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HomeMy WebLinkAboutISLAND CAFE & GRILL - FOOD ISLAND_CAFE & GRILL (t-V)251,Iyannough Rd; FORMERLY: MONTY'S/SUBWAY' _4 If g { zy x € a t v n o- » cn WA V iWIM AVA of � r xr i art, , Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNS.TABLE F.P.(Thomas)Lee,. v$ A 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 695 Issue Date: 01/01/2022 DBA: ISLAND CAFE AND GRILL OWNER: ERICA STERLING Location of Establishment: 251 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 40 OutdoorSeating: 12 Total Seating: 52 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G�n FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: t4 L of For Office Us Initials: .°k"'E' •� Town of Barnstable Date Pard Amt Id$ : .APIMAB M : Inspectional Services MAW •&, ►` fS � Public Health Division cheek# 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 NEW OWNERSHIP @@ RENEWAL NAME OF FOOD ESTABLISHMENT: 7y,G G�. r .L ADDRESS OF FOOD ESTABLISHMENT: 5 I 2�:Ac,"V-v vo LuCA V'l 4tAn► is N4o�-P MAILING ADDRESS(IF DIFFERENT FROM ABOVE): rraa E-MAIL ADDRESS• ' Gnd V n-,CC, Lo 0 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O� ) TOTAL NUMBER OF BATHROOMS: 3 WELL WATER:YES NO X ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:—X— SEASONAL: DATES OF OPERATION: / / TO s NUMBER OF SEATS: INSIDE: 40-- 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? 4 IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES... (MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE&NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:Wpplication FormsTOODAPP 2020.doe OWNER INFORMATION: FULL NAME OF APPLICANT &I►C (� l i"VI. SOLE OWNER: YES/NO D.O.B O R PHONE # ADDRESS (fr: ,C41 i aL CORPORATE OWNER: n 2( r� CORPORATE ADDRESS: C e-- PERSON IN CHARGE OF DAILY OPERATIONS: Lx L CLt c/ ( i✓L 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 J/A/ i SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/agplications.as . 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.31'each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc I p& Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BANNSTAUM Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 695 Issue Date: 01/01/2021 DBA: ISLAND CAFE AND GRILL OWNER: ERICA STERLING Location of Establishment: 251 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 40 OutdoorSeating: 12 Total Seating: 52 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: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WI A COMMON VICTUALER LICENSE Restrictions: UAD �TNE lqw Town of Barnstable For Of Initials: � Date Paid j a ■MWgrABLE. : Inspectional Services M"S659. $ Ca l3q p�� Public Health Division Check# Eo qua Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE FOOD ESTABLISHMENT DATE a� 00 NEW OWNERSHIP RENEWAL /�/\ NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: ')J(l,( as TELEPHONE NUMBER OF FOOD ESTABLISHMENT: �J( o�)SSa-j - cam' W TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO X ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / % TO NUMBER OF SEATS: INSIDE: _0 OUTSIDE: V� 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? �S IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE D^OR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc bWNER INFORMATION: , FULL NAME OF APPLICANT SOLE OWNER: YES NO D.O.B 1 OWNER PHONE# ADDRESS �> ��Ce_VT `�a✓�2. a a1 s C) CORPORATE OWNER: ctr�(�•� ��QS` �� CORPORATE ADDRESS: \T�"'^'Chi ��C' 1,-�{U•�l�LL� �J- I �C PERSON IN CHARGE OF DAILY OPERATIONS: �''it C(-t 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 S�0 0q/ 13 S� hh 510, 10 � SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:\Application FormsTOODAPP REV3-2019.doc I MAIL-IN REQUESTS t Please mail the completed application form to the address below. Also include copies of your employees' food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, please include the required fee amount (see fees at bottom of this page). Make check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 i FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax copies of your employees',food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, you must mail the required fee amount(see box below). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. 250 0 or more seats 300• FEES: Bed& Breakfast Permit— $55; Food Service Permit 0-49 seats $ , 5 $ , Continental Breakfast= $30; Retail Food (only TCS Foods)= $20; Retail Food Store—Less than 8,000 S.F. _ $100, more than 8,000 S.F. =$285; less than 1,000 S.F.; Retail Food Combo/Limited Prep. - $200.00; Cottage Food Industry= $75; Mobile Truck= $50; Mobile Ice Cream Truck= $35; Frozen Dessert License= $30; Additional non-refundable Fee for New Establishment or New Ownership=$100-$500(see staff),Late Fee= $10 Q:\Application FormsTOODAPP REV3-2019.doc S pF Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. eA1V4srA6M 3 Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 695 Issue Date: 01/01/2020 DBA: ISLAND CAFE AND GRILL OWNER: ERICA STERLING Location of Establishment: 251 IYANNOUGH ROAD HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 40 OutdoorSeating: 12 Total Seating: 52 FEES --- FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� _ 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: z . Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNSTABM t Paul J.Canniff,D.M.D. 63. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L.Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 695 Issue Date: 12/10/2019 DBA: ISLAND CAFE AND GRILL OWNER: ERICA STERLING Location of Establishment: 251 IYANNOUGH ROAD HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 40 OutdoorSeating: 0 Total Seating: 40 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G�n FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: For Office Use O..nlj: Initials: �"� .� Town of Barnstable ,,? — ' Inspectional Services Date Paid �a, b� ��$ BARNSTne,B. : p `"" Check# �(J Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE I a NEW OWNERSHIP RENEWAL X NAME OF FOOD ESTABLISHMENT: --ZSVcn-Ok ADDRESS OF FOOD ESTABLISHMENT: 2-5 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAII.ADDRESS: 1-0- o n cam—31 4P- V,4a-tcu l• C-o rr-. TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (5 On) -Z� TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO X ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: I 0/30/]1 TO NUMBER OF SEATS: INSIDE: L4 0 OUTSIDE: 12 TOTAL: 'J! -- 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 REOUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? E.S IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOORS)? 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*** REOUMED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QAApplication FormsTOODAPP 2020.doc OWNER INFORMATION•• FULL NAME OF APPLICANT SOLE OWNER: YES/NO D.O.B l OWNER PHONE# ADDRESS_ I 3 ��,�,�„�c1w� Ur\-e— , 6 Gin rU S , MIA o a 6 o � CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: 1---T L QCn 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 datt-J AU1n / G SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.ast). 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.31'each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH �y ti Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli, M.D. BARNSTABM John T.Norman Mns. F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 695 Issue Date: 12/20/18 DBA: ISLAND CAFE AND GRILL OWNER: ERICA STERLING Location of Establishment: 251 IYANNOUGH ROAD HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: } IndoorSeating: 40 OutdoorSeating: 0 Total Seating: 40 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: — -- --- ----- — -- - - - MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: I PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE { Restrictions: oFt►+e Rey, Initials: Town of Barnstable rr Date Paid 1 Amt Pd$ a, RAS& Inspectional Services NJ 9� 1639. �0� / Cast A,Fo ° Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ;g ray APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE I �! .1- NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: xn ryo�An y% if*�ntS MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: �nUQ.—`�� ►'l��" �C ���" TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS:S WELL WATER: YES NO A ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:2_ SEASONAL: DATES OF OPERATION: 10/3 TO / /9,�-esej NUMBER OF SEATS: INSIDE: Ems.. 0 OUTSIDE: PIA TOTAL: 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) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q\Application FormsTOODAPPREV2018.doc - ------ PLEASE CALL 508-862-4644 OWNER INFORMATION: i FULL NAME OF APPLICANT L--Ql.co SOLE OWNER: YES/NO D.O.B 7 OWNER PHONE# ADDRESS_- S �JIU� Yl(�.Ci\.�01� PJ CORPORATE OWNER: FEDERAL ID NO. : S CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: I1 �G► 1-�'� ` 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 r en Awareness Expiration Date ( ff 1� / 0`a / `�0��1. C-akW, 2. C 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 APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Appfication FormsTOODAPPREV2018.doc tTHE r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of O OFFICE HOURS T P` PUBLIC HEALTH DIVISION 8:00-9:30 A.M. snar+srne�e. 200 MAIN STREET 3:30-43FRIM Item Code C-Critical Item - DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified � ,639 HYANNIS,MA 02601 p +639•p.0 508-862.4644 No Reference R-Red Item PLEASE PRINT CLEARLY rFD M FOOD ESTABLISHMENT INSPEC ION REPORT Name S Date jType of Tyne of Inspection Operation(s) Routine NJ Address Risk Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: r Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) 2 ,/� ^� Non-critical(N)violations must be corrected immediately or J l lul Corrective Action Required: ❑ No Yes within 90 days as determined b the Board of Health. Overall Rating Y Y F] Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations. n no critical violations observed, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 or more non-critical violation 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations s=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 4 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=C. refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen Y N t Violation related to Foodborne Illness _ Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) Y. 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 t 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 1 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or'Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* r 590.003(C) Responsibility of the Person-in-Charge to �I 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage*Applicants* * p g 20 Time as a Public Health Control 3-302.11(A) Food Protection Restriction-Presence and Use* Time 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Res 3-501.19 me 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) Contamination from the Consumer Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a 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* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game o * Ep�r���uuzoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3 401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan - Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g ry 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* g, temporary and residential Sources* 10 Proper,Adequate Handwashing in mobile food,tem o Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the 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* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140'F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products " 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 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. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: I , � ( c k.�- )U3 Date: 5 (l/ t Page: of yoFrNE rOk� OFFICE HOURS ° r 3 2021 am]!'.0 PUBLIC HEALTH DIVISION 8:00-9:30 A.M. 200 MAIN STREET 3:M - . P.M. BARNS TABLE. ` 30 -FRI. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY t639• �0 '�rFO MA'�p FOOD ESTABLISHMENT INSPECTION REPORT Name t I Dated I+( Z e e p of Tvoe of Ins ction Operation(s) Routine Address Risk Food Service Re-inspection Level Retail Previous Inspection r, Telephone Residential Kitchen Dater Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector �� '`� j ( Out: J 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) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands I; 1.PIC Assigned/Knowledgeable/Duties F1 13.Handwash Facilities fs, 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 ` z� PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories ( t Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) �?f Non-critical(N)violations must be corrected immediately or ( )(-)/ Corrective Action Required: ❑,'No ❑ Yes within 90 days as determined b the Board of Health. Overall Rating I Y Y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure []-Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than anon-critical violations. F=f 3 or more critical violations no critical violations observed, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 or more non-critical 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 4 non-critical violations =F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 4 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 refrigeration. within 10 days of receipt of this order. violations observed,7 to 8non-critical violations=C. 29.Special Requirements (590.009) Print: 30.Other DATE OF RE-INSPECTION: Inspector's Signature 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Pri(it: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N i 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.) -- e FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45`F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 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* PP * A licants 7-201.11 Separation-Storage*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* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Resumed Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* 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* 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 Contact Surfaces of Eggs-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* E#ernee 1///2001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155`F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 sec* faces of Equipment* J 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 Game and Wild Mushrooms Approved By 2-30111 Clean Condition-Hands and Arms* 3-401.11(C )(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under . Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* Requirements. 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* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70'F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41"F/45`F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 4.11 Location an Placement*5-20 d 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* 5-205.1I Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 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:590Fonnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. xot 4 I V ISLAND FAMOUSDOC BAR 8 oz Beef Hot Dog Steamed and Grilled,Served on a butter grill roll AMERICAN CLASSIC 006 Relish, ketchup and Mustard CHILLI DOG Chili,Cheddar cheese and onions � Q ISLAND DOG Jerk BBQ Sauce and Pineapple Salsa COOL RUNNIGS D06 c — Cole Slaw and Mustard i REUBEN D06 Sauerkraut,Thousand Island and Mustard DEVIL 006 Bacon,Cheddar cheese, Red onion,Jalapenos L O IRIE 006 3 Saute Mushroom,onions and bell peppers CAPE COD FAVORITE LOBSTER ROLL Served on a warm grilled buttered Roll ;Consuming raw or undercooked meats,seafood and eggs may increase your risk of food bourne illness. Please inform your server if anyone in your party has a food allergy oF.Ne ror TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name v,��Ql .\ _. ��r't Date: / �� ICJ Page: . of OFFICE HOURS AR E.O PUBLIC 0 MAN STREET 3:30-4:30 P.M. DIVISION : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MAC, q MON.-FRI. ,aw. HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY ""'"' FOOD ESTABLISHMENT INSPECTION REPORT Name S Q� �` Date3 I) jy oe of Type of Inspection -Querations outl Address �J`' t Risk IC Fo a -Re--inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) 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 � I EMPLOYEE HEALTH PROTECTION FROM CHEMICALS C/aI\.� Qf t 3 ok ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives Cau C \^ ❑ 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 ` 1 ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding i PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11-Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Itemsl Total Number of Critical ViolatioSj( r 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ Emergency Closure F] Voluntary Disposal Other: ❑ 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than'3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result.in suspension or revocation of the food B-One critical violation and less than 4,non-critical violations if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26-Water,Plumbing and Waste- (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non:critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonou 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 equirements (590.009) within 10 days of receipt of this order. violation,'4 to 8 non-critical violations C: 30.Other DATE OF RE-INSPECTION: Inspe i at re t� ` 31• ster screened from public view I� .G� . Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N W "� #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signatgfe Print: . Self Service Wait Service Provided Grease Trap Size Variance.Letter Posted Y N dldld'"'J Dumpster Screen? Y N v Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 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 Se azation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Coutact 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* specetve innooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- * Ratites-165°F 15 sec* in mobile food,tern or and residential Sources 10 Proper,Adequate Handwashing g' P Game and Wild Mushrooms Approved By 3 401.11(C)(3) Whole-muscle,Intact Beef Steaks 145`F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 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 1 T Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 - Eating,Drinking or Using Tobacco* * Requirements. g Receiving/Condition g• g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g 8 3 403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification 8 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F[0 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 ■ 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to,41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance thin 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices Wi 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 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. pp THE Ipk, TOWN OF BARNSTABLE _ HEALTH INSPECTOR'S Establishment Name:'`�__ I-a-49 1 Date: !qs /•l Page: of c OFFICE HOURS PUBLIC HEALTH DIVISION 8:06=9:30A.M. BARN51'ABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. q MON.-FRI. fib, ,aS9, �e HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT .Name `) Date/ Type o of Inspection Op on s outin Address -� Risk Food S Re-inspection Level ai ' Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint AX Person in Charge(PIC) Time Bed&Breakfast HACCP C� e 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 \� i ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories LD 03 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No es Non-critical(N)violations must be corrected immediately or Overall Rating I within 90 days as determined by the Board of Health. l O ; 9 ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the Fitems checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health-member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the.Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 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 CC-_2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. plation,4 to ritical violations=C. 30.Other DATE OF RE-INSPECTION: Inspe Si ture Prl 31.Dumps screened from public view Permit Posted? ' N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signat Pr' t: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45'F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202:1-2.- Additives* I 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45'F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-102.11 Common Name-Working Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140'F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130'F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.00411 Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) Variance Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and RestrictionsE�] 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 Fg Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.1 I(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashin Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'17 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145' 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg F Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E//li-1i1nooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165'F 15 sec* Sources* 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* 3AO1.11 2-301.14 When to Wash* A 1 b All Other PHFs-145' 15 sec* Other 590.009 violations relating to good retail ( )( )( ) F 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* 3AD3.11(A)&(D) PHFs 165'17 15 sec* 3-202.11 PH F F's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165' 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140'F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the 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* Ln 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[0 70'F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41'F/45'F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 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 1.008 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. )f L Q oF. ► �, � TOWN OF BARNSTABLE LTH INSPECTOR Establishment Name. ate 1 Page: of q� FFICE HOURS PUBLIC HEALTH DIVISION :00-9:30A.M. T 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified • BARNSTABLE. 200 MAIN STREET MON.-FRI. C O HYANNIS,MA 02601 J No Reference R Red Item PL SE PRIM LEA Y r 508-862-4644 rFD MP'� F OD E,%TABLISHMENT INSPE T - N REPORT ry Name at a of sec io g Routi ' ra Addres / isk ood Se spe ion `t Level Previo sp i Telephone Residential Kitchen Date: VI Mobile Pre-o i Owner HACCP Y/N Temporary Suspect II'ness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP - Pff -% ' " Other Inspector u ISM Each violation checked requires 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) ❑ Vol 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 FacilitiesIV tl EMPLOYEE HEALTH PROTECTION FROM CHEMICALS AA ❑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 AF ❑ 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 7 .Proper Adequate Handwashing CONSUMER ADVISORY A/Y❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations �/71 Critical( violations marked must corrected immediately. (blue&red items) !'lr] Corrective Action Required: ❑ No ❑,Yes Non-critical l(N)violations must be corrected rected immediately or OC'C within 90 days as determined b the Board of Health. Overall Rating Voluntary Compliance Y Y ❑ ry p ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,t I ems ❑ 90 Emergency Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ gency 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 re 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 4non-critical violations 26.Water,Plumbing and,Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 n n-rriti I violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 violation,4 to 8non-critical Ion,-, Special Requirements (590.009) within 10 days of receipt of this order. - 30.Other DATE OF RE-INSPECTION: ns o t atu 31.D impster 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 Cs Signatur rint: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted -Y N Dum ster Screen P een .? 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.) S FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) [Demonstration signment of Responsibility* 8 Cross-contamination 1 q Food or Color Additives, Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives ' Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 590.004(F) P 7-101.11 Identifying 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 * 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* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.00411) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( Contamination from the Consumer - 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals 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* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.11 L Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145F 15 sec*' Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective iiinooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A D Violations of Section 590.009 A D m cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( )-( ) ( )-( ) Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved B 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Regulatory Authority y 2-301.11 Clean Condition-Hands and Arms* 3-401.12. Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices , 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* 8 g 3-003.11(C) Commercially Processed RTE Food-140°F 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-003.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140"F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 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 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S.590Fonnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 1 �p 111E r TOWN OF BARNSTABLE. ..HEALTH INSPECTOR-s Establishment Name te: Page: f . OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. ` 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified � MASS. e� HYANNIS,MA 02601 - MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY PrFD 39.. - - 508-8624W . FOOD ESTABLISHMENT INSPE TI N REPORT Name Date a of section p1 Routine Address F,.d Sery Ion Level R Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness ) Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an a ),nation 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 J FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures fie ❑ 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 0.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories �- Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical C violations marked mu be corrected immediately. blue&red items ( ) arke must y ( ) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure [:1 Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590:005 i report may result in suspension or revocation of the food _( )( ) cited in this epo y suspe s 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 Seriously Critical Violation t F is scored automatically if: la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. 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,c to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590:008) 9 violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: In pec is a P. ' R 31.Dumpster screened from public view A 7 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's Sig at a Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen o Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) e FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-20212=` Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold.Holding- Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* _ 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 Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* - REQUIREMENTS FOR= 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition ofAdulterated or Contaminated - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* - _ 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* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 . i_ Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg�"ve iiu2ooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15- Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3401.11(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* RegulatoryAuthority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590..004(C) Wild Mushrooms* 3 401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#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 PreventingContamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g 3 403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Supplied with Soap and hand Drying Devices Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6.2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �p THE rok, TOWN OF BARNSTABLE ' Qgyp///� HEALTH INSPECTOR'S Establishment Name: ( ( f a n C,Q1 Ci • `� ate: ( {O. Page: ofJ q y"� OFFICE HOURS o i PUBLIC DIVISION O : 0- :30A.M. 3:30-4:3o P.M.AR„ rAB,E. 20 MAN STET Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 5 MON.-FRI.08-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 'OTFO MP�p FOOD ESTABLISHMENT INSPECTION EPORT Name ' t �./r i ; ` Date a of of Inspection s Routine SZ Address Risk Food Service = spection _ Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness _ Caterer General Complaint Person in Charge(PIC) Time Bed 8 Breakfast HACCP 'r (M A2 Z 0 In:'0,00 Other Inspector -r Q, �"1 � r-i S Out: rn-t ` 1 vv u Each violation checked requires an explanation oYttknarrative page(s)and a citation of specific provision(s)violated. V,C Ir' e U� Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ 4- Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ S C r U e FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands tooS ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities _ L EMPLOYEE HEALTH PROTECTION FROM CHEMICALS "] ( CA O n M n ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives OA q i n ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals - C u It I n cA 0 OcA r FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures c ❑ 5.Receiving/Condition ❑ 17.Reheating _ a ❑ 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 VP�j '- r^ ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories � Q r nViolations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations I C- S C Q U ✓Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: _ ❑ No Non-critical(N)violations must be corrected immediately or Overall Rating ' within 90 days as determined by the Board of Health. Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑.Emergency Suspension C N Official Order for Correction.Based on an inspection today,the items Embar o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations 26.Water,Plumbing and waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot � C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up;infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations.observed,7 to 8non-cri 28.Poisonous or Toxic Materials (FC77)(590.008 be in writing and submitted to the Board of Health at the above address non-critical violations: If 1 critical refrigeration. ) = 29.Special Requirements (590.009) within 10 days of receipt of this order. violation;4 to 8 non-critic al violations C. 30.Other DATE OF RE-INSPECTION: Inspector's Signa Ire Print: a '- 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 Signatu Print' ' C ^ Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Jr✓ w Dumpster Screen? Y N 3 Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives.. Law Cooled to 41'F/45'F Within 4 Hours* - 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12• Additives* Cooked and RTE Foods.* *. 19 PHF Hot and Cold Holding. 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients F 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45'F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-]02.11 Common Name-Working Containers* 590.004(F) * r 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140'F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130'F* App 7-201.11 Separation-Storage* - 3-302.11(A) Food Protection* P g * 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 - Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdultereted or Contaminated ( ) - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From-Regulated Sources 9 - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004A-B Compliance with Food Law* Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P - - 4-501:111 •Manual Wazewashing-Hot Water 7.206.12 Rodent Bait 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 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 40L11A(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 Eggs-Immediate Service 145'F 15 sec* Animal Foods That are Raw,Undercooked or gg 5-101.11 Drinking Water from an Approved System* * Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eff cove mnoor 4-602.11. Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* Eggs* 4-702:11' Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155'17 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 Violations of Sion 590.009 A cater- 3-201.15 Molluscan Shellfish from NSSP Listed _ _ Chemical* Ratites-165 ( ) �) Section ( ) �) in 15 sec* Sources* ing,mobile food,temporary and residential HE Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Aut Authority Mushrooms Approved By - 2-301.11 Clean Condition-Hands and Arms* Regulatory Aut 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present*' 2-301.12 - _ Cleaning Procedure* 165'F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail ( )( )(b) 3-201.1,7 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-40.1.11 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-165'17 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 foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* - ' illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR.590.000 3-202.18 Shellstock Identification 3-501.14(A 13 Handwashing Facilities Cooling Cooked PHFs from 140'F to 70'F ) g 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 Prectices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 1.003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45'F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Supplied with Soap and hand Drying Devices Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision r 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ I 8-103.12 1 Conformance with Approved Procedures* i S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000; *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. A Little Taste of Paradise LUNCH MENU -TASTY SNACKS- -SANDWICH COUNTER BONELESS CHICKEN TENDERS-$7.99 *All sandwiches served with house files CHICKEN WINGS-$8.50 ISLAND CAFE SIGNATURE BURGER-$10.99 Classic Buffalo or BBQ Jerk 8oz Certified Angus Beef,Pepper Jack cheese, Applewood smoked bacon andd avocado CHICKEN QUESADILLA-$9.50 CLASSIC HAMBURGER $9.50 With peppers,onion and cheese 80z Certified Angus Beef,lettuce,tomatoes,and onion FRIED CAT_AM 4RT_$10.99 CHEESE BURGER-$9.99 Served with a sweet and spicy chili sauce i 80z Certified Angus Beef lettuce,tomatoes, onion,and geese LOADED ISLAND FRIES-$4.99 TURKEY CLUB-$9.50 Pepper Jack cheese,bacon,scallions and sour cream Turkey,bacon,lettuce and tomato GRILLED CHICKEN SANDWICH-$9.50 MUSSELS BIANCO-$9.99 Lettuce,tomato Steamed in white wine and garlic CAPE COD FISH SANDWICH-$9.99 NEW ENGLAND CLAM CHOWDER Local,fresh catch Cod,served with American cheese Cup-$5.25 Bowl-$6.99 TUNA MELT SANDWICH-$7.99 Tuna salad with Swiss cheese WRAP CENTER FRIED SEAFOOD *All wraps served with house fries GAPE COD FISH&CHIPS-$11.99 JAMAICAN JERK CHICKEN WRAP-$9.99 Local,fresh catch Cod,served with house fries Cheddar cheese,lettuce,tomatoes and pineapple salsa SHRIMP PLATTER�$15.99 PHILLY STEAK AND CHEESE WRAP-$9.99 Golden fried shrimp served with house fries Shaved steak,peppers,onions and American cheese CALAMARI PLATTER-$14.99 Fried calamari served with house files HEALTHY VEGGIE WRAP-$8.99 Roasted peppers,onions,mushrooms,spinach, TRIO PLATTER-$18.99 tomatoes and avocados Cod fish,shrimp and calamari ISLAND CAFE SIGNATURE ENTREES JAMAICAN JERK CHICKEN--$13.99 Served with ripe plantain,rice and peas STEAK TIPS-$14.99 Served with house fries and coleslaw SHRIMP SCAMPI-$15.99 Served over linguini --SALAD AND TOPPINGS- .-BEVERAGES CLASSIC CAESAR SALAD-$8.99 Fresh Brewed Coffee-$2.49 Romaine lettuce,Parmesan cheese and croutons Hot Tea-$2.25 FARMER GREENS SALAD-$7.99 Iced Coffee-$2.99 Lettuce,cucumber,tomato,carrots and onions Hot Chocolate-$2.75 Chocolate Milk-$2.75 SPINACH AVOCADO SALAD-$10:99 Milk-$2.50 Baby spinach,avocado,onions,tomatoes,dried cranberries, Juices-$2.75 served with raspberry vinaigrette Iced Tea-$2.50 Upgrade: Grilled/Jerk Chicken-$6.50 Lemonade-$2.50 Grilled Steak Tips-$7.99 Sodas -$2.29 Grilled Shrimp-$8.99 Bottled Water-$2.39 Here at the Island Cafe and Grill,we are a family owned business focused on supportingg local businesses and farms while celebrating the cuisine of our island heritage.The ingredients that we use are urchased from local farmers to bring you the freshest food that Cape Cod has to offer.Island Cafe is an exciting andpindulging cafe with exceptional service in a friendly atmosphere.Come start your day with us and enjoy a little taste of paradise. Please inform your server if anyone in your party has a food allerg"-y *Consuming raw or undercooked meats,seafood or eggs may increase your risk of food borne illness. Town of Barnstable Building Department Services �oFt"ETeyti Brian Florence'CBO BARNSTABLE —SM Building Commissioner L639.2014 BARNSPABLE, 200 Main Street, Hyannis,MA 02601 MASS. www.town.barnstable.ma.us �ar60 MAC a Office: 508-862-4038 Fax: 508-790-6230 January 24,2019 Mr, Patrick Sterling Island Cafd&Grill 251 Iyannough Road Hyannis,MA 02601 RE: Site Plan Review#004-18 Island Caf6&Grill - Addition of 12 Outdoor Seats for a Total of 52 251 Iyannough Road,Hyannis Map 328,Parcel 206 Proposal: Creation of an outdoor patio area with 12 seats at the rear of the parking lot in the location of 2 parking spaces. No entertainment is proposed. Dear Mr. Sterling: At the informal site plan review meeting held January 22,2019,the Site Plan Review Committee administratively approved the above-referenced application subject to the following: 0 Approval is based upon and must be in significant conformance with informal plan depicting the location,materials,and dimensions of the new patio area, including proposed fencing and planters; existing approved interior seating plan for Island Caf6& Grill depicting 40 seats and 2 employees; and scaled site plan adjusted to include the restaurant building, outdoor seating area, and HC ramp and HC parking space. • For food service to the outside patio, an air curtain will need to be installed at the access door to the patio. Contact: Health Dept. 508-862-4644. • An Alteration of Premises application is required to be filed with the Licensing Authority to include the patio area. One plan drawn to scale,which includes the areas of all 52 seats,is required to receive approval from the Building Commissioner before it is included with the Licensing application. Contact: Maggie Flynn,Licensing Assistant 508-862-4774. Number of bathrooms must meet plumbing code. k ® Applicant must obtain all other applicable permits,licenses and approvals required. Sincerely, Ellen M. Swiniarski Site Plan Review Coordinator CC: Brian Florence,Building Commissioner, SPR Chairman Deputy Chief Dean Melanson,Hyannis FD Health Department Licensing Authority I ap - arce 328 - 205 235 thru 251 Iyanoo h oad yan ni , C ; tied - in l Ma* y 20 , 09 --� Y fig lip r 0 r • o ry eUstinp !w I un��.d N oaxhl0�Wi I y ,——__4 _ p w irKye&hop I f ——— — 1 '=J * sdr+3 +3R n t 64 1 at�ftdee0 `� CIam MPl+o wnn line 1 i o at 1 1 OD N KELP 328-210.01 rr 267 W—mjh Rwd!Rte 29 a O r � H O z � o • o r • 0 �r o N o r 'Yannough Road / Rte 28 ~ 1al1 0 00 hotel , S CD _ o i � �1 +dve denpy n .. May ,,X • Wadlington, 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 To: McKean, Thomas Cc: 'Tom Lee' Subject: Sewer Connection for map 328 Parcel 206 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 1 a Q 41 f x►r j ❑O 000 ❑O LTIZIITES / O O O O Q O 0 0 BAC�ROO O o o LUNIICH COUNTER ' Ll Fo ZI n o o � 71 ' o o BATHROOM o O t . o HANDICAP RO BATH n •' KITCHEN ° °HO �. 0 r x Ox-j er Seating Chart. We are keeping our seating sparse- much like Subways was becasue we anticipate most of our business will be take oWdelivery i No...�,,�... - Fins. -------------- THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE App iratiun for Disposal Works Tons Application is hereby made for a Permit to Construct ( ) or Repair QA Individual Sewage Dispos System at: j) ��j(/ ................__....._ -.....��...... ...........---•---•------ -••--- ............... .....--- --..............._---- •ocation-Addre or Lot o. -•--......J .tom. �✓oli!5.....: ��S i yr 19 `9- ► .----- ... -_------•---_--______ �• caner ' � �� dress a ....__.... :. -'0...` . --`------------------------------- ---�� ----`Teti _-_��....r !r T Installer Address pq d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aa Other—T e of Building No. of ersons____________________________ Showers Other—Type g ---------------------------• P ( ) — Cafeteria ( ) 04 Other fixtures -------------------------------•-•---------------------------.._..-----------•------------------•----------------------------.....------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width..........._.... Diameter................ Depth................ Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ P ----_-••-- - - - ---- - ODescription of Soil.......... - 7-----•---------------•---------------------------------•--------•------------------------........_._.. x U •--•---•-----•----•-------------•----•-------------•---•-------......._....--------------._....---------...----•--------------•----------•-•-•----------•-••-------•..__...--•••----•------•------------ x --------------------------------------------------------------------------------------------------------------- y� U Nature Repairs or ter ions—Answ r whe pplicable--_______ _ Q �??'! ._._____. .......................................( � E . .. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with, the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the oard of health. Signed --------------------- v ------.... -- � ��--- re Application Approved By ... --- . ..--. 6----- -- -- --- - -- ------- Date Application Disapproved for the following reaso - --------------------------------------------------------------------- ................. ---------------------------------- ---------------------------------------------- -------- --.....------ -- ------ ------ -- ------------------------------------- ----- Dale Permit No. �.-...-- � .. .... Issued ................ (e . �n THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Uiipnsal Works C�nn�n inn rrntt� G Application is hereby made for a Permit to Construct ( ) or Repair ( f' an Individual Sewage Disposal System at: n , ..... - ..... ......_.... - ------------ ...... -ocation-Addre�� �� or Lot No. f-� S......% STi4v,2T� ? -�f._ `� h L 4+14 ........_... r__.-•................ .... ......... ......... ..................... M ll wner Address ----.......�... -`-�-r y--•..... �:----�:.'.��••..............•-......._ .....��� ...... t y ......................... S I y -r, Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) �4 a 1 Other—Type of Building ................... ------- No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ------------------------------------------------------•-•--- W Design Flow............................................gallons per person per day. Total daily flow................................_...........gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ xDisposal Trench—No..................... Width......._............ Total Length___................. Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date! ----..: Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... G1o, Test Pit,No. 2................minutes per inch Depth of Test Pit.................... Depth,to ground\water........................ ......... � - -D--- ..............................................................-•••••......-------••-•-.........-•••-•-----•-•••--.••--- P4 Description of Soil..............•..._ _ ti x - - V .....•-•••••••---••••--.....•-••-------------••-••••......-------- 1 -- - -� UNature f�Repairs or t�ter s—Answ r whe ,applicable..-_____.f -.S �► �'....................................................... ./ eqS-------- -----•-------�-----•. ��I-�5---------------------------------•----------------•-•--------------. --------•--------------•--•----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued /by�the board of health. Signed'-- -r.. �""' --..:. ------------------------ `�- ..-...... Date------'------- Application Approved ByZ7 � �� ._ ------ . --- - ----------- Date Application Disapproved for the following reaso - ------------------------------------------------------------------------------------..........---------------------------------------- . -... ...... ^= -------- --- --- --------------------------------------- ----------------- !.. .................... ...................... .. --.--- Date Permit No. - Issued r 1 1— �� .-....-.- - ". dare l l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Te>r#tfteate of Tarapltttne THIS IS TO,CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( v) b . E---1 �- Installer ...............�1 ....- -------------tt/--...--------------------------------------------------------- z5�� ... ... ..... .... at y has been installed in accordance with the provisions of TITLF,=S o- The tat 'ironmental Code as described in the application for Disposal Works Construction Permit No. �..r i. � . . :/....-.- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT`BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION ,SATISFACTORY. DATE `�1 .. 1---..,l.... ........................... Inspector ---------- -- ----- .......................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I:., TOWN OF BARNSTABLELNo.__...9..... FEE........ ............. �i��rn��\\1 nrk� �.�n��pruan rrnti� Permission is hereby granted....... ............................................................. to Construct ( ) or Repair Q_),an Individual Sewage Disposal Systems at No........ ��----- -N. v iy. ._._( ° ?.. 'z•-�- �.1/Worn r ... r. Street as shown on the ap lication for Disposal Works ConstructionCeermit No. � C--� aid �,1..._ � C �r --.....-----•-- /—�...... Board of tYeal4h DATE--------•.��--- -�-�-•�`�-�-•-- L/ FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS F1 > No..81.- Fmc.$... ...DQ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................... .own...........OF........$arnstabla.........---------------.....---.._....---------------- Applirtttiou for R-4paatt1 Works Tomitrurthitt thratit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: ..251 IY ................•----------------...----------...-------------------------........__. Location-Address or Lot No. ..]BOb it Boucher_........ 153--Wintex._._.St,,-._.I ra.nnia,_..Y-A---..Q2LO1.................. _.._.>... — - Ownez Address A.&... ..Cessp®1...Service.............................................. -•--•---• Installer Address 4 Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms______________________________ __ _Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No, of persons____________________________ Showers — Cafeteria Q' Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length--------------_ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------_-------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit____-_______________ Depth to ground water------------------------ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ---------------------------------------------------------------------_---•-----__•••-••-----•-•-----•-•------------ --------•••-------------------------------- ODescription of Soil.......Sand-----------------------•-•-••-----._..._._..._..-•---•---•-------------------------------------------------------------------------------------------- x W ----- -------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------•------- UNature of Repairs or Alterations—Answer when applicable_installa,ti on of--a_-2 j00--gala oxlS.ept7.�___tank and 1,000 gallon pre-cast stone Wicked leach pity /,�!--Lo �y �N Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'iTL p of the State Sanitary Code— The undersigned further agrees not to ace the system in operation until a Certificate of Compliance has been ' su `by h� board Pofeal��., //�� D to Application Approved BY------------- C --- .UA4 --- ---e--------•--------------•--••--••--•------- -•--_-----/17781--------_... Date Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------•---------------- --------------------------------------------------------------------------••-----•--.._...------------------•-•--------------------------------------------.-.------------------....-----------•-------- / Date Permit No._.81................................................. Issued- `1Z/81---------------------..._..------•---- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................ own........O F...........Barnst-ab�e............................................... Trrfifirtttr of Totttplittttre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (xx) by____ .•_______A_& BCesspool-Service,-..12$•_Bioo _.T_�xxa�e,--li�taru�is,_._N�A_....Q21a01..-_._ -fi2f4._- Installer 2 1 I anou h Rd Route 28 at 5 y g �..--•---•-•---•--...... --►---Kyms, CIA Q26Q1 -- Rohert__Bnucher. has been installed in accordance with the provisions of TIT 4 5 of The State Sanitary Code as des H ed in the application for Disposal Works Construction Permit No--8____--��______________ dated---------------4/1-7/81__-__--_-__.-__ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. , � I' �, f i'A/ ' DATE.----.....�...$._�__.._/__���.................................... Inspector..........�----------------..__.._...-Ge.. --------------------------- r J No.81---••--......... F:m$$...5..00............ THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH Town......_..._OF........1 x stable........-............................................... Appliration for Disposal Works Tonstrurtion runtit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: 151.?mquZ?)..R&...-.R-QutP...2$-*---Hy-annIsi..kIA- 02.601...................................................................................... Location-Address or Lot No. _Bob+ert Boucher............................................................... 15�.MAzAsx---- tx..Hy nuia,...i A.__..0260.1................... Owner Address A & B_Cessp®1 Service----.......-•-------------------•--.....----.. M__Bishnp._Tp Qe.,...Hy.�xu� �� MA....026......... • Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms-------------------------------- -----Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of ersons____________________________ Showers — a YP g -----•---------•--•----•---- P ( ) Cafeteria ( ) A4Other fixtures ------------------------------------------•••.d -- -•------------------------------------- •-•------- 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 ( ) a' Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground.water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' •••-------••------------•---•----------------------------•...•------------•-............----•-•-----......................................................... 0 Description of Soil....... and--•-----------------------------------------•------•--•--------•-----------------------•----•----•--------------•-------------•----------.....--------- W W ---------------------------------------------------------------------------------------------------------•----------------------------------------------.-------------------------------------------- U Nature of Repairs or Alterations—Answer when a��ppplicablein8tallatiOn...of a 2 00•__galloIl-- eptiC•-t8.tlk and as_1,000 gallon_pre_-cast stone racked_.leach pit. .._ . 0�® ...................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with rov the provisions of i i _ p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been sued b the board of ,ealt /. S ned.....L �� G' GGc >`s ` = � 1 1 Application Approved B .......................................... 17 1 Date Application Disapproved for the following reasons:--• ----•---------------•---------•---------------•--•-------•••------------------•----•---•----------•-•-•---- ------------------•----------•---..._.......----------•-------•-•-----•--•-------•---•-•••-••-------...----•------------------•-------••-----------------------------•---------•---------•---•-•--••--•- Date Permit No......................................................... Issued.4�17/81 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................T.own,.......OF..........Bp=table Tntifirate of TontpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( )) or Repaired PCX) by.. A & B Cesspool Services.128 Biahops Terrace, Hyannis ................................M 75-62 2 Installer (T i i n) at-_..___51 Iyanough Rd. Route 28, i�yannis, MA 02601 -- Robert Boucher ---------------------------------------- has been installed in accordance with the provisions of T T13 j of The State Sanitary Code as fees *bed in the application for Disposal Works Construction Permit No..... �.___..at_�-�_._*._____----_- dated...............A701-............... THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................•--.................--•------------........-•---------•---_.... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9 ,) ......................... .............!. ......OF...Barnstable .....--....................... No.................. ..... ............................................... FEE...... Disposal Works �ons�aion rrntii Permission is hereby grantedA & B Cesspool Seryiee,._.128- B shopls..Zex=oQ,•,.H - nie-,••MA•.---Q2601 ------------------ --- to Construct ( ) or Repair ( an Individual Sewage Disposal System �G at No..251 Tyanough Rd. - cute 28� .H�!annis,..MA - Robert--Boucher-----•- --------------- Street as shown on the application for Disposal Works Construction Permi o� Dated.._.._�.17..8Z.................. 7_ ...................J9..... card --of--He----alth----...............-------------------------- 1-: Board DATE.............--•---......................./................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOZI OFJBA RNSTABLE S-A l c LOCATION ,-._l 0-6•glj d2d SEWAGE # VILLAGE +S ASSESSOR'S MAP 6z LOT INSTALLER'S NAME PHONE NO. J. CRAIG MEDEIROSS�A SEPTIC TANK CAPACITY HYANNIS, MA 0260f LEACHING FACILITY:(type) (size) �'L �i pgvv NO. OF BEDROOMS . PRIVATE WELL OR P BLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED:/ _ VARIANCE GRANTED: Yes No / r r 61 a 0� ,1. l�0 2 1 O o a i v'Po 1Y(4 �s�uua •m y6owept/,Sp a _ # ITEM M UFACTURER ORDORED 6?�'�' C [�5 D 6 O 6 18 TYPICAL 51 4 30" X 30" TABLE PLYMOLD DAI 1 O� 700� y 5 20" X 24" TABLE PLYMOLD DAI 20 BLAt 6 CHAIR PLYMOLD DAI 42 STYI 6 t�5 6 . 6 50 6 _ 8 TRASH RECEPTACLE PLYMOLD DAI 2 DUR NOTE: CUSTOM DUKE FRONT COUNTER: 9 SODA MACHINE PEPSI COKE LOCAL BOTTLER 1 SEE ADD 4' TO REGISTER END. TOTAL LENGTH IS 21'-4". 10 BEVERAGE COUNTER DUKE MANUFACTURING DAI 1 48" HIGH 2• �' 11 RED NEON "OPEN" SIGN HINSON DISPLAY EON GLASS WORKS DAI/G.C. 1 SEE Ir O �1r� 12" 13 BANNERS MODERNISTIC DAI 3 SET ———-� WALL I (23� I 19 RH _ 14 CHIP RACK SUPPLIED LOCALLY 1 36"1 4W X 30" CLEAR 74 17 INTERIOR DOOR MARLITE LOCAL DAI/G.C. 4 SOLI[ SPACE REQUIRED 24 L--J 6 I 18 GUIDANCE SYSTEM LAVI INDUSTRIES. DAI 4 BEE MODEM 29 30 LINE ti 19 FRONT COUNTER DUKE MANUFACTURING DAI 1 LENC O i NELS � 2PANELS / . 04 WAL 2923 SAFE AMSEC C.S.S. DAI 1 29 /RHLH 624 SUBSHOP 2000 P.O.S. MICROS SYSTEMS, INC. SCS DAI 1 PC TYPICAL ` ' 33 25 MICROWAVE AMANA DAI 1 5' F 13 10 9 31 34 3 " I 4225 28 27 27 BREAD OVEN DUKE MANUFACTURING NU-VU DAI 1 O 20' 42 WIRED ENCLOSED BREAD CABINET LOCKWOOD NU-VU DAI 1 4 20• 28 o" 4 6 6 _-4 ___ HEADERwALL 29 MENUBOARD VGS DAI 4 THERMOSTAT I r `� LL ABOVE 4 " 72" 51 30 COUNTER ENTRANCE MARLITE G.C. DAI/G.C. 1 SELI O5 5 37 38 39 31 BACK COUNTER W HAND SINK DUKE MANUFACTURING DAI 1 X O EXISTING EXISTING { ,_ 32 BACK COUNTER DUKE MANUFACTURING DAI °1 RESTROOM RESTROOM EXISTING PHONE 6 6 JACK 33 REFRIGERATED BACK COUNTER DUKE MANUFACTURING DAI 1 48 n 40 34 FRUIZLE DISPENSING STATION NORLAKE DAI 1 502 i 45 5 •� 17 � r, � ,17, ,�. �, 35 ICE MACHINE MANITOWOC HOSHIZAKI DAI 1 ICE 6 O 6 I +: 36 SINK EXISTING 1 3 6 6 40 I 43 37 MOP SINK EXISTING 1 FL0 S 5 6 O 6 7 38 HOT WATER TANK EXISTING 1 ACC O O 39 S.S. WORKTABLE DUKE MANUFACTURING DAI 1 40 WALL SHELF INTER METRO DAI 3 ISUP 6 6 ��--�� 18" `19 41 VEGETABLE SINK DUKE MANUFACTURING DAI 1 1.' iN7140 42 HAND SINK DUKE MANUFACTURING LOCAL DAI G.C. 1 WAL / 43 CLEANING PRODUCT RACK CHEMCO CORP. DAI 1 OPT 17 � •�• 45 AC NEMCO EASY-SLICER NEMCO, INC. DAI 1 M 6 6 O I ; 5[1J1A. �6 EXISTING 46 RETARDER CABINET LOCKWOOD DAI 1 X 49 STORAGE UNITS INTER METRO DAI 1 4 4 42 1 49 50 SODA STORAGE PEPSI COKE LOCAL BOTTLER 1 SEE L 1 51 STEREO SYSTEM DMX MUSIC DMX LOCAL 1 801 6 6 "- o. C OS 6 4 � 50 6 O 6 49 EXISTING IREC FREEZER 35 I 6 OS :63 C O5 D C O5 :6) 17 40" WIDE 49 O OPENING 6 O 6 6 O 6 6 O 6 i� co y'o (zo I . � .i.. '--_�.--J---�-..-.+.�-,.-...--.. ,.-a.,...•..�-.-...,,--___.._.:._.••-_-.,..__•,.._. __...._.--..._�--�--•_-- -.. . . a ..a...;;.,..�__,,..e-__"',.,.e.._ws:rc,:_, .. __..r,_:.._ n _ .._. -..a... _.....ee ..ma,,�:-wva _, 7 3 I i '/ annou h (80- Wle - State HTghwoy) Road Y 9' 36.52 flow Line 36.45 36.96 --- ------- -- ---- ---x _..---� 3752 - --- - C8 E5 Rim=36.16 S 5973.30~ E Planter With Sign � Planter With Sign L:2 6.47 R-960.00 36.92 36.59 37.29 J7.00 36.73 36.52 36.73 36.41 37.72 0 38.3 I °i i Wooden 37.06 Cl) r.Do/%rd '3�1 36.90 37.03 _- - 1` 7.60 0 i f Q'►9 � Edge U menf `..;: ` � •' t -�✓fir a�1�5 � r � , o o ce i ser QLe�°`� 7.23 o (-37.64 a3 n floor E/.=38.29 3711 Picket Fence 3 c ;'Q Floor E1.=3821 / 1 Meter - N Blopndies L floor E1.=38.11 , r( ':: R/Ol5i VW AVE UM17ED PAR7N£RWIP \ .� ���t(l�i i ,�y+�° / 37.01 4 Landing (T 48 ENGINE HOUSE ROAD �' S+ub way . eB y- Quarto eC/ a :. a►►� HYANN/Sy MA 02601 Rim=37.14 (b / 37.27 / /.w�. yc u/,�.ci s -: o 1(y o+ / Readings a �� Cb C00%r (b 8c Dwelling Gas_ '' c► 1 \ w, 0 Fenced /n Deck Mete I I --_-Jr "NSOV, NANCY L TR 1- NANCY L "N"11 A anho/e �_ - iNwST TRUST © Cover (Typ) © 7.36 Growli L H)'ANN/S A/A202601 37.8 3tbr*h7g Arena _ T,56-80 36.51 (Q 136.J8 36.12 i �. Striped Parking 35.81 i I N 55V4'07' W 281.Or' Chain/ink F \ • 35.74 35.5r9 Edge Povp✓nent 35.54 35.03 c�rtgrne louse Road 6 <rde - Public) J7.48 � �W35.59 INC�Q°� Scale:1"=20' Xr ZONING SUMMARY 0 ,o z0 � 40 5o FEET y SITE PLAN OF LAND £ngi ouse ZONING DISTRICT: HB HIGHWAY BUSINESS DISTRICT AT R MIN. LOT SIZE 20;000 S.F. #239 IYANNOUGH ROAD o/ MIN. LOT FRONTAGE 20 3 MIN. LOT WIDTH 160' S!i ��Gf"�8 MIN. FRONT SETBACK 60' (100' FROM ROUTE 28) IN a � L MIN. SIDE SETBACK 10 (SUM OF 30 ) HYANNIS MA MIN. REAR SETBACK 20' MAX. BUILDING HEIGHT 30' (OR 2 STORIES) I tr t t. MAX. LOT COVERAGE 30% PREPARED FOR S t te�'S dt o�n S� SITE IS LOCATED WITHIN THE WELLHEADan �- MARK ELLIS M PROTECTION OVERLAY DISTRICT. DATE: OCTOBER 4, 2005 LOCUS MAP OWNER OF RECORD T. 362 SCALE 1"=2000't ELLIS, MARK F TR off fox -M-4.541 KEVENEY NOMINEE TRUST tax - ASSESSORS MAP 328 PARCEL 206 10 WOOD AVE SANDWICH, I LOCUS IS WITHIN FEMA FLOOD ZONE C MA. 02563 down cape engineering, inc. AS SHOWN ON COMMUNITY PANEL #250001 0005 C DATED 8/19/1985 CIVIL ENGINEERS REFERENCES LAND SURVEYORS LAND COURT CERTIFICATE 167804 939 main st. yarmouthport, ma 02675 LAND COURT PLAN 20814A DATE ARNE H. OJALA, P.LS: DCE #05-111 05-111 BASE.DWG �r�i3/-/ED ,�/,esT Fcoo,e 4 z G� E c.49 v• 40. ?0' 38 - # G ,37. % 1 34 - : 37.30 r G✓ASj/EI.� STO!�/ ZZ 1 t 1 /O' — S 4E- G T OAJ (/ E ,eT. sG /9e- E Pr-opoSGol 9ro or7d Pro f i/e i� / G „ co.c/c. GAS '9 N �,tc� H-20 GoHD/NG SCHEO. 40 ":' V G. 0/e O / FLOW EQUA& TO S PT/G l foot _. �1� rr�intrr,Urr� er /8 - �ZN L�JGLSh@c� stone -- - -TigNAC�- G c _--7 c> 'M/A)• PE�e CO C'S c'< Tf9/v.+r. p/ST. f3 O X �p'p/ia. °. . 6 � TEE 6 Su/rrP • P � / Fes' OG TEE �i2•• ° • ° • C 2) 8,x /z , 00 0 G A L. �s Z E E _ GE�CH � / co,vc,eE7s - — _ -_ / / P N Fv�� Tee •, GEAGH F�/ T B A5 6meNT `n � S G F1 L E. /4 = / - O 39 (o e 25ooG 250o G L. sEPT/ TA�v,e s. T, LoUnJG'E 9� 3q.s !� S / G /L/ - __ -- T� S 7 f--� O L E- Z- O G �6novE O Exi3T. /000G � Q,'Q___=G,�T 2�`T!�!l�f'lV;- Oy TE .• �.30/��— TEST BY' ��__t�/6G.G��r T'P�4, Ta�vr �H3 E t_— T ff P , PE A? G. A'- A T E• _< iE: _ /L7/N://i.1 C H !it// T A/Cr 5 S . ?� _-L9Y� .-- 2t.;r 10 D/.�/ ,eF� rE S G19G5.I0.9Y t3ur-nstab/e 8r- of Hea./t/Li sT. GloeEl1.5E TefrP /000 6/94-. OATuM M.SG t ��BS ,.55'S7-EM SEPTIG TA/V/C. 1�/,I- x / ,S =z57z TEST yOL 6- �/ TEST NOL � #2 / \ (JSE : ��- GAL. T�/�/K c�/ = .36, So a.sp/ra/t � ` D LEACH F�/T : 2 svhso�/ e/ ` 36,33 380 'c4 EFF OPT/! 8.O ' 6AL5/oAY f�/MP le- EX/.S7T- , BOTTOM = IZZ72 S FC CE3SpOOG 4t TOTgL -`/-d.-Z 6r<?GS. �OAY CO2r'Se AY' P/TS Sa_nc� �o /44" e/= 2 .50 no encounter-eo' / GE.E'T/GY THAT THE BCJ/G G�//l/G �� _ S � !ti � G p� � AJ P�Of�OSE� ON THE G�20UN0 rq5 /� Sti0 'Al/v Ong TH/S PLAN O04C- S Foie �or4, on -)C LO 7- H GO/VFO�eM Tn r/-f& 8 i/LO//VG 5E7-- BF3G/L- �E' F_ QcJ/ E' EME/VTS OF THE O�T ��` /G % � � ���L'�S � 1� 0 /� � JJJ TO/.v/v of �,� e�1.s7-*9$�,.E - -- � � ��AJAJ/S /� A S S . BL06. SETB� Cr� �e E a F o-e /4 g / N Aj '_5 ,A='AE'OAJT = N _ FT `ZN OF Mom, H.EVEREIT H Fr P.2 / ---Z 9 - - t s SGAGE : /q5 SHO �//V ��TE ' EVEREII - HINCKLEY �+ H. mN 42 ia No. 1187 '% HINCKLEt Af'? G 132. `!?. t y C/STERyO@ 2i IE -- -- -_ -- -- - — - n✓ !A /i/J M o T-ti SGF� G. E I " = 30 -- -- - - - - - E X., rn 9 Gor/fours Bo�q.@G OF NE-fIc TH ----- - -o --o — o -o — /3.S '