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Home My WebLink AboutQUARTERDECK LOUNGE - FOOD QUARTERDECK LOLiNGE 247 Syanough Rd. 328-Zo(o Hyannis I BOARD OF HEALTH Town of Barnstable John T. Norman Board of Health Donald A.Gaudagnoli, M.D. BAWNSTABLL F.P.(Thomas)Lee,. o� ,� 200 Main Street, Hyannis, MA 02601 Daniel Luczkow M.D. Alt. s 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: 201 Issue Date: 01/01/2022 DBA: QUARTERDECK LOUNGE OWNER: SCOTTISH ROCK LLC Location of Establishment: 247 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 50 OutdoorSeating: 0 Total Seating: 50 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: G�� 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: IN21-11-22 20:41 UTC - +12404749959 PAGE 2i6 TAE M r.f Initials: Town of Barnstable Inset' a Paid $ �p c Zonal Services Public Health Division Check 9 -----= Thomas McKean,Director 'n � 200 Main Street,Hyannis,MA 02601 r� Office: 5.08-862-4644 Fax! 508-790-0304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 11 Oay NEW OWNERSHIP RENEWAL i NAME OF FOOD ESTABLISHMENT: G r,.,-r�Alt Vnr1r I I ,I1�p h, Q --j-"/ci �n ADDRESS OF FOOD ESTABLISHMENT: { MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 6 E-MAIL ADDRESS:-r{� (,SrnnrxroJL n nln n mti TELEPHONE NUNIDER OF FOOD ESTABLISHMENT: R%SD TOTAL NUMBER OF BATHROOMS: eZ WELL WATER:YES_N04 ,..(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: ia SEASONAL: DATES OF OPERATION: /_/ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING:MUST OBTAIN A.COMMON VICTUALLER'S LICENSE FROM LICENSING DI,V. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV AND LICEN6ING AND MEET OUTSIDE DIMMING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE,DINING? ►4JA IS AN AIR CURTAIN PROVIDED AI'WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) P -&FOOD SERVICF, __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*** REQUIRE TO CALL HEALTH D V.FOR INSPECTION PRIOR TO PER iVII BEfNG tSUED PLEASE CALL 508-862-4644 Q"Appiication FormskFOUDAPP 2020.doc r - N"c1-11-"c^c 2N:41 UTC - +124@4749959 PAGE 3/6 OWNER INFORMATION: FULL NAME OF APPLICANT (1,-f1161 SOLE OWNER: >;S NO D.O.B t` 6 OWNER PHONE ADDRESS V V-1• �y CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: T FAIUI st(2)Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff FOOD ESTABLISHMENTS must have I CTheified Food Health D Pr toctio NUTIuse pas yeaanager Rrs' rreco ds. You ATTACH COPIES OF CERTIFICATESust provide new copies and POST THE CERTIFICATES at your food establishment. ` Certified Food Managers Expiration Date Alley en Awareness Expiration Date Dal.26 1 2D4 11.0 2. at� l �� ►a ao2�V SIGNA"PURE OF APPLICANT DATE ***FOOD POLICY INFORMATION**'k SEASONAL FOOD SERVICE:All seasonal food establ 4 to schedule your inspection.ks must be Please call ainspected least(7)days in advance. prior too enin !! Please call Health Div_at 508-862.4644 o Y ab prior to opening and monthly thereafter, ESSERTS: Frozen desserts must he tested by a State Certified l FROZEN DAIRY D Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert with sample results submitted to the Permit until the above terttu are met. or to CATERING POLICY: Anyone wbo caters withint he T�1wwwB °blprnstable.uslbealthdtviision a raust notify theTown by fax r licatinns.as catering event. You must complete a catering notate four OUTDOOR COOKING: Outdoor cooking,preparation, or display of any food product by a food establishment is prohibited. NOTICE: Pcn wts run arioually from January 1st to Dec.31"each calendarDEC l ear. IT IS YOUR RESPONSIBILITY TO RETURN THE CaMPLETED AppLICATION(S)AND REQUIRE FEES ll e-_--tcnrbnAvP Pvv3-7.019.doc Town of Barnstable BOARD OF HEALTH + John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BAWNSTAULL. : Paul J.Canniff,D.M.D. 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, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 201 Issue Date: 01/01/2021 DBA: QUARTERDECK LOUNGE OWNER: SCOTTISH ROCK LLC Location of Establishment: 247 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 50 OutdoorSeating: 0 Total Seating: 50 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: BIKE Town of Barnstable For Office Use Only: Initials: � � Date Paid Amt Pd$ IAMWABLE, ; Inspectional Services MASS. 0 `e pTf1639. Public Health Division Check# Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 i APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: n jT►S}i 1!. CAr Atzo. tAo. a apt pyrl�n � ADDRESS OF FOOD ESTABLISHMENT: al,-l_:�t TiAcknV\OVWL P-OcS AC q eunn(S, o')( a MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: eYYD1 u cx60• ��rYl TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (&b) TOTAL NUMBER OF BATHROOMS: �— WELL WATER:YES NOy ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: /_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING?_ IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)9 r 1 r 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 OWNER INFORMATION: FULL NAME OF APPLICANT FltD 1 /NO D.O.B d p OWNER PH NE# 15D$• 13 a--,`I-l SOLE OWNER: ® (� ADDRESS 0— o CORPORATE OWNER: L CORPORATE ADDRESS: �� c��iO J �� ;� 0 b0 CA N IN DAILY OPERATIONS: �=�� —Ta PERSON CHARGE OF I List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. l Srn� 000 i l a i aoay 1. 1401 u 2. Shams o i l a a2 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 htti)://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3152 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 BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. H,►a.NSTAUL, `+ Paul J.Canniff,D.M.D. MASS a & 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 201 Issue Date: 12/10/2019 DBA: QUARTERDECK LOUNGE OWNER: SCOTTISH ROCK LLC Location of(Establishment: 247 IYANNOUGH ROAD HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 50 OutdoorSeating: 0 Total Seating: 50 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Gi FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Z; For Office Use Only. Initials: WE ° .� Town of Barnstable ` =; Date Paid 0R Amt Pd$ 310 BARNSPABLE.I: Inspectional Services ate- �''�Eo ;+�`� Public Health Division Check# ,y Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 e Office: 508-862-4644 Fax: 508-790-6304 � PPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE %A 1 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: J��2 ®J r-,- ADDRESS OF FOOD ESTABLISHMENT: a'l� nr`� S MAILING ADDRESS(IF DIFFERENT FROM ABOVE): a E-MAIL ADDRESS: o&N TELEPHONE NUMBER OF FOOD ESTABLISHMENT: -1-1 -Was o TOTAL NUMBER OF BATHROO : WELL WATER ES NO ... (ANNUAL WATER ANALYSIS REQUIRED.) ANNUAL: SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: So OUTSIDE: O TOTAL: StD SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? l� T PE 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 w OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES NO D.O...B g 3c7 �� OW j PH NE#ADDRESS C�aYP� 1� �2,TR & e-- CORPORATE OWNER: S� :S LL(,- - 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 1. L� 1. 4DXVA 10, i aS 2. Sh awe 1�, a aK 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 openin0 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/heaIthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.3151 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 t �ptFt BOARD OF HEALTH Town of Barnstable Paul J Canniff,D.M.D. A.Ga q Board of Health Donald A.Gaudagnoli,M.D. • t `sra6aE =' John T.Norman 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 201 Issue Date: 12/20/18 DBA: QUARTERDECK LOUNGE OWNER: SCOTTISH ROCK LLC/ERROL THOMPSON Location of Establishment: 247 IYANNOUGH ROAD HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 50 OutdoorSeating: 0 Total Seating: 50 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Cw� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE l Restrictions: r S i FI►+E r For Office Use Only: Initials: Town of Barnstable Date Paid Amt Pd$ 366 ��'^�M � Inspectional Services �1- -- i63S �0� prE�►�`" 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 IQ 20 ,40 i6 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: OTT1SN oC�L l�l.C`,. r_�ha Wt.LVA'Qcy-�� ADDRESS OF FOOD ESTABLISHMENT: 94 jQ MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 1(S&rrno cn�, a, 6)\Z E-MAIL ADDRESS: bowo I(e, amncs1 I, I ayl-N TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (5o2o-44-1_- m5o TOTAL NUMBER OF BATHROOMS: a WELL WATER:YES NO%C ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: 01 /01 / I q TO 1 )L 31 / l� NUMBER OF SEATS: INSIDE: S& OUTSIDE: d TOTAL: 5-U 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) X 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 Forms\F00DAPPREV2018.doc r ' _- y PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT 4�-fr rg 1 SOLE OWNER: YES/NO D.O.B QB130(i`W-k OWNERPHONE # ADDRESS 0 � 0a D_ CORPORATE OWNER: 200L.AACt, FEDERAL ID NO. : CORPORATE ADDRESS: a y ., PERSON IN CHARGE OF DAILY OPERATIONS: �D 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. 6(AQ4 65 / lb- / lgc(PY. —4 D 2. _� rn t C),0o,� 0 5 / ►�. / 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 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/bealthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q:\Application FonnsTOODAPPREV2018.doc THE rok TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name Datojal&lPage: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified Mp�q. �0 MON HYANNIS, MA 02601 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY p'FDN1P�p FOOD ESTABLISHMENT INSPECTION REPORT s08-8s-as2�saa Name �pY�.. / Date, Type of Type of Inspection P O erat'on s Routine 7 Address �� sk -Retail�ervice Re-inspection evel Previous Inspection Telephone ® Residential Kitchen Date: C� Mobile re-o eraf Owner HACCP Y/N Temporary uspect Illness Caterer General Complaint Person in Charge(PIC) �, Time Bed&Breakfast HACCP In: Other Inspector Out: i r Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ ( C Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conforcr�Ance 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 L - ^ ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ v�r1�1�1Y(''L, 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations t Critical(C)violations marked must be corrected immediately. (blue&red items) ay ay rective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,t e items checked indicate violations of 105 CMR 590.000/Federal Food Code. 1❑ 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 g ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than non-critical violations re 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 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility . (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. ti 4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: nspec or Si Print: 31.Dumpster screened from public view �7� ! Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N - rau` #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si at Prir��.-- Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Seen? Y N cr �- ,r� Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to Law Cooled to 41°F/45°F Within 4 Hours* 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage 20 Time as a Public Health Control 590.003 F Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* ( ) P Y3-302.15 Washing Fruits and Vegetables * Applicant To Report Tone Person In Charge* * 7.202.12 Conditions of Use 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reted of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS. 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Commin uted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* + 590.006(B) Water Meets Standards in 310 CMR 22.0* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source Contact Surfaces of Equipment 3-401.11(13)(1)(2) Pork and Beef Roast-130°F Eggs* 121 min* E s* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 3-202.18 3-202.18 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 practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne * 12P5-203.11 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 3-101.11 Food Safe and Unadulterated fa f 8 Tags/Records:Shellstock Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* * Within 4 Hours* 23. Management and Personnel FC-2 .003 Ta s/Records:Fish Products Numbersand Capacities924. Food and Food Protection FC-3 .004 . Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 * 5-205.11 Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 Supplied with Soap and hand Drying Devices 590.004(J) Labeling of Ingredients* 27. Physical Facility FC-6 .007 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes crfical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. --- t , ,o I 10 l I I +U OJT (V� C Q o Go G o 6' i QUARTERDECK LOUNGE * PER STATE RULES: YOU MUST HAVE FOOD WITH ALCOHOL QD PIZZA BREAKFAST 1 0" BAR PIZZA BURRITO MADE IN HOUSE CHEESE $ 7.00 *CHANGES DAILY, ASK PEPPERONI $8.00 SERVER FOR DETAILS (MORE TOPPINGS TO FOLLOW) $5.00 HOT DOG MEATBALL KOSHER, ALL BEEF IN-HOUSE FRESH $2.00 $2.00 DAILY SPECIAL ASK SERVER FOR DETAILS AND PRICE �5 *MENU ITEMS SUBJECT TO CHANGE & AVAILABILITY *PLEASE ADVISE SERVER OF ANY ALLERGIES PRIOR TO ORDERING *CONSUMING RAW OR UNDERCOOKED MEATS, POULTRY, SEAFOOD, SHELLFISH OR EGGS MAY INCREASE YOUR RISK OF FOODBORNE ILLNESS. �F THE TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name:oc%ar4" Date: f ��-1 Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p ;p39.6. sos8sz-4saa `0� HYANNIS,MA 02601 M- -FRI. No Reference- R-Red Item PLEASE PRINT CLEARLY - 'F "' FOOD ESTABLISHMENT INSPECTION REPORT Name Date /61 Type o Inspection ��LAddress �' ` Risk Food S Re-inspection ~ Level etail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Fbarge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY Lo ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items Total Number of Critical Violations a '`� Critical(C)violations marked must be corrected immediately. (blue&red items) N y Corrective Action Required: I ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. . ❑ Voluntary.Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations:9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC=6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to a noncritical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to Snon-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Insp r atur �� 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' i n lure Prinv7D Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N 1 1 1 r (" Dumpster Screen? Y N V Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) I Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202:12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g * 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contac Eggs 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* F1r cave 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 4-702.11 Frequency Sanitization of Utensils and Food 3-40111(A)(2) Ratites,Injected Meats-155°F 15 sec* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g P arY 10 Proper,Adequate Handwashing 3 401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and AutMidhority Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g� g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) ' .Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23.30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodbome 12 Prevention of Contamination from Hands 3403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 I Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45*F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Form.back6-2doc *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. INE r°,r TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: " Date: / � Page: of ti OFFICE OURS PUBLIC HEALTH DIVISION 8:00=9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS 9. .0� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY p -862-4644 FOOD ESTABLISHMENT INSP CTION REPORT 508 Name Date? ape of o Ise ion 'Opmdo Routi Address -2L/7 noRisk Re-inspection VIM k- 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: � \ Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities \ EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation)Segregation/.Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact.Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 11.Good Hygienic Practices _t7 00 �q❑ yg' ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Itemsl Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ Yes Non-critical(N)violations must be corrected-immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance- ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo ❑ Emergency Closure Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 4non-critical violations regardless of the number of critical,results in an F. if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 = 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations C. 30.Other DATE OF RE-INSPECTION: Ins ec at a rint: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N - #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' nat re 1 _ Print: b-�>, Self Service Wait Service Provided Grease Trap Size Variance Letter Posted. Y N � l i' : 13 - 2 o Dumpster Screen? Y N I 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.) sw FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding - Contamination from Raw Ingredients 15 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) ( )O P 7-101.11 Identi in Information-Original Containers 2 590.003(C) Responsibility of the Person-in-Charge to Other* 8 g 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F* Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 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. Lu 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 Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective ronoa 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 3-0Ol.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 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.hou violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11. PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome Prevention of Contamination from Hands 3-403.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* 12 �) 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 A g - 3-202.18 Shellstock Identification* 3-501.14( ) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Convenien0y 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 Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* ocation an ace 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(,n Labeling of Ingredients• Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 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. e //511/1q TOWN OF BARNSTABLE ® LTH I SPECTOR's Establishment Name ir. Y at Page: of I `y V�.C^�"�;�� ,1 FI HOURS PUBLIC HEALTH DIVISION vv �1 1 8:00 9:30A.M. BAR 95 N EE. 200 MAIN STREET 111c ,�1 3:30 4:3FRIM Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �prFOMp+a�O HYANNIS,MA 02601 �11 1 �� `v s s 4 No Reference -R-Red Item PLEASE PRINT LEA LY FOOD ESTABLISHMENT INSP CT O J50 Name Date ^ e of section p outine Addres Risk f tfoo-d Sery ection Level Previous Inspection Telephone Residential Kitchen- Date: i Mobile Pre-operation e Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP 9.0. Other Inspector t: Each violation checked requi120 zatniong res an explanation on the narrative pa (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 "PROTECTION Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives -40 ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures 5.Receiving/Condition ❑ 17.Reheating 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ' ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for.HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY O ' ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations tFide. Critical(C)violations marked must be corrected immediately. (blue&red items) ` � Corrective Action quire ❑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 todms Embar ochecked indicate violations of 105 CMR 590.000/Federal ❑ g ❑ Emergency Closure El Voluntary Disposal ❑:Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (F6-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.Equipment and Utensils (FC 4 590.005 B=One critical violation and fess than 4 non-critical violations 9 )( ) cited in this report may result in suspension or evocation of the food Seriously Critical Violation=F is scored automatically if: no hot /r if no critical violations observed,4 to 6von-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration.. 28.Poisonous or Toxic Materials (FC-7 590.008) 9 violation,4 to 8 non-critical violatio s=G 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other Ins a �s S nature i PATE OF RE-INSPECTION:; 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N tt #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC Si na ure , Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions {' Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 1q .. Food or Color Additives _ Law Cooled to 41°F/45°F Within 4 Hours* I * - * 3-501.15 Cooling Methods for PHFs 590.003(B) [Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202:12- - Additives Cooked and RTE Foods.* Additives* - 19 _ PHF.Hot and Cold Holding 2-103.11 Person-in-Charge Duties - - 3-302.14. Protection from 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) - * - 7-101.11 Identi in Information-Original Containers 2 590.003(C) Responsibility of the Person-in-Charge to - - Other* g g 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F* _ Applicants* 3-302.11(A) - Food Protection* 20 Time as a Public Health Control " 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* - • Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G)- -Reporting by Person in Charge* - _ _ _ 7-203.11 Toxic Containers-Prohibitions* 3 Contamination from the Consumer 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* r ,, , REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions - g ( ). Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces '' 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* _ 590.004(A-B) Compliance with Food Law* 4-501.111- Manual Wazewashing-Hot Water L 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* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 1g Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* - 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* _ gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* - 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* sg�^°=uuzoot 4.-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B), Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell _ Shellfish and Fish From an Approved Source_ _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish*- 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15, - Molluscan Shellfish from NSSP_Listed Chemical* Ratites-165°F 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 A * Regulatory Authority Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present*- 2-301.12 Cleaning Procedure*_ _ 165°F* foodbome illness interventions and risk factors. 2-301.14 When to Wash* I * Other 590.009 violations relating to good retail 590.004(C) - Id Mushrooms* 3�01.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201 17 Game Animals* 11 Good Hygienic Prictices a7 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinkin or Usin Tobacco* * Requirements. 5 ' - Receiving/Condition - � g, t=- g 3-403.11(A)&(D) PHFs 165°F 15 sec i 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C CommerciallyProcessed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 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 590.060 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 4.1°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours.* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans ' ' 6-301.12 1 Hand Drying Provision 29. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 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. INC r f TOWN OF BARNSTABLE ., HEALTH INSPECTOR'S Establishment Name: V Date: Page: of q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00'9:30A.M. RARNSrAB.[. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION 4 VIOLATION/PLAN OF CORRECTION Date Verified �p a 9:e�0� HYANNIS,MA 02601 More.-FRi. No Reference R•-Red Item PLEASE PRINT CLEARLY 508-862-4644 F OD ESTAB ISHMENT INS EC I N REPORT Name ate p a of Tye of Inspection Eetail Routine Address Risk Re-inspection �. Level Service Previous Inspection Telephone ential Kitchen Date: IM Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires`6A explanation on the narrative page(s)and a citation of specific provision(s)violated. 01 Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS In 1141 ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation 9 Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Af ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY - L11 I - ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations IV Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: In 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 ❑ 90 Embar checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 6 non-critical violations re if no critical violations observed,4 too non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste-, (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials _ (FC-7)(590.008) g violation,4 8ripn-critical violations=C: 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspectanare Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N#Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's S Print: Self Service Grease Tra Size Variance Letter Posted .•Y N Wait Service Provided P Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions G' Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 1q. Food or Color Additives r Law Cooled to 41°F/45°F Within 4 Hours* t 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 Substamces 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 590.004(F) 7-101.11 Identifying Information-Original Containers 2 -590.003(C)- Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* * 7-201.11 Separation-Storage* 20 Time as a Public Health Control 3-302.11(A) Food Protection 590.003(F) Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use*3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11)- - Variance Requirements 590.003(G)- Reporting by Person in Charge* - I Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdultereted or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) - . - 1 Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* _ 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products*-- 4-501.112 Mechanical Warewashing Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs*- Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3 401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Equipment 4-601.11(A) Clean Utensils and Food Contact Surfaces of Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* _ * Eggs-Immediate Service 145°F 15 sec* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effect-rnnoor 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and.Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* - 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009 A)-(D) Violations of Section 590.009 A Chemical ( ( )-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11 C 3 Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under { Game and�/d Mushrooms Approved By � 2-301.11 Clean Condition-Hands and Arms* ( )O P Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 _ _ Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 77 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition - - - g, g g 3�03.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) * 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* L13 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 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004 Labeling of Ingredients* Supplied with Soap and hand Drying Devices (n 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision = 29. Spec al Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* > S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. No. c;t Fee $5 0. O 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for 30igpoga1 *pftem Con6truction 3permit Application for a Pe o Co struc ( )Repair( )Upgrade( )Abandon( ) XX Complete System ❑Individual Components �3 Location Address orLo Iyanough Road Owner's Name,Address and Tel.No8 8 8—2 7 8 4 pannis Mass . ark Ellis 1Kssessor'sMa�/Pazcel �ZL� 10 Wood Ave Sandwich,Mass . 02563 Installer's Name,Address,and Tel.No. 5 0 8 0 7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass . 02632 Box 66 Centerville ,Mass . 02632 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building REST. No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Grease trap Type of S.A.S. Description of Soil Sand and stone. Nature of Repairs or Alterations(Answer when applicable) _Replaced m a r k e d and 1 iz a k i ni grease trap. . Installed 1 -H2O 1000 gallon grease trap with cast iron rings & covers to grade . Date last inspected: 4/2 8/9 7 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu d by this B d ealt Signed ` Date 4/3 0/9 7 Application Approved by Date �— 30 1 7 Application Disapproved for the fulowinl reasons Permit No. 0 Date Issued No. ad _ Fee $50.00 - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migozar`*pgtem Construction Permit application for a Pe oaCo struc ( )Repair( )Upgrade( )Abandon( ) XX Complete System ❑Individual Components Location Address or Lot Iyanough Road Owner's Name,Address and Tel.No8 8 8—2 7 8 4 Aysannis,Mass . ark Ellis sessor's arce'Map/Pl T .� .p6 10 Wood Ave Sandwich,Mass. 02563 Installer's Name,Address,and Tel.No. 5 0 8 677 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5-3 3 3 8 J.P.Mac16mber & Son Inc. J.P.Macomber & Son Inc. Box 66,1Centerville,Mass . 02632 Box 66 .Centerville,Mass. 02632 i Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type`of Building REST. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Grease trap Type of S.A.S. Description of Soil Sand and str©ne. f Nature of Repairs or Alterations(Answer when applicable) Replaee� cracked and leaking grease'-trap. .Installed 1-H2O 1000 gallon grease trap with cast iron . rings & covers to grade. Date last inspected: 4/28/97 - Agreement: - The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu d by this B dI�ea�l •'. s ,.; Signed /• �it.�i r Date 4/30/97 Application Approved by Date - 3� ' �/ 7 Application Disapproved for the fo low.ing reasons Permit No. - `aG _ . _ Date Issued ——————————— g————————————-——--—-- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(XX)�.Upgraded( ) Abandoned( )by J.P.Macomber & Son Inc. at 251 Iyanough Road Hyannis,Mass . has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - o dated Installer J.P.Macomber & Son Inc. Designer J.P.Macomber & Son Inc. The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ——————————————————————————————————————— No. - a`d�; Fee$ 50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Dioozal *p.5tem Conztruction Permit Permission is hereby granted to Construct( )Repair(X)}Upgrade( )Abandon( ) System located at 251 Iyanough Road Hyannis .Mass . and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be ccoom�7pleted within three years of the date of this permit. Date: h� o / / Approved by C.1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTI-IV/, --- ..............OF.........A..a4...... .- A' ...... ' Appliration for Bigpoii al Works Tnnitrnrtion Vanfit Application is hereby made for a Permit to Conct rorfRACair (��, "an Individual Sewage Disposal System at: (� i ��-'Z ` ocation-Address or Lot No. G r O Q/X � } ............................. ?�t t .-5�'�1--..._ C �1: .......�f-l`.'f t% ................................ Owner Address W Installer Address Type;of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............................. .. .....Expansion ttic ( ) Garbage Grinder ( ) Other—Type of Building .CUs!N .97.. No. of persons_.... ___ ............ Showers ( ) — Cafeteria ( ) Other fixtures .................................................................. -----------------------------------------------------------------•.................. Design Flow.._....3.✓'�...........................gallons per person per day. Total daily flow.......... d..._..._...............gallons. W a i v WSeptic Tank—Liquid capacity�,oQ.gallons Length,'A2..� Width..6�r_e" __ Diameter................ Depth...-F`� 'I'_'.. x Disposal Trench—No.................... Width.................... Total Length.................... Total leaching area.....................sq. ft. Seepage Pit No._._.Z..._.__.__.. Diameter..Z __-�'-___- Depth below inlet..... Total leaching��.7/'-..s . ft. Z Other Distribution box ( Dosing tank ( :) . aPercolation Test Results Performed by..�. L. ...................... Date___. ... Test Pit No. lam. minutes per inch Depth of Test Pity- .`... Depth to ground water...z..0� '- w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------------------------------------------------•--------..................--•-•-----......................................................... 0 Description of Soil..© ... A .DR-4,7� .C�!�.v'r�-�!�f'---•---------------•---- x ................................ -u--" .---------- y^ r W ------------------------------i' - /YY '--^--- �- ,�1 5;'--4,60� ----- 5`59^j UNature of Repair r terations—greement: swer he cable------------ _ . - •� --- A y f V r/ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T T._.:" p S of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee��is)sue the boardQf health. Signe hv`! .-`----`'k ------•---------- ...... -/�/ Application Approved B .............- �r:.. PP PP yC, L .... -'._. : Date Application Disapproved for the following reasons:...............•-•--------_. ...---------------------------------------------------------------------•------•-- -•-•----------•-----•--------------------------------------------•--------------------.......------..-- Date PermitNo......................................................... Issued....................................................... Date t THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ............. OF......... .. ...... . 2............................................... Wnfifirati of ToutpliFanrr T I IS 0 CER That e I iv'dual Sewage f �. Sewa e Disposal System constructed or Repaired b ------•-•-. -----•-----• � � j----_----- - J Install VV at .---�- •-•-- i � nc!'�� - , ----- -- -----------------------=----••. has been installed in accordance with the provisions of TI j of The State Sanitary C�de as described in the application for Disposal Works Construction Permit No.'../ .7..._.._.._.. dated.--..{r' e........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......17- 1 77------------------•----•--......----•---._.. Inspector..................................................................................... \ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF` l--IEA" l� t1��-------------OF..... �- Appliration for Uiipu�Fal Vorkg Ton,itrurtion Vautit Application is hereby made for a Permit to Co «(ct or ai (r an I vidual Sewage Disposal_ . System at: r �G �'l /' �2.9 ` i Cs 'c.-�s tr`...... :fit%'".`�y �'��.... f'71�.A^�ia1r:,`�y'� --{=•-�/��J.�M �!r,�:: �:-•(r�_ ocation-Address,/ - -'`"jx", or Lot No. ...... Y_i�.i'dt/�T `-s ...... t .........................I!'Li............................................... Owner r Address W. ` •--••------•..........................•----•---••-•----.._._.....---•-----._._..._....__.......... -...-•-----•--•-•-----•------•--------•-- •-----=..°.......................... Installer Address Q Type of Building Size Lot________________'.__.._._._Sq. feet U Dwelling—No. of Bedrooms___________________________________________Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building No.`of persons_-_.�`1';_ ;..____.-.-.-- Showers ( ) -.Cafeteria ( ) .Other fixtures ----------------------•--•---- -• - - `M W Design Flow.!........-a_ __________________________gallons per person per day: Total daily ,t�flow_---__-__- 4 ; ..............gallons. WSeptic Tank—Liquid capacity;_5 -_gallons Length/ Width _-t1`';--__. Diameter---------------- Depth, ......... x Disposal Trench—No_ ____________________ Width.................... Total Length.......... ._.¢ *___ Total leaching area_ _:�____--____sq. ft. Seepage Pit No.....;�k--......... Diameter_.e-:�®#.;---_._ Depth below inlet..... ........ Total leaching area Z, '!.....sq._ft. Z Other Distribution box ( Dosing tank '-' Percolation Test Results Performed by--_�-��--_-_--- _+ *.___ _. c ______________________ Date....'`�............ � Test`s-pit No. 1 _✓' minutes per inch Depth of Test Pit_/_ • ...... Depth to ground water... --. Lam. Test Pit No. 2.............;:_minutes per inch Depth of Test_Pit.................... D e�pth to ground water.......................... . p - _w Z p r. :_ ' Description of So>1---------------`-'"---------- =------•. ----'_----=---•---._.......,_�-�_.c-s?��.__=`>y-------- '------------------------------------------------------•----- V ----•--•--•••-•-•-•••••----•-•-•-----•---•- -- W ^._._.-_-- -. � --............... _-_-_. _�_ _________-__-.-_. _._________.____.-. Y + txj Nature of Repair r erations— wer hg cable._-.--___ l __-_---__ - �b ------------=......................... A eement: r p � � E The undersigned agrees to install the aforedescribed Individual Sewage isposal System in accordance with f'1 T�'1�-'• the provisions of ��: 5 of the State Sanitary Code— The undersigned , rther agrees not to.'place the system in operation until a Certificate of Compliance has bee issue the boar health. Signe _1, t l -• - -- Da Application Approved BY - f ,a �i�i -- 7.t".�, Date Application Disapproved for the following reasons_______________________`,15 --------------------------------___-----_-_-_.- .'r..__..__.._...-_________-_---___ • ------•-•-•-•-------....-••-----•----•----•----••---------••••-•---••--•---•--•------•---•-•-••-................. ------------------------------------------------------------------------------ '--- Date PermitNo........................................................ Issued--------------------------.......................... r Date THE COMMONWEALTH OF MASSACHUSETTS BOA 'D O HEALTH Tr ttfirat of TPi'ft fttnrr T I IS CERT hat e I wi ''ual<Sewage Disposal System constructed (fe) or Repaired ( ) by.. _.__..___. ..._.. .... .. r a - Install y ' has been installed in accordance with the provisions of TI j of The State Sanitary C e•as described in the a lication for Disposal Works Construction Permit No.--- -____.____. dated-__--- ... 6 p. PP 1 --•--- = = THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE . _. Inspector THE COMMONWEALTH OF MASSACHUSETTS = BOARD OF HEALTH 7 ..OF............. ............... - "......., 2 s .._. FEE........................ Disposal k� �ra�tiaxn� �rutit Permission i eby granted. cg� = ......... to Cons t ( or Rep ) a Indiv' al Sewage DiSystem . at No.- rfiitQ.¢.. � l r' 'f -- as shown on the application for Disposal Works Construction Per t o....__...... ____ D ed__.�-�'�6_' _ �.} G.A!• .............. ... ....-- --_--•--- DATE___�� ` 6 Board of xealt - FORM 1285 HOBBS & WARREN, INC.. PUBLISHERS `��/"` No.............. �' Fss....�..�...... _. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 � -._...................O F. Appliration for Diivnsal 1VOrk.5 Tomtrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systea .�J..2 ................ .......... .. ................--_. ... ................... Location 1,'i_;'ess or Lot No. / �wneg Addres -- Installer AdUress d Type of Building C'2� L ��c� Size Lot............................Sq. feet 7 •vim U Dwelling—No. of Bedrooms............................................ xpansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers — Cafeteria a YP g P ( ) ( ) ' Other fixtures ---------------••---------•----- -•---•---•--•-•------•-------•--•-•------ ---------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow____..... _...........__._._..gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1" Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -•-•--•---•----------•............................................•------------...........•---------......................................................... 0 Description of Soil.........................................................:.............................................................................................................. . x w •--••••------------••---••------•---•-•••--•----•------•--••--------•---•---••-••••--•-••-••-•--•••----••------•---- �--�- j ...... VNature of Repairs or Alterations—Answer when applicable_.... +1.S. �4..!-..(...._.../.G..... . --------•-------------------•--•----•------•--...------------------......--------------------------------------------...--------•----------------------•-•-------•--•-•-----------------------------••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT Li: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issue y the Nr health. . .........••--- �` e ApplicationApproved By.......-• . ..................• ......................... ................................. �G...-•-- Date Application Disapproved for the following reasons:.............................................................................................................. .................................. ---•--•--•-•--......_........................ ------ ........................................................ .........................--••--••-•---•--••.....-•-•......••- _ Date Permit No.......... S7 ... Issued.....-----•----•---••-----------------------•----------- ----••-------•--------------- Date ♦............................. .............................................................:.G................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 (9rrtif iratr of Toutpliatta THIS T CERTIFY at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) Installer at------------- •-"- --------- -��---•--'--- `--`...----- -`�-.--- m ----------------------....__...-------•................----------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code s �lescri ed in the application for Disposal Works Construction Permit No.__.�- ...........................�...... dated_.-.._____��-/_-�_� ........... THE ISSUANCE OF, THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ - Inspector.................................................................................... _� Ficis THE COMMONWEALTH OF MASSACHUSETTS _------- > BOARD OF HEALTH nmj �.. ...................0 F. ApPratiaan for 11ispasal Murks Tono#rurtion Prrini# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S ste/m/ at• // �•�Location Address - N I— �"'c Lot No •F - t7j -• ..».. . .....__Ownez'1 ......-.... . .................. --......I..... ....Address+:.V.._......... �........—� r4-t�,^ti c+ r._ ' ` � ' C:\I i 4 [_ �t �.... .....L.... .._• ............................ ....... .;.... .................. Installer v Address Type of Building U M e� Size Lot................ Sq. feet ,., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building .............. No. of persons..............._.........._. Showers — Cafeteria a' Other fixtures ---------------------------------------------- 411 W. Design Flow........................:...................gallons per person per day. Total daily flow........+ .......__.._..._...gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No..................... Diameter.................... Depth below`inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) � Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -------------------------------•---. -----------..........._.........•-••---•-----------•--•-•----.--...--...........--••-------•-•--•..............--••- 0 Description of Soil............ ........................................................................................................................................................... U ----•----- -- W ....••-------------------•---------•----•---•---••------•----•-----••••-•---••--•-•-••••••••------------•-•-•----•---.---••--••-----•••••-----••••--••-•••-••.....•-•--•-•-••..• . UNature of Repairs or Alterations—Answer when applicable..........:- ?__��4' �r � �!_6:�.r..._C. �..�.`?.�.^s:.�.#^'j j W. .......................... .............................................................. ..................................................................................................... (/ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code-.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been(issuedkby the board-of-health. ......__.S,igned..............................................................r , ..ram.....- ................_.... Appllc tion, Approved By...... ��.!� . -. •.......---. ..............................� _ ' a...... a; Date Application Disapproved for the following reasons:-•--•--•...............••-----•--•-•-----•------.....--•-----------...........-••-•----•--.........------•---- .........................••--•-••.................-•-••-•--••.....••••-•------••...................-•••...•-•--.._............I.......••.....••.....--•-•--•-••-••-•....•••••-••••---................... _ Date PermitNo. .................. -�� Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OFF HEALTH .........................................OF.........1 '.!..°'7w- 'f ............................. (Irdif iratr of Toutphatta THIS I CERTIFY ,1 10 Individual Sewage Disposal System constructed ( ) or Repaired ( ) �5 .. 1 ..---•................•--------•--• r. �-.' ✓ Installer at :. , _. ..... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Cod T'cri ed�n the application for Disposal Works Construction Permit l�o._` �.................•---...._. dated......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. - Inspector............................•....................................................... THE COMMONWEALTH OF MASSACHUSETTS �- BOARD OF HEALTH No....,,Z....�? FRE...... .......... Disposal Toiimd �� 90doMorr Permissionis hereby granted..............-•-•---•-••--••---...........-••.--•...-•••••-•-- --.............................-••••-•---••................................ to Construct ) or Repair ( ) a}l I ivldual Sewage Disposal System atNo................. ... 'G yh. ._........._..... ............ Street / s shown on the application for Disposal Works Construction Permit No. Dated.......... 4� �'• S+ ±. ----�i.r' -----•-•----•---.....-•--•-•--........._�e3lth DATE.. ---..... -•---r......-----•-� -•-----•-•-------------- FORM 12 - LKIN, - INC., BOSTON ` #V t � - yO 7 7JJJ L 0 CA T10 S E T N®. VILLAGE INST'A LLER'S NAME & ADDRESS on OWNER id- DATE PERMIT ISSUED _ - 7 DATE C0IMPLIANCE ISSUED x0a of ?To- ;IrkL 01 CI °1 e J { i t 1 of •* Y n • - ' . i �• January 28, 1980 Mr." EdwS n Taylor, Chairman Board.of Selectmen Town,of Barnstable Hyannis MA , Dear Mr: Taylor:.. : a • , 'The ,Quartedeck •Lounge has'presented no. major ;health ,problems 'n - for the and"of ,Health«. �. A "minor problem +is recurring litter around'the .outAide .of the premises during •the' summer, however, we •have no .objections. to Ahe,grant ng of a liquor li'cerise.. we would recommend.• 'that food from.Tinker's Kitchen should not , • f be, brought to 4:the Quarterdeck ,for, consiumption, by'Quarterdeck I patrons. D ` 4F '. Very truly yours,` .-John Drector -of Public Health • •M a ` •. tit.:. .. ' r u V, of June 21 1979. . T .• _ ... n•. - e.. - •tee" - ,. � ,' .. ' , _ ,. - -,. Mr.r. William -Weller Technical,' Plainriing}Asaaciates f ` P. -O Box 1235 • East- Dennis `.,MA 02641 `{ r Re: On=site sewage system - Quarterdeck Lounge, Hyannis Dear, Mr.•,We1'ler: You are' ranted a variance..to install-`a Y gsewage ,leaching p1tK: • �` _k 13 feet of ron, a,,building' at' the Quarterdeck Lounge, Iyanough Road, Hyannis, , in -lieu_of'•the, required 20, feet with :the folell lowing 'conditionsr (� ) Al other .regulations. contained iri Title 5, -of the , State <Enviion ntal Code and Town of Barnstable,' Health ,regulations taust be `complied" with.. i (2,)• The designing engineer >must supervise placement of . D the pits and .certify; 'in writing,-.that`,his design r rt. has, been. strictly adhered to prior 'to' issuance of a r complianc® certificate". F _ ,' ' This variance`expires.,Juiy, r- 1,9806, °' • -* "- ; Very t u y yours, ,. f, Robe L. Childs, Chairman C ♦ , _ - 4 e ; - 1. . ~Ann Janelshbaugh. f ; A . W, Mandelstam°, BOARD OF HEALTH -TOWN OF BARNSTABLE' Y ; { ? +. '!'a ` t. . 'TECHNICAL PLANNING M ® ASSOCIATES �= P. 0. Box 1235 - 1070 Route 134 EAST DENNIS, MA 02641 LETTER (617) 385.8343 Date To_.._ ._. ... ........ ......... ...._._ Subject ��-- Guve�/ d CO.......... C ��.... /_ate_C.��..��..� :..... _._...... . ._... l-- - _......... _ . .�, .. .. .. . . ... �..... ...... .........1 ... - .. f ..Y ..................... ......_.c. <—.T.. ........... ....... ......... _. ._.... .. . .............. _ .. . ......... _ . ... .. ......... .. ........ ... ............... .......... . .......... ........... ................... ........ .... .. .. ......... ....... SIG E ❑ Please reply ❑ No reply necessary FORM 186-2 Available from �Inc.,Groton,Mass.01450 I Town of Barnstable �oFIME 200 Main Street,Hyannis,Massachusetts 02601 9 �m Regulatory Services Thomas F. Geiler, Director �ArF p p Building Division Tom Perry, Building Commissioner Phone(508)8624679 Fax(508)862-4725 www.town.barnstable.ma.us October 7, 2010 c ? CI Quarterdeck Lounge c/o Attorney Michael D. Ford f; "Z Law Offices of Michael Ford 9 72 Main Street, P. O. Box 485 c West Harwich, MA 02671 =' RE: Site Plan Review#026-10 Quarterdeck Lounge Site Redevelopment 239 lyannough Road, Hyannis, MA Map 328, Parcel 206 Proposal: Redevelopment of the site: site contains 5 existing building. Residence 821 s.f.; Store 1,360 s.f.; Restaurant (Subway) 1,561 s.f.; Restaurant (Quarterdeck Lounge) 1,544 s.f.; and Store 1,989 s.f. Proposal is to demolish both stores and add 1,827 s.f. to the Quarterdeck Lounge building. Residence and Subway buildings to remain as they exist. Overall square footage on site will decrease from 7,377 s.f. to 6,278 s.f. Dear Attorney Ford: Subsequent to the formal site plan review held August 26, 2010, revised plans for the above-referenced proposal received an administrative approval subject to the following: • Approval is based upon plans entitled V247 lyannough Road, Hyannis, MA" prepared for Errol Thompson, by Down Cape Engineering, Inc., Yarmouthport, MA and dated February 5, 2010 with a last revision of September 23, 2010 consisting of 4 sheets; and Drainage Area Plan dated September 22, 2010. • Elevations will require approval from Growth Management Department for compliance with Hyannis Gateway District Design Infrastructure Plan standards for design. • The demolition of a building 75 years or older(ca 1920 store)will require the prior approval of the Barnstable Historical Commission. s • If future improvements to Route 28 include the utilization of Engine House Road for traffic improvements, the use of proposed parking spaces that back out onto Engine House Road will need to be discontinued at that time. • Upgrade to a full service kitchen will require a fire suppression and alarm system to be installed. 4 f • Applicant must obtain all other applicable permits, licenses and approvals required, including but not limited to, Hyannis Fire Department and Health Department requirements for restaurant use. Upon completion of all work, a registered engineer or land surveyor shall submit a letter of certification, made upon knowledge and belief in accordance with professional standards that all work has been done in substantial compliance with the approved site plan (Zoning Section 240-104 (G). This document shall be submitted prior to the issuance of the final certificate of occupancy. A copy of the approved site plan will be retained on file. Sincerely, Ellen M. Swiniarski Site Plan/Regulatory Review Coordinator CC: Tom Perry, Building Commissioner SPR file Health Dept. Hyannis FD Growth Management Dept. Barnstable Historical Comm. MaCngton, Ellen From: McKean, Thomas Sent: Monday, January 12, 2009 12:04 PM To: Wadlington, Ellen; Stanton, David; Desmarais, Donald Subject: FW: Sewer Connection for map,328 Parcel 206 - FYI - -----Original Message----- From: Burgmann, Bob Sent: Monday, January 12, 2009 12:01 PM Q�Jd To: McKean, Thomas Cc: Tom Lee' Subject: Sewer Connection for map 328 Parcel 206 o,3 9 Z4k27k acl-"l Hi Tom, Please be advised that DPW is in the process of granting a sewer connection permit for the above referenced property. All of the buildings on the property will be connected to the town sewer in the intersection of Ridgewood Avenue via a pump station that is to located on the lot. All of the onsite septic systems are to be abandoned. The owner has been informed that permits must be obtained from your office for the abandonment. Existing grease traps will be retained and will still require inspection by your personnel. Bob Robert A. Burgmann, P. E. Town Engineer 508-862-4070 508-862-4711 fax J - -- ---.Map dt"ce 328 - 205 235 thru 251 fyanoo oad yanni , _`D LJ tr+p dYe tlLLMH ifa�c tr{p C C 5sN tied - in May 20 , 09 ---/ all r f I - ' r 0 r 0 r I V r _ r wrtiny / unrlegrard N oa7ch�od�iW w EL 1 l at A dm from AW to prop lrne i ti o 1 ti l s l AWP 32119.01 hotel C { 187 lyennWh�.gh Rm Rued!Nt!lAI bill UQ- 0 5 � O Cr" H O z 0 r o ' o tYannnug�Road / Rte 28 F hotel 3 ro � 9 tit {71 ^� � � •yam 6� JLi Y� y May .`•. No. — P,,oFq"ETowy OFFICE OF THE BOARD OF HEALTH y� -n OF THE o BARNSTABLE, TOWN OF BARNSTABLE, MASS. y MASS. OVA 1639. �� y �OMAYOr� ''J� / -- ------ -' ---- 19 SEWAGE DISPOSAL PERMIT Permission is granted to �___ ___� _______ r ._•' �'�• -�,_ to construct - :_�Y_ �_____ _ _ I Upon the Premises of Sketch In the village of 40, r more feef,' from any 'source of wd` r supply 20 feet from building 10 feet from property line - Health Officer. r � �C `S - Si. Zug -Irf- COMMONWEALTH OF MASSACHUS is !/af EXECUTIVE OFFICE OF- PNMENTAL AFFAIRS' � DEPARTMENT OF ENVIRONMEN' VROTECTION 1-005NA a9 At, 10: s TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICA'I`ION - - / /ram" o,-- /�gt?�t/sT9 B CCr Property Address: 2��1�T�� i ��<��q� Owner's Name: Owner's Address: i �� i� f— ��¢� C ,'t ve Date of Inspection: F9�y Name ofn Inspector: (pl�seprin ) � /�q /�� Company Name: C ,� (� Mailing Address: l�w / Z 5---7 16ov oz s�3 Telephone Number: —� —� CERTIFICATIONSTATEMENT I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant�ec15.340 of Title 5(310 CMR 15.000). The system: Conditionally Passes Needs Further Ev luation by the Local Approving Authority Fails Inspector's Signature Date: The system inspector shall submit a copy of this i pection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments C/4 1/��Z y ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: QTZt3 Owner: EZG/ Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Syst Passes: I have not found any information which indicates that any'of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Z-;Y7-1/14r RVS' B. stem Conditionally Passes: O or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The stem, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not rmined (Y,N,ND) in the for the following statements. If"not determined" please explain. The septic tank is metal and o 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration o xfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying sep ' tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is s ally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is avai e. ND explain: Observation of sewage backup or break out or high static wate vel in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. tem will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s . The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of i l OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: r— �A-ze la-1'47titi1< Owner: - (. Date of Inspection: ,`— G — a }� C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failin to protect public health, safety or the environment. 1. Syst will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the syste s not functioning in a manner which will protect public health,safety and the environment: _ Cessp of or privy is within 50 feet of a surface water Cesspoo or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the B rd of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner t protects the public health,safety and environment: _ The system has a septic tank and it absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a s e water supply. The system has a septic tank and SAS an he SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the AS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SA 's less than 100 feet but 50 feet or more from a private water supply well". Method used to determine di ce "This system passes if the well water analysis,performed at a EP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is ee from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or ss than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached t his form. 3. Other: 3 Page 4 of 11 • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Z35'eT ZB Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No / $aekup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or c ged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or c ool A /¢ Li depth in cesspool is less than 6"below invert or available volume is less than day flow equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number � es pumped rtion of the SAS,cesspool or privy is below high ground water elevation. Eater ortion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface upply, onion of a cesspool or privy is within a Zone I of a public well. 4 _ portion of a cesspool or privy is.within 50 feet of a private water supply well. " Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria / are triggered.A copy of the analysis must be attached to this form.] 4l° (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. rge Systems: To be co ' ered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate eithe ` s"or"no"to each of the following: (The following criteria apply to systems in addition to the criteria above) yes no the system is within 400 feet of a surface drink ater supply the system is within 200 feet of a tributary to a surface drinkin ter supply the system is located in a nitrogen sensitive area(Interim Wellhead Protectio ea—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or ered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 f� . Page 5 of 11 • OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: '�3S�TL6 Owner: i S Date of Inspection: Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes/�o �/ _ Pu ing information was provided bY e owner cupant,or Board of Health L/ of the system components pumped out in the previous two weeks? -�,' Zs �ystem Y Y P P P received normal flows in the previous two week period? _ Have large volumes of water been introduced to the system recently or as part of this inspection . Were as built plans of the system obtained and examined?(If they were not available note as N/A) as the facility or dwelling inspected for signs of sewage back up Was the site inspected for signs of break out? ere all system components,1 1" 01 e SAS, located on site Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the ba es or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _7_ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ti Yes o xisting information. For example,a plan at th Board of Heal Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] G�t/T�/Z� S 72-W 5 Page 6ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: (2�/ Date of Inspection: 5-- 4- —� SIDENTUL FLOW CONDITIONS N Nufttbq of bedrooms(design): Number of bedrooms(actual): DESIGN ed on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current r ts: Does residence have a garbs ' der(yes or no):— Is laundry on a separate sewage syste s or no):_ [if yes separate inspection required] Laundry system inspected(yes or no):— lri Seasonal use:(yes or no):_ Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no):_ Last date of occupancy: CO M M E R CIA L/IND U S T RIA L Type of establishment: -s Cf sign flow(based on 310 CMR 15.203): d asis of design flow(seats/persons/s ,etc.): rease trap present(yes or no):62- � Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 s ste y .s or no)�� ater meter readings, if available: f—G (/��s ��,✓ Last date of occupancy/use: Z�� OTHER(describe): Yj `�' C 6 GENERAL INFORMATI N y��re v Pumping Records ( 7 / Source of information: ��✓wl�) �� -Y--e4p�t a� �K27 6 o� Was system pumped as of the ins ection s Yrl y P (y or no):�1 �� 1f yes, volume pumped- allo -- ow was uantih ppum��22ed d termined? �/ 64 `5 Reason for pum ' 8 ae — Iva J/o TYP F SYSTEM eptic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool _—Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,datei stalled(if known)and sour e f info nation; Were sewage odors detected when arriving at the site(yes or no):—410 6 Page 7 of 1 1 • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 4JIV is Owner: t�ZL(S Date of Inspection: 57 �5 BUILDING SEWER(locate on site plan) Depth below grade: /?'! Materials of construction:_ t iron —40 PVC_other(explain): n 5c 62dL Distance from private water supply welf or suction line: 2�-Ire �/r c !C�_� SYS /6R�--'4vy o� Comments(on condition of joints,venting,evidence of leaka e,e�tc.): SEPTIC TANK:—(locate on site plan) Depth below grade: Material of construction:— oncrete—metal—fiberglass—polyethylene —other(explain) If tank is metal list age:�o Is age confirmed y a Certificate of Compliance(yes or no):,U�(attach a copy of certificate) � �Y �,� Dimensions: /o /S'o� J-- 5 Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: s /y.� /S' �n (rd✓-r� Scum thickness: All ' !� /z Distance from to of scum to top of outlet tee or baffle: /✓ Distance from bottom of scum to bottom of outlet tee or baf�l-e: /0 ��/�/v!! How were dimensions determined: _ tit d �I�CE ��' /Z" avTirT Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert evidence of.leakage,etc.): / 77�,/� Z�nOU - Q �'' N/�GR SE TRAP:—(locate on site plan) jL ��V! �`y Depth belo grade:— Material of co ction: concrete metal fiberglass polyethylene—other (explain): — — — Dimensions: Scum thickness: Distance from top of scum to top utlet tee or baffle: Distance from bottom of scum to botto of outlet tee or baffle: Date of last pumping: Comments(on pumping:evidence mendations, inle d outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert of leakage,etc.): 7 Page 8 of I 1 a OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2 �� ev ui Owner: Date of Inspection: TIGHT o—rHQLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete etal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: �� X��X, Si yv.k� Comments(note if box is level and distrib tion to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): ^ 45g0v V PU HAMBER: (locate on site plan) Pumps in working order y Alarms in working order(yes or no): Comments(note condition of pump chamber,con t ' f pumps and appurtenances,etc.): 8 Page 9 of 1 1 0 • OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: (c1.�-�J Date of Inspection: s,e.' vy SOIL ABSORPTION SYSTEM (SAS): V (locate on site plan,excavation not required) 1-1 V SAS *located d 11 Q w ,� �- 2�rL✓t � . -P . G•1 i�� e w TYPe �9' C a ea -0,�1 ching pits,number:_ T, � � �/ _ leaching chambers,number: leaching galleries,number: Jn /�jD� ' z s�'�� jf� " 7e• Ste/ leaching trenches,number, length: s� / �t'Tj',;' -,--S- x2 leaching fields, number, dimensions: fi�� L( overflow cesspool, number: 412 innovative/alternative system Type/name of technology: � ej C Comments (note conditi n of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, %etc. : d� 7Zok/ ;k,� C SPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) rCu" t Number an oration: Depth-top of liquid t invert: Depth of solids layer: Depth of scum layer: !/ Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level o ding,condition of vegetation, etc.): PRIVY: site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of pon ' condition of vegetation, etc.): 9 Page 10 of I 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) . Property Address: 3S ' �1✓�l Owner: 15 Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties,,to.at least two permanent reference landmarks or benchmarks. sate all wells within IQ0 feet. L9cate where public water supply enters the building. S �Z3� 10 Page I I of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23r 7Z--r Owner: Date of Inspection: SITE EXAM Slope /_ 3 '/ Surface water i✓��f Check cellar G2A'w� Shallow wells *VA/&' c sti(j'1(a'ted depii4aground water feet S ✓ r J`t P 'tea �/2 / 'Please indicate(check)all methods used to determine the high grounld_water elevation: ( t Obta' from system design plans on record-If checked, date of design plan reviewed: served site(abutting property/observation hole within I 0 f et of SAS) Checked with local Board of Health-explain: env Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: �j You must df scribe hoNy you stablished the hi h round water ele ation: _ 9e •7 /-t/< e- /L 6. /Z 97 �?8 - 2 8 97 zz r6z.#1;16)-�r_ 4 .7 5,f�,, -P zp/. 6� 411K rnvV.-o,5;p,� J.Gd qj 9v v ti'-,c� /2 fi of SAY PAGE 1 TOWN OF YARMOUTH ubcnsinq 05/0405/04/2005 /20 U/B CONSUMPTION HISTORY REPORT ACCOUNT # CUSTOMER NAME PARCEL LOCATION STATUS SERVICE MAN METER # CD READ DATE BY BILL # CURR READ USAGE REPL USAGE CHARGE AMT BILLED AMT -------- ------------ ACTIVE ------------ ---- --- -------------- - ------- -- 928 ROUTE 28 02012189 322921 BLONDIES MAP 1 LOT 21 .00 126.84 100 1 WATER PRO 43199453 A 07/26/2004 12122 477 63 0 .00 .00 100 1 WATER PRO 43199453 E 05/04/2004 9157728 414 0 0 .00 .00 100 1 WATER PRO 43199453 E 02/02/2004 9157730 0 .00 .00 100 1 WATER PRO 43199453 E 11/04/2003 9157731 414 0 -00 .00 100 1 WATER PRO 43199453 A 07/22/2003 9157732 330 80 00 .00 100 1 WATER PRO 43199453 E 05/01/2003 9157733 330 0 0 00 .00 100 1 WATER PRO 43199453 E 02/03/2003 9157734 330 0 .00 .00 100 1 WATER PRO 43199453 E 11/01/2002 9157735 330 0 .00 .00� 100 1 WATER PRO 43199453 A 07/23/2002 9157735 248 82 0 .00 .00 100 1 WATER PRO 43199453 E 05/01/2002 9157737 248 0 0 .00 .00 100 1 WATER PRO 43199453 E 02/04/2002 9157738 248 0 0 _00 .00 100 1 WATER PRO 43199453 E 11/02/2001 9157739 248 0 -00 .00 100 1 WATER PRO 43199453 A 07/31/2001 9157739 248 59 0 .00 .00 100 - 1 WATER PRO 43199453 E 05/01/2001 9157740 189 0 ** END-,OF REPORT ** od6PAW� �XN CL, vQoo vm Sel— � 4 � r U Qv1— 4 col) �' ��`,J y'v�r � � � � , _ D� Cq"" �iC� 2�,o � � C�� L �� Qv ��"��"' � �� Grease Interceptors��/ The new WD Series grease interceptor is now available from Watts Drainage. Engineered to meet the changing needs of both the specification and replacement markets, the WD Series features a new lower design for ease of installation as well as a revolutionary high efficiency layout for faster cleaning. The baked-on epoxy coating ensures long life and durability. Each WD Series interceptor is North American made and individually tested before leaving our factory. Watts Drainage is proud to bring you a true value in the new WD Series. Secured D x E Non-slip Cover Locking Clean-out Device Plug Neoprene ` Gasket T One-piece Air Relief C Removabl - By-pass Baffle — — — ------------- -------------- No-hub LA (NH)Inlet& Static I Outlet(') f Water I Integral Level Deep Seal B Trap Baked Epoxy, Fixed Coated Body I Sediment Baffle 3/8" Note: 'Optional Threaded Inlet And Outlet • 9002 C D P D Air Space (includes Threaded Flow Control) CERTIFIED IAPMO ,w ilntetYep�91' �• Lts„�t �jec,�llrnp y�� W'� G,�aSe 4 � 5 b*:u "`"' `•`. °' `� S�d } Catalog�rPrlcec Trcff'c. Rae Ca acl1 le r � YNumlier� .. A�R�E /.Qrer G LG E�utt� yZ�lielght 4r 1qFWD-4 667.00 1,312.00 04 08 2" 7-3/4" 3-1/4" 16" 1011 11" WD-7 926.00 1,470.00 07 14 2" 8-1/2" 3-1/2" 18" 1311 1211 43 D-10 1,088.00 1,580.00 10 20 2II 8-1/2" 3 1/2" 21-3/4II 14" 1211 WD-15 1,612.00 1,700.00 15 30 2" 10-1/2" 3-1/2" 2211 151' 141' WD-20 1,973.00 1,800.00 20 40 311 11-1/2" 3-1/2o 2411 15-3/4❑ 15" WD-25 2,216.00 1,900.00 25 50 311 1211 4-1/2" 26" 16-1/2" 16-1/2" WD-35 2,739.00 2,100.00 35 70 311 1411 511 3011 1811 1911 WD-50 1 3,627.00 2,200.00 50 111 100 411 16" 5-1/2" 32" 22" 21-1/2" Option Description Option Suffix List Price Option Description Option Suffix List Price Sediment Bucket -B 548.00 Flange&Clamp Device -FC 473.00 Extension Up io 12" E 987.00 Inlet&Outlet other than Standard Size -O 171.00 Extensions over 12",add per inch -E(specify) 82.00 Threaded Connections -THD No Add Heavy Duty Traffic Cover -HD P.O.A. Stainless Construction --SS POA -HD Heavy-Duty Traffic Cover rated at 10,000 Ibs,maximum safe live load. WD-L Series Low-Rough installation t�cf°fet cePt°x stlo G`egs F ta�O ga� Eg L ; Ot , Npmb`er' B GPlkt; ten egg WD-20-L 2,660.00 20 40 311 7-3/4" 4" 35 23111 21 _. WD-35-L 3,425.00 35 70 4" 7" 4-1/2'1 4111 3311 1211 WD-50-L 5,802.00 50 100 411 8-1/2" 5-1/21' 55" 3311 1 141 VAWATTS' Consult factory for all applications outside of listed parameters. DRAINAGE 63 Prices do not include applicable taxes. TOWN OF BARNSTABLE LOCATIONo2,3 7V SEWAGE # VILLAGE ASSESSOR'S MAP& LOT L3 INSTALLER'S NAME&PHONE NO. IJ �. lepo ^� SEPTIC TANK CAPACITY f S �;7tp / LEACHING FACILITY: (type) t 4-- ! — an 1 (size) I OQQ NO. OF BEDROOMS -� BkRLM OR OWNER PERMTTDATE: L?'�-5;1 ' COMPLIANCE DATE:L�� . Separation Dist ance lance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by_ Feet c;2� { �f E ` f _ e e _ a . C A low Via,. . , ..',;: .'VOTE: rr7arT<il11 P4 fO rQcr ax• <. t t ,. ey/sf fir-Si 7t' ors S�pfiG txr ', /-eXr7 k- /each /oif 35 4- �r --- -- - -- i :. �_ '`_ �_/eczc} -_3_ y -Y .---- AA cl a ----•}- ____.___._.__. Y 4 .-T v_..-.- . � ,�17.i + �,1.A.•7� ___. ._. _- __ —__. -_ /E' �JV�TrT�'+Cyt J��7C. _.._..__..__1_ .r -:FA# I t L 3�o.Oo •T AC/n�F LG-ACrY/'�►�- eAI.stir747 yr-oUr7ed Profi /B---o o—o --o -- Pr000seo/ c�rour7d /orofi/e -7-2 5 c H E o. 4 o P v c. o,e F c, o w - ---�•- �'� ' EQu/9� To.9EPT/G / d 2" o �B �2N wash e d/ sto nes C /'rVi»iM17U"� tr foot} f C TgnJK� '" G cor+c. 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