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HomeMy WebLinkAboutHEARTH N' KETTLE - FOOD - FOOD TOPL)O Qd- MCtA a-73 �- I 108 OLD MILL RD., MARST.MILLS A= PO 20 a k pfr TQ{F Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. DAM STABLE.. F.P.(Thomas)Lee,. d°AM I Daniel Luczkow,M.D. Alt. 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 638 Issue Date: 01/01/2022 DBA: CAPE COMER RESORT/H EARTH&KETTLE/GRILL OWNER: HEARTH 'N KETTLE PROPERTIES Location of Establishment: 1225 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 278 OutdoorSeating: 25 Total Seating: 303 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: :l For Office iK : �`"�r°' . Town of Barnstable i Date Paid $ : . �ABtE Inspectional Services `�� Public Health Division Check# �� FD MA A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE IQ NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: age ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE):�J n E-MAIL ADDRESS: �e-6 L`p C'��C� ��/ aC' ,n6&, eenl l TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (M TOTAL NUMBER OF BATHROOMS: WELL WATER:Y'ES NO %,/...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: ✓ SEASONAL: DATES OF OPERATION:_/ / TO. III NUMBER OF SEATS: INSIDE:Ag OUTSIDE:,�& TOTAL: D3 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 and PCl Q:\Application Forms�F00DAPP 2020.doc rw `V OWNER INFORMATION: // ) ` FULL NAME OF APPLICANT �/ SOLE OWNER: YES/NO D.O.B OWNER PHONE# 6?,?9- 7,7 ADDRESS CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date >/� SIGNATURE OF L CANT 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.asn. 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 V each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc t 12Zxt � L0CAT10 S E W A C I PERMIT NO. V I L L C INSTALLER'S NAME i ADDRESS �rtCss� /yle—s:r�se�..� C�u . 7� ��.��.� �� Scar,�c�-c-1-� �-•c.._ 4 U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED � �k Z 0 FliA, ' � f o e LOCATION SEWACE PERMIT NO. VILLAGE INSTA Lt. ER'S NAME A ADDRESS 0-r'7 17 BUILDER OR OWNER D► A T E PERMIT ISSUED � Z DATE COMPLIANCE ISSUED �, Z 1" A KmT'R y �1 -� oF�ecar l f 'OA a ;� 9_ r � 9 00 w r .. r � o�-i�� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..................................---......OF......................................................................................... Appliratiuri for Bi-spao it Worko Tomitrur#iun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ... ..._./� ..... ... .......... Location-Address or Lot No. .._.. l..� ...... !.'?.. ..................................................C W5 •-•-•--•...---•--------............................. a Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building .............. No. of ersons__-••____-__-______-________ Showers — Cafeteria Pa YP g -------------- P ( ) ( ) Q' Other fixtures .........--•-••......••-•-•--••• - w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:: Septic Tank—Liquid capacity...........gallons Length................ Width................ Diameter................ Depth................ w Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit--___-_-.____•_____- Depth to ground water------------------------ Gia Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ••--•-•-••••-------------•-•-----------.....-•••••-----...-•------•-•-•-•-••••••............................................................................. 0 Description of Soil..... n u` ----•-------------------------------------------------------------------------------------------------------------------------------------- x U ..............................................------•--••••••--••••••-••••--•••••••-•--••--....•••--•-•-•••-•-------•---•--••-•••---•--------------•---•-•-••-•••-•••---------•---------••-••••......••. w U Nature of Repairs•or Alterations—Answer when applicable..as -P-._.J=_.-1a®®��-_�?P?_ K,.... - inv _����. --"_�''O1�C_...-,�1�t--�--��•d-�f�=�--- :.�..�..I.� i Agreement: �-L -� �� 749:, ` �4- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b�-- f health. Signed .. Z Date Application Approved BY ....... ........ /. Wit,.... DaEe Application Disapproved for the following reasons------------------------•-------------------------------------------------------------....--••••......------•-•-- --------------•-----------•...•----••••-•-••••••--••-•-•----••-----------------••-••-•....-•---•••--•••--•••--••----------------•---------•-••-•-••------------•---.................................... Date PermitNo......................................................... Issued....................................................... -r Date ,,4e No..Ca_' ©? FEs?�.f.'......•-•....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - - .................OF.........................-'-•--.........--------........................................ App iration for Dispriii ai Workii Towitratrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _ - i1Ir�IJ�S ......... --.............. ...................................... ....... ... --- ... ''^�- Location-Address or Lot No. f�.�r� rjs S`�^ `s`� ro.)I;e:5 -----•......................•...--•----•-•-•--•---------................---.... _............... .. e Address ....... ............ " � •8$�.......... .................. .............._...........----•-......----.....-•-•-•------•----•..................-----•----•-. Installer Address � Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures -----•--•--••---------•----•---- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid:capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►-' Percolation Test Results Performed bY.......................................................................... Date........................................ aTest Pit No.-1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----••------------------•---------------•-•--....................•.......•...-----•-•--•-------..........---..................------------------------- ODescription of Soil..... e u'•�-'�'.......................................•--•-•----••--•••------•------•------------•••-------•-•--•----••-•-•---------•---••---------••-•_.. x U --------••••-------•----------------------•-------------••••--••-----------•---•...---•......••-•--------------•-•-•---•-...•------•-•-•-----•---------••----------•-.........--•--•-----.......-------- W ---•-•----•------•----------------••--•-••-•---------------•------------•--•-•••••• ------------•-------•-------- UNature of Repairs or Alterations Answer when applicable /��JA e7Bvc�,�.---- r`r R1 .`- ',Qfi------ �+. f''•_.fi7-GO. .�:.f..._ ���__,!0• t Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ue "bit the boa of health. Signe Date At Application Approved BY -----------------•--------- - • �------ Date Application Disapproved for the following reasons-----------------------------•--•----------------------------------------------------------...---•-•-•........... -••-------------------------------•---------•---------------•------------------------------•--------------••--------•-•---••----•-•----•--•-•----•----- Date PermitNo......................................................... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i 7 ..........................................OF..................................................................................... r (Irtifirtttr of f�untplitturr JI THIS O CEEXLFY, That the Individual Sewage Disposal System constructed ( 11*ror Repaired ( ) by........ .... =`...............•----•--•------•------------------•----------.....---....-----•------..................----...----...-----••-•--•---...... 11 , If Installer 006 has been installed in accordance with the provisions of TITLE, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._...� _"_;7­0.>.....___..__. ,d�Ted------------------------------------------------ THE ISSUANCE F HIS CERTIFICATE SMALL NOT BE CONS T AS A GUARANTEE THAT THE SYSTEM WILL FU T)6N SATISFACTORY. Z- DATE.............CL. ---- .....----------------••---•-•--------•-----•-----. Inspector:-- --.---------------------------------------.----------------.---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �A ................:..........................OF...................................................................................... No ....:........ram.. \ FEE...�.I::�..-- i �asttt r k1i taiirrtt Orprrmit Permission i ereby granted..... ---------------------•-----------------------•---•---............_.........------ to Construct,( for 12epair ( an Individual Sewage Disposal Sys em at No.--- �- r�3&]i...._...... - -..:-. ......��.222.........:, '00. .�.......... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... •_ •r''t- � - r;---ealth-----------------------------•----------•-••- /' oard of H H DATE..................... ...... -:VAL...-•--•-----------. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS