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HomeMy WebLinkAboutKETTLE HO - FOOD I l KETTLE HO fled 6 53 12 School St. Cotut �► Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. nARNSTAa F.P.(Thomas)Lee,. p MASS Daniel Luczkow,M.D. Alt. j6�q• 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 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 238 Issue Date: 01/01/2022 DBA: KETTLE HO OWNER: CLARTIN INC. Location of Establishment: 12 SCHOOL STREET COTUIT„ MA 02635 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 49 OutdoorSeating: 0 Total Seating: 49 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: �� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent .I FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: 1H%E For OfficInitials: z Town of Barnstable ' Inspectionai Services Date Paid��f �I AmLLId S—�///�� y AtAS.4 $. ' Public Health Division c-n�ek# Thomas McKean,Director 200 Main Street, 11yatutis,itLk 02601 Office.: 508-862-4644 Fax: 508?90-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE I� � NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: i iC_! I Q I N . ADDRESS OF FOOL}ESTABLISHM:F..NT: _ ? CA 60L 0 0 IT M A t Z O MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: �' t d •I TELEPHONE,NUMBER OF FOOD ESTABLISHMENT- � �I.-� - d' (� 2-- TOTAL NUMBER OF BATHROOMS: WELL WATER: YES___NO—?< ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:� SEASONAL: DATES OF OPERATION:^!_/_ TO / (_ NUMBER OF SEATS: INSIDE: q9 OUTSIDE: )� TOTAL: S.EAT.ING: 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 REOUIR.EMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN.PROVIDED AT WAI,TSTAF.F SERVICE DOOR(S)? TYPE OF ESTABLISHMENT; 011LEASE 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 42) *** SEASONAL,MOBILE& NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSCJFD PLEASE CALL 508-862-4644 QlApptication Dorms\F00DAP1'2020.daC OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES 6-9) D.O.11-3 -77OWNER PHONE# (b 7 0 S 3 VK ADDRESS 6 - CORPORATE OWNER: CORPORATE ADDRESS: /_Z 5 (Hod L j 7— C 67-V /7— Vie. PERSON IN CHARGE OF DAILY OPERATIONS. A\ (AA, COAk,\<� List (2) Certified Food Protection Managers AND at least (I)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I Certified Food Protection Manager PER SHIFT. "ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2 SIGN Tl[�IWIE OF APPLICANT DATE ***FOOD POLICY INFORMATION**..* SEASONAL FOOD SERVICE: All seasonal food establislunents,including mobile tnicks must be inspected by the Ilealul Div, prior to ot)eninLy!! 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 thereatler, with sample results submitted to the Health Div. Faihire to do so will result in the suspension or revocation of your Frozen Dessert Pennit until the,above terms are met, CATERING POLICY: Anyone who caters withfii the Town of Barnstable must notify theTown by fax or mail prior to-caterin" event. You must completea catering noticefotind at h i, L 4kim -OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually froin January Ist to Dec.31"each calendar year. IT IS YOUR IkESPONSIBILITY'.1'O RETURN THIS COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC I st. Q\Application FormsTOODAPP REV3-2019,doc p4 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 238 Issue Date: 01/01/2021 DBA: KETTLE HO OWNER: CLARTIN INC. Location of Establishment: 12 SCHOOL STREET COTUIT„ MA 02635 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 49 OutdoorSeating: 0 Total Seating: 49 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: L De vo�-� Town of Barnstable For Office Use Only: Initials: Date Paid 'I Amt P�$��� x OMMSfABLE, : Inspectional Services 1639. Public Health Division Check# iOrFo Mai a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 'APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE�d g NEW OWNERSHIP RENEWA NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): C J E-MAIL ADDRESS: , �o 493.C- ,€EGG d TELEPHONE NUMBER OF FOOD ESTABLISHMENT: Cza�e ,� TOTAL NUMBER OF BATHROOMS: _ WELL WATER: YES NO_k... (ANNUAL WATER ANALYSIS REQUIRED)A/ro _ SEASONAL: DATES OF OPERATION://y/A/ro 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?�� IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)91 � TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) F OD 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 LQA�Applicafion Forms�.FOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/ O D.O. S WNER PHONE# �� �`� � �✓` ADDRESS CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least (1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date l 2. G ATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openine!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/api)lications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January Ist to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. QAApplication FormsTOODAPP REV3-2019.doc pF Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNSTABM Paul J.Canniff,D.M.D. ,6 9. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate D" d 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: 238 Issue Date: 12/10/2019 DBA: KETTLE HO OWNER: STEPHEN CURTIN Location of Establishment: 12 SCHOOL STREET COTUIT, MA 02635 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 49 OutdoorSeating: 0 Total Seating: 49 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: C,Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: *e Town of Barnstable For Office nitials: Date Paid 9 Amt Pd$ 3W MA ,E ; Inspectional Services �Es6 9. 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 DATE l�, ` NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: A ADDRESS OF FOOD ESTABLISHMENT: C� C�'� 5z— MAILING ADDRESS(IF DIFFERRE,NNT FROM ABOVE): E-MAIL ADDRESS: �CilL � TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO c/ ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION::/Z-11 O z&? y ab NUMBER OF SEATS: INSIDE: t7O 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. a� IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?A& TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) t/ 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 QAApplication FounsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANTi'` ( � SOLE OWNER: YcE�S& D.O.B c5".lJy OWNER PHONE# ADDRESS C7/ �iK !tea✓ _� i �o�iy q CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: �� � List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Manners Expiration Date Allergen Awareness Expiration Date �z SIG14ATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/apalications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Application Forms\FOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH # Paul J Canniff, D.M.D. A.Ga � Board of Health Donald A.Gaudagnoli,M.D. BARNS^TABLF,, John T. Norman '$ A 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508)862-4644 Fax: (508)790-6304 www.townofbarnstable.us I Permit to Operate a Food Establishment I In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections I 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: i Permit No: 238 Issue Date: 12/20/18 . I DBA: KETTLE HO OWNER: STEPHEN CURTIN Location of Establishment: 12 SCHOOL STREET COTUIT, MA 02635 Type of Business Permit: FOOD SERVICE 1 Annual: YES Seasonal: I IndoorSeating: 49 OutdoorSeating: 0 Total Seating: 49 FEES I FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: --- ------------ ------ -- MOBILE-FOOD: MOBILE-ICE CREAM: G�,� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: coo pFiHe*oyy Initials: Town of Barnstable 11 i • Date Paid OG Amt Pd$ 0 BAMSTAB Inspectional Services ArEo16 9 * ,�a Public Health Division Check# i Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 t Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE ,l 47 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: O ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �t E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: /Sl—rl-4 TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ... ANNUAL WATER ANALYSIS REQUIRED)U ANNUAL: SEASONAL: DATES OF OPERATION: 12TO 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? 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) 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 - --- ------- -- ---- ----- .... .. G PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES& D.O.B S' ' OWNER PHONE # ADDRESS_Z2 c7a,-s— CORPORATE OWNER:(felC�l/}� IIV(:f—FEDERAL ID NO. : CORPORATE ADDRESS: Gib PERSON IN CHARGE OF DAILY OPERATIONS: C . 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 S16<ATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1 st. Q\Application FormsTOODAPPREV2018.doc Bellaire, Dianna V`•��/ From: McKenzie, Marybeth Sent: Tuesday, December 04, 2018 4:07 PM To: Bellaire, Dianna Subject: RE: Kettle Ho All Set.O From: Bellaire, Dianna Sent: Tuesday, December 04, 2018 3:37 PM To: McKenzie, Marybeth Cc: Bellaire, Dianna Subject: Kettle Ho Hi Marybeth; Kettle Ho has everything in on my end. The last inspection was in August. Please let me know if you are okay with them having a 2019 permit. Thanks. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02E01 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us I, 1 pp INE►oy, TOWN OF BARNSTABLE .. .HEALTH INSPECTOR'S Establishment Name: - Date: .Pager_ of P` ~per OFFICE HOURS . PUBLIC HEALTH DIVISION 6M-930A.M. BARNSTABLE. ` 200 MAIN STREET 130-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date Verified 639. ,0� HYAN NIS, MA 02601 MON.-FRI. No Reference- R-Red Item PLEASE PRINT CLEARLY F°MP FOOD ESTABLISHMENT INSPECTION REPORT sos-ss2asaa 3 C _ Name Date Type of Type of Inspection ) No Operation(s) Routine Address Risk t Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness L i Ab 11 daz Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP S w r In: 3: t�PY4 Other Inspector Out: 1 Each violation checked nAluires 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) i✓/ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands c ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities J EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives r ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals l�� / C/ � ,� n FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) vV�/ J ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures I:Kj ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling -6Q/�, kp` j- _ / f/• ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding vi''r ) �( [/t(,/,v1-� J PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control bt VLfilt� ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) (wedSr+ Ae ` ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP _1442 ) I f l ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY Q 11.Good Hygienic Practices 22.Posting of Consumer Advisories ❑ Y9 ❑ 9 LZ _ Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations D� Uri Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: S ❑�. _ ❑ Yes Non-critical(N)violations must be corrected immediately or 1 4.Overall Rating 2 Jl 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 an inspectio 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 6=One critical violation and less than non-critical violations if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than non-critical. If If 1 critical refrigeration. critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations. If within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspect s Signature Print: 31.Dumps screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen', Y N '--._.-^,... •�;.-�y1_ _ rrr._-^-a.;-�^.. .-.w.;__��.--..y... .. -. ,.� - --.,-..- .- .+.+... -.. ....fir., s- �._.._. �___�- ����,.�.J,: x, ..�1-.- -. -.-.-. - ��, - _ Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs d F Cooked and RTE Foods.* - 19 PHF Hot and Cold Holding 2-103.11 � - Person-in-Charge Duties - � - - 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to -� - 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* - - - - * p g 20 Time as a Public Health Control 3-302.11(A) Food Protection 590.003(F) , Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* 11 Restriction-Presence and Use* Applicant 3-302.15 Washing Fruits and Vegetables 7-202. 3-304.11 Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use* 590:004 11 Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) ance q Contamination from t Consumer he 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 g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance_with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual 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 P * 3-201.13 Fluid Milk and Milk Products* 4-501 Al2 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of - 3-202.16 Ice Made From Potable Drinking Water* - 3-401.11A(1)(2) Eggs-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* g PP y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef ctiw riinooi 4-602.11. Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish*' 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- - Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By -- 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms A( )(1)(b) All Oth practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.1.1 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C 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* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F * 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 lHandwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. a oFT rWr yid "' TOWN OF BARNSTABLE... HEALTH INSPECTORS Establishment Name: Date: Page .of P. 3•"_ OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. --' Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. .•� HYANNIS,MA 02601 M-8 -464FRI No Reference R"Red Item PLEAS P. N CLE LY , n - 508-862-4644 rF°M ,.FOOD ESTABLISHMENT INSP T REPORT " Name Date De of Inspection Routine - Addres Risk Food Servi -Re-ms � Level ail Previo i nq Telephone Residen is I chen Date: 1{1 Mobile Pre-op ti Owner HACCP Y/N Temporary Suspect Illn ss VVV Caterer General Complaint Person in Charge(PIC) ime Bed&Breakfast HACCP Other Inspector AA Each violation checked requires an explanation on the narrative p ge(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and RI k Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ a Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ V MA FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities p 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 IA WVX FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) - , ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures v ❑ 5.Receiving/Condition ❑ 17.ReheatingA FS ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling O ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control 1718.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 �13 U ✓"`' QViolations Related to Good Retail Practices(Blue Items) Total Number of Critical Violation Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑P ❑ 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 i m ❑ 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. FC 4 590.005 B=One critical violation and less than 4 non-critical violations 25.Equipment and Utensils ( 9 )( ) cited in this-report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.water,Plumbing and waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than,9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical viola'ons. If 1 critical refrigeration. t s violation,4 to 8 non-critical violations within 10 days of receipt of this order. =C. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: I ctor' i na re 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signalure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y NW Dumpster Screen? Y N �- llJJll Violation related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* $ Cross-contamination 1q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved 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 590.004(F) 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 y g 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 Tone Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rated or 7-204.12 Chemicals for Washing of Food* Produce,Criteria* HSP HIGHLY SUSCEPTIBLE POPULATIONS 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food'and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A7B) Compliance with Food Law* 4-501.111 Manual 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 Hermetically Sealed 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* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eryecnve mrzoo/ 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) I 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 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Chemical Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 1 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. h*W 2-301.14 When to as * Other 590.009 violations relating to good retail i 590.004(C); Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 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 * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location`and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004 J Labeling of Ingredients* Supplied with Soap and hand Drying Devices () 9 9 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. of IHE* TOWN OF BARNSTABLE -HEALTH INSPECTOR'S Establishment Name: Date- Page:. . of OFFICE HOURS 7�L PUBLIC HEALTH DIVISION 8:00=9:30A.M. BARNSTABLE. ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CO RECTION Date Verified MASS.9. .0 HYANNIS,MA 02601 508 862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY N1A�a FOOD ESTABLISHMENT INSP CT O REPORT J Name Date Type of T Insipection Address Risk ood Se ift Us rvice -i pection Level ai Previous Inspection _ Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an a planation 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) ❑ a 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 J ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives V IV ❑ 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 Procedure's/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within.90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ 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 (- 1=C-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,.Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. viol to 8 nA-critipal violations C. 29.Special Requirements. (590.009) within 10 days of receipt of this order. = 30.Other PATE OF RE-INSPECTION: Insp is Sign re Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N C's �re 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 i 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 590.004(F) 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 7-201.11 Separation-Storage* PP 3-302.11(?,) Food Protection* 20 Time as a Public Health Control F) R 003 590. es Responsibility 000 or An 7-202.11 Restriction-Presence and Use* - ( p- ty-f A Food Employee 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* .REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* .590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served _ P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs*. Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 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* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g trY 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 Reeeiving/Condition 2 401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PFIF'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 * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F. Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 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 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `op THE Tom TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date- Page: of o OFFICE HOURS BARNSTABLE. PUBLIC HEALTH DIVISION 8:00-9:30 A.M. 3:30-4:30 P.M. 200 MAIN STREET Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified e3. .0� HYANNIS, MA 02601 508-62-4R6" No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSP CTION REPORT Name Date-5AXI if Tyne of Type of Inspection L e Address ! Risk Level lion Telephone Residential Kitchen Date: 14 Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection .REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating 3. 13 19- �� within 90 days as determined by the Board of Health. ❑ Voluntary_Compliance [-].Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction-Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an orderof the Board of Health. Failure to correct violations(FC-4 regardless of the number of critical,results in an F. 25.Equipment and Utensils - 590.005 B=One critical violation and less than 4 non-critical violations g )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC=5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-u p;infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to.anon-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 8pon-critical violations=C. 29:Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view L Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's Sign a re Print: Self Service Wait Service Provided Grease Trap.Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) i - _ FOOD PROTECTION MANAGEMENT �` PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 1 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 UnapprovedAdditives ' Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15, Poisonous or Toxic Substances 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F ty' g to 7-102.11 Common Name-Working Containers* Require Reporting by.Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* * 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 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated orce,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 3-861.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590,004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* y 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-Mi.112 Mechanical Wazewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS * c 4-501.114 Chemical Sanitization-Temp., H. CONSUMER ADVISORY 3-202.14 Eggs and Milk Products,Pasteurized P�•P 16 Proper Cooking Temperatures for PHFs 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate . Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E//cdw 1112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* `' 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 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* I 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* 3A03.11 C Commercial) Processed RTE Food-140°F* Blue Items non-critical 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 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* y Convenientl Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 P Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction*. 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures I 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1 .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* !_ 8-103.12 Conformance with Approved Procedures* 1 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� ►ok TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page; of a OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. ARE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS, MON.-FRI. HYANNIS, MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY. FOOD ESTABLISHMENT.INSPECTION REPORT N) Name Date e o Type of Inspection 0peration(s) Routine C Address Risk Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: �1" - { C Mobile Pre-operation "\ 7 Owner HACCP Y/N Temporary Suspect Illness 1\ Caterer General Complainttll Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other ( _ Inspector Out: / G 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) 4 (� L Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands /n c w- ❑ 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 G ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals A FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures i ❑ 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) i ❑ 9.Food Contact Surfaces.Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Prop6 Adequate Handwashing CONSUMER ADVISORY J ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Loc Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) ra Il Corrective Action Required: ❑ No TO Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,t e 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. B=One critical violation and less than Orion-critical violations 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically lack of hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have aright 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. 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 h violations tical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non critical violations=C. 29.Special Requirements (590.009) y p - _ 30.OtherRE-INSPECTION; Inspector's Signature Print: 31.Dump ter scr ned from ubli qie , XT pr Permit Posted? Y N se Trap Previous Pumping Date (J Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's's!Si nature Print: / Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) ° FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination F 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 75 7-101.11 Identifying Information-Original Containers Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name: Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* * 7-201.11 Separation-Storage* LIP_ 0 Time as a Public Health Control 3-302.11(A) Food Protection 590.003 F Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* * (.) P Y _ 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* _ 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions nisposition 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 y Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell.Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 ' Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking'Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ery c6ve rnizooi 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11. Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From-an Approved Source - 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11- Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish*' 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009 A D m cater- Chemical ( ) ( ) Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11 C 3 Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By - -- - ( )O P 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 Pieseht*' 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#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* _ 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* r 1g Proper Cooling of PHFs following sections of the Food Code and 105 CA4R 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 5-205.11 Accessibility,O ration and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback5-2doc '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. `oFtHE ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page:. . of ktio PUBLIC OFFICE HOURS BAR E, 2 0 MA N ST DIVISION - - 3:30-s:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. A 63q. `0$ HYANNIS,MA 02601 soa-862-464a No Reference. R-Red Item PLEASE PRINT CLEARLY 'FDN1P�' FOOD ESTABLISHMENT INSPECTION REPORT 16 y Name D ` Type of s c io / rationts"Isutine Address Riseo ection L Level a Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP _ ilk_ l In: Other _ d` 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) ❑ - r Action as determined by the Board of Health. Allergen Awareness 590.009(G) U 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 ez 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 1 ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling �+ ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding L PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today, he 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 if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9non-critical: If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violationsobserved,7 to 8non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC 7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.DumpsteF screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N 's Si njur Print: / #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC /U � l Self Service Wait Service Provided Grease Trap Size Variance Letter Posted -Y N C.r Dumpster Screen? Y N """` Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors,(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003 A Assignment of Responsibility* 8 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours* ( ) g14 Food or Color Additives 590.003(B) �Demmstrationof Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to _ Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* _Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* - 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) - Reporting by Person in Charge*- 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)j Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ) Disposition of Adulterated or Contaminated - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 - Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed S gouts Not Served*. 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and P 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell.Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective rnnom 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 12i 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 g g try 590.009(A 3-..01.15 Molluscan Shellfish from NSSP Listed Chtnvaal* Stuffing Containing Fish,Meat,Poultry or -(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g P ary 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms*. Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 23-30) 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items non-critical Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18. Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 g 3-202.18 Shellstock Identification (A) Cooling Cooked PHFs from 140°F to 70'F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* 3 402.11 Parasite Destruction* 5-20 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 4.11 Location and Placement*.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* 5-20 Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004 Labeling of Ingredients* Supplied with Soap and hand Drying Devices (J) 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S: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. 4.oF� row TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: age: _of v o OFFICE HOURS 4A PUBLIC HEALTH DIVISION s:oo-ssoA.nn. BARNSTABLE. • 200 MAIN STREET s:so-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF 6ORRECTION Date Verified 2639. `0� HYANNIS,MA 02601 soa-s2-4644 No Reference R Red Item PLEASE PRINT CLEARLY �FON1A�A FOOD ESTABLISHMENT INSPECTION REPORT d Name Da 'Type of T s c io `C O e utine Address Risk od Se e-i ion _ Level ai -Previous Inspection -- k Telephone Residential Kitchen Date: Mobile Pre-operation 142-1 Owner HACCP Y/N Temporary Suspect Illness 5 Caterer General Complaint Person in Charge(PIC) �� Time Bed&Breakfast HOA,CeCF n: InspectorLL� dal 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 TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Y ❑.4.Food and Water from Approved Source ❑ 16.Cooking Temperatures (..(� f. ❑ 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 r `� 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 �'. , � VV ❑ 10.P'operAdequate Handwashing CONSUMER ADVISORY L ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories 41 ^^f2 Violatio`hs Related to Good Retail Practices(Blue Items) Total Number of Critical Violations DIM `lj) � Critical(C)violations marked must be corrected immediately. (blue&red items) �l�L I l� Corrective Action Required: Non-critical(N)violations must be corrected immediately or r � Overall Rating within 90,days as determined by the Board of Health. d ❑ Voluntary Compliance ❑ Employe�xc s - io eduled ❑ Emergency Suspension C N ; Official Order for Correction Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other. checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24..Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 400n-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility . (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,,7 to 8 non-critical violations. If 1 critical refrigeration. thin 10 days violation,4 to 8 non critical violations within of receipt of this order. =C. 29.Special Requirements (590.009) y p 30.Other DATE RE-INSPECTION: Inspector's Signature Print: 31.Du r scr en f om pu is vie `/-'� (� L Permit Posted? ma e p Pr ions Pumping Date Grease Rendered Y N --1 �� PIC's Signatu Print: #Seats Observed Frozen Dessert Machines: Outside Dining Y N Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N _.. :� -. .. ......0 :.~1-- �--•-7-........IK'.r°.'tr"'+s..c..-v.�.tr.�-v c.'^:': �.� :-.-.-..... .. -_.__..� _ ..-.� .. �-.,r..-. •-. y.-,_. -... �,r..m -� � -x . - .+r- .- r ,. _ - � _ _.� .-.. .� _ _ _ - r ....- _..-... . Violations related to Foodborne Illness - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) T FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.1.4(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 1 q 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* 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 590.004(F) 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 I- Others` * 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 i Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* --- " -- 7-201.11 Separation-Storage* PP � 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202:11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* _3-302.15. .Washing Fruits and Vegetables * Applicant To Report To The Person In Charge* y 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* * 590.004(11) - Variance Requirements 590.003(G) Reporting by Person in Charge* - 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* .REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washin Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beveragcs 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*. Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* J 4-561.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* _ Sanitization Temperatures* TIMElTEMPERATURE 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 -601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec Not Otherwise Processed to Eliminate" * Animal Foods That are Raw,Undercooked or 4 5-101.11 Drinking Water from an Approved System* I , * gg Equipment 590.006(A) 1 Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* sg r"9P 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-I55°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* - Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish-from.NSSP Listed _ 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* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401JI A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail - _ _ _ _ ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition - 2-401.11• -- Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 _PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3 301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ,. - - ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-203.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F 5-203.11 Numbers and Ca acities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products P 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFI Made from Ambient * 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 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-.Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* ` S.,590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. - *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `oF•KKEwti TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of p o PUBLIC OFFICE HOURS BARN ABLE. 2 0 MAN STREEETSION 3:30-4:30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P:M. MASS. MON.-FRI. '�, +6}9• �0� HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 'FDN1P�a ' FOOD ESTABLISHMENT INSPECTION REPORT Cyr Name � _Date a of Type of Inspection MID r--ft jrratl`on s Routine 7 •� _ cv Address Risk ood S e Re-inspection p at Previous Inspection Level - / �+l l /�t �( Telephone Residential Kitchen Date: <-- / Mobile Pre-operation Owner HACCP YIN Temporary uspect III en s'sa�` Caterer General Complaint 'i - Person in Charge(PIC) Time Bed&Breakfast C-E In: Other Inspector h „ T/� �� J Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. ` 10 r c _ Violations Related to Foodborne Illness Interventions and Risk Factors(Red Related to FOOdbOrne Illness Interventions and Risk Factors(Red items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ `�' J� ti� ,LiA_ _ ❑Action as determined by the Board of Health. Allergen Awareness 590.009(G) 1 � l _ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS f z ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives �' l ❑ 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 ,LJ ie-C ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(BlueViolations Related Retail Practices(Blue items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other. checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless,of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If p,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non critical. If no critical ' water,sewage back-up, 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) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: <17 31.Dumpster screened from public view NV"I = &L-,"e S Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N V #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature- .- �` ` __ Print: Self Service Wait Service Provided Grease,Trap Size Variance Letter Posted Y N Dumpster Screen? Y N / " Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) _ Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives, Law Cooled to 41F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding_ _ 2-103.11 Person-in-Charge Duties -" 3-302.14 Protection from Unapproved Additives _ Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) _ EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-201.11 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 * ( ) 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 3-302.15 Washing Fruits'nd Vegetables. 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* __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 * 590.003(G) Reporting by Person in Charge*- - - 7-203.11 Toxic Containers-Prohibitions Contamination fiom the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR „ 3-306.14(A)(B)Returned Food and.Reservice of Food* 7-204.12 Chemicals for Washin Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources - 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A7B) Compliance with Food Law* _ _- _ * 3-801.1](D) Raw or Partially Cooked Animal Food and * 4=501.111 Manual Wazewashing-Hot-Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13- Shell Eggs*. ___ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3 401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145*F 15 sec* PP Y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* z 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.l l(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan ' Contact Surfaces of Equipment* Shellfi"sh* - 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, 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* the a ro riate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave PP P 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. i * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* 2-301.14 When to Wash 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* practices 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements ld be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* _ 3-403.11(A)&(D) PHFs 165`F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* _ 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) Critical and non-critical violations,which do not relate to-the foodborne 3=101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Froper 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) i .Cooling Cooked PHFs from 140°F to 70°F ConvenientlyLocated and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* - , Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 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 IRE row TOWN OF BARNSTABLE .HEALTH INSPECTOR,s Establishment Name: Date: •� _ Page: , of p� bo OFFICE HOURS 9ARIVSTA9LE. PUBLIC 2 0 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ' 3:30-4:30 P.M. MASS. =r• MON.-FRI. 9$,, ta39• �0 HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item - PLEASE PRINT CLEARLY. ,EOMP,> FOOD ESTABLISHMENT INSPECT N REPORT Name F, Da _ ea i n s u Tveo Inspection ` ��`�� r Address k �✓ Ri Fo e _ - - ` r V Level Re ai Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP I Other n: Chi l� i Inspector K' 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) ,❑ r Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.0091(F) ❑ 1 Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands @J 1 64A P t Z, � ❑ 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 /4 ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals Y FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 441W1 ❑ 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 V IV ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 11.Good Hygienic Practices 22.Posting of Consumer Advisories _ ❑ Y9 ❑ 9 Violations Related to Good Retail Practices(Blue Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) n Corrective Action Required: � o El Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signatux Print: 31.Dumpster screened from public view NV)W%AN0AdZ 0 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signatu a Print: Self Service Wait Service Provided Grease Trap Size Variance.Letter Posted .Y N Dumpster Screen o Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C)_ PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15 Cooling Methods for PHFs m 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Addves* - Cooked and RTE Foods.** * 19 PHF Hot and-Cold Holding 2 103.11 Person in-Charge Duties` 0 3-302.14 Protection from Unapproved'Additives " Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590'.004(F) * - - - - - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * 2 590.003(C) Responsibility-of the Person-in-Charge to - Other*- 3-501.16(A) Hot PHFs Maintained At or Above 140°F g 7-202.11 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 * ( ) 7-201.11 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)Retumed 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 Disposition of Adulterated or Contaminated g ) - Food - 1 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces ( 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B). Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual Wazewashing-Hot Water- 7.206.12 Rodent Bait Stations Raw Seed S routs Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and P 3-801.11 C Unopened Food Package Not Re-Served 3-201.13 Fluid Milk and Milk Products* � 4-501112 Mechanical Wazewashin -Hot Water Monitoring* ( ) P g g g 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*- 3-401.11 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* Eg dive 1//12001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell _ Shellfish and Fish From an Approved Source _, - 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15_ , Molluscan Shellfish from NSSP Listed - _ 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* in mobile food,temporary and residential Sources g. P rY 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 violations relating to good retail * 11 Good Hygienic Practices 17 Reheating for Hot Holding practiceess should be debited under#29-Special 3-201.17 Game Animals Requirements. 5 Receiving/Condition - - 2-401.11 - Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* -; 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 Commercially -140°F* (Blue Items 23-30) 3-202.15 Package Integrity C( ) C il)y Processed RTE Food Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products P 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 I `Parasite Destruction* f 5-204.11 Location and Placement* 3-501.14(B) - Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 ' S-205.11 Accessibility,Operation and Maintenance Temperature Ingredients[0 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 Supplied with Soap and hand Drying Devices 590.004(J) Labeling of Ingredients' � 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures 1 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.006. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. i oFT ►ow TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date tPage: of �' patio OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. eAnNsrAeLe. 200 MAIN STREET 3:30-4:30 P.M. -Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. g. MON.-FRI. t6sv .0 HYANNIS,MA 02601 soa-as2-0644 No Reference R-Red Item PLEASE PRINT CLEARLY �'FO1A�`p FOOD ESTABLISHMENT INSPECTIONREPORT Name Date hype of vDe o ns ection t. s Routine Address Risk6PMspection 7 1_1kn 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 In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. S 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 l� Vim. ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities D - 4 n _ EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 1 ` r G - ItW ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives i ❑ 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 AA ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) v Corrective Action Required: No - -Y s Non-critical N violations I r 4 ❑ ❑ at ons must be corrected immediately o - ( ) Y , i Overall Rating 9 within 90 days as determined by the Board of Health. ❑ Voluntary Compliance mpl s ctio c �on-9ch40dh7• ergency 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 6=One critical violation and less than non-critical violations if no critical violations observed,4 too 6 boon-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 aright 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 Boon=critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: ( _ Inspector's Signature Print: 31.Dumpster screened from public view ((� IYJ/J rn/ / Permit Posted? Y N Grease Trap Previous Pumping Date "� Greas endered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signatur Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N (,j Dumpster Screen? Y N ,14 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 Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding - 2-103.11 Person-in-Charge Duties 3-302.14., Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous oi�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 Conta 7-102.11 Common Name-Working Containersiners* 590.004(F) * - * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F - Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 7-201.11 Separation g azation-Storage* - 3-302:11(A) Food Protection* 20 Time as a Public Health Control 3.302.15 Washing Fruits and Vegetables 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* * Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* _ - - 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B.)Returned Food and Rrated or of Food* 7-204.12 Chemicals far Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food_Law* 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 * l 3-201.13 Fluid Milk and Milk Products* - 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* _ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E�cti� 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed 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 1=010 Proper,Adequate Handwashing 3-401.11 C 3 Whole-muscle,Intact Beef Steaks 145°F* kitchen op erations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Arms* Condition-Hands and A * ( )( ) Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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 Hygieriic Practices 77 Reheating for Hot Holding practices should be debited under#29-Special Requirements. S 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 C tamination 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 3-403.11E Remainin Unsliced Portions of Beef Roasts* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Item Good Retail Practices FC 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities*- apacities* 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) Coaling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45*F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 1 Conformance with Approved Procedures* S.590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. r` • I PyQp THE rok� TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name- Date: Page: of o .`OFFICE HOURS BAR E. PUB2 0 MAIN ST LIC HEALTH RETSION 3::30-4:30 P.M.0-s:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 639• `0� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �A. 508-862-4644 'ED 1A FOOD ESTABLISHMENT INSPECTION REPORT Name Date a of T ns ection tine Address Risk od Service _ -nspection Level 1Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on th 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) ❑ hk4r 2f i6ie 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 '41. - ❑ 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) ilwN �k A 4 te ❑ 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 1AA1 J - Violations Related to Good Retail Practices(Blue 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: o 6 ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Em yee Restriction/ clusion ❑ Re-inspectio Scheduled ❑ Emergency Suspension C N Official Order for Correction Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If g p,infestation of rodents or insects,or lack of 27.Physical Facility )( ) aggrieved y y g g q C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up, y ty (FC-6 590.007 a rieved b this order,you have a right to a hearing. Your request must violations observed,7 to 8.non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signatur Print: Self Service Wait Service Provided Grease.Trap.Size Variance Letter Posted Y N �(�r.1< ��� u•� Dumpster Screen? Y N F. Violations related to Foodborne Illness - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12• Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* *_ 19 PHF Hot-and Cold Holding 2-103.11 Person-in-Charge Duties � 3-302.14 Protection from Unapproved Additives - - Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C)- Responsibility of the Person-in-Charge to - Other* _ * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-101.11 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 ( ) 7-201.11 Separation-Storage* Applicants* ,� P g 20 Time as a Public Health Control 3-302.11(A) Food Protection 11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 7-202. 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*____- __ _ 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 . . 3306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* I Beverages with Warning Labcls* 4 - Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B.) Compliance with Food Law* 3-801.11(D) Raw or Partially Cooked Animal Food and - - - - 4501.111• Manual Wazewashing-Hot Water _ 7.206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* `- 4-301.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs*. Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY * Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 4-601.11(A) Clean Utensils and Food Contact Surfaces of' Eggs Immediate Service 145°F 15 sec* 5-101.11 _ Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg cnvc 11112001 590.006 B ' Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* ( ) Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContainingFish,Meat,Poultryor 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* Proper,Adequate Handwashing ing,mobile food,temporary and residential 10 -. -Game and Wild Mushrooms Approved By - 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority', 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* - 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 _. Receiving/Condition - 2-401..11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* :, 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations;which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 1 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 3-202.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish,Products 5-203.11 Numbers and Capacities * Within 4 Hours* 23. Management and Personnel FC-2 .003 Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) * 5-20 .11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45'F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 :007 7 Conformance with Approved Procedures/ 4 6-301.11 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 _ Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1990 Food Code or 105 CMR 590.000. `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. w RUBIN A N D RUDMAN KENNETH M.BARNA PETER F.GRANO F DONALD J.OUILR COUNSELLORS AT LAW GENE T.BARTON.JR. JAMES H.GREENE MARGARET A.ROBBINS SUSAN A. BERNSTEIN EDWARD R.HILL,JR. DANA F. RODIN 50 ROWES WHARF MILTON BORDWIN JANE ELIZABETH JONES HOWARD RUBIN JONATHAN D.CANTER DALE ANN KAISER STANLEY H. RUDMAN B O S T O N, M A S S A C H U S E T T S 0 2 1 10-3 3 1 9 J. ROBERT CASEY JOHN D. KALISH W.BRADLEY RYAN MICHAEL R.COPPOCK SUZANNE L.KING SELIG A.SALTZMAN TELEPHONE: (617) 330-7000 MARK W.CORNER THOMAS R.KOLB DONNA C.SHARKEY MICHAEL K.CROSSEN RAYMOND M.KWASNICK JASON A.SOKOLOV LEONARD M.DAVIDSON DIEDRE T.LAWRENCE CHARLES J.SPELEOTIS TELECOPIER: (617) 439-9556 JOHN A.DETORE ROBERT J.MACK HAROLD STAHLER JACOB AARON ESHER ALAN D.MANDL PHILIP L.SUSSLER GUTERMAN 6 GUTERMAN PETER B.FINN HELEN E.MORGAN LAWRENCE E.UCHILL FOUNDED 1920 DAVID C.FIXLER ANDREW J.NEWMAN ROBERT S.WALKER STEPHEN C.FLASHENBERG ALAN K.POSNER EDWARD R.ZAVAL GUTERMAN. HORVITZ RUBIN 6 RUDMAN 1969-1985 January 4, 1994 The Town of Barnstable Barnstable Board of Health 367 Main Street Hyannis, MA 02601 RE: Donald Patchin d/b/a Kettle-Ho; Permit to Operate a Food Establishment Dear Board Members: Mr. Donald Patchin has come before the Town of Barnstable Board of Health seeking a variance and a permit to operate the Kettle-Ho restaurant at a seating capacity of forty-nine (49) persons. O . cr -a:c 1. Dcccmber 1, 1992, Don Patchin purchased the Kettle-Ho restaurant, located at 12 School Street in the Village of Cotuit. Prior to purchasing the Kettle-Ho, Mr. Patchin was told at the Office of the Barnstable Board of Health that he could secure a Permit to Operate a Food Establishment with a seating capacity of anything less than fifty (50) persons. in fact, after purchasing the Kettle-Ho, Mr. Patchin was granted the subject permit with a forty-nine (49) person seating capacity. A copy of the 1993 permit is attached hereto as Exhibit A. The forty-nine (49) person seating capacity as stated in the 1993 permit to operate is fully within the limits previously stated in a June 17, 1982 variance to install a septic system which was granted to the former owner of the Kettle-Ho, Mr. Bruce Burlingane. The 1982 variance authorized the installation of a 2,000 gallon septic tank, a 1000 gallon grease interceptor and a 10 foot by 12 foot leaching pit. The 1982 variance also expressly stated that upon installation of the new septic system the Kettle-Ho was to have a seating capacity of fifty (50) persons. The former owner relied on this statement and installed the new system. Likewise, Mr. Patchin relied on this statement 789921 f RUBIN AND RUDMAN The Town of Barnstable January 4, 1994 Page 2 now decrease the seating capacity of the Kettle-Ho would cause irreparable harm to Mr. Patchin and his business. A copy of the June 17, 1982 variance is attached hereto as Exhibit B. On or about December 15, 1993, Mr. Patchin was informed by the Barnstable Director of Public Health that without a variance the Kettle-Ho would be issued a permit with only a thirty-two (32) person seating capacity - a reduction of thirty-four percent (34%) in seating capacity from 1993 to 1994. Such a reduction would drastically reduce the income generated at the Kettle-Ho and, given the facts of this case, would result in a manifest injustice to Mr. Patchin. We urge the Board of Health to grant the requested variance. In order to grant the requested variance, the Board of Health must find that failure to so act would do manifest injustice and that the environmental protection objectives of Title V will still be met under the terms of the variance. 310 CMR 15.20. Clearly, the irreparable injury to be suffered by Mr. Patchin with such a drastic reduction in his seating capacity demonstrates the requisite manifest injustice. Further, review of actual meter readings of established water flows (142,000 gallons for the seven-month period April, 1993 through October, 1993) demonstrates that operation of the Kettle-Ho with the forty-nine (49) person seating capacity has not violated the degree of environmental protection required under Title V. See 310 CMR 15.02*. For the foregoing reasons, we urge the Board of Health to grant this request for a variance and to permit the Kettle-Ho to operate with a forty-nine seat capacity. Accordingly, on behalf of Mr. Donald Patchin d/b/a/ Kettle- Ho, we respectfully request that a variance as requested above be granted and that a permit be ,granted authorizing the operation of the Kettle-Ho restaurant with a- seating capacity of forty-nine (49) persons. Sincerely, iOhael �. Vrosl_en MKC:nc 78992_1 TOWN OF BARNSTABLE y�Q TN E Taw OFFICE OF PA"ITAnBOARD OF HEALTH � MAl6 vo i639' 367 MAIN STREET HYANNIS, MASS.02601 January 6, 1994 Don Patchin Kettle Ho 12 School Street Cotuit, Ma. Dear Mr. Patchin: You are granted permission to continue to provide seating. for 49 patrons at the Kettle Ho Restaurant located at 12 School Street, Cotuit, with the following conditions: ( 1) The in ground grease trap shall be pumped every three months. Receipts for such um in s shall be kept on site m P 9 P P for review b inspector a health and shall be available y anytime the establishment is open for business. (2) No more than 49 seats are authorized. ( 3) All other regulations of the State Sanitary Code, Article X and of the Board of Health regulations shall be strictly adhered to. This variance is granted because you provided actual water meter readings which demonstrated that the same degree of environmental protection was achieved without strict application of Title V, the State Environmental Code. You are reminded that the Article X, the State Sanitary Code For Food Establishments requires a handwash sink at all food service establishments. You are directed to install a handwash sink on or before March 1, 1994 . This variance may be revoked anytime unsanitary conditions are observed or anytime the septic system exhibits any evidence of malfunctioning due to excessive waste disposal. Sincerely yours, oseph C. Snow, M.D. OARD OF HEALTH TOWN OF BARNSTABLE cc: Michael Crossin, Esq. 0 0 � -I:O.5 PM TOWN OF BARNSTABLE THE OFFICE OF I BOARD CIF HEALTH rota 'ab 1639• �� 367 MAIN STREET HYANNIS,MASS.02601 u�Ts OF •`71{E_ Board of Health lteetifig Agenda January 4, 1994, 7:00 P.M. Town Hall Building 2nd Floor, Cbnfdk*hcb ltoonl 367 Main street, Hyannis r� "3. Public Comments- ;ohn o'M-a.t� Con•Ple` -4 ee.3n4,4D omp- �1��T a gaol 6s -r e«wI¢, 'Taman TNd;� A1a;(or a.j u��,a Fi r-Ee's ��art��^q 51GIotb co�pl���� II. Variance Request - old augWisss>; Granted w'017:10 Peter Sullivan, P.E. representing Seapuit Inc. - Lot 38 MIALk le- Cor.d;t;ons Smoke Valley Road, Osterville, sphagnum peat moss Cs eQ 0.4. le-{-ce-r system. d e-kd 1/40/9�D III. Variance Request - Nei' Rueih6bdf Qrar)}(?d w4h, 7:25 Don Patchin - Kettle Ho Restaurant, School Street, cond�(-,ons Cotuit, requests a seating capacity of 49. Only one C1) ,vp ovre. tUe/\ leaching pit provided which can handle only 30 seats according to Title V, licensed for 32 seats for many M-3 1�a�d ,sH,N^K fled years, shqu be ;ns�t� on M b2 Mara, ►, 101c)2(. IV. Proposed Hoard of Health Adquidifbt Draft Hazardous CoN_''Nu�. Material Regulation - License application requirements, Tpb �'� ►q`�`t license fees, expiration and renewal of licenses, f3.e,11. Mee f%11 notification of changes. V. Definitive SubdiyisiOnat C,oNr,NufD� A. Richard and Vivian Cahoon - Route 6A West Barnstable, Ads --r-Two lots ( 1: 15 and 1.05 acres in size) , private wells Q�an s►�r� t3c .v;s nand septic systems. AP aved B. Robert and Debbie Donaldson Y krk6t Road, West ,u ulye- Barnstable, three lots (greater than 2 acres each) , c once, E;�,ns private wells and septic systems. VI. Correspondences LF64 v' ilea t+k A. Letter and reports received from H. Richard Geiss+er Concurred of Cape Resources Company dated December 17, 1993 in -VV%e- sumac'+°^ 40 response to the Board of Health request. u rK ;� r2,3a,&5. +D Petition received December. 27# 1993 regarding Cape of tU4- AtoN le46� Resources Landfill located at 280 Old Falmouth Road daaecd .►mac, ?0)09-5 Marstons Mills. C. Letter from the American passage 'Therapy ${�l�ano� Lam Association, Inc. , Massachusetts Chapter, dated t2?,esoaw--- Co, December 12, 1993 regarding the model regulations No froceec�j% or. recently received. 1►2ac�, w-,11 Jne scheduled be�ore `tk- o c, 4k-44t Cif a- sou rcev • •IJU._ DATE )2 zo q3 oil TOWN OF BARNSTABLE FEE fy ` a�. i�. °. OFFICE OF f�atfiraett � RECEIVED BY MA., BOARD OF HEALTH 1639. 367 MAIN STREET MAI A` HYANNIS, MASS. 02e01 VARIANCE REQUEST FORM All variances must be submitted FIFTEEN (15) days prior to the scheduled Board of Health meeting. NAME OF ,APPLICANT Dcjn P24�kin TEL. N0. ADDRESS OF APPLICANT NAME OF OWNER OF PROPERTY (DO n atC V`1 n SUBDIVISION NAME DATE APPROVED ASSESSORS MAP AND PARCEL NUMBER LOCATION OF REQUEST O 2. SIZE OF LOT �j 6Pcr- SQ. FT. WETLANDS WITHIN 200 FT. OF PROPERTY: Yes No� VARIANCE FROM REGULATION(List Regulation) j tD GtM2 1�`00 ,� SGa,-( q� C a�ac` y 0 6, WoaJ' l' ek'-Qj Caoaf6tCi:� OAp n I otw- C add+ 1Prt' ID X (D REASON FOR VARIANCE(May attach letter if more space is needed) 0 PLAN - rua COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPROVAL S11M G.PW%(i wlv=wn Joseph 0.snow,MA Brian R.Omdy s. _ Town of _ 13AMSfilc \� . 5 5 �� Of)e- 10 x I LLe ct c A 011e'- 2000 'Go L Sep Q ►o• �j� 10.00 G ,-( ! G Rc�)sc T, ,� -)STR I but ; on 'Sox ��: g kc }� in ?; f t ee o be Io " DP , � 1r) DiGmeTe,R LJith o I % Sr�n� BRuce Bugjin9dme Gti� �JUt1C� 4 - .--%SchooL ST. III � K E TTLE -a,,L COUT . j7T Sca C �r� _ v TOWN.OF BARNSTABLE LOCATION /oZ Sc 44-ot SST SEWAGE # .Sep�i VILLAGE Co L f ASSESSOR'S MAP & LOT 3S -5-3 I STALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY d e-e� `,`'C LEACHING FACILITY:(type) /p 'X /L-r t' (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER Y BUILDER OR OWNER [,� rO cp Ilt�-�p� DATE COMPLIANCE ISSUED: f, r VARIANCE GRANTED: Yes No HErp� TOWN OF BARNSTABLE P � OFFICE OF i DAl1IIlTADf,i, S rAee. BOARD OF HEALTH �ppA f blq. \og' DM�YM 367 MAIN STREET is HYANNIS, MASS. 02601 June 17, 1982 Mr. Bruce Burlingame Kettle IIo Restaurant School Street Cotuit, Ma. Re: Kettle Ho Restaurant Dear Mr. Burlingame: You are granted a variance to install a 2000 gallon septic tank, a 1000 gallon grease interceptor and a 10 foot x 12 foot leaching pit five feet from the property line and five feet from the building, in lieu of the required ten feet. The leaching pit will be 13 feet from the building , in lieu of the required 20 feet, at your food service establishment known as Kettle Ho with the following conditions: (1 ) All other regulations contained in Title 5 , of the State Environmental Code, and the Town of Barnstable Health regulations must be strictly adhered to. (2) You are limited to a seating capacity of 50 persons. This variance expires July 1 , 1903. Vey u ,yyo r) L. Chit s, Chai. man Aran J ne, E hbaugh - h)p e F. . Inge, D. BOARD OF HEA TH TOWN OF BARNSTABLE i L TOWN OF BARNSTABLE OFFICE OF • ALTH I A83lT1BL D O F H E D BOAR ■AM s639. ` 367 MAIN STREET �0 M HYANNIS,MASS.02601 December 15, i993 Don patchin P.O. Box 41 Centerville# MA 02635 RE: Kettle Ho Restaurant Dear Mr, Patchin: Your request for a variance from the Board of Health Regulation #11 (Toilet Facilities) , to increase the number of seats at the Kettle Ho Restaurant located at 12 School Street, Cotuit without constructing any additional toilet facilities as required, is not granted. This food service establishment has been licensed for the past several years for a maximum of 32 seats. Your variance request included a proposal to add 34 seats to a total of 66 seats. The existing onsite sewage disposal system is of insufficient size to handle your request for 66 seats. The existing septic system consists of only a 2000 gallon septic tank, a 1000 gallon grease trap, and a 10' x 6' leaching pit with three feet of stone surrounding the leaching pit. Calculations reveal that this is sufficient for approximately 32 seats total only. Additional leaching area would need to be constructed in order to handle any additional seating Please submit to the Health Department detailed design data information from a registered sanitarian or from a professional engineer if you wish to increase the seating capacity above 32 seats. cerely yours, oseph C. Snow, M.D. oard of Health Town of Barnstable JCS/bcs cc: Edward Barry PATCHIN DATE `G0k�," Cylie" To-WN OF SARNSTABLE FEE � f9 OFFICE OF RECEIVED BYE. i�tVAI 19r�eir. '"0 9`� ARD OF HEALTH 'q► 03o• 3e7 MAIN STREET HYANNIS. MASS. 01601 VARIANCE REQUEST FORM All variances must be submitted FIFTEEN (15) days prior to the scheduled Board of Health meeting. NAME OF APPLICANT /��✓ TEL. NO. ADDRESS OF APPLICANT Po- Cox NAME OF OWNER OF PROPERTY �6�✓ ��� G��°'� SUBDIVISION NAME DATE APPROVED ASSESSORS MAP AND PARCEL NUMBER LOCATION OF REQUEST SIZE OF LOT o i9<- SQ. FT. WETLANDS WITHIN 200 FT. OF PROPERTY: Yes No VARIANCE FROM RECULATION(List Regulation) REASON FOR VARIANCE(May attach letter if more space is needed) (j'zPtS7m/Te-d �S�tY/ �/Sy ' e--- PLAN - fnuR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPROVAL A A �d` SusanG.RaskChakwamn Joseph 0.Snow#AM 5— 57 j Fee �6 D THE-COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for �Dizpogal 6pgtem Construction Permit Application for a Permit to Construct( )Repair(vilulpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. f a �C Yt v u �� O�ner's Nacq�,.A�g,,s and Tel.No. Assesso 's Ma /Parcel �dFv�f (Joel �q hrn 01673 P U B o ;it e n4. Installer's Name,Address, Designer's Name,Address and Tel.No. �. F ; system R Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures cl- Seq t_T ,)_ ofX. Irk l r I li{'°'lQL Q Design Flow 805, gallons per day. Calculated daily flow��, gallons. Plan Date Number of sheets Revision Date Title c S{ice.3Size of Septic Tank otAo� G I 1 U(�� Type of S.A.S. Description of Soil exta-Vtnj I V Iezc6 Pi-1- Nature of Repairs or Alterations(Answer when applicable) All P 1!51-14/le V5 t.tJ/ S le•� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of alth. Signed Date /4-0-91 Application Approved by ti Date Application Disapproved for the following reasons - Permit No. ( 7'x Date Issued �"�rr ,n.iY'r5ry'� r,,•n,�"-+„�.J"rL��� _ %r.ws.t4 : + n NOq _ �Z 5-5 Fee t, 3 a t ° THE'COMMONWEALTH OF MASSACHUSETTS Entered in computer:. Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE,,MASSACHUSETTS :application for D.igpont *pgtem Construction Permit ' App adon for a Permit to o struct�( )Repair( Upgrade( :`)Abandon( ) El Complete System ❑Individual Components Location Address or Lot No., J C u u �� ner's Nar�� Address and Tel.No. � �0ltui�' t7Yt l�iC�►%�'1 Assessor's Map/Parcel "� /� /2� I.' 14 OJ -_ 015 O 1 d t Installer's Name,Address'yand Tel.No. �� m Designer's Name,Address and Tel.No. f e rK CGrAOA i N,;... Type of Building: I Dwelling No.of Bedrooms Lot Size sq.ft. ; Garbage Grinder( ) Other Type of Building :s l..r_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures 4 Ste+'lb Z N SSG ------------ Design Flows gallons per day. Calculated daily flow �,rt"f h Ca`+fi� -gallon Plan.Date Number of sheets Revision Date r Title x, ,qg%Wj,qi ize of Septic Tank _a0AON 1 6 T: Iii )1:1 ____Type of S.A.S. Description of Soil ex'tSki Ac� (y X(o leach i+' h Nature of Repairs or Alterations(Answer when applicable) p/ I. +l 1 ,r I Date last inspected: j Agreement: a The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the,provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Iftalth. Signed Date /.) Application.Approved by Date Application Disapproved for the following reasons Permit No.�/_ . 621 Date Issued ------- - ------------------------------ THE COMMONWEALTH OF MASSACHUSETTS, ,i BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( . Upgraded Abandoned( )'by e",q J/d at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this,permit shall not be construed as a guarantee that the system will function as designed., Date { t '1 t Vl Inspector No. Fee --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION,- BARNSTABLE, MASSACHUSETTS Diopozar 6p.5tem Construction Permit Permission is hereby granted to Construct(. )Repair( ✓ Jpgrade( )Abandon( ) �� 65f h n 0,—\ System located at / 1 i;c-C A,Q � and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. jl Date: J 2 10 AL Approved by IIt CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated (a 1 (, , concerning the property located at /0 Sc`� a c� c�� /r, meets all of the following criteria: There are no wetlands within 300 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed There are no variances requested or needed. SIGNED: U)1 � � DATE: / — LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). 2�oc,, Town of agaRnMble. 3(,X �'x \ /VE w One- i ox .--- 00r)c- 2OOO G QL J c , . �.. r io n e- 1000 G a L G i On e -D ;STQ ;bU,; on to be Io Dto P , 6 in DjC4meTc R �J; th BRuce BURIingame _ aAounC� SchooL ST K -1-T L C0) TUiT SCaLe : ► tj - 2 ko. �T . L 0 AST low SEWAGE NO• C D V ILAGE INSTALLER'S NAME i ADDRESS • U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED aY�,� l �� � � '� � ' 4 V I e � �~ � 0 E � - �. �,� . I4 . �� 7 y�� aye � � �_ '. �� � �- �-. � � ,, r No.. ----- -l... Fps. Q.A_............... P p R 0 V E D THE COMMONWEALTH OF MASSACHUfar stable Conservation Commission BOARD OF HEALTH TOWN OF BARNSTA ign �1 1tratio fur Uiipoiitt1 Works Toustrurtion rrmit Date Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: -•-�. ....5. o�.:....---..5. .---...... .�..fi� -�..................................................................... Loc��ti(Qn-Addd=s ,r 'I- /� Q�n� or Lot No .........-.J._) ^T1 Qe.._. � O .../ 1 •" `L= '.,..-__. _..... -------•.------- _.•- .---. --•--•--' ---- -•-•------------------------------------- Owner a : t Address rAess ... c ..-- ---- 1b ..-11.7 � o ------------------------.............. y r'N Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers 0.ai YP g ---------------------------- P ( )--- Cafeteria ( ) dOther fixtures ..---•-----•-------------------•-----------•----------•-•--•----•-•--•...-------•----------------•--------•----•--• ---------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter....--...---.--..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........... ............................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.---.................... 44 Test Pit No. 2................minutes per inch Depth of.Test Pit---...........--.... Depth to ground water........--...........--. a ---------------------------------------------------•---••--•------.............-•------------.-----•......................................................... ODescription of Soil...............................................................................--•--------------------•----------------•------------------------------.......•--...---- x UW -----•=---•-----------------•--••--------•--••••-•--•-••.....----..................-•--•--•---••--------••r- -----.. ....-...------•---------•---•-••.-•-•--/J...-•.--.••---- •.:-..-- . Nature of Rep�aai-r -or Alterations—Answer when applicable...... - nc---- --- ----------Lbea--_- .±.... ..............._. ---r`' .......&7;� --•...................•--••----------------........----------------...-----------------------------....------------ -------•--•--••----•--....... ........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State E tal Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant as been iss ed y the board of health. --- -0 ti Signed ..... ...--- - - -- -- - ---" ................................. .. � .....- ------ -- ------ Date ApplicationApproved By �------ - - - ------------------------------------------------------------------------- � Date Application Disapproved for the following r as, ns- ------- ------------------------------------- ................... ----......---------------------------- Issued � ------------------ e ..............................No. --- �l__...---- --------------------------------------------------------------- ---------------- THE Date COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE V�Prtificate of Tantyliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by..........19...7t�a-........Cin�.Y.0.C.-�---------------------.-- ------ ---- -- Installer at ......I_.L....... ' H.d.(a................6......!.)............cQ-........➢...`-- ---r----- -------- ---- ............................................... ----........ has been installed in accordance with the provisions of TITL f Th tate nvironmental Code s ' ed in the application for Disposal Works Construction Permit No. F ... .......TD ......... dated ....�t' ..._ ------ the application for Disposal Works Construction Permit No. --------- TH- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO S AS A GUAR TH SYSTEM WILL FUNCTION S TISFACTORY. 4 DATE.... �'�� ------------------------------- Inspector ------- "sail THE COMMONWEALTH OF.MASSACHUSETTS BOARD OF HEALTH � TOWN OF BARNSTABLE �x Appliration for Disposal Works Toustrnrtiun ramit � Application is hereby made for a Permit to Construct ( ) or Repair (V'an Individual Sewage Disposal System at: ......................: ...... ••-- • --•-.............••••-••••---••--•-•---••......••----••..........--••-- Location-Address or Lot No A 1. S o►-�._`..... K T �� Q-------�.- i"A U 2A_.. .. ...... ............................ Owner Address a ...... ..±.:!;...... fa'! ?............................................. .... ':. 11_A QUOUTIA._... - Installer ess Type of Building Size Lot............................Sq. feet U DwellingNo. of Bedrooms............................................Ex Expansion Attic a — p ( ) Garbage Grinder ( ) Pk Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ........................-.......................................................................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth.................. Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----_--------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date...............................I........ ,Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..............j........ rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.__._._....................... , t �+ ----------------------------------------•----------•---•---•-------••---------...........•--............................................................. 0 Description of Soil...............................................................................:.................................................................................... . _ x V f--------------------- ------------------------------------------------------ .-..------------ ......._...----------------------------------------------- .------------------- .._..---- ---..-..-----------! W . ......................... ^....:!? ....:..........:..11 U Nature of Repairs or Alterations—Answer when applicable_-__ . +�• +�> .--../�?0o. i''......... .................. 1 � ,-------•----------•--------------------------------------------••----------------------------------•----------•---'---------------------------.... ........ Agreement: t The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance�has been issued 'y the board of health. w 4 _ -Signed hF — ..............................-- ---------------------------------- Date Application Approved By .. ... �_rL.... ----------------------------------------------------- - - -- �� .. �............ ....J.- ----------- ----------------D-ate----------------- Application Disapproved for the following re�'ny: ...................... . . . . ...........:. ........� , .. / ' p-..1! A .�_.. Date Perms No. ..------PL.. ...... ',ff.. . ................... Issued vy - re THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE . C�er#tft.cttte � C�om�ItttrtcP ', THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( L•­' byr�...71 ..........0 P..►. .0 c�--------------------------------------- Installer at .- -+f �`� „- ....e -----.......CO.`.�"U-- -- -�------------------------------------------....------------------------------ has been installed in accordance with the provisions of TITLE of The State Environmental Code as desr'bed in the application for Disposal Works Construction Permit No. ._--_ ....... dated ....� �..'. ��1 r xr THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU.�D AS A GUARA'NTE THAT THEE SYSTEM WILL FUNCTION SATISFACTORY. a DATE--------- --------�o Inspector .. j= ... I �--- ------------ -------------------------- / l I' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No...................... FEE.......o.' ...... Disposal Works T-PaInstrurtion rrmfit Permission is hereby granted......&!)t 7-R.....('..9.1M .c.o.......................... to Construct ( ) or Repair ( g_),,an Individual Sewage Disposal System f atNo.. ? . �_C1 ___. �... "..(.. / ---------------------------- --- •= ---------------- ---- — r r j �........................ Street 6t 1� 1 A 1 111 r as shown on the application for Disposal Works Construction Permit No.,-�.................. Datedn__._-_----_-.-.-_.__..._. ..,....._.. .16 //� Board of Health � DATE......................v- ;a ; �. FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS - . [ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �_�✓ ..... ...............OF...I.��v e,�.s /�LG�--------------...._.......................... Appliratiun for 11i.ipnual uxkg Tvn,trurfiun Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (\4 an Individual Sewage Disposal System at: 1.�.�_......... �5�1 v eh! ................... ........ . l.F...... ........ .._..........._. Location-Ad ss or Lot No. n -......................................... .....Cm!"�i-T........ ................... n -•---Owner. ..............................•.Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa,, Other—Type of Building ............................ No. of persons............................ .Showers ( ) — Cafeteria ( ) Ga Other fixtures -------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width-__-_...___-_-__ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area....___..._.......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit......._............ Depth to ground water........................ • , . Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil......................... yam' x ----•-------------------------------------------------------------------------------------------•-------• .------------------------------•---•------..........---- Nature of Repairs or Alterations—Answer when a licable._______ __ ................. -------------------- -------•------------------------------•------------------------...............----•-------------------------------------------------------------...-----------------•---------••-•. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued by the oard of 4iealth. ned ------- ApplicationApproved By..... -��---......---•----------------------•----•---.....---•----•------•-------•. �{ " e ....... 4 Date Application Disapproved f the ollowing reasons---------------------•----------•-----------------------•---------------- ------------------------------........_ --------------------------•-••-•--•-•-------•-------------------••---------------......---•-•----------..._...........-•--------------------------------------------------------------------------------- Date ............•...... ....................... Permit No-----------------•------•-----._..._. Issued.__...----------•--•------------= Date • ' No.�,r7r 1 ► , Fw3 A$........... ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I P.(a/,t.....................OF... Appliration for Diiipoiia1 Works Tonstrnrtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( , an Individual Sewage Disposal System at l ................ .........I ee --• -- P. ...................................... ,J Location-Address or Lot No. ...... ......... ------------------------------------- --------- ------------------ �,,.a p� ••-Owner,- •-•••-••------•.-------Address �-•••-• -......'�/ �l�:Z,G .......................................•. ....••--•.........-• ._....------•-•--.........------------..... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q, Other fixtures .................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results, Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_________________-______ -------•---•---------••---•----•--••-•-...--•-•-•-------------------------------•-----•-•--•-----••.......................................................... 0 Description of Soil........................................................................................................................................................................ x ---------•--------------------------------------------------------- - - C -------- - ------------------------.............. ---- ------- U Nature of Repairs or Alterations—Answer when applicable.__._.__...• y _- ._______ _.•_____________- ------------------•-------------------•-------•-------..•....._..----•--•------------...........................------------••-------------------------•--------------------------------................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Complianceeshas been issued by the board of health. filled......Z.................:.------••--------------------------•------------------- _ .........to ••-----•----- Application Approved By------ .....�6• ••t�r_.�...{-......:........................................................... ........ _ ........ 4 Date Application Disapproved f the oBowing reasons:....................-----------•--------••--------••--•------•-•-•-------------•......-----••--•-•-•••-•------ -••••••-••--•••••••-••••••--••••-••-•••••••-•••••---•••-•••.........•-•••--•--•••...............••-•-•...._...........-•-•••••••-•-•-•-•-••••••-•-••--•--•------•--•---_.....--•••...•••---••---...•-•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS / ,. BOARD OF HE LTH f.�`f "f.........................OF...... .... ................................... Trrtifiratr of font li nrr e IS IS 110ERTI Y, That the Individual Sewage Disposal System constructed ( ) or Repaired u by--- . ., tt, A ..... --- ------•------- aff '` s� staller V been installed in accordance with the provisions of TITIZ 5 of The State Sanitary Cod as •cribed in the application for Disposal Works Construction Permit �V rdated....ro Y/8' •- o-____'F_�.'"___«�__;.1�............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON E® AS "GUARANTEE THAT THE SYSTEM 1ddILP FU�C�TION SATISFACTORY. DATE......t�' -----•--•---••------...---•-•------•------------- Inspector.-•-- -- .-•-•------...--•---•----••--------•-----••-•----------•-•----....--- THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA TH No.. .... ....... FEE.....vr................. 11ispo 1 Rhkil Tanotnulian ermit Permission is he eb ranted'r '`' ----•--•--------•-----------.•..----•---•---•--•--...-•---•--•-•.......................... yg bosal to Construct).f drkepair;` an 44iwid r evvage System J t str t as shown on/thheplicati for Disposal Works Construction Pe o._2."✓%J_ Dated.._ ___` ' ':............ •.. .................Board .. Health.... ......•=--- DATE•..., ..............•-•..._....---------...........-•--•--•-•--. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Town of Dansfigb�e. -One- i .�O x I L e Q 1') 01 t 00 ' 0 O h e- 1 0 0 0 G- O L_ G- ec(-)s c -T o io -� One. -D ).STO i button Box � eaL h irl ? to be 10 ' Dt( P BRuce BuRlingctm.e Q1� C)un i . SchooL ST K1, LE - H0 e Y COTUiT ScQLe : IN 20 Fr TOWN OF BARNSTABLE + �. LOCATION �� lidt _. r.SEWAGE # 7�, VILLAGE AV-L ASSESSOR'S MAP &LOT j INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 14- !2,#1 LEACHING FACILITY: (type) e-5- (size),n Y 2? o' Y ._ NO.Of BEDROOMS BUILDER OR OWNER Me #lam - 1/ PERMTTDATE: 1 '— I . COMPLIANCE DATE: 1—d- ,�7 Separation Distance Between.the: Maximum Adjusted Groundwater Table and 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) ICI` Feet Edge of Wetland.and Leaching Facility.(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 'Coyeyed L.0 ATI SEWAGE P RMIT NO -VI L LAG E K&7oli I N S T A LLER'S NAME i ADDRESS I U I L DER - OR OWNER i • DATE PERMIT ISSUED �' Z� �Z- DATE COMPLIANCE ISSUED 2v� � l 1 I , rf I7 y� . M - yam. , . • ar,tHETo TOWN OF BARNSTABLE OFFICE OF DAR'S A'DIX, BOARD OF HEALTH MAM 1639 M 1 367 MAIN STREET �0 MAY k' HYANNIS, MASS. o26ot June 17, 1982 Mr. Bruce Burlingame ?` I Kettle 1Io Restaurant School Street r Cotuit, Ma. Re: Kettle 110 Restaurant Dear Mr. Burlingame: You are granted a variance to install a 2000 gallon septic tank, a 1000 gallon grease interceptor and a 10 foot x 12 foot leaching pit five feet from the property line and five feet from the building, in lieu of the required ten feet. The leaching pit will be 13 feet from the building, in lieu of the required 20 feet, at your food service establishment known as Kettle Ho with the following conditions: (1 ) All other regulations contained in Title 5, of the State Environmental Code, and the Town of Barnstable Health regulations must be strictly adhered to. (2) You are limited to a seating capacity of 50 persons. This variance expires July 1 , 1983. Vey/ uyyo L. Childs, C(h afi man Aran J ne. E hbaugh--.. F. Inge, ( . D. BOARD OF IIE TH TOWN OF BARNSTABLE I . �7 -z-, ". -,� ? I t -,,'*' * ",'i�,-,�3*,I f , r -jz- -.1 �." I � ,�, , .44,. , ­ ­ �. , .)t�, , , - �, �. . .. ..",� A.I,4',..,, , t ;1, 4 $-.L ;L 4,,,, �-­,.'­ - . A,4 'j. 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'�,�" ,l -,, , , ,�V ­I , "" V� I -1--f- ,r� t,it , ", ' ,, -, ,w .-"- 144 . , �,' - � ., ? ,. 4" ". � , r li�l f., :",k�, -, i� , .;;;, I _ w I,I.4k.x�� � lk..I . w I .... _ 4 t��4 ,�" `. , �;,�� ,� .1 - �.��;, . I I ��. )j 'O- "I�' '' "' 'A ' , • ,� , 1�I �., �J�, ii p-Cif n Fes- ,; .t,I t, "t,j;;_.: � ..,0,..-L " �1. . V � 0 4, "%"^ . I..,(.r",,..A �." , ,,, ? I­ ," A�­k'�'.",6,2'� .... .�� :,'k, - t June- 1982 To; Town of Barnstable Hvannis. Mass, 02. 01 I Bruce Burlingame request a variance for a set back of a minimum of five feet of rear lot line, and a mi.ni.mum of five feet from rear of Kettle Ho, for the installation of a 1000 gallonerease trap. 2000 -Rallon septic tank. and a 10 x 12 lea;chi njEc pit. Side line set backs will be ten feet. Project Representati..ve Joseph D rte Jr. /r�r,Gc /tom IOIF /d(/CJ C)��� d �•- T� �C v/t�.e� �U /'GAT Q �Gte- GC�Gtu�/y ,Air �=v y /f& Ae $C JT6r��rC / �GsF� � ra d i /,5113 — -- - - J i rY r r;y�', ✓ f• f�'r;':je�'^Y� �f`t�M'.Y�yjy'yi'.. _ � .. _ _ _ _ 1 Town_.of 13_a_ s.tgbl�_. _ -0 n( t e. i o x LeQcJ ' , ®n e 2 O O O G• Q ,- `Sep to . 0h e- 1000 G- Q L G- roc�)s e- T,�3 f) p -� One. utto n JPC)x t , -ta be- )o' De`vP / s 13.BuCe Bu ��_n9�cm.e _ Q1�QUnd =i x S dh- 00 L S T. KETTLE H (J e ' COTUiT SCQLe : IN = 0 FT ULTRA-MAX(M RADIANT CHAR-BROILERS Models 8124RCB, 8136RCB, 8148RCB, 816ORCB & 8172RCB Features/Benefits: * Heavy-Duty Ultra-Max'Radiant Gas Char-Broilers are designed for the most demanding foodservice applications. Ultra-Max" Char-Broilers deliver maximum performance and provide years of maintenance-free operation. * Heavy duty, high strength steel radiant transfers maximum heat to tiq' r steak,chicken, burgers,fish and other menu items. Our exclusive steel radiants with flavor enhancing grooves deliver more heat than traditional cast iron radiants and will not bend or crack due to thermal shock.Three year warranty on Star's exclusive steel radiants! , * 30% more cooking space with our high capacity design to meet all your back-of-the-house broiling needs. r'au * Available in 24",.36",48",60", and 72"widths to fit any foodservice operation's space requirements. * High performance 20,000 BTU straight tubular steel burners every 6" i� of width provide more heat to cook faster and sear in flavor, better heat distribution, and more sectional control. * Heavy-Duty cast iron grates can be individually positioned (flat or Model 8136RCB. slanted)to accommodate a variety of broiling needs. Plus,our grates are reversible with a thin side for searing and a thick side for more delicate menu items. * Large capacity stainless steel water pan for easy clean up. * Stainless steel,5"high,tapered splash guard maintains cleanliness. * Gas convertible in the field with conversion kit supplied with each char-broiler. Units are shipped Natural Gas. * Cool to the touch stainless steel bull nose front provides knob protection and comfortable work zone. * Heavy-duty 4"adustable legs to match the height of other Ultra-Max n , equipment in your line. �in * Floor models available with custom equipment stands. = . * Optional items include 7"extended plate shelf and round steel grates. Applications: Ultra-Max radiant char-broilers are designed for high volume and reliability. Whether it's steak,chicken, hamburger,shish kabobs or other menu items- Star's heavy-duty Ultra-Maxchar-broilers will fullfill your back-of-the-house cooking requirements and more! a> rah Quality Construction: ke Ultra-Max line of radiant char-broilers feature stainless steel side panels, front panel, bull nose,drip pan,splash guard, and grease trough. Model 8148RCB Char-broilers have heavy-duty full polycarbonate graphic panel. Steel Shown with Optional Mobile tubular burners every 6"with adjustable valves and standing pilot. Radiants are heavy-duty steel designed for maximum heat transfer and Equipment Stand durablity. Cooking surface consists of heavy duty, cast iron grates adjustable to flat or slanted positions. Heavy-duty legs are 4"with a C. IIS 1-5/8"adjustment. X. UMWarranty: _ V L ►50-suoaadoo Ultra-Max Radiant Char-broilers are covered by a one year parts and labor warranty. In addition, Star's steel radiant is warranted for 3 years! ] Star Manufacturing International Inc. -10 Sunnen Drive-P.O.Box 430129-St. Louis, MO 63143-3800 .Phone:(800)264-7827-FAX: (800)264-6666-www.star-m g.com S250/0065 .;h z ®J` FM-RMB-600 / FM-SMB-600 Floor Model Radiant or Ceramic Coal Gas Charbroiler 8" 27-1/2"(698.5mm)--{ See Below --I (203.2mm) LL. t9 CO 32" 34" i (889mm) 40" (863.6mm) (1016mm) 5-3/8" 27-3/4" 10-7/8" (136.5mm) (704.9mm) (276.2mm) LL 6-5/8" (16813mm) GAS REQUIREMENTS Gas Type Burner Manifold Pressure Model Gas Input per Hour(Per Bumer) 15,000/20,000 Natural Gas 4"W.C.110 mbars 11 kPa FM-RMB/SMB 624 60,000 BTUs/80,000 BTUs L.P.Gas 10"W.C./25 mbars/2.5 kPa FM-RMB/SMB630 90,000 BTUs/120,000 BTUs 3/4"NPT FM-RMB/SMB636 105,000 BTUs/140,000 BTUs FM-RMB/SMB 648 150,000 BTUs/200,000 BTUs FM-RMB/SMB 660 195,000 BTUs/260,000 BTUs FM-RMB/SMB 672 240,000 BTUs/320,000 BTUs DIMENSIONS Model Floor Space Cooking Area Top Grid FM-RMB/SMB624 24"W x 35112"D 60.9 x 90.1 cm 513 sq.in. 3,314 cm One 20314"W x 24314"D 52.7 x 62.9 cm rid FM-RMB/SMB 630 30"W x 35112"D 76.2 x 90.1 cm 662 sq.in. (4,271 cm' One 263r4"W x 24314"D 67.9 x 62.9 cm rid FM-RMB/SMB636 36"W x 35v2 D 91.4 x 90.1 cm 810 sq.in. 5,233 cm2 One 32314"W x 24314"D 83.2 x 62.9 cm rid FM-RMB/SMB648 48"W x 351/2"D 121.9 x 90.1 cm) 1107 sq.in. 7,145 cmz Two 223re"W x 244"D 56.8 x 62.9 cm rids FM-RMB/SMB 660 60"W x 351a"D(152.4 x 90.1 cm) 1404 sq.in. (9,063 cm� One 20.r4"W x 243/4"D(52.7 x 62.9 cm)grid Two 18"W x 24314"D (45.7 x 62.9 cm)grids FM-RMB/SMB672 72"W x 35112"D(182.8 x 90.1 cm) 1704 sq.in. (11,001 cm� One 241m"W x 244' D(61.3 x 62.9 cm)grid Two 22318"W x 24314"D(56.8 x 62.9 cm)grids Working height for all models is 35"(88.9 cm) SHIPPING INFORMATION Model Approx. Weight - Crated Approx. Weight - Uncrated Crate Sizes FM-RMB/SMB 624 220 lbs. 99.7 k ) 185 lbs. 83.9 k ) 31"x 46"x 40" 78.7 x 116.8 x 101.6 cm FM-RMB/SMB630 260 lbs. (118.4 k ) 225 lbs. 102.1 k 37"x 46"x 40" 94.0 x 116.8 x 101.6 cm) FM-RMB/SMB636 295 lbs. (133.8 kg) 260 lbs. (117.9 kg) 43"x 46"x 40"(109.2 x 116.8 x 101.6 cm) FM-RMB/SMB 648 425 lbs. (192.7 kg) 380 lbs. (172.4 kg) 55"x 46"x 40" 139.7 x 116.8 x 101.6 cm) FM-RMB/SMB 660 565 lbs. (256.3 k ) 490 lbs. (222.3 k ) 67"x 46"x 40"(170.2 x 116.8 x 101.6 cm) FM-RMB/SMB 672 655 lbs. (297.1 kg) 580 lbs. (263.1 kg) 79"x 46"x 40" (200.6 x 116.8 x 101.6 cm) SHORT •- SPECIFICATION Provide MagiKitch'n floor model radiant or ceramic coal charbroiler. Unit shall be gas heated and shall cook by means of gas burners. Charbroiler shall be single unit supported by(specify legs or casters). Unit shall be double-walled stainless steel construction,and fully insulated on all sides. Provide with independent gas burners. Individual burner controls shall be mounted every 4 to 4'/:inches for flexible use. Convertible design allows operator to quickly change from radiant to coal style cooking with an optional conversion kit. Provide options and MagiKitch'n Equipment Corp., P.O.Box 501,Concord,NH 03302-0501 • 509 Route 3A,Bow NH 03304,USA Phone(603)225-6684•Fax(603)225-8472•www.magikitchn.com L10-136 Rev 1 (08/03) Specifications subject to change without notice. Printed s / cr . �" " a ULTRA-MAX' THROTTLING THERMOSTAT GAS GRIDDLES MOMS 824T, 836T, 848T, 860T & 872T Features/Benefits: * Thermostatically controlled with a throttling thermostat control from 150°to 450°F provides accurate temperature control of+/-20 degrees of set point. * Unique internal plate sensor accurately measures the temperature of the griddle plate 3/.16"from the cooking surface for instant P response to surface temperature change and fast recovery. * Available in 24", 36",48",60"and 72"widths to meet your space} and volume requirements. s, * Ultra!Max high capacity 24"deep cooking surface is ideal for high -.:+»�",.*- volume operations. * Highly polished 1"thick steel plate for superior heat distribution, Zl fast recovery and energy efficient operation. ��bc.. * Custom designed steel 30,000 BTU burner every 12"of cooking ' surface provides superior cooking performance. * Heavy-duty construction with all-weld body construction and stainless steel front,side panels,bull nose and splash guard. 848T * "Euro-style"design with stylishly curved, ergonomically advanced front panel providing easy access and viewing of controls. * Standing pilot light for consistent performance. * Spatula wide 3-1/2"front grease trough and grease chute for easier cleaning. . * Large 5 quart stainless steel grease drawer(2 drawers on 50"and 72"models). * Extra-heavy 4"adjustable legs to fit your countertop needs. * Floor model stands available for free standing unit. Optional casters available. Applications: • Ultra-Max Throttling Thermostat gas Griddles will exceed your food service operations expectations. Designed for high performance and reliability. Ultra-Max griddles will provide years of trouble free opera- tions. Construction: " Ultra-Max thermostatically controlled griddles feature 1"thick highly polished steel griddle plate with 5"tapered stainless steel splash guard and 3-1/2"wide front access grease trough with 6 quart grease drawer 836T capacity. Includes a 30,000 BTU aluminized burner every 12"of width Shown with Optional Floor Stand A controlled by throttling control valve with standing pilot light, 3/4" N.P.T. male gas connection with convertible pressure regulator, and 4" adjustable legs. GM-FIRED Warranty: Ultra-Max gas griddles are covered by Star's one year parts and labor c(DUS LISTED <; warranty. c_UMMATION x IM9ooI:z000 � }n Star Manufacturing International Inc.-10 Sunnen Drive-P.O. Box 430129-St. Louis, MO 63143-3800 ' Phone:(800)264-7827-FAX: (800)264-6666-www.star-mfg.corn.. S203/0106 M IW, Y . !Star Manufacturing International Inc . ULTRA-MAX° THROTTLING THERMOSTAT • GAS GRIDDLES • Models 824T, 836T, 848T, 860T& 872T A B 1 30 5/8 t [77.acrA] ---------- • 13 9/1fi [34.4CM] ' 57 16 4 [13.811 GAS IN Er 22 1/4 Dimensions Model (A) (B) (C) (D) No. Plate Approximate Weight No. Width Depth Height Leg Width Controls BTU Grid Area Thickness Installed Shipping Inches Inches Inches Inches 824T 24" 32-3/8 18" 21" 2. 60,000 573 sq.in. 1" 220 lbs. 246 lbs. © (61 cm) (82.2 cm) . (45.7 cm) (53.34) (3,697sq cm) (2.54 cm) (993,kg) (111.5 kg) 836T 36" 32-3/8" 18" 33" 3 90.000 860 sq.in. 1 330,lbs. 369 lbs. (91.4 cm) (82.2 cm) '(45.7 cm) (83.8) (5,545 sq cm (2.54 cm) (149.5 kg) (167.2 kg) 848T 48 32-3/8" 18" 45" 4 120,000 1146 sq.in. 1" 440 lbs. 492 1bs. (121.9cm) (82.2 cm) (45.7 cm) (114.3) (7,394 sq cm) (2.54 cm)' ... (199.4 kg) (222.9 kg) 860T 60" 32-3/8" 18" 57" 5 150,000 1433 sq. in. 1" 550 lbs. 615 lbs. I, (152.4 cm) (82.2 cm) (45.7 cm(144.78) (9,242 sq cm (2.54 cm) (249.2 kg) (278.7 kg) 872T 72" 32-3/8" 18" 69" 6 180,000 1719 sq. in. 1" 6601 738 lbs. (182.9 cm) (82.2 cm) (45.7 cm) (175.3) 11,091 sq cm) (2.54 cm) (299.0 kg) (334.4.kg) Gas griddles are constructed of stainless steel,valve knobs are protected by a stainless steel bull nose front: Griddle plate is 1" (2.54 cm)thick highly polished steel plate with a 5"(12.7 cm)high tapered wrap-around stainless steel splash guard. Unit has a 3-1/2"(8.3 cm)wide front grease trough with with grease chute and a 6 qt.(5.68L)capacity stainless steel grease drawer. Models 860T and 872T house two each 6 quart grease drawers.Units are equipped with a 30,000 BTU aluminized steel burner for every 12"(30.5 cm)of width and are controlled by a throttling control valve with standing pilot light,3/4"N.P.T.male gas con- nection with convertible pressure regulator.Griddles are supplied with 4"(10.2 cm)high stainless steel legs that have a 1-5/8" (4.5cm)adjustment. Units are approved for installation within 6"(15.2 cm)of combustible surfaces and are.UL and CUL Classified and UL classified to NSF Standard 4 Sanitation.Printed in the U.S.A. Due to periodic changes in designs,methods,procedures,policies and regulations,the specifications contained in this sheet are subject to change without notice.While Star Manufacturing exercises good faith efforts to provide information that is accurate,we are not responsible for errors or omissions in information provided or conclusions reached as a result of using the specifications.By using the information provided,the user assumes all risks in connection with such use. Star Manufacturing International Inc.-10 Sunnen Drive-P.O. Box 430129-St.Louis, MO 63143-3800 Phone:(800)264-7827-FAX:(800)264-6666-www.star-mfg.com KETTLE HO OLD OWNERS 1966-2006 . N ATT I C Nog — —J T ee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS a Zipplication for �Dig oot &Paem Con6trurtton Permit Application for a Permit to Construct( )Repair(V<Up grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. f a ,,Sc n v o/ cJ ge�ner's Nang Add{ess and Tel.No. �o�vT�' OYi f?4�CNin AssessO 's Ma /Parcel p ,oL �J, 3� 037 o 6 O � ; e_ n4eL 94 Installer's Name,Address;�n a ® �� Designer's Name,Address and Tel.No. Spf aem 350-Altai^ c.. C n en Fp e W.YarmMlth MA 02fiZ3 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building — No.of Persons Showers( �. Cafeteria( ) Other Fixtures q. er � Le Design Flow ���1 gallons per day. Calculated daily flow allons. Plan Date Number of sheets Revision Date Title ,oce5Vin�Size of Septic Tank Type of S.A.S. I 4 n� Description of Soil Nature of Repairs or Alterations(Answer when applicable) _Tn A All X!J f i`n i /� S f r» Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance wi..h the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Boar of alth. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. �/ - 6 7 3- Date Issued lAttith a 8-kete►r plan ortne proposea system. t%wv,r u10 f1W1KDGu 1110calms VVOa 0 0 a w.v,rw r—r....., this plan should be submitted). �'X /V IL -- - . TOWN OF BARNSTABLE LOCATION , �� �� c SEWAGE , VILLAGE f L �,� ASSESSOR'S MAP &LOT 03L, INSTALLER'S NAME&PHONE NO. �/� SEPTIC TANK CAPACITY -201JZI 1 ladeLl '�1 �j ( ' LEACHING FACILITY: (type) Y size) ad NO.OF BEDROOMS- BUILDER BUILDER OR OWNER Ae- f7/ PERMITDATE: J t ' . ---COMPLIANCE DATE: 1—d- ,f Z Separation Distance Between the: Maximum Adjusted Groundwater Table ind-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) 1 Feet Edge of Wetland,and Leaching Facility.(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by I _ ii • 0 ® a i I- TOWN OF BARNSTABLE INSPECTION WORKSHEETci CERTIFICATE NO: 21245 CANCELLED: MAP: r 035 DBA: IKETTLE HO PARCEL: 053 NAME/MANAGER: IDON PATCHIN STREET: 112 SCHOOL STREETi VILLAGE: ICOTUIT STATE: MA ZIP: 02635- SEQ NO: 1❑ BUSINESS TYPE: IRESTAURANT CONSTRUCTION TYPE: 15B STORYI: CAPACITY: F 75 USE1: A-3 Capacity Under 50: C STORY2: CAPACITY: USE2: STORY3: CAPACITY: USE3: Outside Seating: r BY PLACE OF ASSEMBY OR STRUCTURE CAP1: 50 LOCI: DINING AREA CAPS: L005: CAP2: 25 LOC2: BAR CAPE: LOC6: CAP3: 75 LOC3: MAXIMUM CAPACITY CAP7: LOCI: CAP4: 1 LOC4: CAPS: LOC8: INSPECTION: DATE ISSUED: EXPIRATION: ^t ��&fier 64IZ8= 1 04/01/2006 L 04/01/2007 COMMENTS: rr 8>CT TITLE �+l U '�. � `n.,,'t'i C S 1(-li. �-l-.F� fit._f.,eR �-✓%.:s:�,.�o-✓ .. vL pt - _ tr _ \ rbr. ARE i �1 �; � _ 1. !,i 1 � r ��• '\. i tl l�s I t � it { k Central Con n Company, Inc. 5'lc�w �p a�lir�•l id J- ..___ adk£Excitentent is fail in g w 020 Main SIMI•Gatuit,MA+08-420.1��U . _._. ihlktgite w +.: riatcapor+atrRArtion.,c:cafro DRAWN JOB ' � f NO.O. .+a.a. tr:E 7 •`'`� �p� s J e e r I s - ����i`,;,� Ian:,•,� :-�:� —; 5 ( ` .� I G- jr s ;Jil NA, i ( } j t f t - ` _ eG t 30 ftVn,:c_ - 46 ' `, L' ff �~ \ J _t bra cm-, � E l iI • � __' i E {� ---d••1 U�4.._.V Elf - / t i ..�•..... — _ — - —- - - Central Construction Companyt Inca 'Sieve DMit?0 president "The EvOmment is Building 820 Main Sep et a Gotuik,MA,508.420-1340 - - mdll:cartt, �'�8�&:4k� '4kYV'�f.t:9F'!Y+"�iGslkJ�Ce3�'i�itg$Ck1U11.15Ss}�1 3 t i Lai?TL � _ H 1 O G N ._ .2 �...... �, DESMN ila Jli �i 2� _. ._...._.. . - -......._......._ r 11 4,, t .._ �r (Yf"�`fit• � f ! T. .F ci J*fzLl ri. - i 17 pi �fitvv' �- 4 R� 9 } i Y ! y, Inc* ' 1 - Veve F'111 •f ti"iHa rc D?1 The Ex.f*- vMenf is saitftg _,._... .•tom` A.'-` R w. . . - _ �210 Af19113,Stroot d rput bit,M4+508-4'20.1:.} k Ei---iil��t9l: fig+�ti��Gi7s7i�tfLlct#f�tt:�:fi �PTiRll.s�i7! 36 4Ps�3�€ftJ: �Vr?tf.GltFii� l.tGtl�il,.t:d�i i iLl j f ' ��tit` yr3AG NCs, DES CHECK DRAW,# Y r {•� /-i i i s 14 , PPEPAPUD FOR i. 4 i F li !3tts. 70 �v �J Centel Construction Company, Taco 10f, "The Exs*ePwwt b Building" 820 Malay Stteet o(,intuit.PEA-508x420-1340 mail:cantralLonstr'uctioncoQ", it,cot wahs:ite.www.>:=�r�tralr. r".ris�atff?.scdfort. e� E `J DA _j[4 i _�.. _ i i HEC:K_ j f MEN WOMEN UTILITY& LAWS a 000 114 5F. OO OO Di�O - OO : Oa OO � 0 00 0 I, Li OG/' o KITCHEN : O 359 SF > , 19 2 OLL ----- -----_ OO O,O O � oO o 00 � 0 13 �✓ O 7 , I - --- RESTAURANT O ENTKANGE • 46 SEATS — 009 SF. O O O 900000 12 SERVICE EX15TING EQUIPMENT 5CHEDULE _ _ 359 SF. -- t ' 1 SIZE I BTU-INLET REMARKS # DESCRIPTION ELECTR G 1 REACH-IN FKEZZEK 36" X 32" 120V, 18 � - 00 0 EEL }'IZlrf TABLE I ,I --- - 14 Q 2 5TAINLE55 sT 5 X 30 O� � UP ;_ o 0 0 0 5TAINLE55 STEEL DISH TA13LE 1 L 3 5 X 301, — - ------- 4 D15HWA5HEK 24 X 24 27 6 25 ( 24 _ E IYER'Y— � �VICE � D L 23 5 INLE55 STEEL 3 BAY 51NK 50' X 25 = V 12A S F. o o W 2 0 0 -- Q 6 WALK-IN COOLER 8' X8' _ 7 SAND WICH I'KEP TAB LE 2T X 26 4 b „ E r r D , > '�aBf~E 7 X 3 I OKK 8 SS STEEL W STAINLE 1 _ 9 5TA{NLE55 STEEL WORK TABLE 61 X 30 a A Fio 10 CONVEGtiON OPEN 38 X 36PR01'OSED CAFE 11 60 1/2 X30 558 SF 6 BURNER sTOVE W/GRIDDLEo :.. o .. ,.. Beats... U . - 16 X 30 12 FKY 0 LAtOK m!� N N • 42 X 20 I `a � 13 2 BAY UTILITY 51NK � _ � _ E E � 14 E MAKER 24111911 L 5 BURNER COFFEE C 15 5EKVICE CCU NTEK 8 X 3 �3O�) - - _ cz II OFFICE ! 03 m 16 MILK Dlsf ENSE}� 26 X 19 t to _ O 97 5F. 17 BACK BAR COOLEK 72"X 24 7/8 18 PASTRY DISf LAY UNIT 14 X 3 New walls or artfon5 19 5EKVICE COUNTER 72"X 28" .- Z-...:....... ..:.. ..:.. ..... 20 GKIDDLE 36"X 25" : 11 it ... .. 21 MICRO-WAVE OVEN 18 X 20 PROP05ED CAFE EQUIPMENT 5C EDUL . 22 FORMICA 5EKVICE COUNTER 5'-0" X 2'-D" 23 CASH REGISTER' 13"X 141/2" m -- `u W � � UNDKECOUNTEK KEFKIDEKAtOK 23 7/8 X 23 °° rl 24 X 22' 25 12 DEEP COCKTAIL UNIT 26 51NK — --: __ J G ---------- — --- 1v ! Xl 3 0 � r,.� E � a� W 50"X261/2" u � � O -=_ a 27 BEVERAGE COOLER I � � E E 28 UNDEK GOUNTEK GLA55WA5HEK 23 5/8" X 23 5/8 --- --- ou - 0 29 2T T) LEV15ION N � o '++ O --- --- I � � m o � Z N � 30 � NEW!3PAf EK DISPLAY 5HELVE5 8-0 16 Y � O- .. W 31 UPKIGHT BEVERAGE COOLER 29"X 36" 32 ' UPRIGHT BEVERAGE COOLER 44' X 34 3/4' 331 ICE MEKCHAND15EK 301/4 X 291/4 DRAWING TYPE: seating & Eq,uipment flan do r O 9 SHEET NUMBER: I