Loading...
HomeMy WebLinkAboutSTARBUCKS COFFEE - FOOD Starbucks Coffee 655 Iyannough Rd. - Hyannis._ 311 -oog r n L f 04 T Town of Barnstable BOARD OF HEALTH O John T.Norman Board of Health Donald A.Gaudagnoli,M.D. I' ¢A1LN,WAOL_ F.P.(Thomas)Lee,. MASS Daniel Luczkow,M.D. Alt. $ a9• ,� 200 Main Street, Hyannis, MA 02601 0" A Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 345 Issue Date: 01/01/2022 DBA: STARBUCKS COFFEE #15703 OWNER: STARBUCKS CORP. Location of Establishment: 655 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 24 OutdoorSeating: 0 Total Seating: 24 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-IFOOD: MOBILE-IICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVED VARIANCE 10/25/2011- 1.) A GRID shall be installed and maintained in accordance with MA Plumbing Code. 2.) A weekly log shall be kept with regular cleaning and maintenance. 3.) The menu is restricted to 4 page of foods including bakery items, breakfast items, yogurt parfaits, bistro boxes and sandwiches. 4.) Only paper plates/plastic utensils shall be used. 5.) Variance in non-transferable. 6.)This variance shall be posted on wall adjacent to Food Permit for inspections. 1 :r For Office Initials: ' a. Town of Barnstable i 4" Date Paid 6'� a'�Amt Pd$ A Inspectional Services 1659. Public c Health bli 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 12-17-2020 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: STARBUCKS COFFEE#15703 ADDRESS OF FOOD ESTABLISHMENT: 655 IYANNOUGH ROAD T MAILING ADDRESS(IF DIFFERENT FROM ABOVE): PO'BOX 34442, S-TAX 2 SEATTLE, WA 98' �\ - a • r: E-MAIL ADDRESS: LICENSESERVICES@STARBUCKS.COM , K�• i TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( 08 ) 771 _ 4880 TOTAL NUMBER OF BATHROOMS: 2 WELL WATER:YES NO V ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V SEASONAL: D TES OF OPERATION: / / TO f / NUMBER OF SEATS: INSIDE: 19 OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V.00D 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 REV3-2019.doc 9 OWNER INFORMATION: FULL NAME OF APPLICANT JANDI GAMBOA SOLE OWNER: YES/NOV/ OWNER PHONE #206-594-7273 ADDRESS PO BOX 34442, S-TAX 2 SEATTLE, WA 98124 CORPORATE OWNER:STARBUCKS CORPORATE ADDRESS: PO BOX 34442, S-TAX 2 SEATTLE, WA 98124 PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. *ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1.FATIH AKDEMIR 10 . 7 2024 1. FATIH AKDEMIR 6 4 2022 2. NANCY YOUNG 3 / 25 / 2026 U 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 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FonnsTOODAPP REV3-2019.doc f > � Town of Barnstable BOARD OF HEALTH l Jahn T.Norman Board Of Health Donald A.Gaudagnoli,M.D. �x �: re►� 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, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 345 Issue Date: 01/01/2021 DBA: STARBUCKS COFFEE #15703 OWNER: STARBUCKS CORP. Location of Establishment: 655 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 24 OutdoorSeating: 0 Total Seating: 24 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVED VARIANCE 10/25/2011- 1.) A GIRD shall be installed and maintained in accordance with MA Plumbing Code. 2.) A weekly log shall be kept with regular cleaning and maintenance. 3.) The menu is restricted to 4 page of foods including bakery items, breakfast items, yogurt parfaits, bistro boxes and sandwiches. 4.) Only paper plates/plastic utensils shall be used. 5.) Variance in non-transferable. 6.) This variance shall be posted on wall adjacent to Food Permit for inspections. I tT For • Initials: 1 Town of Barnstable 0;a Pd Date Paid BA MffrAB1� : Inspectional Services 1639. ►`� Public Health Division Check#�D Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax; 508-790-6304i I APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 12-17-2020 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: STARBUCKS COFFEE#15703 ADDRESS OF FOOD ESTABLISHMENT: 655 IYANNOUGH ROAD MAILING ADDRESS(IF DIFFERENT FROM ABOVE): PO BOX 34442, S-TAX 2 SEATTLE, WA 98124 E-MAIL ADDRESS: LICENSESERVICES@STARBUCKS.COM TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( n 771 - 4880 TOTAL NUMBER OF BATHROOMS: 2 WELL WATER:YES NO V ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: 19 OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) ,,FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) r 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 REV3-2019.doc I OWNER INFORMATION: FULL NAME OF APPLICANT JANDI GAMBOA SOLE OWNER: YES/Nov OWNER PHONE#206-318-8705 ADDRESS PO BOX 34442, S-TAX 2 SEATTLE, WA 98124 CORPORATE OWNER: STARBUCKS CORPORATE ADDRESS: PO BOX 34442, S-TAX 2 SEATTLE, WA 98124 PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1.FATIH AKDEMIR / a' / 2"074FATIH AKDEMI G� / Vj / 2, ANASTASIA BROWE 74 " 1 t 3- 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 htty://www.townofbarnstable.us/healthdivision/ai)plications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNsreBL Paul J.Canniff,D.M.D. o 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: 345 Issue Date: 12/10/2019 DBA: STARBUCKS COFFEE #15703 OWNER: STARBUCKS CORP. Location of Establishment: 655 IYANNOUGH ROAD HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 24 OutdoorSeating: 0 Total Seating: 24 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVED VARIANCE 10/25/2011- 1.) A GIRD shall be installed and maintained in accordance with MA Plumbing Code. 2.) A weekly log shall be kept with regular cleaning and maintenance. 3.) The menu is restricted to 4 page of foods including bakery items, breakfast items, yogurt parfaits, bistro boxes and sandwiches. 4.) Only paper plates/plastic utensils shall be used. 5.) Variance in non-transferable. 6.) This variance shall be posted on wall adjacent to Food Permit for inspections. T • Initials Town of Barnstable I . Date Paid Amt Pd$S`� , BARNSTANIASS.BLE, : Inspectional Services 10 q (-7 s639. Public Health Division Check# f Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 i Office: 508-862-4644 Fax: 508-790-6304 it tt 'APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE � `-t 1 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: 5jwx yvWS Ulf" �5�3 ADDRESS OF FOOD ESTABLISHMENT: 4$S L" Awvokj w MAILING ADDRESS(IF DIFFERENT FROM _AB.OVE): f_0 �� 3AAq_" E-MAIL ADDRESS: IAbt,-J v�r��S 0— Sj��CV-j u`N` TELEPHONE NUMBER OF FOOD ESTABLISHMENT: " TOTAL NUMBER OF BATHROOMS: WELL WATER: YES_NO ✓ ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: h OUTSIDE:,---' TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QAApplication FormsTOODAPP 2020.doc n OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO OWNER PHONE # Z' (4 ADDRESS CORPORATE OWNER: p � �¢a(L (lp✓J CORPORATE ADDRESS: r t�C Z S"fink Z PERSON IN CHARGE OF DAILY OPERATIONS: F�<k k4- J� e j�v-- List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. ��� i�/��-►ram i i 1. ���" �'� tr� b� `� � �ZZ 2. 11 , 13 � 1°l 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.asi). 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 1st. Q:\Application FonnsTOODAPP REV3-2019.doc 0 Town of Barnstable BOARD OF HEALTH G Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. 3AWNSTABL John T. Norman yA p$ 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: 345 Issue Date: 12/20/18 DBA: STARBUCKS COFFEE #15703 OWNER: STARBUCKS CORP Location of Establishment: 655 IYANNOUGH ROAD HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 24 OutdoorSeating: 0 Total Seating: 24 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - --•- MOBILE-FOOD: MOBILE-ICE CREAM: �Q.n FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: f PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: toy, Initials: o Town of Barnstable For Office Us Date Paid ��` Amt Pd$�( 9 MAM Inspectional Services Public Health Division Check#WL)0� ° `�3 Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISIEWENT DATE � NEW OWNERSHIP RENEWAL 'S NAME OF FOOD ESTABLISHMENT: u ffiw-rY SS ADDRESS OF FOOD ESTABLISHMENT: 11A,\JKbV4# ". MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �0 3�N�1 S T Z" � T �v* E-MAIL ADDRESS: (� V�'�'� O!F�'z�'✓ -Ci--- TELEPHONE NUMBER OF FOOD ESTABLISHMENT: l TOTAL NUMBER OF BATHROOMS: 1- WELL WATER: YES NO /... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS, IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) J 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 Fonns`,FOODAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANTg ( � J SOLE OWNER: YES/ OWNER PHONE ADDRESS_ "°k V-fw jry S,� • CTt�L i..�►a �I f�(?�p CORPORATE OWNER: "lAq C P4 FEDERAL ID NO. : CORPORATE ADDRESS: 7--A o l V-f w4 kr S• yWricrn . fj k q r(3 4 PERSON IN CHARGE OF DAILY OPERATIONS: 1 fL List (2) Certified Food Protection Managers AND at least(1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date ller en Awareness Expiration Date 1. ��G��'S 1/Y �i.-�►. z � � / �l 1. �RrC�iI- I�'1�%iYCN�Yt.- � / � ��/ 2. 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.asy. 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 1 st. Q\Application FormsT00DAPPREV2018.doc n / yip IMF fpk� TOWN OF BARNSTABLE_ .. .- HEALTH iNSPECTOR's Establishment Name: CSar��lJ�.. Date J��-.Page: . .of PUBLIC HEALTH DIVISION OFFICE HOURSs00-9230A.M. BARNSTABLE. • 200 MAIN STREET 3:30-430 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mnss. 0g RI F MON. HYANNIS, MA 02601 - . No Reference R-Red Item PLEASE PRINT CLEARLY. �p .ens•n 508-N. RI fFOM"� FOOD ESTABLISHMENT INSP CTION REPORT Q_ 644 NameAa Dat� Type o T o section p Routine Address ' Risk Foo Re-inspection Level Retail Previous Inspection `> I<J Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary. Suspect Illness Caterer General Complaint Person in Charge(PIC) �/ • Time Bed&Breakfast O HACherCP r- n: -- Inspector t; 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) ❑ s 1 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 TIMElTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures oc-<- <2JC2� ❑5.Receiving/Condition ❑ 17.Reheating - ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP.Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) / ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: I ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 9 0 days as determined by the Board of Health. � F] Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 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.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. viol to 8non-critical violations=C. w 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspe t 's S g tur Print: rN 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N \ #Seats Observed IFrozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N >%Ln,L/ 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* * 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-]03.11 Person-in-Charge Duties 3-302.14 Protection4rom Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Tozie 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 * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge*. Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 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* 3-801.1](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 E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Utensils and Food 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef m-11112001 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* Animals-155°F 15 sec* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell 4-702.11 Frequency of Sanitization of Utensils and Food Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and a ide in cater- * Ratites-165°F 15 sec* in mobile food,tem or and residential Sources 1 p 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. 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 929-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23730) 3-202.11 Package Integrity Critical and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands 3-403.11E Remaining 3-101.11 Food Safe and Unadulterated ( ) g 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 13 Handwashing Facilities Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 - 5-20411 Location and Placement* 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 I 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6.2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oFTHE rok TOWN OF BARNSTABLE HEALTKINSPECTOR'S Establishment Name: V � Date: 1 � Page: of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. 0s869. HYANNIS,MA 02601 562-4466aa No Reference R-Red Item PLEASE PRINT CLEARLY '"�`' FOOD ESTABLISHMENT INSPECTION REPORT - Name Date T e o T of Inspection e Address Risk Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other \Inspector Out: y p 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 Qo ❑ 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 PIT- 0 ' V ❑ 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 1 X ❑ 10.Proper Adequate Handwashing' CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories O Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violatio Critical(C)violations marked must be corrected immediately. (blue&red items) T � a�D, Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal .. ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the.number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. -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 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 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 olation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspect ' i u 31.Dump ter 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 Signar a Print: h 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 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility ' p y of A Food Employee yee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a 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. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 1 g3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* EB dive 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 1 p Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and 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 77 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* (Blue Items 23-30) 3-202.15 Package Integrity g g 3 403.11(C) Commercially Processed RTE Food-140°F* 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 to 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 an Placement* d Plat* 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. 590.00 J Labeling of Ingredients' Supplied with Soap and hand Drying Devices 4O 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical itern in the federal 1999 Food Code or 105 CMR 590.000. oFTHE► TOWN OF BARNSTABLE HEALTHINSPECTOR's Establishment Name: vrbc�rS Date: Page: _of�_ •^yp....'{iy'[jj'�/ ti PUBLIC OFFICE HOURS BARNSTABLE.O� 2 0 MAN STREEET 3:30-4:30 P.M. DIVISION : 0- :30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 Sob 82 FRI. No Reference R-Red.Item - PLEASE PRINT CLEARLY - �,FDM�,a FOOD ESTABLISHMENT INSPECTION REPORT Name �f'ql' V Date l,l'6 Tyoe of jyw4f Inspection Operation(s) 4"Routine Address Risk ood rvice Se ection , 655 to �� Level Re a- Previous Inspection m I n Telephone Residential Kitchen Date: n W-1 b!-�'D)1L 1 oo Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness - <d S 6D Caterer General Complaint n Bed&Breakfast HACCP �' [C--16( tVd- 1(0,9 Person in Charge(PIC) r R r Time Other In: Oth •_� i vJ r l�o Inspector P G11 Eva c Out: rQ < 'V1 Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. - ✓C P;/' i�f l S Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ a)1:I 14 fS 10 ri t'I Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ `/ etas / 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 ? l liq ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories l Violations Related to Good Retail Practices(Blue Items] Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 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 8 non-critical violations. If 1 critical refrigeration. violation,4 to 8 non-critical violations=C. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address 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 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.* 79 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 5 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources' 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P * 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 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* 3-401.11A(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 5-101.1E 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 crave//uzoo/ 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)(I)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency r f cesSanitizationquof Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or - 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing - g' P mTJ' Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. radicsshould be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C 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 12 Prevention of Contamination from Hands 3-403.11E Remaining 3-101.11 Food Safe and Unadulterated* ( ) g 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 * 13 Handwashing Facilities 3-501.14 3-202.18 Shellstock Identification (A Cooling g Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification.Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41`F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11. Parasite Destruction* 5-204.11 Location and Placement* 3-501.14 B Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 ( ) Temperature Ingredients to 41°F%45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures I 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 130. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* I S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 596,000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. f'7�' I, Op 1XE TOWN OF BARNSTABLE. HEALTH INSPECTOR,s Establishment Name I� Date: ;I Page: of OFFICE HOURS AR Eo PUBLIC 0HEALTH D NSTRETSION 8:00=9:30 A.M. 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mass. 'g, MON.-FRI. HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item, PLEASE PRINT CLEARLY, 'FDN1P� FO D ESTABLISHMENT INSP CT ON REPORT _ l, �1 Name Date rr? dyne of Ins ection r ^ e Routin n Address r Risk Food Service a-inspe ion " Level i ai Previo n pe i / r .l ` N Telephone � Residential Kitchen Date: Mobile Pre ope atiu Owner HACCP Y/N Temporary Suspect Illness ' Caterer General Complaint - �r Person in Charge(PIC) Time Bed&Breakfast HACCP 7, A% r Other ! v' Inspecto Each violation checked requires an explanation on the narrativ page(s)and a citation of specific provision(s)violated. �" rf' w 14 W Violations Related to'Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ /f r Cl) Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ 4 A - Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ �; l FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands / I ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities �• y" F r f EMPLOYEE HEALTH PROTECTION FROM CHEMICALS A ❑ 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 TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) - _ A / ❑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 r ✓ "> I PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control r� ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ' s. ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP 1 c r v ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer AdvisoriesI X�' _ � I f Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Vu Critical(C)violations marked must be corrected immediately. (blue&red items) �`�-� tthite 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 tod , ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no.more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non critical violations 9 25.Water,Plumbing and Waste (FC-5)(590.005) establishment permit and cessation of food.est r revocation operations. d 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 9rion-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-cnti al vi lations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8 non-critical violati s=F. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other q DATE OF RE-INSPECTION: Insf ect 's 'gnatur G� (a int: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N v #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI s Si ature Print. Self Service Wait Service Provided Grease Trap Size Variance Letter Posted . Y N dr- 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* 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202-.12- Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * - .19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties - _ 3-302.14 Protection from Unapproved?;dditives Contamination from Raw Ingredients 15 I Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) * • - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) "-Responsibility of the Person-in-Charge to - _ Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F*Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F* - - Applicants*- 3-302.11(A) Food Protection* 20 rime 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* F 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ ,, REQUIREMENTS:FOR- 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) � Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated - - - - - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* _ 4-501.111 Manual 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* 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* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* sffe°"°e ioaoor 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 Cough[Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and- 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section.590.009(A)-(D)in cater- Sources* 1 p Ratites-165°F 15 sec*Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By - 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under 2- n ition-Hands an Ann Regulatory Authority 301.11 Clean Cod d s 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*. i 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 1 7 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* _ 3-403.11(B) Microwave-165`F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands r 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*17 to 41`FAFF 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 1 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 1 Conformance with Approved Procedures* S:590Formback6-2doc l *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ^Denules critical item in the federal 1999 Food Code or 105 CMR 590.000. N °F. rok TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: /,-3 1J Page: of q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00=9:30A.M. BARNS7•ABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p M639: 5 n o� HYANNIS,MA 02601 MON.-FRI. No Reference R-.Red Item PLEASE PRINT CLEARLY_ rFo MPS FO ESTABLISHMENT INSPT REPORT08-862-4644 ON NamenriqldM ate �( e�o_f f ns eC ion ' g Ro ;Risk Foo rvi Re-inspecti n Level Address -- Previo Telephone � Residential Kitchen Date: r Mobile Pre-opera on Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspect o 1-00 1 1 1�2) " ,O Each violation checked requires an explana ion on the narrat a page(s)and a citation of specific provision(s)violated. 11 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 i1 ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling / ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action No Y Required:q ❑ ❑ es 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 Uthte, ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than9 non-critical. If no critical water,sewage 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must non-cr ga back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-criti violation If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 to on,4 to 8 non-critical violatiQ =C. 29.Special Requirements. (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: ctor S' e O P' t: 31.Dumpster screened from public view cl/ Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N ICs Sign w, Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* S Cross-contamination 1 q 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 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* 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers* 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G) Reporting by Person in Charge* _ 3-304.11 Food Contact with Equipment and Utensils 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 AdulteReserrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAduIterated 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 F Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made from Potable Drinking Water" Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of . ean Utensils and Food Contact Surfaces of Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-60111A( ) Cl Eggs-Immediate Service 145"F 15 sec* Not ot Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff cd,e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 1 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 3-201.17 Game Animals* Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the ff Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.12 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 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. her 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 Barnstable Board of Health MANSTAOM MAM g 200 Main Street, Hyannis MA 02601 1 HV s63q. ♦� RFD MA'S A 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi BOARD OF HEALTH MEETING RESULTS Tuesday, May 8, 2012 at 3:00 PM Town Hall, Hearing Room, 2ND Floor 367 Main Street, Hyannis, MA I. Hearing - Housing: Ann Peterson, owner—494 Elliott Road, Centerville, Map/Parcel 226-192 5.73 acre parcel, housing — low ceiling in basement. APPROVED. The Board voted to approve the ceiling variance in the basement with the condition that the basement is not to be used by any tenants. II. Hearing - Septic / Housing (Cont.): Linda Pinto, CNS Engineering, representing Kenneth Carey, owner—439 South Main Street, Centerville, 3 units, Map/Parcel 207-066, 0.66 acre parcel, multiple variances. The Board would like the septic tank to be monolithic if the two-compartment tanks are available as such. Otherwise, the tank will be waterproofed and that will be all right. The Board voted to approve the variances with the following conditions: 1) record a six-bedroom deed restriction at the Barnstable County Registry of Deeds, 2) provide the Health Division with a proper copy of the deed restriction, 3) a floor plan and proposal of what will be done to the third building shall be given to the Health Division to document that there are no bedrooms in it. III. Innovative /Alternative System: Dan Ojala, Down Cape Engineering, representing Theodore Skirvan, owner— 114 Long Pond Rd, Marstons Mills, Map/Parcel 030-123, 0.49 acre parcel, I/A system. Page 1 of 4 BOH 5/08/12 APPROVED. An innovative/alternative system will be put in. The Board voted to approve the monitoring plan. IV. Informal Discussion: A. Arlene Wilson representing Jay Bergeron and Joanne Crowley, owners — 59 Short Beach Rd, Centerville, Map/Parcel 206-034, 0.15 acre parcel, Oct 11, 2011 Board of Health meeting conditions # 2 and # 3 must be met. The Board expressed that they would like to submit the information of the "constructive approval" to our town attorney and as long as she agrees with Arlene Wilson, then the permit will be allowed. The Board believes an answer may be possible by the end of this week. The Board also requested a revised floor plan be submitted which shows the second floor bedrooms to be #2 and #3 (versus #3 and #4) to avoid any confusion of the three bedroom plan. The "constructive approval" would still uphold the enforcement of standard requirements which the DEP have set forth for the septic system. Ms. Wilson agreed and asked for a call as soon as the attorney has decided because the septic permit is holding up the homeowner from getting his pier permit which has a tight window for applications. B. Grease Traps - Food Establishments on Public Sewer. Last week, Dr. Miller met with David Houghton and Ruth Weil in the Legal Department, along with Mark Ells, DPW, and discussed the handling of the grease trap variances. One difficulty is that DPW does not have the authority to go inside businesses and inspect. No final decision was made. It was suggested that the granting of the variance be done by DPW and the enforcing be done by Health at this time. Mr. McKean and Mr. Parsons will work together. Tom McKean, Director of Health, Roger Parsons, Town Engineer, and Ed Jenkins, Plumbing Inspector, will review the food establishments needing grease traps prior to the application of a grease trap variance. Dr. Miller said that it must be made very clear to the people operating the businesses that there is a group of three people (Mr. McKean, Mr. Parsons and Mr. Jenkins) who must review grease trap applications and respond to the applicants prior to applying for a grease trap variance. The three member group is not included in the timeframe of which the Board of Health must respond to a variance application. Therefore, they must allot sufficient time to avoid delays in the operation of their businesses. Page 2 of 4 BOH 5/08/12 V. Food (New): A. Retail Annual Permit: Cynthia Cole representing Mid-Cape Farmer's Market new location —486 Main Street outside First Baptist Church,, o pt tCr uc , Hyannis, same vendors. Cynthia Cole presented the annual application for the Mid-Cape Farmer's Market. The location has changed this year. It is proposed at the First Baptist Church. A site plan was submitted and approved. The church will be closed during the market. Candy Corner will be accessible to the vendors, only. The Board voted to approve the renewal of permit. B. Dan Brennan representing CTS Fiduciary— Starbucks — 655 lyannough Road, Hyannis, Map/Parcel 311-088, requesting further review of grease trap variance granted October 11, 2011. Richard Marchesseault, General Contractor for Starbucks, was present. Starbuck's is returning asking for an amendment to their variance previously granted, as the menu is all prepared foods. The Plumbing Inspector had mentioned to them that he felt the inceptor would do the job as no cooking is done at the location. The Board was concerned that the grease inceptor would not be sufficient with the menu. The Board voted to amend the grease trap variance with the limitation of the menu submitted as is and without any changes or adcWions (with the exception of f eliminations) with the following conditions: 14Lhey must submit a drawn plan of the area including the grease inceptor, 2) monthly inspections and cleaning must be done, �I 3) the monthly logs must be submitted to the Health Division 4) no'cooking will be done on the premises, and 5) the Board of Health must be giorma ion on how the size of the grease inceptor was determined. (Unanimously, voted in favor.) VI. Old / New Business: The following Temporary Policy is in place until the Board has the opportunity to hear the full item next month: Mobile Trucks In order to obtain permission to remain at a fixed location for more than four hours, the mobile food unit shall be equipped with the following equipment, -Adequate refrigeration capable of maintaining temperature at or below 41 degrees Fahrenheit for the number of hours requested. An onsite electrical connection, a generator, propane, and/or battery back-up power may be used to satisfy this requirement. Page 3 of 4 BOH 5/08/12 J -Adequate hot water heating tank/heating unit capable of maintaining hot water at temperature of at least 43 degrees C (110 degrees F) through a mixing valve or combination faucet. A heating facility capable of producing enough hot water for these purposes shall be provided on the mobile food unit for the number of hours requested. An onsite electrical connection, a generator, and/or battery back-up power may be used to satisfy this requirement. -If there are no restroom facilities provided onsite, the mobile food unit shall be equipped with a restroom facility (equipped with a toilet and its own handwash sink which is separate from the handwashing facility provided in the food preparation area). However, a mobile food unit capable of easily relocating to public restrooms multiple times throughout the day (e.g. a self-propelled unit) is exempt from this requirement. NOTE: The applicant shall comply with Chapter 141 Outdoor Businesses, of the Town of Barnstable Code and shall strictly adhere to all local Town regulations including but not limited to licensing, parking, zoning, and site plan review. r Page 4 of 4 BOH 5/08/12 r i BROWN LINDQUIST FEN UCCIO & RABER ARCHITECTS, INC. 8/11/2011 Mr. Donald Desmarais Health Inspector Health Department Town of Barnstable RE: Potential Starbucks Coffee Shop Christmas Tree Plaza, Hyannis,MA Mr. Desmarais, i represent the property owner'who proposes to lease space at the Christmas Tree Plaza on Route 132 to Starbucks for a coffee shop. The space is the end unit facing Route 132. 1 am writing today to request your preliminary review of the attached plan and a determination that a full size underground grease trap is not required. 1 understood from our previous telephone conversion (a few weeks ago)that normally a I;000 gallon or more precast grease trap is usually required in a restaurant use. We plan to use a grease interceptor(recessed in the floor slab) in lieu of a larger system involving significant site work. This is consistent with Starbuck's stores in many nearby locations. We have attached copies of several pages for your review including: • site plan • existing floor plan • schematic floor plan ( illustrating the seating plan=29 seats) { • enlarged engine plan (public counter) • enlarged workroom plan (staff area) VE • picture illustrating tenant's wall menu board 1 2z t • reduced copy of other drink offerings Q • two pages of food items menu :xUZI The food items are not prepared or, cooked on the property,they are delivered to the stom'.on a regrZr basis. In some cases these items are warmed,toasted,or heated in small convection appliances. T tenant plans no use of dishware or flatware. Please let me know at your earliest convenience if the--) enclosed materials are satisfactory to make a determination that the larger grease trap will not be re'$ired. If further actions are required, I would appreciate„if you'can call,me to discuss, or schedule a meeting to discuss. Regard Ku E. Raber Enc. 9 pages Cc: E.Mullin,Mill Lane Mgt. 203 WILLOW STREET,SUITE A PH 508-362-8382 YARMOUTHPORT,MA 02675 WWW.CAPEARCHITECTS.COM FAX 508-362-2828 t`J GPE A yrNEYggo ELECTRIC CO.lTgL MgYFLOWEq]f f.t EASEMENT 30'WIOE 6 GO SIMgy pROPCEp1yCgKpPT. �OMEM f19,2a] yI ST .O,BOx6r3 E CCU �n s st1•tq'SBw �j w wG iAPous.w m slat' aaefzB wn P•qti° N a .S ,� s1o•.ezTw � fn f zes � rkA' ��i X' WOOOEN eo"o, s,z'S9�y„ ppQQ mm rSS 6t1'\B'6>w eGa TO m ^g� 9 Jr.Og g 218.28' BOARDS m ��Utl OV 101.)B 3 'MGH J,+.,O % g 2t),fir v F/O JITgH HOAEI^TEI IL.CnIE WALL a� �Y9 St2I•r0 c N . _ .95 Wg1ER 61N'ACEME BROCNTgyEORNT C. F a u STOCKADE FENCE 02Jpf � D ��R RETAWrNG WALL • �65.ST 1 , RETM 9 KING N,2.69'IgE GOR -668.8aS 6<.Or 56 NEARNEYrS LC. pS ]3.]B' NEFOHq,G gO'10G RAMP .q GHAIN FENCE 0 �.Mq 0✓3m —NRYBUILOING Y I — A`� TIESTO O CORNERBLOCNS _ 6.r 5 GH — -- gC u0i�n 2 � wC a¢ OGG_ 3358 SiJ• sz 1oo,oG' d r �GA 9,a•08�]ly .o6t per_ S+]']3 , 1a1,, 14 sr:•ts'Jew m F" �m - ze�,q,.l a3r-- q'08ZTy� $iQq _ STOCKADE FENCE - G META BUILDING N ]m CHgrN FENCE �• fi N�^ivC 22� JO"A �N Sz pPt"' CvO FALMOUTH.. . s - 210 . _ lyESTMA,,STREET 6T Z tq.ANNI Mq K 4�rR _ 02H0, SAILFISH PgRT RETAINrq IO'I" NERS L.P G C WALL = Al:REAI ELSNgTE ACCOUNT V� /f . \ /7,✓(1 rON.NJ $�m � 0]Os3 EXISTING SITE PLAN-OVERALL VIEW FOR REFERENCE ONLY Nynnnis.MA Regonal M!Ddefn-Full Remodel SchemMtiC Confidential I June 8.2011 6 wd Scope of Work Existing Floor Plan 0 ° Notes Drawings are not to scale Document for design intent only Do not use for construction I, Seating it Existing: Soft Seats: N/A Hard Seats: N/A Total: N/A 1.800 SQ.FT. 1 0 L, ---------- *33 WD PARTNERS Document prepared and presented by WO Partners: 7007 Discovery Blvd.Dublin,OH 430.17 (614)634.7000 wdpartners.com This document contains information that is privileged and confidential. Any unauthorized rllSClosure,reproduction,distribution or use of this es EXISTING FLOOR PLAN information without express written authorization is strictly prohibited. Hyannis,MA-Regional Modern-Full Remodel Schematic Confidential I line 8.2011 7 61 VW FRONTBAR: SEATING/SALES WORKROOM CONT. RFSTROOM i0New merch bays 20 New painL&wall hardening throughout a4 New hand sink 6o New paint,flooring&wall hardening lNew New"A" pastry case, E338 11 New flooring&the base as New 1,000 Ib.ice machine 61 New baby changing station New POS with safe,POS 13-01 22 New soft seating.floor lamp&side 46 New single door True 62 New Xlerator hand dryer _New L-shaped espresso bar, ESP 24-02 tables refrigerator 63 New lavatory with soap dispenser sit-here bar with stools z3 New cafe tables&chairs 47 New double door True 64 New water closet,grab bars,& BACKBAR: 24 New banquette&low-wall refrigerator restroom accessories 10 zs New condiment cart 4s 6s New mirror New storage cabinets Q New 3-comp sink with Q Scope of Work z6 11 New warming station.WRM 03-01 New community board sanitizer below EXTERIOR Schematic Floor Plan z7 Iz New hand sink,ADD 01-01 New artwork throughout a9 New mop sink with water 7o New wordmark si n is New entry door g 13 New brew station, BRW 10-02 heater above Notes 14 New CBS station,CBS 10-01 z9 New walk-off mat 71 New outdoor seating package WORKROOM so (3)new recycling bins Drawings are not to scale 15 New variable width cabinet,ADD 10-01 st New metro shelf Document for design intent only 4o New paint sz New manager's desk Do not use for construction al New FRP 53 New data rack az New flooring Seating 4a s4 New lockers 60 61 62 Existing: Soft Seats: N A Maintain existing electric panels g� / 63 64 65 Hard Seats: N/A - ------ --------------- - �__— __..1— -- - Total: N/ AL30V l ++ z3 -T- :; ( - la , 1 Proposed: Soft Seats: 05 70 : ] r 7_ Hard Seats: 24 Tofal: 29 r } 7 j: { { { I l } ARTWORK + r .. �.. 1. 1 � I{ } 24 { .i el t _ 1 m Artwork location 7. l } + + + 1 ! -- _.........f 1RJOA�t7 1G H7 7�_.T_r f +I f {: + -r, - {t F 51 5 SIGNAGE z T - t i 53 oo { { Signage location 1 50 j f I 49.. as st 42 --- - }- s l } �. Z i 28 A13 15 ., u ., i4l J' yj Ir f 45 4C '47. 1. -........ -- - - ---------- '. e----------------------------------------------- --------------------------------------------------------- ------------------- ----------- W D PARTNERS Document prepared and presented by WD Partners: AL'QVE 7007 Discovery Blvd.Dublin,OH 43017 (614)634.7000 wdpartners.com •--------------------' 70 This document contains information that is privileged and confidential. Any unauthorized disclosure,reproduction.distribution or use of this SCHEMATIC FLOOR PLAN inforntaatloa widtout express written authorization is slAtd.ty prohibited. Hyannis.MA-Regional Nloclern-Full Remodel schematic Confidential June 8.201.1 9 1vid Scope of Work 2-DOOR uC FRIDGE(BELOW) Enlarged Engine Plan COMBO SINK (2)MASTRENAS -- - Notes L-SHAPED ESPRESSOBAR ESP24-02) POS W/SAFE(POS 13-01) "A"FOOD CASE(E338) _ Drawings are not to scale Document for design intent only e /_o 9 _ _ Do not use for construction a O - s O O o F ®® io 45LB ICE 3'-53/4"00-10 3 BIN, SAF (BELOW) r w I � 95LB ICE n BIN a Ire i% O u O L L * 7YW a (2)BLENDERS 2-DOOR UC WORK (2)SHUTTLES BREW WORK GRIND& HAN OVEN 1-DOOR UC STORAGE STORAGE FRIDGE SINK I SINK SCALE SIN FRIDGE CABINET CABINET (BELOW) TRASH (BELOW) 8'-81rz' 9-9• s-o° 5'-4" CBS W/SHARED ICE(CBS 10-01) BREW/GRIND/TRASH BRW(10-02) WARMING(WRM 03-01) (2)STORAGE CABINETS 1' 3" HAND SINK(ADD 01-01) WD PARTNERS Document prepared and presented by WD Partners: 7007 Discovery Blvd.Dublin,OH 43017 (614)634.7000 wdpartners.com This document contains information that is privileged and confidelitial. Any unauthorized disclosure,reproduction,distribution cruse of this ENLARGED ENGINE PLAN intonnation without express written authorization is strictly prolubited. Hyannis.MA-Regional Modern-Full Remodel Schematic Confidential I June S.201.1 10 and - - \ MANAGER'S DESK LOCKERS METRO C, DATA -- �� o RACK Scope of Work Enlarged Workroom Plan EXISTING ELECTRICAL PANELS Notes Drawings are not to scale W to Document for design intent only Do not use for construction • METRO 3 3-COMP INK --/--- -t METRO 4 MOP SINK \ �� (WATER HEATER ABOVE) --- • / \ rn WATER FILTRATION / ¢ SYSTEM (ABOVE) -- W 1 1 I I it 1 H�AN. , I S[N... 1.00OLB ICE 1-DOOR TRUE 2-DOOR TRUE FRIDGE MACHINE FRIDGE STORAGE STORAGE CABINET CABINET O I WD PARTNERS Document preparred and presented by WD Partners: 7007 Discovery Qlvd.Dublin.OH 43017 (674)634.7000 wdpartners.com This documenr Contains information th�t Is privileged an(1 Confidential. Any unauthorized disclosure,rcpiodur.noo.distribution or use of this ENLARGED WORKROOM PLAN information without express written authorization is strictly prohibited. Hyannis.MA-Regional Modern-Full Remodel Schematic Confidential I June 8.201.1 ] ©©©) J THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR I QUALITY ORIGINALS) IM ^CC DATA L �.-dll4tl11�!!'Ir, �rt�; 'r.'a,l:{11,� La►�lcr• � .ill Ila991'6A ; .. i � Willie cl't-xvirde mo&it *Y.a `- _ Fi�tu ltau:ia.a. :gau4l+e.a�tas:�: a1 Tim saimm.a Ciaara. and marKtltnl.p MAKE IT YOUR DWI t► I`tllt+ ?L!� 1Xt'Fl!ice ;} l� IN O and other favorites RUM"113M COVSIM B1m cRftm TZAI-A a nel/Cara=L Light Strawberries & Cr6ine C.>bd Tea.Latta Sh en feed Tie TALL 3:2i aRUDE315 VOU425 TA. L' 3.25 WANRE3.75 klUifl, 425 TAU Z11U GRANDFI 5 WK M MIA GME1.75. V ZJDD 3M,9400t1. 4XI L MMUL 41100L 570cal. 7..50cat 2 1 cd 294Mt 360cd 604 0ta. 12hfiL Shaken Wed TAM 3-4 E a.� V TALL TO AGE 3:T4" TALL 2.70 GRMDE D V 3M . 3WHO +� 041. Murat tea , Ago cal cal M MML 31a� ����� TAU 22 GWORA MUM AVAUABLB HOT OR OVER ICE TAM - E , - 4- TALL�-25 r t�€3,75 425 19010 - MA50Oil UCH-c cal.. - MW PKWED MS 1N E-51 L-BLM v PASSION Java Chip ChAI Tea TALC 3z OKUME lis VEFITE 425 TALL 325 GRANDIE 3.75, 110f6E 4: 3PD Cd 5110 C& 6 Wf;al. N0 Cal. s16 r 1 iQ cal Bucx T uk mff AYd -i'cl41 'White Cho",late Mocha 'Green,. Tea RMALTRAUU1111H, T `-3 ' tl c 1 TALI,3' [ WEED+1 F O f I D ' .. Pd0 c3t. 4001 450(mL al. 03-1 Tall1-16 - -E1.75 VM 1.75 Classics preppie U t Mocha 0 COL QC* a TAL_JL E:3caT; V 4 Hot chow . md �O mil, 0 . _ TAU MU W °E2,900_ � �c►c� c5a� Asa Tanger-tue TALL3.05 GRAN E3Z5 V 4, got Brewed. CoffeePTI �n �re�c l40 ca9. IN Cal 2W TALL 2 30 G11A�05 255 V101TE 240 UQEJ�'ER O � TALL i,45 GAftt1� 1,75 CRL ®USE r lFAT Ku TALL 3,05 GR ME 155 !�ENTE 4,05 Iced crewed 0.0ee Caramel Apple Cider ,41 TY s9a�t . a. aYanI AUT OS TALL 1,80 GAANDE Z10 V 2 TALL Z45 GAAND12,70 ME 2.115 0 G i) 2110 CaL 2130 cal .�U cat ,tom 1►NIUMUMD { 130 call S� Ott' i5 Cti 3h1 tSL t 10 cal t3l 0MAMWERMUff LJ=Q WAXWO COFFEE mwmwrrH FREsw anEwuluzoom 1,Ced Brewed CA Con eChe Kids brinks TALL 1.601 GRANOE 2,10 VM 2,45 1.O6 E FL4F 110 ML WOW 180 cat Sffi Rftz brlx tde FO OD ITEMS Bakery: 8-Grain Roll, Apple Bran Muffin, Apple Fritter, Asiago Bagel, Banana Nut Loaf, Birthday Cake Mini Doughnut, Blueberry Oat Bar, Blueberry Scone, Blueberry Streusel, Butter Croissant, Cheese Danish, Chocolate Chunk Cookie, Chocolate Croissant, Chocolate Old Fashioned Doughnut, Chonga Bagel, Cinnamon Chip Scone, Cranberry Orange Scone, Double Chocolate Brownie, Double Fudge Mini Doughnut, Ginger Molasses Cookie, Hawaiian Bagel, Iced Lemon Pound Cake, Mallorca Sweet Bread, Maple Oat Pecan Scone, Marble Pound Cake, Marshmallow Dream, Morning Bun, Multigrain Bagel, Old Fashioned Glazed Doughnut, Outrageous Oatmeal Cookie, Petite Vanilla Bean Scone, Plain Bagel, Pumpkin Bread, Pumpkin Scone, Raspberry Scone, Reduced Fat Banana Chocolate Chip Coffee Cake, Reduced Fat Cinnamon Swirl Coffee Cake, Reduced Fat Very Berry Coffee Cake, Starbucks Classic Coffee Cake, Zucchini Walnut Muffin Bistro Boxes: Cheese & Fruit, Chicken & Hummus, Chicken Lettuce Wraps, Chipotle Chicken Wraps, Protein, Salami & Cheese, Sesame Noodles, Tune Salad Starbucks Petites: Birthday Cake Pop, Carrot Cake Mini Cupcake, Lemon Sweet Square, Peanut Butter Mini Cupcake, Red Velvet Whoopi Pie, Rocky Road Cake Pop, Salted Caramel Sweet Square, Tiramisu Cake Pop Food Items Cont. Hot Breakfast: Bacon & Gouda Artisan Breakfast Sandwich, Brown Sugar Topping/Dried Fruit Topping/Nut Medley perfect oatmeal, Ham & Cheddar Artisan Breakfast Sandwich, Reduced Fat Turkey Bacon White Cheddar & Cage free egg white classic breakfast sandwich, Sausage & Cheddar Classic Breakfast Sandwich, Spinach Feta & Cage-Free Egg White Breakfast Wrap, Veggie & Monterey Jack Artisan Breakfast Sandwich Sandwiches, Panini & Wraps: Chicken Santa Fe Panini, Egg Salad Sandwich, Roasted Vegetable Panini, Roma Tomato & Mozzarella Sandwich; Tarragon Chicken Salad Sandwich, Turkey & Swiss Sandwich Yogurt Parfaits: Dark Cherry Yogurt Parfait, Greek Yogurt Honey Parfait, Strawberry & Blueberry Yogurt Parfait Z1170 l�ov SPECIFICATION SHEET ZURiN® GREASE INTERCEPTOR TAG Dimensional Data(inches and[mm])are Subject to Manufacturing Tolerances and Change Without Notice i i i i C D ! E i i i i F INLET G = WIDTH OF BODY OUTLET Inlet/ Flow Rate Capacity Approx. Dimensions in Inches Size Outlet G.P.M. Water Grease Wt. Lbs. Size* [L] Gal. [L] Lbs. [kg] [kg] C D/E F G 100 4 [15] 3 [11] 8 [4] 42 [19] 10 [254] 7 1/4 [184] 20 3/8 [518] 9 718 [251] 200 2 [51] 7 [26] 5 [19] 14 [6] 53 [24] 11 1/4 [286] 8 1/8 [206] 21 3/4 [552] 11 7/8 [302] 300 10 38 6 [231 1 20 [91 66 [301 11 3/4 298 81/4 [2101 251/8 638 14 356 400 15 [57] 10 [38] 30 [14] 83 [38] 13 3/8 [340] 9 3/8 [238] 27 1/8 [689] 16 3/4 [425] 500 20 [76] 16 60 40 15 381 11 3/4 98 30 [762] 17 1/4 [438] 600 3 [761 1 25 94 21 [79] 50 [23 124 [56] 17 [432] 1 12 1/2 [318] 32 1/4 [819] 19 7/8 [505 700 35 (132] 30 [113] 70 [32] 1 151 [68] 18 3/4 [476] 14 1/4 [362] 34 1/8 [867] 1 22 1/2 [572] 800 50 [189] 40 [151] 100 [45] 180 (82] 21 1/2 [546] 16 [406] 36 [914] 1 24 1/2 [622] ENGINEERING SPECIFICATION:ZURN Z1170 Acid Resistant Coated interior and exterior fabricated steel grease interceptor,PDI,rated at_ GPM and _ Lbs. grease capacity, with internal air relief by-pass, bronze cleanout plug, removable pressure equalizing/flow diffusing inlet baffle, fixed bottom outlet baffle, and visible double wall trap seal. Gasketed non-skid secured cover complete with center tie down assembly, with Z1108 flow control fitting. Regularly furnished with a high inlet and outlet connection. Note: Location of outlet from bottom of interceptor cannot be changed. PREFIXES Z Acid Resistant Coated Fabricated Steel* ZS All Type 304 Fabricated Stainless Steel SUFFIXES -AL Aluminum Cover -DI Dual High/Low Inlet. -E Acid Resistant Coated Interior and exterior fabricated steel extension section. (Specify'C' Dim. required)for recessed installation. -HD Heavy Duty Cover rated at 10,000 lbs. maximum safe live load.A 3[76]minimum extension height is required when Heavy Duty Cover (-HD) option is specified. -K Anchor flange 1 3/4[44]down from top and 2[51]wide.A 3[76]minimum extension height is required when anchor flange(-K)option is specified. -KC Anchor flange 1 3/4 [44]down from top and 2[51]wide with clamp collar.A 3[76)minimum extension height is required when anchor flange (-K) option is specified. -L Angle type (Z1108-L) flow control device with plunger. -R Acid resistant coated interior and exterior fabricated steel recessing receiver for recessed installation is equipped with adjustable support brackets and gasketed non-skid cover with covered recessed lift handle. -RE Acid resistant coated interior and exterior fabricated steel recessing receiver enclosed type for recessed installation. Furnished with adjustable support brackets and gasketed non-skid cover with covered recessed lift handle. -T Cover recessed for tile/terrazzo.A 3[76]minimum extension height is required. (Specify recess depth- 1/8 [3], 3/4[19], or 1 1/4[32]). REV. L DATE: 1/9/08 C.N. NO. 97929 *REGULARLY FURNISHED UNLESS OTHERWISE SPECIFIED DWG. NO. 58905 PRODUCT NO. Z1170 ZURN INDUSTRIES,LLC ♦ SPECIFICATION DRAINAGE OPERATION ♦ 1801 Pittsburgh Ave. ♦ Erie,PA 16514 Phone: 814k155-0921 ♦ Fax: 8141454-7929 ♦ World Wide Web: www.zurn.com In Canada: ZURN INDUSTRIES LIMITED ♦ 3544 Nashua Drive ♦ Mississauga, Ontario L4V1L2 ♦ Phone: 905\405.8272 Fax: 9051405-1292 AquaSense ZURN. TAG AquaSense Sensor Faucet " m_ zo ,. Suffix Options(Check/Specify Appropriate Options) .r- -F .5 GPM Vandal Resistant Aerator -IA3 InletAdaptor(3/8"[10]compression) 11 1.5 GPM Laminar Flow Control -K 1.0 GPM Laminar Flow Control -L 1.0 GPM Vandal Resistant Aerator (T� -MJ Mini Junction Box -MT Mixing Tee i -MV Temperature Mixing Valve oEs�i111D �, „, -PB Polished Brass PVD Finish -SH Supply Hoses for Mixing Valve -TMV Thermostatic Mixing Valve for Multiple Faucets , FAE -TMV-1 Thermostatic Mixing Valve for Single 7 Faucets PaoW� Other Zurn Lead Free products(-XL)are manufactured to comply with state laws and local codes that mandate lead content levels less than one quarter of one percent(0.25%)total lead content by weighted average. ❑ Z6915-XL AquaSense Battery Powered Faucet ENGINEERING SPECIFICATION:The Z6915-XL sensorfaucet is a battery powered sensor faucet with an integral four inch cover plate for retrofit and new construction. The faucet incorporates an infrared convergence-type proximity sensor into the chrome plated cast brass spout. The faucet is furnished complete with sensor module,spout module and in-line filter, 4"AA"batteries, a 1.5 GPM vandal resistant aerator, an inlet for a 1/2"[13] ball riser, and a single supply hose. Sensor range is factory set for optimum performance. ❑ Z6915-XL-ACA AquaSense Plug-In Powered Faucet ENGINEERING SPECIFICATION:The Z6915-XL-ACA sensor faucet is a plug-in powered electronic sensor faucet with an integral four inch cover plate for retrofit and new construction. The faucet incorporates an infrared convergence-type proximity sensor into the chrome plated cast brass spout. The faucet is furnished complete with sensor module, spout module,in-line filter,a 1.5 GPM vandal resistant aerator,6 VDC plug-in power converter,an inlet fora 1/2"[13]ball riser,and a single supply hose. Also included are 4 'AA' batteries that provide battery backup power to the faucet during power outages. Sensor range is factory set for optimum performance. ❑ Z6915-XL-CWB AquaSense Hardwire Powered Faucet ENGINEERING SPECIFICATION:The Z6915-XL-CWB sensor faucet is a hardwired electronic sensor faucet with an integral four inch cover plate for retrofit and new construction. The faucet incorporates an infrared convergence-type proximity sensor into the chrome plated cast brass spout. The faucet is furnished complete with sensor module, spout module,in-line filter,a 1.5 GPM vandal resistant aerator,connecting wire to power converter,an inlet for a 1/2"[13]ball riser, and a single supply hose. Also included are 4'AA'batteries that provide battery backup power to the faucet during power outages.Sensor range is factory set for optimum performance. NOTE: For Hardwire applications furnish P6000-HW6 power converter.The P6000-HW6 will power up to 8 sensor faucets.Order P6000-HW6 power converter seperately.. All polished brass(PVD) products come with a.limited lifetime warranty on the finish. ZURN INDUSTRIES,LLC. ♦COMMERCIAL BRASS OPERATION♦5900 ELWIN BUCHANAN DRIVE♦SANFORD NC 27330 Phone: 1-800-997-3876 ♦ Fax:919-775-3541 ♦ World Wide Web: www.zum.com In Canada:ZURN INDUSTRIES LIMITED ♦ 3544 Nashua Drive ♦ Mississauga, Ontario L4V1L2 ♦Phone:905405-8272 Fax:905-405-1292 Rev. Date: 6/8/09 AquaSense is a registered trademark of Zurn Industries, LLC. Dwg. No. 200178 Product No. Z6915-XL TYPICAL Z6915-XL AquaSense Battery 6 [152] Powered Faucet 78 [182] 4 [93] 4 [102] Optional Mixing Valves � �2 [51] L] 3/8 COPPER TUBE FAUCET SPOUT 413 CD OTHERS) W/ SENSOR [1 22] ASK ®J 1 BRASS �+IXING TEE 1—I ELECTRONICS MODULE m COMPRESSION NUT W/ SOLENOID (�\BRASS FERRULE 58 [1 37] 41 6 [123] u'j'J�FILTER HOUSING TYPICAL Z6915-XL-ACA BACK CHECK 0 AquaSense Plug-In s PLASTIC FERRULES Powered Faucet 6 [152] P6900-MT 78 [182] 4 [93] 4 [102] Mixing Tee 5p Z4 �,"� b �2 [51] § r z 4116 }z [122] P6900-MV !, Temperature Mixing Valve 58 [137] !� —ACA PLUG—IN 41 6 [123] POWER CONVERTER TYPICAL Z6915-XL-CWB AquaSense Hardwire DC COMMON '(GND) Powered Faucet (SOLID BLACK) +6VDC Optional: *OPTIONAL MINI m (BLACK W/ STRIPE) *Optional -MJ mini junction box JUNCTION Box m P6000—HW6 for connecting up to 8 faucets 6 [152] - POWERS UP 7g [182] 4 [93] 4 [102] o TO 8 FAUCETS l o B EQUIP. GND 1 (GREEN) L NEUTRAL 13 (WHITE) 416 2 [51]j- 115 VAC [122] (BLACK) 15 VAC (BLACK) 58 [137] WIRES BY OTHERS 416 [123] =CWB CONNECTING WIRE (LENGTH 7ft.) NOTE:MUST USE EITHER ZURN P6000-HW6 HARDWIRE POWER CONVERTER OR ZURN P6000-PC6 PLUG-IN POWER CONVERTER TO ENSURE PROPER OPERATION.USING A POWER CONVERTER OTHER THAN ZURN MAY RESULT IN OPERATION MALFUNCTION OR UNIT FAILURE. ZURN INDUSTRIES,LLC. ♦COMMERCIAL BRASS OPERATION♦5900 ELWIN BUCHANAN DRIVE♦SANFORD NC 27330 Phone: 1-800-997-3876 ♦ Fax.919-775-3541 ♦ World Wide Web:www.zum.com in Canada:ZURN INDUSTRIES LIMITED ♦ 3544 Nashua Drive ♦ Mississauga, Ontario L4V1L2 ♦ Phone:905-405-8272 Fax.905-405-1292 AquaSense®is a registered trademark of Zurn Industries, LLC. Finish Schedule- Starbucks - Iyannough Rd, Hyannis Room Floor Wall Ceiling WORKROOM Quarry Tile FRP Vinyl Faced Tile SERVICE AREA Quarry Tile Ceramic Gyp. Board Tile wjFio"' oy TOILET ROOM Ceramic Tile Ceramic Gyp. Board Tile Wl CpoxY FOOD STORAGE Quarry Tile FRP Vinyl Faced Tile MOP SERVICE Stainless FRP Vinyl Faced Steel Tile WAREWASH AREA Quarry Tile FRP Vinyl Faced Tile 1 HWE �t ' �, Town of Barnstable 200 Main Street,Hyannis,Massachusetts 02601 Regulatory Services Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner Phone(508)862-4679 Fax(508)862-4725 www.town.barnstable.ma.us January 23, 2012 a Starbuck's Coffee P _n Christmas Tree Plaza, Hyannis r U C/O Mr. Dan Brennan r1. Z 50 Holt Road " -En Andover, MA 01810 r w RE: Site Plan Review# 034-11 Starbuck's—Christmas Tree Plaza 655 Iyannough Road, Hyannis, Unit 6 Proposal: Change of use for 1624 s.f. unit in Christmas Tree Plaza from retail to a restaurant with 24 seats. New signage and exterior seating on existing patio is also proposed. Dear Mr. Brennan: Please be advised that subsequent.to the formal site plan review meeting on January 12, 2012, the above-referenced proposal was found approvable subject to the following: • Approval is based upon and must be substantially constructed in accordance with plans entitled "Site Improvement Plan of Land in Hyannis, MA", Scale 1"=10', dated January 19, 2012 depicting location of striped Fire Lane and signage at the rear of the building, locations of 2 HP parking spaces with ADA ramp and curb cut, enclosed dumpster location, and all utilities in the immediate area. Plan entitled: "Christmas Tree Plaza,Route 132, Hyannis, MA Site Plan" last revised 5/14/90 depicting existing parking calculation for entire Plaza. • Plans submitted at the building permit stage will need to depict the use of railings for the ADA ramp. • Applicant must obtain all other applicable permits, licenses and approvals required, including but not limited to Health Department and Fire Department approvals for interior fit out, Common Victualer's License,Board of Health Variance, and permit for signage. I • Repainting of existing faded crosswalk, directional and fire lanes as needed and as originally approved for the site. • A conditional use special permit for restaurant use in the Highway Business District will need to be granted from the Zoning Board of Appeals. • A final plan depicting all conditions of the Zoning Board of Appeals as well as outstanding conditions of site plan review must be provided for the Site Plan Review file. Upon completion of all work, a registered engineer or land surveyor shall submit a letter of certification, made upon knowledge and belief in accordance with professional standards that all work has been done in substantial compliance with the approved site plan (Zoning Section 240-105 (G). This document shall be submitted prior to the issuance of the final certificate of occupancy. A copy of the approved site plans will be retained on file. Sincerely, / G Ellen M. Swiniarski Site Plan/Regulatory Review Coordinator CC: Tom Perry, Building Commissioner SPR File ZBA File Health Department Hyannis Fire Department Licensing Dept. r 577 Main Street Hudson, MA 01749 E N V 1 R O.N M.E N T A L Inside Grease Tel : 978-841-5198 Fax : 978-562-7255 www.wrenvironmental.com Submitted to: Job Site: Starbucks Coffee Company Starbucks Coffee Company Store#15703 655 Iyannough Rd Hyannis,NIA 02601 Prepared By: Lee Arnold Date: May 15, 2012 Wind River 14 Point Inside Grease Trap Preventive Maintenance Program: RI Inspect cover 0 Check flow of trap © Inspect gaskets Z Check for leaks a Inspect bolts Z Advise need of Drain Cleaning Services a Inspect rods 0 Inspect strainers R Inspect baffle 0 Inspect screens RI Inspect baskets 2 Advise of frequency changes RI Inspect for rust 0 Complete condition report on every visit Wind River Inside Grease Trap Cleaning: we do a full cleaning, including: L Remove all floating fat,oil and grease Z Scrape down sides of trap 0 Remove all waste water 0 Clean/replace baffle Z Remove settled solids Z Run water thru to inspect flow a Remove baffle 0 Fill out BOH maintenance logs Our Inside Grease Trap Technicians are trained and able to replace gaskets during service,and snake a clogged line.We can set you up on a frequency schedule to insure your grease trap is being cleaned and inspected regularly.We will properly dispose of the grease according to regulations,and can assist with Best Management Practices to reduce internal grease trap or waste water line abuse.We have multiple location discounts available. We have a staff of Drain Cleaners available to water/trailer jet main/branch lines and camera/locate lines to find blockages with excellent diagnostic skills.We have a Master Plumber able to handle all plumbing needs including grease trap. _ replacements which are done overnight, allowing you full service the next morning. Standard Pricing for Services Inside Grease Description NOTES: trap pumping One location Service one 50# First service to be provided Grease Trap. after store opens-Date to be determined Service to be provided every 4 Net 30 days weeks Lee Arnold/ SALES/ Wind River Environmental/ 978.841.5023 email/ lamold@wrenvironmental.com If you have any questions,do not hesitate to call the above number. 577 Main Street Hudson, MA 01749 ENV IR4NM.ENTAL: Inside Grease Tel : 978-841-5198 Fax : 978-562-7255 www.wrenvironmental.com Submitted to: Job Site: Starbucks Coffee Company Starbucks Coffee Company Store#15703 655 Iyarmough Rd Hyann s,MA 02601 Prepared By: Lee Arnold Date: May 15, 2012 Wind River 14 Point Inside Grease Trap Preventive Maintenance Program: a Inspect cover 0 Check flow of trap a Inspect gaskets R1 Check for leaks a Inspect bolts 0 Advise need of Drain Cleaning Services 0 Inspect rods 0 Inspect strainers 0 Inspect baffle a Inspect screens 2 Inspect baskets 0 Advise of frequency changes a Inspect for rust 0 Complete condition report on every visit r Wind River Inside Grease Trap Cleaning: we do a full cleaning, including: a Remove all floating fat,oil and grease 0 Scrape down sides of trap 0 Remove all waste water 9 Clean/replace baffle 9 Remove settled solids 0 Run water thru to inspect flow 0 Remove baffle 0 Fill out BOH maintenance logs Our Inside Grease Trap Technicians are trained and able to replace gaskets during service,and snake a clogged line.We can set you up on a frequency schedule to insure your grease trap is being cleaned and inspected regularly.We will properly dispose of the grease according to regulations,and can assist with Best Management Practices to reduce internal grease trap or waste water line abuse.We have multiple location discounts available. We have a staff of Drain Cleaners available to water/trailer jet main/branch lines and camera/locate lines to find blockages with excellent diagnostic skills.We have a Master Plumber able to handle all plumbing needs including grease trap replacements which are done overnight,allowing you full service the next morning. Standard Pricing for Services Inside Grease Description NOTES: trap pumping One location Service one 50# First service to be provided Grease Trap. after store opens-Date to be determined Service to be provided every 4 Net 30 days weeks Lee Amold/ SALES/ Wind River Environmental/ 978.841.5023 email/ larnold@wrenvironmental.com If you have any questions,do not hesitate to call the above number. � u � � ��