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HYANNIS ELKS - FOOD (2)
HYANNIS ELKS � 852 Bearse's way 1 Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. raAWNSTAB e, F.P.(Thomas)Lee,. IMAM Daniel Luczkow,M.D. Alt. 039• tim 200 Main Street, Hyannis, MA 02601 ��N1P�A 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: 248 Issue Date: 01/01/2022 DBA: HYANNIS ELKS LODGE FRATERNAL OWNER: HYANNIS ELKS LODGE FRATERNAL #1549 Location of Establishment: 852 BEARSE'S WAY HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 237 OutdoorSeating: 0 Total Seating: 237 FEES FOOD SERVICE ESTABLISHMENT: $300.00 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, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: A. For Office Use Only: Initials: �'"F'°' .� Town of Barnstable h - Date Paid Amt Pd Inspectional Services Public Health Division Check# 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 Ndy 44�6a\ NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: I�rS�O /` �� A" v� 4 y q ADDRESS OF FOOD ESTABLISHMENT: S MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: '271 - / ` '�� "�� • ' TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NOX ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: '2k SEASONAL: DATES OF OPERATION: ©bto/XTO/Cl 411 NUMBER OF SEATS: INSIDE 037n OUTSIDE: "Ir- 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) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-86246" lication Form T D P 2 2O.doc Q•1App s 00 AP 0 OA a. OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO OWNER PHONE# ADDRESS CORPORATE OWNER: CORPORATE ADDRESS: 14 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 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 1.h C�.l l `Y /C � 1. •�1 f C 1 2. �] m Pam , =l SIGNATURE OF APPLICANT DATE i ***FOOD POLICY INFORMATION*** FOOD SERVICE:All seasonal food establishments including mobile trucks must be inspected b the Health Div. SEASONAL g r Y prior to opening!! Please call Health Div.at 508-8624644 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 httii://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 I st to Dec.31 n each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC Ist. ' s Q:\Application FormsTOODAPP REV3-2019.doc `oFtNE r� TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: liPage: of 4 OFFICE HOURS BARNSTABLE o: PUBLIC 0 MAN STREEETSION � 3: - :3 A.M. :300-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mAss. �r MON.-FRI. HYANNIS,MA 02601 508-862-4644 No Reference R Red Item PLEASE PRINT CLEARLY 'FON1P'p FOOD ESTABLISHMENT INSPECTION REPORT Name -Type aEftpect ion O R ine Address Risk iggLeWwlR � Level Retail— Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: def 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 ()�'yv►`w9 ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS `, ,fix ❑ 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 i ❑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 1� Critical(C)violations.marked must be corrected immediately. (blue&red items) l V 9 ;1,1 Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo Emergency Closure Voluntary Disposal Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 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 aright to a hearing. Your request must violations observed,7 to anon-cri 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address non-critical violations. If 1 critical refrigeration. violation,4 to 8non-critical violations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. = ture Print: Si 30.Other DATE OF RE-INSPECTION: Inspector ,��],� /31.Dump ter screened from public view „/�, "v`' n _ �& Permit Posted? SLY N Grease Trap Previous Pumping Date Grease Rendered Y N 1^ #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature4;;�? Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted. Y IN - 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* 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*Other* 590.004(F)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 Se azation-Storage*Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An __ __ 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 590.004 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* (11) q 590.003(G) Reporting by Person in Charge* _ -. - Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR I 3-306.14(A)(B)Returned Food and Reservice of Food* 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 ( ) P 4-501.111 - Manual Warewashin Hot Water 7.206.12 Roden[Bait Stations 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical 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 Watei* - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water froui.an Approved System* Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* sg c"°e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11- - Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) 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 IS sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing g' P ry Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* practicOther es should violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding RequirementsId be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.11 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11 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 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* 1 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �F IKET TOWN OF BARNSTABLE HEALTH wSPECTOR,s Establishment Name: Date: Page: of OFFICE HOURS RARNSTAtlLE,O` PUBLIC 0 MAIN LTH STREEET 3:30-4:30 P.M. DIVISION : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified p39. �0� HYANNIS, MA 02601 - - MON.-FRI. No Reference R-Red Item. PLEASE PRINT CLEARLY 8- 62-46 prFo MPr p' REPORT 50844 FOOD ESTABLISHMENT INSPECTION Name / Dat 1444 a oIf n c i n °I O erat' outine Address Risk ood Service.. a-I ection Level a a1 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 ® JX In:� Other Inspector Out: 411 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 v v ❑ g g ❑ 13.PROTECTION F Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives \V1' ❑ 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 fun ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Recprds/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS,FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY (L� ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories �V Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violation Critical(C)violations marked must be corrected immediately. (blue&red items) (i Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating y y ❑ Voluntary Compliance ❑ 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 0 Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed;7 to anon-critical violations. If 1 critical refrigeration. violation,4 to 8non-Critical violations=C. 29.Special Requirements (596.009) within 10 days of receipt of this order. 30.Other, PATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dump'ster 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 P Signatur Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N < � Grl v �� Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 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 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 5 590.004(F)Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45*F EMPLOYEE HEALTH,. 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * Other* 3-501.16(A) Hot PI Maintained At or Above 140°F 2 590.003(C) Responsibility of the Pelson-in-Charge[0 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y * P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products 4-501.112 Mechanical Wazewashing-Hot Water Monitoring 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Equipment* 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* Eff-nve uinooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization Hat Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )(b) 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 CommerciallyProcessed RTE Food-140°F* (Blue Items non-critical 23-30) 3-202.15 Package Integrity ( ) Critical and non-critical violations,which do not relate to the Foodborne * 12 Prevention of Contamination from Hands 3-403.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated �) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.1 A CoolingCooked PHFs from 140'F to 70°F 3-202.18 Shellstock Identification ) 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41'F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE r TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: `�-- lr Date: Page:-�of q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified BARNSTABLE. MON.-FRI. "rEu ren+"�0 HYANNIS, MA 02601 sos-asz as44 No Reference R-Red Item. PLEASE PRINT CLEARLY , FOOD ESTABLISHMENT INSPECTION REPORT Name (A y1✓►i f S Date Tyne of Type of Inspection r G O r ns Address Risk 'e e-inspection �G r v ' Level alb Previous Inspection Telephone Residential Kitchen Date: r Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness t _ Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP o �,r ^ n(� In: Other C� -I-�. sr V Inspector G ` e-S Out: Lodi�? Al C r i s. W c. cn a Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. G ) Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 3 Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ AI �✓� 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 HSPt ❑ 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 g4es Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating oluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,th 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 9 if no critical violations observed,4 too 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27 Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Ni 27. 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 to anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 no ritical violations=C. 29.Special Requirements (590.009) y P , 30.Other DATE OF RE-INSPECTION: InXpector ! Prin.31.Dumpster screened from public view 1 _ ✓1 VW Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N#Seats Observed Frozen Dessert Machines: Outside Dining Y N PI Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y . N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from EachIdentifying * 590.004(F) P 7-101.11 Information-Original Containers Other* g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P 8 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* )590.004(11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 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* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical 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. 18 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils an Eggs d Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg«nw 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A D Violations of Section 590.009 A D in cater- b 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( )-( ) ( )-( ) Ratites-165°F 15 sec* Sources* 1 p Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arens* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (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 3-101.11 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* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204A I 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 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. Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BA►RNSTABLE, � Paul J.Canniff,D.M.D. 9 MA F.P. Thomas Lee Alternate 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: 248 Issue Date: 01/01/2021 DBA: HYANNIS ELK LODGE FRATERNAL S OWNER: HYANNIS ELKS LODGE FRATERNAL #1549 Location of Establishment: 852 BEARSE'S WAY HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 237 OutdoorSeating: 0 Total Seating: 237 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: AID:S oFINE r f• Initials: � Town of Barnstable Date Paid Id. U Amt Pd$ Inspectional Services BnaNsrest.e, + �y p a l "''y Y MA3S. 8, "1 '� Public Health Division Check# U jDrFc Ma+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 DATEp'e�o NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: gYG-V)Vl( e, 6-115 8 ?OC: ADDRESS OF FOOD ESTABLISHMENT: S d �e�.c5 1S U��y , �1 M!aV—%I MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: Ll�/orn 1�d S `�F��[p? C21�1a�1 CQ W1-- TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ) TOTAL NUMBER OF BATHROOMS:_ WELL WATER: YES NO (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:_ SEASONAL: DATES OF OPERATION:gLAg L_j TO&/_3L/_&] NUMBER OF SEATS: INSIDE: OUTSIDE: 0 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 WAI'TSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc i OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO OWNER 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 z 2S-l z(J new. out r Z3 2� CV f (aSs. Sc,.v� , (o ;?% ca° 2. /<�C v, �Jl�� / / �cNVt YLS vQ�-5 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** "c 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.asy. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3 V each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:\Application FonnsWOODAPP REV3-2019.doc — I fp4 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. • a�sNr�aw 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, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 248 Issue Date: 12/10/2019 DBA: HYANNIS ELKS LODGE FRATERNAL OWNER: HYANNIS LODGE ELKS FRATERNAL #1549 Location of Establishment: 852 BEARSE'S WAY HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: Indoor5eating: 237 OutdoorSeating: 0 Total Seating: 237 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G 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: V Town of Barnstable _ For Office Use Only* Initials: Date Paid Amt I'd S MAN STABLE : Inspectional Services t9! Public Health Division Check# Thomas McKean,Director 200 Main Street,Hyannis, Iv1A 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE I NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT:}f&a\yL,nc,S ADDRESS OF FOOD ESTABLISHMENT: �J� @c,,c S Ls-IS (J`.2�� YT NC 13 I' 0 ( G J MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: k 40,X" a S' 'QVV1 cC VV TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: _ WELL WATER: YES NO__4- ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:_ SEASONAL: DATES OF OPERATION:UI /C�L/'hjOj6_/3/1')' NUMBER OF SEATS: INSIDE: 7 5� OUTSIDE: TOTAL: S SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? � IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? Aj C� TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V--FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REOUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QAVApplication FormsTOODAPP 2020.doc w.E, 1 OWNER INFORMATION: FULL NAME OF APPLICANT /�f�1 —. t SOLE OWNER: YES QO OWNER PHONE#<-Cj '7} (�_ S� ADDRESS j1`, CORPORATE OWNER: CORPORATE ADDRESS: ( , q 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 11/3;Lj)!�j_T b A sN(:!j ✓A SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div, prior to 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/apiilications.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.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Application FormsTOODAPP 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. aAMNSTAUM John T.Norman v MAM F.P. Thomas Lee Alternate +539 200 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: 248 Issue Date: 12/20/18 DBA: HYANNIS ELKS LODGE FRATERNAL OWNER: HYANNIS LODGE ELKS FRATERNAL #1549 Location of Establishment: 852 BEARSE'S WAY HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 237 OutdoorSeating: 0 Total Seating: 237 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: -- - -- - - - MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: j FOR ESTABLISHMENTS WITH SEATING: j PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE j Restrictions: TIME y� ' 'own of Barnstable For Office Use Only: Initials: o Date Paid � Amt Pd$ 6D STABLE, « Inspectional Services v�plED s�e� Check# �- ) 'l/ o&Plr Public Health Division Thomas McKean, Director Iw ' 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE I NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: O'er 2� 5 �� �27,66) MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: 1\-,1Q sn 14 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: tic - 119 TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO_)�_... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: < SEASONAL: DATES OF OPERATION:fL/�!L//q TO /V/L$ NUMBER OF SEATS: INSIDE: ! OUTSIDE: TOTAL: Isa 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 PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT 6 � C--7„'J K SOLE OWNER: YES/NO OWNER PHONE# �� - ADDRESS_ p� � � o�< LQ l 4.►`�/ N�G�U,-It( I Q CORPORATE OWNER: P�A-- FEDERAL ID NO. : r~1/tJ (� / o11 ` 9 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 ller en Awareness Expiration Date zu Q t j2p7_1 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to 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.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPPREV2018.doc IN RE: PETITION OF HYANNIS ELKS HOME r .PETITION FOR VARIANCE OR RELIEF I. Facts: The Elks Home is located on Bearse's Way in the Village of Hyannis and is a national, fraternal organization: The premises has two full stories with a member's bar downstairs and a bar, dining room/function room and kitchen. The member's bar is also separated from other rooms on the first floor by a supply room and a bathroom. The Home requests a variance for the first floor bar area only which does not serve food. The Elks Home is presently in full compliance with the regulations as passed. II: Issues: A. Do the regulations as passed apply to private clubs with members only? B. Does the Board, under its present regulations, have the power to grant a variance of the regulations? C. Can a variance be issued for a portion of a facility or is the variance inextricably linked to the whole,licensed p"remises. III. Arguments: A. The regulations as passed do not apply to a private, members only clubs. The regulations provide under Section III - Definition as, subsection A and D clearly state the licensed premises would be those that serve "the public" or "guests". A member is neither "the - public" nor "a guest." The courts of Massachusetts have long held that a statute (or regulation) cannot be stretched beyond its fair import. Words of a statue are to be awarded their ordinary meaning and approved �usuage. The courts strictly interpret the language of any regulation when sanctions and/or penalties are being enforced; any ambiguity usually results in a finding against the enforcing authority. The Hyannis Elks clearly does not serve alcohol or food "to the public" and this argument is limited to defining the word "guest". The regulations and chapter 111 of the general laws do not define guest. This definition must be obtained by ordinary meaning or approved usuage in the law. Black's Law Dictionary states that a guest is "a person who is received and entertained at one's home, club, etc., and who is not a regular member". The legal definition of"guest" and/or "member" can be gleaned from several areas of Masachusetts law dealing with municipal licensing, including chapters 138 and 140 of the general laws. None of the general laws treats "guest" as a synonymity for "member". B. A Board has the power to grant variances under the provisions of any regulation promulgated under chapter 111 of the general laws. See Tortorella v. Town of Bourne (1995) 665 N.E.2d. 633. But the petitioner believes the Town's Board of Health must provide for relief or variance in its own regulations before it is empowered to grant such decisions. C. If empowered to grant a variance, the Board could designate areas in any portion of a building for smoking. The regulations presently allow smoking under certain circumstances in a function room/hall within a food service establishment. The petitioner in submitting the above arguments feels like the condemned man supplying the rope to hang himself. But a variance granted without authority is a nullity and any legal decision in favor of the petitioner would be short-lived if based on definition alone. Respectfully submitted, am s F. McGillen Ju a Advocate r N F tHE 1p� Town of Barnstable . '" MASS, Board of Health s6;q 9� 10� iOTEp 39 6 P.O.Box 534,Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 July 13, 2000 Mr. Al Souza Hyannis Elks #1549 852 Bearses Way Hyannis, MA 02601 Dear Mr. Souza: Your request for a variance from PART IX, SECTION 2.00, of the Board of Health Prohibition of Smoking Regulations, to provide an indoor smoking area at the Hyannis Elks #1549, located at 852 Bearses Way, Hyannis, is not granted. The Board of Health Regulations specifically prohibit smoking in all food service establishments, Lounges and bars. On April 5, 2000, you filed a request for a variance from the provisions of the Town of Barnstable Smoking Prohibition Regulation, which was adopted by the Board of Health on February 10, 2000 and became effective April 3, 2000. (See copy attached hereto as Attachment 1). In your request you stated that the Hyannis Elks first floor area is for members only. On March 15, 2000, June 12, 2000, and on July 10, 2000 public hearings were held before the Barnstable Board of Health, at which time the applicant was given an opportunity to provide the Board with information in support of the variance request. The applicant, represented by counsel, provided the Board of Health with a detailed legal memorandum. The applicant presented information indicating that the first floor bar is only open to members of the Hyannis Elks, a national, fraternal organization. However, you stated that a member may bring guests to the first floor bar area. Also, any person can become a member of this organization if he/she is over 21 years of age, he/she U. S. Citizen, has no felony record, and has no associate membership. The applicant also presented information that the first floor bar area is separated from other rooms on the first floor by a supply room and a bathroom. No food is served in this area. Section VI of this Board of Health Regulation Part IX, Section 2.00 specifically states "any smoking bar in existence as of the date of publication of the notice of a public hearing regarding this regulation Fnay apply for a variance before the Board of Health from this regulation." Smoking bar is defined as "an establishment whose business is primarily devoted to the selling of tobacco products for consumption by patrons on the premises and in which the serving of limited foods are incidental to the consumption of such products. An establishment which serves full meals is not considered a `smoking souza f bar' for the purposes of this regulation. An establishment which serves appetizers and snacks may be considered a `smoking bar' for the purposes of this regulation." Section III, of this Board of Health Regulation defines bar/lounge as follows: An establishment with a food service license, devoted to serving. alcoholic beverages for consumption by guests on the premises, in which the consumption of food is only incidental to the consumption of such beverages. Based on the information presented, the Board finds that the applicant failed to demonstrate that the Hyannis Elks #1549 first floor bar is not a bar/lounge as defined in the Board of Health Prohibition of Smoking Regulation Part IX, SECTION 7.00. Furthermore, the applicant failed to demonstrate that the Hyannis Elks # 1549 meets the criteria for a variance established under the regulation. Upon review of the evidence presented, the Board finds that you do not meet the criteria consideration of a variance under SECTION VI of the Board's regulation. Accordingly, your request for a variance from the provisions of the Town of Barnstable Smoking Prohibition Regulation is hereby denied. Sincerely yours, Susan G. R sk, R.S. Chairperson Board of Health Town of Barnstable SG R/bcs cc: James F. McGillen, Judge Advocate souza I_ PART IX: PROHIBITION OF SMOKING REGULATIONS SECTION 2.00: REGULATION PROHIBITING SMOKING AT FOOD SERVICE ESTABLISHMENTS,LOUNGES, and BARS ADOPTED 2/10/2000,EFFECTIVE DATE 4/3/2000 ' �P�pF tME r�ti Town of Barnstable MMMSTABM 9�A "�: ,m� Board of Health TED MA'S A P.O.Box 534,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. REGULATION PROHIBITING SMOKING AT FOOD SERVICE ESTABLISHMENTS, LOUNGES, and BARS SECTION I - FINDINGS AND PURPOSE WHEREAS, Environmental Tobacco Smoke is a leading public health problem in the Town of Barnstable and throughout the United States; and, WHEREAS, there exists conclusive evidence that Environmental Tobacco Smoke causes cancer, cardiovascular disease, respiratory disease, negative birth outcomes, allergies and irritations to the eyes, ears nose and throat of both smokers and non-smokers; and, WHEREAS, the Environmental Protection Agency (EPA) has designated Environmental Tobacco Smoke to be a Class A carcinogen, similar to radon and asbestos, with no known safe level of exposure; and, WHEREAS, children, the elderly, individuals with cardiovascular disease, individuals with impaired respiratory function, and asthmatics are among those people who are particularly susceptible to the harmful effects of inhaling Environmental Tobacco Smoke, THEREFORE, pursuant to Massachusetts General Laws, Chapter 111, Section 31, the Town of Barnstable Board of Health adopts the following regulation, to be adopted for the express purpose (1) to protect the public health and welfare by restricting smoking in all restaurants bars and lounges; and, (2) to assure smoke- free air for non-smokers; and, (3) to recognize that the need to breathe smoke- free air shall have priority over the desire to smoke in an enclosed public area. PAGE 1 OF 5 SECTION II -AUTHORITY The Town of Barnstable, pursuant to Massachusetts General Laws Chapter 111, Section 31, adopts these regulations as reasonable health regulations designed to protect and improve the health of its residents. SECTION III - DEFINITIONS a. Bar/Lounge - An establishment with a food service license, devoted primarily to serving alcoholic beverages for consumption by guests on the premises, in which the consumption of food is only incidental to the consumption of such beverages. b. Employee - A person who performs services for wages or other consideration. c. Employer - A person, partnership, association, corporation, trust, or other organized group, including the County of Barnstable and any department or agency thereof, and any municipal entity, which utilizes the services of two (2) or more employees. d. Food Service Establishment -An establishment having one or more seats, in which food is served to the public, that is a covered area and/or located within a permanent structure. A food service establishment is further defined as an establishment devoted primarily to serving food for consumption by guests, where the consumption of alcoholic beverages is only incidental to the consumption of food. e. Function Room/Hall - A separate, enclosed room used for private functions within a food service establishment. A function room/hall used for a private social function, in which the sponsor of the private function and not the owner or proprietor has control over the seating arrangements, is exempt from this regulation. f. Smoking - The lighting of, or having in one's possession any lighted cigarette, cigar, pipe, or other tobacco product. g. Smoking Bar - An establishment whose business is primarily devoted to the selling of tobacco products for consumption by patrons on the premises and in which the serving of limited foods are incidental to the consumption of such products. An establishment which serves full meals is not considered a "Smoking Bar" for the purposes of this regulation. An PAGE 2 OF 5 r , establishment which serves appetizers and snacks may be considered a "Smoking Bar" for the purposes of this regulation. h. Tobacco - Cigarettes, cigars, snuff, chewing tobacco or tobacco in any of its forms. SECTION IV - PROHIBITION OF SMOKING IN FOOD SERVICE ESTABLISHMENTS, LOUNGES AND BARS Smoking shall be prohibited in all food service establishments, lounges and bars as of April 3, 2000. SECTION V - SMOKING PERMITTED Notwithstanding Section IV above, smoking may be permitted in the following places or circumstances: a) Function rooms/halls used for private social functions provided that the sponsors of the private functions have control over the seating arrangements; and b) Outdoor seating areas of food service establishments provided that: 1) such an outdoor area is not enclosed except for the one side which adjoins the establishment and 2) the smoking section of an outdoor seating area shall not be located within ten (10) feet of any doorway, any mechanical ventilation intake fixture, and/or any window of the establishment. SECTION VI- PRE-EXISTING SMOKING BARS Any smoking bar in existence as of the first date of publication of the notice of the public hearing regarding this regulation may apply for a variance before the Board of Health from this regulation. SECTION VII - POSTING Every person having control of a premises where smoking is prohibited by this regulation, shall conspicuously display on the premises, including the primary entrance doorways signs reading "Smoking Prohibited By Law". Posting of the PAGE 3 OF 5 international symbol for "No Smoking" (consisting of a pictorial representation of a burning cigarette enclosed in a red circle with a red bar across it) shall be deemed as compliance. SECTION Vill -VIOLATIONS AND PENALTIES a. Violations of this smoking regulation may be enforced by the provisions of M.G.L. Chapter 40, Section 21 D et seq. non-criminal disposition and by the Town of Barnstable General Ordinance regarding non-criminal dispositions. b. Any person who knowingly violates any provision of this regulation, or who smokes in a food service establishment, bar, or lounge as defined in this regulation in which a "Smoking Prohibited By Law" sign or its equivalent is conspicuously displayed, shall be punished by a fine of up to $50 for each offense. c. Any proprietor(s) or other person(s) in charge of a food service establishment, lounge, and/or bar, who fail(s) to comply with these regulations shall be subject to the following actions for each offense: 1. a warning shall be issued for a first offense. A fine of up to one hundred dollars ($100) may be issued for the second offense, up to two hundred dollars ($200) for a third offense, up to three hundred dollars ($300) for a fourth offense, and up to three hundred dollars ($300) for any subsequent offense; 2. no provision, clause or sentence of this paragraph of this Regulation shall be interpreted as prohibiting any Town of Barnstable Department or Board from suspending or revoking licenses or permits issued by and within the jurisdiction of such Departments for repeated violations of this Regulation. d. In addition to the remedies provided by VIII-b, and VIII-c above, the Board of Health or any person aggrieved by the failure of the proprietor or other person in charge of a public place or workplace to comply with any provision of this subsection may apply for injunctive relief to enforce the provisions of this subsection in any court of competent jurisdiction. e. The Board of Health or its designee(s) shall enforce this regulation. PAGE 4 OF 5 SECTION IX - SEVERABILITY If any provision of these regulations is declared invalid or unenforceable, the other provisions shall not be affected thereby but shall continue in full force and effect. SECTION X - EFFECTIVE DATE These regulations shall be effective as of April 3 2000. 9 p Susan G. Rask, R.S. Sumner Kaufman, M.S.P.H. Ralph A. Murphy, M.D. BOARD OF HEALTH TOWN OF BARNSTABLE PAGE 5 OF 5 "r"":1;.:"y'1Ri��.-^"�`�rt.r'+:nl4v�.'.+•-i�n(�w,.:f""'"''""i?�,-r '. - ". : .. �yz+�ay^;+'"""*>'*c^D'7.;...4'rst;:yli�1.✓7J1{H9."v,,.r...°J"'-la"Gr'av1 LE"; � . TOWN OF BARNSTP,B -W, Ordinance .or Regulation WARNING NOTICE Name of Offender/Manager. Ci /I dob Address ..of' Offender MV{/MB Reg.# village/State/Zip SSA Name, / / C.Al/" a y am/.pm,� qn / "�" 20 ✓ _ C..... Business Address Lp..5�� / T Nj "��✓�, �� �,d / Signature of Enforci:ng..Officer Village/State/Zip i Location of Offense. /1 "r: " �� r.:, /,`� �• r'c,�� Enforcing_Dept/.Divis ion: . Offense l /� , 1 r 1 t.`� i Gf r...Gi l -^ , ,/ J l""✓11, i.t" L' 1"�'ls! /'/Ts�IIYy7 Facts < )t r.nL/ f`/✓. ! t r.r ( f// ft+fla . rlcr /./iii,-f y g'.'-At.,this `time no -lega.1 a`ct`ion''H-a's b'een.-taken. This will - serve only,. as a warning. It is the ..'goal :of:, Town. agencies to achieve voltnt'ary'. ';compliance of " -Town Ordinances, ' Rules ,.and`'Regulations: Educat""ion efforts ,.and warn'ing' notices are attempts, "to "gain. 'voluntary compliance. S,ubsequent, vioiations :will result in appropriate "legal action :'by the Town." i TOWN OF BARNSTABLE BQ'W `z Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip Business Name Flk-( cl. ,l am/pm;, on •�/-? �'" 200/ Business Address5� Signature .of Enforcing Officer Village/State/Zig �rxa°, ��,. �` /' f',; (> U / Location of Offense ` , �`r"-, . , , . "/ °/ r-W//X7 Enforcing* Dept/Division Offense Facts /" ..1 , ��r. o /., , ✓� �..�. ., .,,,. .� r� .rs/.�. This will serve only as a warning. At this time no legal ictioff'h--as been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to .gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. SENDER: SECTION i • DELIVERY ■ Umpiete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B.'Date of livery item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. C. Si nature {J ■ Attach this card to the back of the mailpiece, X !�� ❑Agent or on the front if space permits. LLL ❑Addressee D. Is livery ad different fro item 1? ❑Yes 1. Article Addressed to: I ES,enkf delivery addre elow: ❑No A 6 h5c. S a act c 5 �S 0 3. Service Type I$Certified Mail ❑ Express Mail 14 ��N v\ � s, A , Div 0 Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number(Copy from service label) 7- d 1 ZI 4 8 a s PS Form 3811,July 1999 Domestic Return Receipt 102595.00-M-0952 UNITED STATES POSTAL SERVICE First-ClSsMair Postage&Fees Poid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Board of Heafth Town of Barnstable PO. Box 534 Hyannis,Massachusetts 02601 I A}+'- R M�co� ,m� tic Z• 2®3 498 922 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sentto I ii 06 Street&Number i Post Office,State,&ZIP Code Postage $ 3'L' Certified Fee ' ! U Special Delivery Fee Restricted Delivery Fee U) @ Return Receipt Showing to Whom&Date Delivered n Return Receipt Showing to Whom, Q Date,&Addressee's Address QTOTAL Postage&Fees $ 7 L CO Postmark or Date LL µ a��� a, aoo� Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service y window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. 00 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ti 6. Save this receipt and present it if you make an inquiry. 102595-97-B-0145 d r' No...,Z�.f_ -S] � Fms...�.............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Applira#ion for Di_gpas al Vork.6 Tonii air tun rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: P Li 1 ••••••---•. .... . / ocatiyn-Address ) �+ �'^�' or Lot No. G�j. ✓!t� 1 to F ./.c.�� v i� a.. S . a ............................ , ner Add- ress c W � o y f'✓...e ........... h t��- `- Installer Add, s d Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria dOther fixtures -----------•----------------------------------------=-.---------------------------------------------------....•-----..._-----•--------.._........----- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Depth................ Disposal Trench—No_.................... Width.................... Total Length.................... Total leaching. Septic Tank—Liquid capacity______..____gallons Length................ Width................ Diameter-------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. 1________________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........................ x -- O Description of Soil_.________ __�"!___..__'�___..__. _ � J U •--•---------------------------------------•---------------------------------------------------------------------------------------------•------------_---- UW ....................... ............................................................................................................... Nature o epa>rs or Alterations—Answer when a licabl S 1�___.___. __ ______"a G' . --------- tTgyp e� .... f�,. S l rYY Agreement: 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 Compli nce been issued by the board of health. Signed --- -------------------------------------------------.................... �?/ ............. Date ApplicationApproved By . -.. ... ------------------------------------------------------------------- ^ 6a[e�� ------ Application Disapproved for the following reasons- ---------------------------- ------------------------------------------------ --------------------- ---------------------- ........................................... ----- -- Cj d--7 Dace Permit No. f �� ' ---1----------------- Issued ..��.�.................... Date :1�� <.c..,� f- ram'{•�� r a No- ---. .. 5.1 F�$.... ....... - THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works T. tuarnrtiun tIrrmit Application is hereby made for a Permit to Construct or Repair /an Individual 'ewa pp y ( ) p ( Sewage Disposal System at: A"'9 -------•--•• --••------•-......_..-••••-•-••••----•----- ---------•-•--•...............•----••••-- ocatio Address or Lot No. \ f O ner Address w �1 C --0i y `✓1 E,`�el w 5 -� 7� �E� -� l J7iG 0� Installer Addre s Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of ersons__--________•__---___-__-_ Showers — � YP g --------•-----------•------- P ( ) Cafeteria ( ) d Other fixtures -•----------------------------------------------------._ W Design Flow............................................gallons per person per day. Total daily flow..........................._...............gallons. W Septic Tank—Liquid ca.pacity............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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-_____-________•--_--.- fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 - ---------- ------------- O Description of Soil....._.....`_ ..... ............................................................�C W --•••••---••-•---••-----••--------•-••-----••-----••-------------••--•---•--•-•••-•------.....-----•-••-•-••••••••-•-•-----•-••---•----••--••-••--------•-•-•-•-•-•-•----••------------••-•-1•--------- ------------------ ------------------------------------------------------------------------------------------------------------------ ----•••--- U Nature off epairs-- Jor Alterations—Answer when applicable_____- �-+ S.�` _�J______-5 ---fit --e-____j........... �;c� •- Agreement: 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 Complia ce ha!Peen issued by the board of health. Signed ........... y Date Application Approved By �. ......... �G Date Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------------------------- ---- -------------------------------------- ----------------------.......................................................... Date -- Permit No. ............ ._ ....- -.� Issued -, "'..-C� ''" ............... — Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of•Tompliance THIS IS TQ,CERTIFY, TA ha dividual Sewage Disposal System constructed ( ) or Repaired ( (14 by------------- -�... ... ..... ! S Installer ems"®u �(.-6 S e s e-- DL /,�at ----------------- -------------------------------------------------------------------- -------------------- ----------------------------------- --.....------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. --------,�G....----... 57---- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNC)ON SATe-LISFACTORY: DATE G a.- - --------------------- - --- Inspector ....------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No...C� TOWN OF BARNSTABLE /�.'.�:�-•� FEE... ...—:. - Disposal Works Tontrnrtion "permit Permission is hereby granted.............. ...: _ ................................._.......... to Construct ( ) or Repair (fin Individual Sewage Disposal System at No..... A✓I -o `j _ A:S Street qq,, as shown on the application for Disposal Works Construction Permit Nosl�_,;5 Dated.......................................... ........................-•-.............)-\-.-?M..............................................- ` Board of Health DATE..........-G-•-'--�-------�- ............................................0 `,! FORM 36508 HOBBS&WARREN.INC..PUBLISHERS No..P.Y--•--••--= Fim . .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -------- OF........ ...S � /,e; ......................................................... Appliration -for Di_qpviial lVarkii Tonfitrurtion Prrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: .................................................. .............1.......................... ................................................................................................ , Location- ddress / —Y -33wY or Lot No. All-a 5 -45 .......4 ..........7----- -- ... �h.—............................................. Own I ............. .................................. Address , cMa .e. . _.AnC , r !=Mt_o .l.-.-.----.--R-----a--------------------------- ........... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms___________________________________________Expansion Attic Garbage Grinder ( ) P-1 Other—Type of Building ---------------------------- No. of persons__-._____---______-_--__-.__ Showers Cafeteria ( ) Otherfixtures ----------------------------------------------------------------------------------------------------------------------------------------------------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity------------gallons Length................. Width................ Diameter___._...-..-____ Depth..........._.... Disposal Trench—No..................... Width..............._._.. Total Length_-_-__--__-______-_ Total leaching area--------------------sq. f t. 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 U --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------__------------------------------------------------------------------------------------------------ ------------------------ ------ . .. . ..... .. .,--- 0 0 4Lo U Nature of Repairs'or Alter i S Answer when applicable------------ _,v------------_----------------------- ............... ... -- -------- ------- ------------------------------------------------------------------------------------ ---------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Mai Signe _ ----------------------------------------------------------- ...........I-------------------- Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:........................................................................................................... ......................................................................................................................................................................................................... PermitNo......................................................... Issued.... .............. Date -—------------------------------------------------------------------------ No..O.Y.......... Fstc.2...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / ...........OF.........'J.:3... :" „ Appliration -for Biiipoottl Workii Tonotrurtion Vrrm t Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -----------•----••------------ .---------------------------------•------............------..... --•-------------------------••---------•------....-•-......----•-----..........-•---•------•----- Location.Address _, or Lot No. s _ > Owner Address .I `}f� /e,e jam, ,7 r—n — --t :._!--{ ----- ------------- Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 0-4 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ----------------------------------------------------- -------------------•-•--------•--- ..................------------------------------------------ d W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. USeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter---------------- Depth---------------- xDisposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area-_--..----___-__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 U Vw ------------------------------------------------------------------------------------------------------------- ------- . Nature of Repairs or Alterations—Answer when applicable.......______� `_ 7_ ?.c_c�. ....___!_ ___"___'. ........ -r -_------- C Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ,, _ �'..�.-�--y �� � - ------------------ Date ApplicationApproved By.................................................................................................. ------------------......--------........ Date Application Disapproved for the following reasons----------- .............................................. ...................................................... ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date 1 THE COMMONWEALTH OF MASSACHUSE TS BOARD OF HEALTH .............'.r.....................OF..........il — s Trrtifiratr of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by... -------- ---• .................... -----------------------------------------------•-----•-----------------••---------•---•-•-..••---- Installer _ at-------� /...........!......-----•--"L-' ` -C•---.,� /`�_.5.......''...-j.__......--•'�?-<::�................................................------ has been installed in accordance with the provisions of Article Lo The State Sanitary C de as described in the application for Disposal Works Construction Permit No _ .................. dated... ....a._.'" ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST AS A ARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ........................................................................... Inspector.---- •-•--------- ---------- ............................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' ---------------------- c.G..� No... ..--•---•-�------ FEE,? .................. Worbi Clonitrurtion rrmit Permission is hereby granted------: ------ ...... ------------------------------------------------------- ............... to Construct ( ) or Repair (/) an Individual Sewage Disposal System atNo..................................... � Street / as shown on the application for Disposal Works Construction P i No._... .�_l_�.'.'. _ ated....L-.-_:..Z-_7` ...... � DATE... /------------------------------------- Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOW14 (IF bARNSTABL.E LOCATION '� �!"- -,,.'� SEWAGE "� 7 VILLAGE %�� s�;�". _"���.� ASSESSOR'S MAP & LOT J. CRAIG MEDEIROS �► INSTALLER'S NAME & PHONE NO.. Zs-LlNDEN-ST.___,____ - �N , NIS, MA 0260t SEPTIC: TANK CAPACITY�,�� ��____ LEACHING FACILITY:(type) � ����� 5 NO. OF BEDROOMS PRIVATE WELL. OR UBLIC. WATER I BUILDER OR OWNER_ llA'I'E PERMIT ISSUED: DATE COMPLIANCE ISSUED= VARIANCE GRANTED: Yes NO_�� --7 � A 7,11 I j ® q ' \r o i I. I CHARLES E.FARRELL,Secretary CHARLES S. PELUSO,Exalted Ruler CHESTER C. EVANS,SR.,Treasurer 55 Walnut Street 133 Witchwood Road 103 Bay View Street Hyannis,Mass. 02601 South Yarmouth,Mass. 02664 Hyannis,Mass. 02601 Phone(617) 775-3446 Home, 775-8103 Office Phone(617)394-2735 Phone(617) 775-2111 Secretary Emeritus,Elmer A.E.Richards a, vanni�j oLocl%e 110 BENEVOLENT AND PROTECTIVE ORDER OF ELKS 852 Bearses Way/P.O.Box 964/Hyannis,Mass. 02601 Phone(617)771-1549 September 20 1977 Mr.Kelly,, Board of Health, Town of Barnstable, Hyannis,Ma 02601. Dear Mr.Kelly: We the ,Hyannis Lodge of Elks 15h9 located at 852 Bearses Way,Hyannis,Mass are proposing to enclose the rear end of our building, which is now open supporting our dining room and kitchen., It -_s supported by steel lally columns and steel girders.. We had a serious lire this spring, and it has been recommended that we close in this outside perimeter with cement block. Our problem concerning the Board of Health is that in this area we have two 1000 gallon tanks for sewerage,which we want to eliminate and install a new tank to replace.We have on an average of fifty people day useage in the athletic facilities which involves this area.We have separate systems to take care of the toilet facilities and another for the kitchen which you probably are aware of. Mr.Craig Medeiros will be involved in this venture who I feel is a qualified contractor in this field. He will submit to you the lay out of same for approval. II Ow, 7�— Sincerely yours, Robert S.Churchill Sr, Chairman Building Committee Charles E.Farrell,PER,Secretary Joseph D.McMahon,Jr.,Exalted Ruler John J.Bell,Sr.,PER,Treasurer 55 Walnut Street 423 Oakland Road P.O.Box 186 Hyannis,MA 02601 Hyannis,MA 02601 West Yarmouth,MA 02673 (508)775-8103 Office,775-3446 Home (508)771-1104 (508)775-5205 6 g I —JV(yGinnij 'np.0c./gre 1 jO. 154 9 BENEVOLENT AND PROTECTIVE ORDER OF ELKS A FRATERNAL ORGANIZATION 852 Bearses Way Hyannis,MA 02601 Phone(508)771-1549 January 5 , 1990 Town of Barnstable Department of Health South Street Hyannis , Ma. 02601 Dear Members of the Board, I must first apologize for not contacting you sooner. Our Board of Directors is elected at the end of May of each year. With this election comes the inheritance of several problems from the previous Board and year. We have been aware of the septic system and your concerns . We also have been trying to come up with a logical and financially feasable plan to remedy this situation. Enclosed please find copies of estimates for repair of the system and an explaination for the concerns you had in your letter to us dated November 9 , 1989 . It is our wish to comply with the Town of Barnstable in any request that is made by your office to us . We are dilligently working on the problem and should have it corrected within six months. Please work with us on accomplishing this goal . Respectfully, .0— Leo F . Rockwood Chairman TOWN OF BARNSTABLE OFFICE OF BOARD OF HEALTH »Ae� � � 387 MAIN STREET o ,6 W�Q 9. NYANNIS, MASS. 02801 November 9, 1989 Ellis Johnson Benevolent & Protective Order of Elks Hyannis Lodge No. 1549 Hyannis,MA 02601 NOTICE TO ABATE _VIOLATIONS OF 310 CMR, 15.00 STATE ENVIRONMENTAL CODE: TITLB V Dear Mr. Johnson: The Department of Public Works has notified us that your on-site sewage disposal system may be inadequate. Their records indicate that your system was pumped 5/6, 5/8 and 7/3/89. The Health Department sent you a letter requesting voluntary compliance on October 31, 1988 because your system was pumped 7/15, 7/23, 8/18/, 8/23, 4/16, 4/25, 4/30, 6/28, 1988. We again strongly recommend that you obtain the services of a licensed disposal works installer to evaluate and upgrade your system. Enclosed is a pamphlet explaining the importance of maintaining your on-site sewage disposal system. Please call 775-1120, extension 182, if you have any questions. Very truly yours, Thomas A. McKean Director of Public Health TM/bs enclosure , ACE CESSPOOL SERVICE [NUMBER E P. 0. Box 534 Nov. 14 , 19 8 9 CENTERVILLE, MASSACHUSETTS 02632 Phone 775-1056 Hyannis Elks Club 852 Bearses Way Hyannis , Ma. o2601 Attn: Mark Guzaj TERMS PLEASE DETACH AND RETURN WIT.YOUR REMITTANCE $ R '5T'`AND` ED�S' 1..'�,..,.p., 5k.1.3i �trFe� BALANCE FORWARD ,; In . response to your inquiry of Nov. 12 1989 . The dates mentioned in the letter from the board of health; for the year of 1989 can be explained as follows . The waste treatment plant can only accept a certain quota of waste per day that they can process . On May 6 , 1989 the Elks system was pumped however only one load could be dropped off for processing at the pla t. When we went over with the second loa the plant was closed. The second load had to be dropped off on the 8th. of May. On July 3 ,1989 it was not your septic system that was pumped but the (over PAY LAST r,AMOUN7 �/ IN THIS COLUMN ACE CESSPOOL SERVICE PRODUCT96-1 ACE CESSPOOL SERVICE DATE P. 0. Box 534 Nov. 14 , 19 8 9 CENTERVILLE, MASSACHUSETTS 02632 NUMBER Phone 775-1056 Hyannis Elks TERMS PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $ 'n rSR _;xt,-•at't* Ss urr:..•:a"; 3xc 'yr -sR" ..^o.a Q .+ , .y # �I 1P �.. it` BALANCE FORWARD .: grease traps from your kitchen. In regard to the dates mentioned in 1988 it was my recommendation that several of the leaking toilets and showers be repaired. The excessive pumping of the system was directly related to the amount of water being drained into the -tanks by these plumbing problems . Sincerly, zJ 5 ��i,�•�,-_D PAY LAST AMOUNT ACE CESSPOOL SERVICE � 4U/ IN THIS COLUMN PRODUCT96-1 Sewerage and Drainage SAND- LOAM - GRAVEL - CESSPOOLS BUILT - BLACK TOP DRIVEWAYS J. CRAIG MEDEIROS TRUCKING AND BULLDOZING �- 78 LINDEN STREET f HYANNIS, MASSACHUSETTS ti'.-.` �r�"'= TELEPHONE 775YAYAY 0828 November 15, 1989 Est. 1957 Fraternal Lodge of Elks 1549 Attention of Mr. Mark Guzaj 852 Bearses Way Hyannis, MA02601 Gentlemen: This is in answer to the Elks House Committee about the septic system in question that needs expanding and that I installed. This system is over 20 years old which consists of 2 precast leaching pits, 3 foot of stone pack, 2500 gallon septic tank, and distribution box. This system needs 8 stone packed galleys added to the system, on the north side of the building where there is ample space and room for future expansion. I would recommend that you do this needed expansion in the early spring, 1990 so that blacktop patch work won't be delayed all winter. Sincerely, J. Craig edeiros JCM:b e STATEMENT SAND-LOAM-GRAVEL.CESSPOOLS-SEPTIC TANKS & LEACHING FIELDS J. CRAIG MEDEIROS TRUCKING, SEWERAGE r AND BULLDOZING - -- OFFICE: 78 LINDEN STREET GARAGE: 142 CORPORATION ROAD EST. 1957 HYANNIS, MASSACHUSETTS 02601 TELEPHONE: 775-0828 — 775-4458 L ,, x DATE November 16—1989-- Fraternal Lodge of Elks 1549 ATTENTION of Mr. Mark Guzaj 852 BParsec Way r ,-==MA=Az�^ ----- — - i _ . _ . - . -'------- -.. ._.__ -- ----' - -- -- - ' - .. ............ - .. Contract Price to _install $ Galleys stone packed a d pip ---- ----from---dis-t-r btit on--box------.... ._..___._.... ns all mewl frames a d -cov e rs - ---- - - .. -- --- . ,,6 89.0.;00 _I 1� -' -- -- --- - --------_-- 1 jl _ I i .....___ ...... ......... .. .... # ...................- ... 4 ----' --- - _- - __._ 6- 890.,00_ PLEASE NOTE: ALL ACCOUNTS PAYABLE ON RECE PT OF I BILL. ........... -- --- --- ---- --- -- __. .._ ._. INTEREST OF 1 V2°70 PER MONTH 8 G PER EAR) ..-- .-. --._....... . . ..... .. _ ..._.. — — ._._ .._.. .... __...� 1 TOWN OF BARNSTABLE ��f THE Taw OFFICE OF i BABaSTABLE, BOARD OF HEALTH NAM � 367 MAIN STREET moo 1639 'O�rOIII HYANNIS, MASS. 02601 October 4, 1988 Ellis Johnson Hyannis Elks 852 Bearses Way Hyannis MA 02601 Dear Mr Johnson, The Board of Health voted on August 4 , 1987 to require all . semi-public swimming pools to be tested for coliform bacteria at least monthly, and that hot tubs and whirlpools be tested for pseudomonas as well . Our records indicate that your pool has not been tested since March 14, 1988 . You are directed to have each swimming pool tested monthly for coliform bacteria. Test results for August must be submitted to the Board of Health prior to October 30 , 1988 . Failure to comply may result in the closure of your pool . You are also reminded that violations of 105 CMR 435 . 000 : Minimum Standards for Swimming Pools (State Sanitary Code : Chapter V) subjects you to a fine not to exceed $500 . Each days failure to comply constitutes a separate violation. Very Truly Yours , Q,/ Thomas A. McKean Director Barnstable Health Department October 27, 2020 . Town Heath Director, At a recent visit to the Hyannis Elks bar on Bearse's Way I was wondering why the Elks doesn't offer any food in the bar. No one in the bars was eating anything just drinking. I didn't see any menus at all. I asked the bartender (a big guy with a whiffle) and he just gave me a funny look. I thought they were to serve food. Please send a Health inspector to investigate. Please consider this a complaint. Anonymous No._ l!S Fimic...`f .U. ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD yOF HEALTH /_ /f,C/w.<T&/6- .........OF................................ ..... ............. - ............ , ppliratiun -fur 4%ipoiial Workii Tomitrnrtinn Vrrngit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: r ........................................ � 5 C=>Cl6S ! S Location-Address or Lot No. W ... ... .................. ......caner... l . � � br Of /O�^ �� Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms------------_______________-----------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building-..__G _=_.____ No. of persons_...sU Showers ( ) — Cafeteria ( ) dOther fixtures .--_--------------•----•_-- ----•---------_----_--------- •---------•--•--•-•---------•-------------------------•-•-••--------•------- W Design Flow...._..__�13................. ..... gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity d® _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 "Pest Pit.................... Depth to ground water.-.-_-_...._-.-_--.-_._- (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.--.-.-__.--__.__-.___ ----------•----------------•- Description of Soil---------------------------------- - -. -- ---------------------- 77 V •�1ti -_..•_.. /y�G_�Q._..._....1'_�_��----.•.._'���G�i/ - W ------------- ------- ----------- ------------•--------- .--------------------------------•-•--------.---- (Z) V ature of ,Alterations—A saver when applicable.._____ .___...,r __________________________ _----- ___ ----- greement i� The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systern-in accordance witli the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued the board of health. Signed..... ....... -------•---••-------------------••----- •----------- .................. D ApplicationApproved By----- �-------------------------------------------------- ----- ------------------ .........../J- .. .J�•. Date Application Disapproved for 7zefollowing reasons:................................................................................................................ ..............•-------....---------------------------•-------•.-•----------------•-------•--••...--------._---_.._...---.•-------.-•.-----_.._....._•---------. ------•-----------•-•--------.------.---- Date Permit No.......%/5--------------------------------------- Issued....... 2 �'-r 77 ate Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH App 14 ii ion is hereby made for a Permit to Construct or Repair an Individual Disposal System at: Location-Address or Lot No. --------- -~-^'----' ' '------------' --'-------- � � �� v,�, � ,� �� � -.-_-��--'.--..--_-'�_---.-''�-�^-��---...---------' -'^"-=----zr� �-�'�--..=`"°�.-..,.'�'.�--.-. z��or Aa�=" ~ � ---------------------- Type of ' S�rLot-'------_��o feet Dwelling--No. of Bedrooms............ __--_-. Attic ( ) Garbage Grinder ( ) (�tbrr--Iyyc o6 DoJd�q�'-�"�.��...x-- No. of persons. ---' Sbo°cca ( ) -- Cafeteria ( ) Design Flow_ ......... ----------------------- _-_ per person per --'. Total daily -'-------,.------...~-�-s 04 Septic Tank--Liquid "- � `,gallons Length Width............_ Diameter----- .......... Depth------ Disposal Trench-No. ..................... Width.---.---.. Totu} 6. Seepage Pit No--.----- Diameter-------------------- Depth below inlet.................... Total lezciog area-_--.---sq. b. Other Distribution ) Dosing tank ( )ercolation Test Results| ~~ --'-� Dut�--'------.--.-' Test Pit No l----------------minotcsyezinch Depth of Test Depth to ground water ------- [14 Test Pit No per inch Depth of Test P6-------------------- Depth toground water--------' nu ^ --- `-'---'---' --------_-----------''-----------^--- [) Description of 'o'^4._- ....................- r - - ' . .- � "*^=""="t. - The undersigned agrees to install the uforcdoscribcd Individual Sewage Disposal System in accordance with the provisions of Article XI.of the State Sanitary CO,de-----m The,undersigiled further agrees not to place the system in ,ftf health. - ' Signed 4ng ��--- ---'.--._---- � ~�" ��=o�� �� / Apy�u600 Approved Dy-- - -----------_-_--_'��- -_--�.�--��-.x..�.-- /� u� Aupn�ut�n Disapproved �r �Bx /o/�zm��/ reasons:----------__-.-------.--�-�-_-.-'--_---.............. ....................................-.- -.--.__'----..-- ------'--__^--.. --.-__'_-'_---.-----.-�..�----_-'- ! ' Date Permit Issued........................................................ � ^ Date THE oowMowwsxLr* OF MxssAcHussrrs ������ F HEALTH �� '���w+�°�---��F-- ...�����~~---_---------. ,°� ��prtifir*ote of 0AMp4iuo*»rr THIS IS T&,CERTJFY, Thatthe In�lividual Sewage Disposal System constructed or Repaired s I sta e "in accordance wi --- fVisions of Artj�je -XI of The State Sanita" -t"TkE ISSUANCE OF THIS CERTIRCAtE SHALL NOT BE CONSTR.UED AS A GUARA TEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. trk_q Towitrudiwi Prrmit at ^`".........4"-*��---^°P.,"ft. ..=`....^�°="�^=�.. ..�~-====-_jp-a------=--------------_' Street as shown on the application for Disposal Works Construction Permit No---- ........ Dated..... .............................); ...... ................ ......... ~~roxm '=== ""°"" & "°,".E B"="="S � ' _ "Y, y uD p/ __ r,S p `—'► c� O V 'u �\ (P \', o � U • �� — pis 1. - �� 0), I � � V i \ 2 pN 9 �. AD Yc-NS6 Cp J LEAS. 1-I 11�C� 1 1 �� 1 \ A" F ? f C �S i V O Ll� - \ elf (12') T-�..( _r-1r' F LF j T 'mot F E.E_-T, S l k 14.E C N 4 ALL I CA3 Tc� f2-)E. ) }13 6,CCO R_ �DL\lK3c yL Wff " T1 � �_ PROVl(�) it� 1..5 O A R i C l__ $3 o v�- T r� Loam , �t� Lor11`;O�s E-YOZ WC-4 C R A D F_� C) LU �,J }� S Y 5TE—" F- O K f C P C-4D. N F_,&,L ._T H G L_ U t I Q C . E _AY AA V 15, I_14s`,3. s F �.3C, 1 1l1 E=E-Re- a • d w �R t