exterior wall AC type 3248 Vinyl Siding Central gMT 2 Style Interior wall Bedrooms Ranch Drywall 00 D �4 ---- 16 $� Model Interior floor Bath rooms. Commercial Carpet 0 Full-2 Half Grade Foundation Total rooms Average Conc.Block Stories 1 Permit History Issue Date Purpose Permit Number Amount InspectionDate Comments 10/12/2017 Addn Alt-Comm 17-3441 $4,000 08/21/2018 Replace Existing back deck and stairway(same size as existing). 05/01/1984 Addition B26488 $0 03/15/1985 . CO ADD'N 07/01/1974 Out Building B17187 $0 01/15/1975 TENNIS COURT v_ Sale History Line Sale Date Owner Book/Page Sale Price 1 08/19/2011 MALOY,JOHN L JR TR 25632/32 $1 2 03/15/1996 MALOY,JOHN L JR 10107/319 $57,000 3 10/03/1975 MALOY,JOHN L JR&JOHN L SR 2243/218 $0 r_ Assessment History 1/6 Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2020 $76,700 $18,200 $170,500 $230,100 p $495,500 2 2019 $76,700 $18,200 $188,700 $230,100 $513,700 -3 2018 $74,300 $18,200 $197,800 $230,100 $520,400 4 2017 $73,100 $19,200 $207,600 $230,100 $530,000 5 . 2016 ... _ $73,100 $19,200 $207,600 $230,100 $530,000 6 2015 $72,200 $17,300 $203,600 $244,500 $531,600 7 2014 $72,200 ' $17,300 $211,800 . $244,500 $545,800 . 8 2013 $72,200 $17,300 $189,600 $257,100 A-r^ $536,200 9 2012 04,100 $17,300 $1-75,260 $187,500 $454,100 10 2011 $35,160 $0 $233,900 $187,500 $456,500 t1 2010 .$35,100 $0 $252,600 $187,500 . $475,200 12 2009 $35,100 $0 $43,300 $439,600 $518,000 13 2008 $51,100 $0 $47,300 $471,000 $569,400 15 2007 $51,100 $0 $47,300 $471,000 $569,400 16 2006 $50,400 $0 $34,900 $392,500 $477,800 17 2005 $45,400" $0 $34,900 $376,800 $457,100 18 2004 $42,800 $0. $34,900 $282,600 $360,300 19 2003 $23,400 $0 $34,900 $260,600 $318,900 20. 2002 $23,400 $0 $34,900 $260,600 :$318,900 21 2001 $23,400 $0 $34,900 $260,600 $31000 22 2000 $22,400 $0 $34,900 $187,200 $244,500 23 1999 $22,400 $0 $34,900 $187,200 $244,500 24 1998 $22,400 $0 $34,900 $187,200 $244,500 25 1997 $24,600 $0 $0 $125,900 $204,900 26 1996 $24,600 $0 $0 $125,900 $204,900 27 1995 $24,600 $0 $0 $125,900 - $204,900 28 1994 $24,300 $0 $0 $94,400 $182,400 29 1993 $24,300 10 $0 $94,400 $182,400 30 1992 $27,000 $0 $0 $104,900 $203,800 31 ": 1991 $52,400 $0 $0 $188,800 $350,200 32 1990 $52,400 $0 $0 $188,800 $350,200 33 . 1989 $52,400 $0 $0 $188,800 $350,200 34 1988. $41,100 .-$0 $0 $83,900 $216,100 35 1987 $41,100 $0 $0 $83,900 $216,100 36 1986 $41,100 $0 $0 $83,900 $216,100 v_ Photos 2/6 f ll �� ©2018-Town of Barnstable-ParcelLookup j. r 6/6 .5�{ it 1 3.�� ''�! n^•t_. �`- ' llllllll�li� , � 11kill1�� 1 1 5„wv g' . a 00 Cll26Z009 :�a"xK�t� } x z110 f r s mt - 14i .,gip✓. �t:.� t'T � �� � 72 a ` I 21 .z 8 �0 8, w � ,uu a iete � r i �f'1TC1`lt��1 8a i` __-_•.•• -4 M SM s n a cill Y ° 1011 fi/201r2 ce ", 1.O f.1 G`/2012 a , 3 +w r:� i Y, a7 �. ire 3jgti�. f�CC11 y a x h. 10/16/2012 8 21.2018 ¢ ntC9nC i i, P } } KN i .- " JQ/1612012 10/16J2012 It t 10/16/2012 J — } r ^""lOh1�6'.h20t12 1h `zd. h �".,j•Iy�� � _ ..ti �ii1 ,�� �,tff v lii®jip} �� ilI i IiIiii,IIII1IIII�I 1 U�Tlil I,.;.i 10716/2012 Miorandi, Donna From: McKean, Thomas Sent: Friday,January 10, 2020 8:48 AM To: Miorandi, Donna Subject: FW: Informal Site Plan Review Agenda - 01-14-2020 Attachments: 011420 Site Plan Review Staff Agenda.doc; 740 BEARSES PARKING SKETCH PLAN 1-6-20.pdf; KingsGrant_FINAL_STAMPED - For Construction.pdf; 609 lyannough Road - Existing Conditions Plan (8 Jan 2020).pdf, 609 lyannough Road - Proposed Parking & Utilities Plan (8 Jan 2020).pdf Follow Up Flag: Follow up Flag Status: Flagged Please let me know of you have any comments about this proposal (plans attached): SPR 003-20 Kings Grant Racquet Club (Dave Medeiros) 12 Old Kings Road, Cotuit Map/Parcel:022/106 Zoning: RF Proposal:Applicant is moving bathrooms from basement to first floor using part of the existing deck. Enlarge deck as to provide handicap access and change configuration of bar area. From: Flynn, Margaret Sent: Friday, January 10, 2020 8:44 AM To: Anderson, Robin; Anthony, David; Barrows, Debi; Beaudoin, Griffin; Brigham, Anna; Capt David Webb; Ch18Requests; Maruca, Joe; Winn, Michael; Rhude, Paul; Collins, Nathan; D Paananen; Deb Krau; Deputy Chief Rick Fautz; Duffy, Robert; Elizabeth Wurfbain; Burke, Peter; Fire Dept at Hinckley; Florence, Brian; Flynn, Margaret; Pulsifer, Frank; Gallant,Therese; Gregory Shopshire Hyannis Fire; Hartsgrove, Elizabeth; Jenkins, Elizabeth; Karle, Darcy; Keijser, Hans; Kennedy, Sue; Lauzon, Jeffrey; Lavelle, Timothy; Logan, Erin; Lt. Tim Lanman; Martin MacNeely; McKean,Thomas; McPherson, Gloria; Collins, Nathan; Oakley, Shirlee; O'Donnell, Stephen; Puckett, Carol; Sara French; Scali, Richard; Scott Knowland; Servis, Katie; Smith, Tracey; Stanton, David; Starr, Gordon; Therese Gallantt; Wackrow, Paul; WebRequests Subject: Informal Site Plan Review Agenda - 01-14-2020 Good Morning, Attached please find the Agenda and supporting documentation for next Tuesday's meeting. Please let me know if I can be of any further assistance. Maggie OOEIOPMEyrO �4 Maggie Flynn 4 C ', 'am Permit Coordinator I Planning&Development \N a Town of Barnstable 1200 Main Street I Hyannis, MA 02601 G ti margaret.flynn@town.barnstable.ma.us ro�H�fBhRNS�P��'c. P 508-862-4679 1 SITE PLAN REVIEW STAFF MEETING Scheduled for 2:00—4:00 January 14,2020 Planning& Development Department 200 Main Street,Hyannis,MA INFORMAL AGENDA SPR 002-20 Gilbert Wood (Robert Trapp) 740 Bearses Way,Hyannis Map/Parcel: 294/060 Zoning: B Proposal: Applicant is requesting approval of a a plan for an existing Class H Auto dealership.New tenant is to be determined. Currently licensed for 16 display vehicles. SPR 072-19 Route 132 Motors Inc. (Ed Pesce and Nikoletta Kounadis) 609 Iyannough Rd (Route 132),HY Map/Parcel: 311/007 Zoning: HB Proposal: Applicant proposes to operate an auto dealership with vehicle display parking, customer and employee parking and access from Nightingale Lane. The existing building will be used as the business office. ****UPDATED Plan and application**** SPR 003-20 Kings Grant Racquet Club (Dave Medeiros) 12 Old Kings Road,Cotuit Map/Parcel: 022/106 Zoning: RF Proposal: Applicant is moving bathrooms from basement to first floor using part of the existing deck.Enlarge deck as to provide handicap access and change configuration of bar area. 1 LOCUS GENERAL NOTES ' 3 J ; LOCATION ENAVV 1988 BASED OOORDIN T SYSTEM USED HE SURVEY ANOORDIN TE SBASED ON .\`*'K ; PARCEL THE NANO G W. DATUM.COORDINATE SYSTEM USED IS THE MAlA;UNLANO COORDINATE SYSTEM, 021077 DATUM:NAG B3.UNITS:U.S.SURVEY FEET. N.r. FINISHED BOOR ELEVATbN(FIN.FL.EL.)SHOWN HEREON IS BASEOON AN ASSUME01'r[1WFR r 5 1 'Y"•l! N 46 28 OS E -__-_ __ [ 1HAN THE SURVFYFP THRESHOLD CLEL'ATK1N.AN INIEHIOR INSPECTION OF BUILDINGS WAS NOT 28U 1 / PERFORMED. a ___________ fT ZONING DISTRICT:RF ___ �.F 1 I 1 PROPERTY IS LOCATED WITHIN AN AREA HAVING A ZONE DESIGNATION OF X(NONNAZARD)BY THE i FEDERAL EMERGENCY MANAGEMENT AGENCY(FEMA),ON FLOOD INSURANCE RATE MAP NO. 2.M1C0.5341.Wi7HAMAPEFFECTIVEDATEOFJULYI6.NI4. THSLOTIS LOCATED WITH DEP PPROVEO ZONEII1ON LNADPROTECTION ARFh. rs LOCArED WIr T EGR UNDW R LTro OVERUYOISTHICT. � >•` :{ w✓ _ ' I TH S LOT IS LOCATED WITHIN THE GROUNDWATER PROTECTION O REGU DISTRICT. •i.�, &' 1; y S A I 4"'1y'b ^ LOT(SE IS LN TEDGAR GLE WITHIN THE SAN2ATER ESTUARY PROTECTION nONS) 1HIS LOT IS LOCATED WITHIN THE SECT WATER ESTUARY PROTECTION DISTRICT. TW S LOT IS NOT MAPPED WITHIN A MESA NATURAL HERITAGE AND ENUANGERED SPECIES AREA. LOCUS MAP NOT TO SCALE WIND EXPOSURE CATEGORY:ZONE g �0 1 I iJ LOT COVERAGE: 32$ ' LOT AREA=—.4 F UP f PARCEL `��' IF EXISTING LOT COVERAGE BY STRUCTURES.PARKING PAVING .61.1.3.F.(4 M) � `i \ � �,tn -��'� I 'I GEED ftEFE0.ENCE:ROOK 25fi32 PAE 32 ~I PLAN REFERENCE BOOK 288 PAGE 27 OWNER: COURTNEY E.KEYSER TRUSTEE j _i I I THE JOHN L.MALOY.JR.FAMILY TRUST 12 OLD KMGS aOAD GOTUIT.MABZ833 ice'=�I f �r Oj N41"37-13.E 128.9T i tl LOT 110A 136.923 S.F. 1 111 c PROPOSED WALXWAY -,A "sill, C 11 1 1 PROPOSED DECK 1 1 1 1 tr 1 N FS� 5 1 YvJ , PROPOSED /ly I NfI F V 1 1 .!.3 raTx / BATHRooNs / I 1 m s, 1 1 aDUIiION NorICE RODE 1 / oL¢aHANc l 'f'c r.u c N I- rnxrNR„IrwwA.RrI PARCEL f I i _ \'�-�•' ;' L.�:C '1 I'� .0.. I [mo+n oc ovEam awY Wu«L�ww..Y°'Y" vravxw 022106 1 l rF tr, �Y rC+i rC..bs2` { ^cF.I:E IY f-;i lri f '( W ' r;OPYHrGHT fCJ NY CAPC 41SLAND3 CNGWEER NG,INC.ALLRrGffi RE _-"`:!.- K` � �"•� tr PROPOSED UP '�'I DESC0.IPTION — DATE BY CHK LEGEND F / <Y ADA MMP AREA Z7 PARED FOR. COURTNEYEKEYSER TRUSTEE l MAINTAIN ACCES I THE JOHN L.MALOY,JR.FAMILY TRUST STO/ CB ---CONCRETE BOUND ...7. • lEM I 1 1COTU TI MA 02636� SB ._.-STONE BOUND LX i < / h y? —— 1. CIRC .......ROD OIP ... IRON MPE FOUND I 'P_,fA '1,ab Sfi�(X 1 :._?. :fi 09 0P f PROJECT: SEPTIC SYS GONERS SL HYD-1 {� ---t - -,—-t i.Y ct l L T' I L�Np+ i/; >T ......WATER SHUTOFF ` ....... \ ..( ' CATGI BASIN SOUARE 13 y 12 OLD KINGS ROAD r �- 1 I ! :� 29000' Q, _._,.. umltt POLE - . A J GUY POLE it 't S 41'OT COTUIT,MASSACHUSETTS GUY-RE 1, rQTt '� — "'- PROPOSED STAIRS 'IX .............LIGHT POLE I All PROPOSED WALK SIGH ROAD SHEET NO,IOF 1 DATE:DECEMBER23,-19 CONIFEROUS TREE 3 UP I:rXv __Eg_.._. __._..__..._.___ W PUBLIC) FlLLIN ACCE65 i0 LOYlER IEVEL DRAWN BY:JVB CHECKED BY:MG Q DECIDUOUSTREE _- 1L EV OLD KINGS (�WIDE- REMOVE ILLL RETAINING WILLLS PNO STL-YS g -- TREE STUMP REVISE EXISTING DECK STEPS TO MEET NEW GRADE. PREPARED BY: SHRUB CONSTRUCT NEW DECK AND STEPS TO MIRROR EXISTING. CONIFFROUSSHRUB CAPE&ISLANDS ENGINEERING ... .�.y.,... .-�..,. TREE LINE CM CNGINE.ERING-NAND SURVEYING-ENVIaO N r4l.ff—I RING ----OHW--OVERHE_ RES STONEWALL 8WFALMOUni ROAD SUffE Sr1C �A77,9272 PHONE In fo$rJCI1p8Eng.wm MASHPEE.MA 02649 SOB.aTT.9072 FAX www.CBPBEIg.Ixm --C-0—J—FOSTB RAH-FENCE S FENCE D ZD SD 100 DRAWING TIRE: TOCKADE —R—�—x—PICKET ROW a CHAIN LINK PENCE SCALE:1"=20' PROPOSED ADDITION ASSESSORS INFORMATION: MAP 22 PARCEL 106 _ EXIBTING�NBTR YELLOW DOOR LLC I GLTION II C� NEw coNSTRucTgN I TENNIS COURTS 03 I TAre AND Loco 1 A 40NO CTODES Auo EcuuTr S I 1 novmE-EZZa.Tl"Liw..us,aa=OlE AIOF i I a. DETAILS AND SECTIONS ON THE DNAMIDS ARE SHOWN AT RE-ROUTE PATH AS RE�QU RED SPECIFIC Louno«s DE-1S NOTED AS—IMxV ALL CONDITIONS TREATED SIMILARLY,MODIFICATIONS r0 BE NADE S ALLOMENSCpNSAREFINS«�EDFACEOF Oa LARNTI S. OT«ERWSE NOTES.NOT INCLUDING WALL TILE OR OECORATNE TRIM 6 ISSING ON `. TING wR RENDNFORNATION rn HARE«RECT PaIOR CONFLIC TOCONSTRULTgN. NRTCAL DNENSgNSAREDESgNATEDO-NOTIEETTnE S. PROVIDE FlaEUIEXTINGULSHFa,MN I FEa—SF AND.. WINDOWSSANp DOORS ARE E%ISTNG UNLESS OMEawISE ° - / XPANDED DECK :.LE u s CNANGE O Rer�nuu uwEss oiHeaamse r�ioTep. MATCH E%ISTING' _ z.GRADECI ADYLETENTS BE TO NMEDINTHEFIEL RMANEANrN z CO ArREQUIRED TRMTYALL IDN NOTES: To NEW S IN EE E T�eLE RAMP LENGT / s EW EXTERIOR DOOR ANDn DOORSMEAND % 1 � pwARE TO BE SELECTEDD BV OWNER REMOVED.RIOR WALL w«EaE E%TERgR DOOR WAS / XISTING WALL TO BE REMOVED AND EIDSTING DECK STAIRS TORE MOD FIEp TO NEw GRADE—EN / CEILING FRAMING MODIFIED TO BE 1 i/ I x3 02 aTAILs�AuoISiurmEaonuspco FFIw+�cuAEaMDE NUMERF�rz o�Fwos VAULTED SIMILAR TO OPEN CEILING IN 1 'I Js REou REp N INS FIELD. EXISTING CLUBHOUSE , 1 !i �a nEw EXTERJOR DOOR.RAON BECXw/coBE coMFLMNrsrAms TO NEw / 1 Israa «MNRIMwE WDE ID-Ta CEADSFAND MAxauMa . PIO tlgP CL19g11Q , \ 1 I Qs u CONUSENECTING E%ISRNG BASEMENT ANB LEVELIFOR owNeRD ED T«EFIEID.PRON.EW UMe CI£AMNCE ABOVE STOM. 11M I 1 G EXTER—WALL ASSFMBLV.(SIDING,wFAT«ER BMRIER, ..................................................................................... 1 1 SHEATHING]XS SNOCONSTaI1CT1ONWIFACE11I1 I _ i 1 E I INSUTATgN,GwBI I 1 B 1 I 1 OO NEwINTEwORwuLEWsrrl}GMSOTHSIEA- FOR PERMIT s OVICIE11e I 1 cHED TO BAaNEDooa NORYwAU OFEU BNG DOOR I r 1 i t3 r W b O LOCNINGNETO BE S¢ECTE08V OWNER PROvIOf E0.EO A/tC T --- r,,.R.o EXISTING WALL AS REDUIRED FOR NARpw ry ^ Ew ROOF—NAND—END EMSTNG—LINE NO«ARD B ,� aF �� ' OB N ¢�G LIM RL aEAFL ADargn ro l/gLwEaN mT«REsrRooLs� /� _ apA COMPLMNi TOLL ET,vAu_ANO S IIII«ANDIALLS. 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' © TRAN50M WINDOW 1Y K SS'.SELECTED II MIER NORTH ELEVATION 04 ENLARGED PLAN EQ s;=URALGGLI'MNGIADIN—PANEL EN`LGSLIREOR 03 T^ '-0^ ^_1'-0" ®o OFEMNO,DOOR,FRAME,HARDWARE.SELF EBY a wIEN ®owlEn smW�E—ERDROP1S—RDREATERI sELECT ©I� ADA CpR0.WI+T RAMP wrtH IANwtAILM1av RAIL t82P AFFI.GUARgL,IL R DESIRED av OwNEA 6 DROP IS GREsa ER naN N.RMIP NOT TO EXCEED t:t3 ®ExISTING STAIR TO REMAIN.MODIFY IANDRAIL TO MEET ®i EITENDE%ISnNGROOFUME ® CURRENT CODE ®eE RDPAwTI'TOMAicIIXlsnxGwooDLATTOE FOR PERMIT ® LOw[O0.FRAMmG.SEE STRUCTURAL OOWUTTE GR TO COINECT TO EKISnNG;uIILILE EIBSTW ® ISPOIIT $At12E]AROHt` fl I FLEVATED FLOOR ASSEMBLY:FINISHED FLOORING By �yV�N1 ZIMMF,p.�C ____.-...........__...__..___....._..___________._.. ® OwxER.M.0.MnvOOD.3.tPILIMOF ROCKWOOLIXi CLOSED O CELL FOAM INSULATIDN MINIMwt OF RaO.DENSOLASS 2 SHEATNING.PLUMBINGTOBELVRAPPEDIN INSuunON. E f l—. W ® L MA J I ............. .._....... 3 KINGS GRANT RACQUET CLUB © ® O SOUTH ELEVATION EAST ELEVATION BATHHOUSE ADDITION I,I 01 1, �,_0, - 02 T._�.-0, ELEVATIONS 0 4 T'.Na.Fr. oT OW ,—IS A2.01 b II 1 2 3 4 AREA OF WORK I I I I I 1 I r AREA OF A001T10 I I I --- -- — __—_----- I - i EXISTING WALL TO BE REMOVED AND CEILING FRAMING MODIFIED TO BE —/ M VAULTED SIMILAR TO OPEN CEILING IN — EXISTING CLUBHOUSE - - - a C besv ae.nry . I PRoalaaa auomeousE I I I IElw..ma&+ SLU&IgLSE LADING Ell -n sane ma lovriouy KEYSER FAMILY AREA OF WORK KINGS GRAM RACQUET CLUB t Proposed First Floor FLOOR PLAN —I,-Number. M19G6 Dalc ]211.19 A1.1 ARIA OF WORK _ — l _._: ..... :.. ...... ..::: ....:: .:: .._ - . ..: ..... Milli 1 South El evation tulf 2 ast E evation -J AREA OF VJORH /i lj��L Au . Q. b� 3 North Elevation KEYSER FAMILY KINGS GRANT RAC QUSI'CLUB AREA OF WORK EXTERIOR ELEVATIONS PmjM Number p1946 �r� 1211.19 A2.1 West Elevation 1 2 3 4 4.5 5 T I ti 1 i� I I Ixl Da.:er�Fwmmn I I I s.�.rm.w. _........... m —.1FAxr,moaKeEW—Exi1 — e —----�———— IN]Deck Above �. ---------------------------------------------------------- " C a E [E]Deck Above I --- -+-- - -- ' I - I I I ,� I�Ixip.mo.a Fa.wevarw r umm r ' I N I .rm b � I IEl rcuuJ O I k 1. o p I neon¢e �i cue ww [E)F'nSh Basement Mlz..zra rm wa y. SPotl mb wz.oc I I IEI o..aan. � O _ F --� --+ + -- +---- ---- -I-] w _ w ALTERNATE 10"Concrete Pier - - I axw.r GreP w:���I��Fxraaxl KEVSRR FAMILY 1 Frt- 6'Sqen KINGS GRANT m,Form wawamo.w, RACQUET CLUB 4 - I 4 Hi F FOUNDATION PLAN �1 Foundation Plan _ 3Diamond Pier Foundation Detail TYP u-,a m ,c PmjM Numbm. M1906 Dc6c 1211.19 F1.1 1 Y ¢e I I I — Ll — I 3 u I I I 1 B wN i D Irl IT Iw _.. 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I.IRwas�u or,xz EmeM sw.ea.,ry Aso.,e, o,x e,00 aF:I.E.,w�we.EE`o®,so:<on F.srER�.E.E.s,a emoE oue,W TKW S o First Floor Framin SM E o- r =Ex.,WuA TIES k,saE..SIR sl.00~R,.,eere. ­ TO _ — - ,o, .E kw,s.vo..r....,.o� f -r-- sro ., .E .. .-- �RwREw�,EOUrn»� SIR ISE unuxuErRuu ttv acwuo®.e ocwnvs,xxasrennv*En s ytrom- w tea& ly i KEYSQR FAMILY KINGS GRANT 1 RACQUET CLUB FRAMING g ` t PLANS C i d t-It +smtc R.au�v.,—TE p f4r� s 'P-NI- HFIS CV Dti..l t F s 7 N! it x+� ,tltCYELE CCDIIA PE = �' T»tF Y Ht '^'t MICIfF3F C i ProjM Number. kIC k1946 wxe: izii.iv sh IS=r,Llt� SII FI_�I Vl=lf 2,Q0 IlT F— El 2E R�15 p— ITI-1--1 F111 T.—T-I.— IT" IT-10 TIP—T E BULTIP�ADER T�PIECES W 11-IP— .-T P ER ST. 11_ZT TlEl.1"I T-1111 D P_T= IF, F-TIRI TO —T E TI.IF IIE I. T, Y— L V..R.E-"T.—I F—II—ISTOR—5 T�,$�—sP�nce .cs.OIT 1.TIE F.—.1. 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'.. � ,t , '0 � '_ , .1 1, I . . �;,-.,. ,, t . . , ; _ ,- , 't!k, I . . .1 I . . I t ,$,. 'r ," . j, .� ,1'1�-" . , I,. I. 'I. ",��, . �A_"I -�1 ., .. #.,I- 4 Yj 1..; ., �,z- , -� , .4,.- �. . . ". . . a- , I 4", i � ,W.",-,"�, � - . - .� -,� � IL , , - ,!I- ;� . � . . 4"" , .� " �" ,, , -,--I ,�,It, -�.,�� 1* _-, �., , ­4 . �, �.• . . , ..,F. , ': -'1�w .�' ,� � �,rf� k 4 I ,..... I --j": .". ...-", I '11," , , � , __ k �­ I'll J .� I � , :k ��,�f , lz, , ��,-, -T�, , _k,I. I - . .,�", ,- ..,.- • dQ'�P.�i .� ' • Date— ° Fee OfTNf TQ� OWN OF BARNSTABLE OFFICE OF FS s ]SARI BOARD OF'HEALTH 367 MAIN STREET HYANNIS, MASS. 02601 A` VARIANCE REQUEST FORM All variance requests must be submitted fifteen (15) days prior to the scheduled Board of Health Meeting. �O�1tJ NAME OF APPLICANT ,4- �GU e " Clc16 TEL. NO. qQ R-S `?Ll / ADDRESS OF APPLICANT IN tJ. aZ 3 E NAME OF OWNER OF PROPERTY dAj M6 10 e � " f L i SUBDIVISION NAME �� ��.p,J7- �QIO(�II�pM�2a�"r DATE APPROVED 3 F ASSESSORS MAP AND PARCEL NUMBER LOCATION OF REQUEST E VARIANCE FROM REGULATION (List Regulation) (� REASON FOR VARIANCE (May attach letter if more space is needed) b � a6 f 2. 'ZLo SQ4T/e a d O&) d��lrGh �Z� z�e�ot�•S u 6 14 T r PLAN - TWO COPIES OF PLAN MUST BE SUBMITTED- CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPROVAL a. s. A P Robert L. Childs, Chairman Ann Jane Eshbaugh Grover C.M. Farrish, M.D. BOARD OF HEALTH TOWN OF BARNSTABLE 4C QUE1 G Make Plans To Relax With A Sandwich And Beverage After A Watch Invite Your Friends! SOUPS SUNDY BRUNCH Crock Clam Chowder . . . . . . . . . . . . . . . . . . . . . 2.25 Low-Cal . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.25 TENNIS PRO'S BREAKFAST Two eggs cooked to order. Served with bacon, SALADS sausages, and toast . . . . . . . . . . . . . . . . 9.95 Tossed . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 .50 BAKED QUICHE ON THE SIDE Du ,lour (ask your server) . . . . . . . . . . . . 2.95 Potato Salad . . . . . . . . . . . . . . . . . . . . . . . . .75 Cole Slaw . . . . . . . . . . . . . . . . . . . . . . . . . . .75 SATURDAY SOCIALS MATCH POINTS Salad, Chowder & Sandwich Stuffed Quahog . . . . . . . . . . . . . . . . . . . . . 1 .25 per person Chicken Nuggets . . . . . . . . . . . . . . . . . ... . 3.75 9 0 0 tax ind. Tekki s 3u lls SANDWICHES Available on Portuguese, white, rye or wheat bread WARM UP STRETCH Choice of potato chips, potato salad or Cole slaw English Muffin Hamburger . . . . . . . . . . . . . . . . . . . . . . . 3.25 Doughnuts Cheeseburger . . . . . . . . . . . . . . . . . . . . . . .3.50 Toast Tuna Salad . . . . . . . . . . . . . . . . . . . . . . . . 3.00 DESSERTS Chicken Salad . . . . . . . . . . . . . . . . . . . . . . 3.25 Bacon Lettuce & Tomato . . . . . . . . . . . . . 2.75 Check Board OPEN UNTIL : - P. M . Function Room Available for Priv?'� 3 Qu S Ja m ® z > -° •a •00 1 I J fed 1 f 7f .� 0o Q • It, A ao •�tr •,c' I 410 li C ° se 4� r•�Js �\ I 0 e pp ace `bAs J fry J m 40 I m I N ,• f to D C.J.Riley Builder,Inc. Invoice 10B wtanno Ave. = — Osterville,MA 02655 Date Invoice# � 4 Fax 428-6076 3/30/2010 3163 508-428-6376 cj@cjrlley.com Bill To Ship To John Maloy John Maloy King's Grant King's Grant Cotuit,MA 02635 Cotuit,MA 02635 Terms Project � w Description Amount Pumped and cleaned two tanks 2500 gallons r 600.00 Pumped and cleaned 1000 gallon grease tank 300.00 Please remit payment to P.O.Box 382 Osterville,MA 02655 Total $900.00 Phone# E-mail Payments/Credits $0.00 508-364-1044 cj@cjriley.com Balance Due $900.00 OPLICATION FOR SIT PLP 1ZV1W F Location JUL 18 2001 C/—p Business Name: Kings . Grant Racquet Club TOVVN Ur 8Ar*4SiA&E ! Assessor's Map and Parcel Number: R022 106 Property Address: Main street and 12 old Kingt Road, Cotuit, MA Owner of Property Applicant Name: John Maloy Name: John Malay Address: 341 Main street Address: 341 Main street Cotuit, MA 02635 Cotuit, MA 02635 Telephone: (5m 42o-os92 Telephone (508) 420-0892 FAX , Enizineer David sanicki Attorney Name: Cape & Island Fng;nPPr;ng Name: Philip Michael Boudreau Address: 800 Falmouth Road Address: 396 North street Mashpee, MA 02649 Hyannis, MA 02601 Telephone: (508) 477-7272 Telephone: (508) 775-1085 R E C E I V E D FAX (508) 771-0722 JUL 17 20 01 Storage Tanks Zoning Classification Existing Propoi vv _ ABLE District RP Number NONE Number BLit_niNr, nu Groundwater Overlay GP Size Size Sewage Daily Flow * 1 , 025, d (total prop. Above Ground Above Ground Lot Area 3+ ACRES (3 . 14 acres ) Underground Underground Fire District Cotuit Contents Contents Number of Buildings sting 1 SPr posed NnnP D olition No Utilities 5 6-0 1 Sewer- ❑Public OPrivate To al Floor area By Use Water- ®Public ElPrivate Re idential None (prop. 794 s f) Electrical Aerial ❑ Undergrou ice 100 sg. f t.. Gas - ❑x Natural ❑ Propane Medical Office None Commercial 1,080 sa, ft. Parking Spaces Curb Cuts 1 Main St. Wholesale Required Existing 3 old Kings Road Institutional Provided 42 Proposed None Industrial On-Site 42 To Close (Specify Use) Off-Site Totals Handicapped 2 All Other Uses On Site tennis courts *GP or WP areas restrict wastewater discharge to 330 gallons per acre per day into on-site system. �rw 0 w - Old King's Highway Regional Historic District Approved? Yes x❑ No Hyannis Main Street Waterfront Historic District Approved? ❑ Yes ❑x No Previous Zoning Board of Appeals action? Yes In Area of Critical Environmental Concern? No Project within 100' of Wetland Resource Area? No Note that all Amu must be discussed with Ms Urenas at the Building Department Listed in National and/or State Register of Historic Places? ❑ Yes ❑x No Perimeter setbacks: Front 311 Side n/a Rear „/a Percent of Lot Coverage (pavement and buildings) n/a Number of floors 1 ( 2 prop. ) Floor area: First 1,080 Second none (prop. 1 , 080 ) Other(Specify) n/a Are there accessory buildings? ❑ Yes ❑x No Accessory building floor area: n/a Please provide a brief narrative description of your proposed project: I propose to build a two (2) bedroom apartment ahcwP the Pwic:ting as an accessory use caretaker apartment. I assert that I have completed(or caused to be completed) this page and the Site Plan Review Application and that, to t est of my kno he information submitted here is true. ature Philip Michael Boudreau Date Attorney for John Maloy J ,.,.s<�;-. 4r. _ -� y_ ""t� �a' s�-�-F„ F x'�°'i,'�. 1 ^'t ti �, :. 7 r' t n `t� 1 �` 'a:re ` .t ..'4 e _ 's"�" 4 o '„ ' J'frj. < & "4.7z t ,< S 1f} 7ya 3 } to `^r r d+i l e` F x- t 3 ! -.. ''/: _ is T - ' �-,,., r_._ . 5 - -- Y _ i 2� t S y t ., t' t . . .. m ,.: : - :, - - .. 3 ..'.w Y ...: Si :. 4 .. : .. �� . . .. .. .. �� �� _ N .�, .. �r � tt .t SE-W&� E-PERNIIZIa O r. ;. 1 . ' - - r 3 __ ' � ', r Sf'.. a - .a > ` t + �it et 67t4ttil�am'QY10+ltgatjfi 4�I-A.I....;�.5:.-m:.._.�-.-L'"r.a I a r�:L..i—�r:.f.r..I.-."a.'.r�.a-,.-.....��.,:-.--��..i..I.I"�I.,�.'.I..r A.aym:..-.r.��.I.:I..4:K.f-.''.-r—I:.-.."-'-�'-,:,-.O.:.::aLI* w S D►L- L E R-S-►J©tom E Q I. t _ t..c I pia Y .. l — Y !;: Y14FIit i jtlt r i �+...: VI ly ! 1 '. :^.. _ - LJ-L.J-� . I r.. . —' `'— ✓-QT�G-- � — t lI t+5tr tt u�t}'!; lT t:' $.L t N .. 7 p ., „ - -fat a j , .. .. i. - ..'. .. �:.I��.1Ia.!."'­;�"'.,'�-�..;,1­�",O!,'' . . - �� t t...,"am.-r*'W.Z!,..�:-�:.!..a..'I.-I.:,.-�I7'..r.,-.7I.:t-i.-��...�.!.I i-I..-.�1._.;m�'�.0.;�:.I�',I.;I� >. ('� -,�!II�'"a t:l..-�:.,�L,.,M.�-:Li xc:'�'� ��►�CE--DER 1-'L_ �5 511ED , .-,.. (. kf r ' - .� .. ,. p D-AME_GQ ILL L&KICE_1 S 11EQ-, ) t 4 .!v+ 4t . .. J ! t i f r a+ --.-- ---.. ---__ .__ t'. `, % '„� ,. � -- - t v E _ n Mgt L'zr�a 4 . �ti S x .. - - -..:a . ., t —' - .. .. r. .. .. -f .. ... r.. ,. I . . t . '., ., ttJJff - Jt I- ... . . .... .._. - [{ - ,. % 1./.I a . ., _ ... �j 1 ." ;. t : ,/ I — C ., - - — _ M. ,, .. .. .. - % oe . . .. +, lr i .. �... ._ M f . - . .. � ®� �_ . . _.._ . ..., ..._. _. ,: - : I . . , . . . ; _ . - . . :. . .. . '. _ . :__ . . . aol No. ------------------ Fee------ ----------- BOARD OF HEALTH TOWN OF BARNSTABLE Zippiication forlVeii CongtructionPermit Application is hereby made for a perms to onstruct (Alter ( ), or Repair ( )an individual Well at: Gas �ajg _ �+ L Location — Address Assessors Map and Parcel Owi(er _ Address _ Installer — Driller Address Type of Building Dwelling ---------- ----- Other - Type of Building---------------- No. of Persons-----------=------_________ Type of Well— - —_ ______ Capacity-----/`'<--a�� Purpose of Wel --- -�L "-- �^— -- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation un�* CertP .o m a e has been issued by the Board of Health. Signed date Application Approved By — ate Application Disapproved for the following reasons: ------- — ------------------- _ date 101/h� I Permit No. — Issued-- --- - ----------- - date -- BOARD OF HEALTH �I TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CER IFY, That the Ind4vidual We 1 Constructed (!/), Altered ( ), or Repaired ( ) C�� �� by--- —_---------- -------------- ----------- ----- �� Installer at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ------Dated----THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector + No. ------------------ `•�BOARD OF HEALTH Fee------ -----------=-,� � TOWN OF BARNSTABLE A lication-*rVei[ Con0ruction Permit Application is hereby made fqr a perm t to onstruct (Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel Ow er Address T Installer — Driller Address e of'Building 111 YP g � Dwelling ------------------------------ Other- T pt.f of Building-;-- _.—_ No. of Persons-----------_____--______ Type of Well- - - ----- Capacity Purpose of Well%'' --z d_ !a �"�- Agreement: l The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until�a Certate of m 'a 'e has been issued by the Board of Health. Signed � — . � date Dom. Application Approved By" ate Application Disapproved for the following reasons: date— Permit No. Issued { date c BOARD OF HEALTH l TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individ al We 1 Constructed (!(Altered ( ), or Repaired ( ) bY— — Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulatio n n as described in the application for Well Construction Permit No. - ---Dated----- -------- Z THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. f DATE--- - /Inspector—__------ ----__ ----—- BOARD OF HEALTH TOWN OF BARNSTABLE Ivell Con!gtruct ion Permit No.Li - O)& � Fee- ------- Permission is hereby granted to Construct (Alter or Repair ( ) an Individual Well at: ----------- -------------------------------- - --- Street as shown on t e plication for a Well nstruction Permit Q� No.----- - Dated --- - ------------------- --- - ------------------ c oard of He DATE alth- L O CATION SEWAGE PERMIT NO. ti e247— �'�•36S` VILLAGE INSTA LL`ER'S NAME & ADDRESS 'BUILDER OR " OWNER DATE PERMIT ISSUED 0 ��,��y DAT E COMPLIANCE ISSUED s 34 S c� FINISHED FLOOR 5 U . � B. M. NOTE. , TYPICAL SYSTEM PROFILE ca— AREA PLAN 11117 FINISH GRADE= A NOT TO SCALE : 1 EX15�", Fll�-1154��(.) '�tRsT' „t�` 1.1tA.d FDN TOP - -- ,, --: FINISH j SCALE . I 3O FINISH GRADE OVER TANK 45, I __ ..,.. le GRADE OVER PIT , ­T, ....... PI�OROS: AID r"T°10tJ I—E Ixwx�l�_ .,.:: 4 I?arc r TO ' -�� 1 -i r • - • r 1 1. e - CL L.3 ! ,« ;,_:. PVC OR �] U C� .,.. ,.. . _..tea �: ,� ..,,. �5 'IT ...,. •. "kll�C. I. TEES � _ A4.3a • r • e 1 e 1 FLR S 0V KIfGAL W T 3 DIST BOX REINFORCED' e • • •• •1 1 • , e • • • • e e 1 CONCRETE s t....• . TO BE IN TA'LtED ON ,• A A • 1 , , • e • I I h A LEVEL STABLE SE � SEPTIC TANK 19 y- . 1 • I , • • • 1 e 1 1 "4�. : W - .. !. i -. .. Cl s �{ TO BE BE INSTALLED ON A e 3r.y � � I e • e ! I • 1 • • 1 LEVEL STABLE BASE . I e r e • 1 • . , 1 • j r_r >., - 2 -I - 12 WASHED PEASTONE ALL ! BRICK & MORTAR COURSES AS r • e • • o e 1 AROUND FREE OF IRONS, , ' REQUIRED TO BRING COVER TO GRADE 3q.1? Bo�rl�or;.I. K. u�t AND DUST IN PLACE w ..,. LEACHING PIT �-�r�a _+j ` 24 "C.I.MANHOLE COVER !� I: 3/4 " TO 1-i 2 „WASHED CRUSHED ' ' -STONE ALL AROUND FREE OF BASE TO BE LEVEL 0 � ; FRAME cc, - IRONS, FINES AND DUST IN m j PLACE NBOTTOM PIT CI=Qt'�. �r A - : GRAISS FOR FIN. GRADE . , 'Q a; SEE SYSTEM PROFILE` SOIL AND PERCOLATION , u • s — It1Nt I—14� W� , :. . ,a DATA � 4 Pf�2[ 4S�L�F DGST it?69 -. 20'x 34`: New lcsc GAS.P ��r cu. � GRi tt M .; ...� _ ,----,� e - --�-.-._-� . = PERC. RATE.. < 2 IN./IN. �.�� ,,sty:tsta�tGw� L�.Th _ .... _ t��w M;5c^ cork ew�t 4" o FOR INV. ELEV SEE ° 4C.I I .tea, n C. D. SP0HR, P. E. , ( F~EAGHit�1Gc P T� , i .' . . INLET - , o , ,...., ,- SYSTEM. PROFILE TAKEN BY . Ol-i A LINE p J M -T COel �3.'H, a o PIP. WITNESSED BY. ,?- `- E4•.F5 0 0 OPENINGS W/4-1�8 a LITER DIA. & '1 -3 4 o DATE .0 / ,. L.l. INSIDE DIA. o .� .. ► IRD�iT1Cz�.l r 14EW F=t �r ca4ac '1�-�cax 7 TEST PIT GND ELEV, ,.•i 1 w 6 p a p 0 , 1 se PVI-0� TOTAL 1. -i.. (j` p 3 .� c.�� N t� AREA LOAM ,r 1 S.F. «� �,E L,�a' ' � :try a is � 0 0 0 0 2 ' 4 4�,G I_ s UA, A -. _ ->t aft �)tr jp� t 4 .:k g° c S1,, _ - `.:' a' o• 0 0 O .0 0 0 0 p RAS'S r. ..o !r r.. , , d_ _CAST �' � #'r � �a.,4 j.� '�. n 3 -. ., NE►J 7.LTQ'�Gt�L LiR� ,.r:.: .:+^'. ._ x.F�•'!n. ...fir k.,. .t� 1.. 4..'S -,. ... . .�k, I © ` .�.• ,.._..d,.r... ... _,,,...,,.. -.. l2bC'11:_E. A11 i7 1 u /- 'x l .k+•+•. ..-t.1n ,5: .� t� er«' s..M' tF`t .tea.. ._ j.'f. — 3- _ i t '` 6 .6 DIA bMr .r..e Gil BOT. PERC. HOLE I smamw= awe= ISA�Ti � ', .I _ { � (o . .EFFECTIVE DIA: -4 70 Sm S .41i7-id �K - �OA DOWN I 1+ LEACHING PIT - SECTION �2 '1TEi) NO SCALE DESIGN DATA : NOTE:: DO NOT RUN HEAVY EQUIPMENT OVER SYSTEM NO. DES I GIN DATA-. Di5 ?GSAL LEACHING PIT NOTES. EST. TOTAL DAILY EFFLUENT 14fl� GALS. I Ci T'A 1� � l � • 'A 0 x 3 . 1 4 z 20©0 T� _ `�� I . CONC. TO BE .4000: P.S.1 (n 28 DAYS'. SEPTIC TANK GAL. - r� r � rr GROUND WATER ELEV. NOW F 5F-PTIC TAMI; ( I _,C3 °sQ = l UC] G �,l,_5, 05 9 000 v[,N�_ r 1-1-tO PkE•. �?S`I •'Q•...p?�. �� a Q __. -« 2. RC1NF W 6 x 6 6 GA. W. W. M. �. �- ►oo ^.+w. IS f B t 1 1 — �,/ }y , , �� 'T'AIM31 �'.-t t�1 ,.. � I - TAI� K 11 i L0Ni�3 G vV10c 5 NIG '1 �.;IC Lr E:L.. Y7 L 1 I .�. 3. 2 AND 4 SECTIONS ARE AVAILABLE FOR NOT 'E,,.�- :. } `� -k y�° � °"" r '.,,, PTH REQUIREMENTS GENERAL ES I` a,,,,,f I t, ! I...�I f ,-, O T H E R D E 0 I . ALL SYSTEM COMPONENTS SHALL BE INSTALLED 1N ,, �' r. w, 1 I i - ICI;" � .I�.,.�,..3 ���'4'?,.a. + �`� r � ���C�.�� t��� ��''k': 1 ,.,,< ► �''�F�. � � LfONG � ICS Wi ...�._. NOTE. ACCORDANCE WITH TITLE OF THE STATE SANITARY CODE I t �, _ EXCAVATE TO ELEV. 3c0, 1� OR LOWER AS DATED JULY 11977 & ANY LOCAL RULES APPLICABLE. HIG�-I A' 11' L,IQL)1D LEVF-L_ 'v�'fITH 1 {-! L:ET TcE fi& tv, ! t> DlF-,pTH• UTL-Vt �" �'�� � �. � I 1 y REQUIRED TO REMOVE ALL LOAM AND CLAY CONTAINING -2. ANY CHANGE TO THIS'PLAN MUST BE APPR D. IN I"'a' ? -B BENEATH PIT. REPLACE EXCAVATED MATERIAL MATERIAL EN WRITING BY MR. ' CHARLES D. SPOHR. ,,,.,. ,,, .. WITH CLEAN,CLAY FREE GRAVEL, MECHANICALLY 9 SEl�Ac2TE Al_l_ L-t )t�I=�1 ci� a�': I "t" , 1�: I i s .4-11 ,t`•! . �!`iCA i`1 - ' "'r "f t-EF GrS� 'fi�, 3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLIN6, O h � COMPACTED IN PLACE. R F T _- :- _ 1 _ ,-- � p NOTIFY THE ENGINEER AND B0� J 0 HEALTH FOR INSPECTION. -[-12fi.P At�IG> ; .L OTl t .F c. PF' �..R .I�.?-c" �Dttc.�t`L �" ," "H I_, To�._. ,stK°.. _ SIDE AREA S. F.�� GAL/S:F. �- GALS 12? I C? t l 4. FOUNDA-ION ELEV. MUST BE CHECKED WHEN COMPLETED. . - c - •� v rG ' CBOTTOM AREA S.F♦1._ GAL/S.- GALS { ADD ITI0MAL_ TO t TS- ,V_ e�., },� 't` Iia1I -0 � .�1-iCaV`��r'��.� .`��. 4°ti/e� "�",,�� �» ��..t� I��.�� .r 1.A �'�'C}, al� ,, 5. THESE ELEVS. MUST NOT BE CHANGED WITHOUT WRITTEN TOTAL AREA S. F. TOTAL ` ��I ;a GALS APPROVAL .BY CHARLES D. SPOHR. I - LEGEND 6• FOUNDATION INSPECTION REQD. WHEN EXCAVATED. -I. 50.0' EXIST. GROUND. ELEV. 50.0 FINISH GROUND ELEV. 'UNDERLINED" R PTI PLAN 3. M. NOTE*A EA4750 PIPE INVERT. ,ELEV: REV. DATE DEsc oN ' h.I >. � �Ivt! Al ,C i"1"'��"T'U A ... m � T. I_ ALL ELF--VAz �C��S �!�'��t� T, P o TEST PIT LOCATION ' AREA / SELVAGE D I S POSAL SYSTEM F^# 1 t EC,T � NI �}�>1 MC _`F t�IISH�t� FOR �/N% I C . o o S E P T I C TAN K �r i FL �� _ � COTUIT TENNIS CLUE DISTRIBUTION . BOX a S T. OLD It 1 N G S f Q. _ MAIN N � 4 C. 1 . OR PVC PIPE (SCH 40) �� , sty : COTU I T MASS, Cha.Iaa D. �, 4' SCHEDULE 40.PVC: PIPE 02635 I� SPOIL f t io \.f+ No. 74fiS I w DESIGNED: C:D^SPOHR DATE. MO'%Y £?A D R A W I N G NO. — -- PROPERTY LINE 1 . DRAWN: C.S . SCALE:AS SHOWN MIN. CODE DISTANCE s9,��t,� MAP SEC P CL LOT HOUSE AREA S. F. 5 4 HECK Ep: C. D. S -i--ill — i - .------. ---__ ___ \ SOS \ �o \p w \ ^ S1 d ° \ \o `° o0o c°yb X d Ns� co 1 \ \ rv- � � o, \ 0 srdl. ° , • OHO � \o F, . / � ^S� • O S 6" \ \Oc? ° �° ° � \ TOWN MAP 22 PARCEL 106 .. ,,.._.. �? / \ 12 OLD KINGS ROAD ,° COTUIT,MASS. p ,� �° c.� \ LOT AREA 3.14ACRES Ir o 'O O S O !pull e. \ tZLAN � DECK \\ L ._.. __.. F A o S P �, O '9s�Gs�G� — — 5 6 ® 1 / PAVE-D. ARKING °� / o Dq EXISTING BUILDING o� i p hF?� / 0 1st FLOOR EL.85.03 `P6', O / PLAN OF LAND w / LOCATED IN Rio !?l /"D �� \ °C� xF� i o / o I COTUIT - BARNSTABLE MASS. o c x;f \o .....�.. � o PREPARED FORREC - aw �'> � \ ��°\° �;, `� JOHN MALLOY i E KING'S GRANT RACQUET CLUB 17 2001 �� Q 'JUL..\�•i1t LAWS�`" � / - .. �•ai. PAV DRIVEWAY x X ° F DATE:JAN..25,2001 SCALE: "=30' TOWN OF BARNSTABLE O9' x ° l� 's c9 G BUILDING DIV FILE:166BA kngsgrnt so ., F x � CAPE & ISLANDS ENGINEERING , _ �,�, — — — — , ' F �. , 800 FALMOUTH ROAD SUITE 301 C 6 ��, x MASH PEE,MASS.02649 [508]477-7272• 6'• c�� F� F EDGE OF PAVEM jE T F �l Sil P L, 6' �6, .� ,a0 OHO 0 2 4 .,. . 0 0 60 Js _ • OLD � r.. ._. .... .: - l� v �b ,�^ • KINGS ROAD . "v