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HomeMy WebLinkAboutKALMUS BEACH SNACK - FOOD r T - 1 KALMUS B3WO NACK 670 Ocean Street,.Hyannis f IKE Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health, Donald A.Gaudagnoli,M.D. LIAIRNTrAUL.f.* F.P.(Thomas)Lee HA&& „ 1 51 200 Main Street, Hyannis, MA 02601 Daniel Luczkow, M.D. Alt. Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems 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: 240 Issue Date: 01/01/2022. DBA: KALMUS BEACH SNACK BAR OWNER: RIVERWAY LOBSTER HOUSE, INC. Location of Establishment: 670 OCEAN STREET HYANNIS, MA 02601 Type of Business Pe,mit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 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- FOOD: MOBILE-ICE CREAM: an 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 i i Restrictions: for Office U Town of Barnstable Initials: Date Paid 4 1 22-A„>ltPa Q� Inspectional Services 63 Public Health Division Check# 19 ol� 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 �a NEW OWNERSHIP RENEWAL V NAME OF FOOD ESTABLISHMENT: W l m u s f3Qa C k srq c k 13 R C ADDRESS OF FOOD ESTABLISHMENT: lll (��✓l 7� �` Q ✓�1 15 , All MAILING ADDRESS(IF DIFFERENT FROM ABOVE): I (-U aj i'1 G 4 i t- MA n D b)5 E-MAIL ADDRESS: d 0► 0• ►� l ✓�t,1a �D,1C Q S Y,-e, ,-t .< TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( b)17 g- 7-7~T v TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: 5 / f 5;,-)rO l /301 a NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIY. ***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? f1 0 IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? n TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) '/FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FonnsTOODAPP 2020.doc ry • OWNER INFORMATION: FULL NAME OF APPLICANT a S S� s�o2 SOLE OWNER: YE /'NO D.O.B I I /9 1 7 OWNER PHONE # g' ADDRESS �CU q Ln Cv I t/(I t AA !► 0 ,-)G 3 S CORPORATE OWNER: V Q,d W0( L O vSQ I Vl C CORPORATE ADDRESS: I J� i I S. �G✓ 0'✓t d a PERSON IN CHARGE OF DAILY OPERATIONS: `/"I Sd n �i c c&— List 2 Certified F ert ed Food Protection Managers AND at least 1 Allergen Awareness Certified Staff O g O g s Cert ed Sta 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. G SkzG , 3 . Gfej SIGNAT 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 openin-!! 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 1 st. Q:1Application FormsTOODAPP REV3-2019.doc pp IHE rpm TOWN OF BARNSTABLE HEPLTH_INSPECTOR,s Establishment Name: Date: .Page: of OFFICE HOURS ` P ° PUBLIC HEALTH DIVISION 6 00-.9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified :'6;9: HYANNIS,MA 02601 MO8 -FRI. No Reference, R-Red.Item PLEASE PRINT CLEARLY ,e 508-862-4644 'FDN1P'' FOOD ESTABLISHMENT INSPECTION REPORT Name Da T e Type of Inspection a On Routine Address - Ris 'food Se Re-inspection C Lev Previous Inspection Telephone Residential Kitchen jr:e:-;.Zjt),on Mobile Owner HACCP Y/N Temporary s Caterer General Complaint Person in Charge(PIC S + Time Bed&Breakfast HACCP Other In: Inspector Out: oaoo 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) ❑ VkL 1-5 cel�is 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 Q EMPLOYEE HEALTH PROTECTION FROM CHEMICALS l 4 ❑ 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 oods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating - 1. ir ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holdi�g PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control Df ❑ 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 r� ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories IV1`�1 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) � 9E�Ei Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating E� ❑ 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 6=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 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 g violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other GATE OF RE=INSPECTION: Inspector's Signatur 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 IC's Signature Print: Self Service Wait Service Provided Grease.Trap Size Variance Letter Posted Y N Dumpster Screen? Y N 4- Violations Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding ' 2-103.11 Person-in-Charge Duties - - � 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 3-501.16(B) Cold PHI s Maintained At or Below 41 15 Poisonous or Toxic Substances 590.004(F) * - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Other* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 1 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 7-201.11'� Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F _ Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control "590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* r' + 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Reservior of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served*7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-40]'.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of ? Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* _ gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* Equipment* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e/f cri�c innoor 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 ca[er- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Authority 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Mushrooms Approved By 2-301.11 dean 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* t 2:301.12_, Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercial) Processed RTE Food-140°F* (Blue Items 23-30) 3-201.11 Package Integrity y Critical and non-critical violations,which do not relate to the foodborne . 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* r 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Coaling Cooked PHFs from 140°F[0 70°F Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* y Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 1 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Fonnback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. i� t Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. aAnvSraoLL : Paul J.Canniff,D.M.D. A 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508)862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 240 Issue Date: 01/01/2021 DBA: KALMUS BEACH SNACK BAR OWNER: RIVERWAY LOBSTER HOUSE, INC. Location of Establishment: 670 OCEAN STREET HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE . Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 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, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: 4 t,9 U For OM • Initials: Town of Barnstable Date Paid BAMWABLE, : Inspectional Services 163 `�� Public Health Division Check# RFD MA't 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 3 S a ► NEW OWNERSHIP RENEWAL ✓ NAME OF FOOD ESTABLISHMENT: KQ )m uS S yl a c* 8c '� ADDRESS OF FOOD ESTABLISHMENT. U O Q - — x - MAILING ADDRESS(IF DIFFERENT FROM ABOVE). ( �- k. YYii — �,tc•1 ,07 j E-MAIL ADDRESS: 0(a VI), i- V4 vo a a CaS -7 ?;.' !L �- TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( Og) 1 -1 9- 0-7-1 -7 p Lm r TOTAL NUMBER OF BATHROOMS: 0 Ctla WELL WATER:YES NO `' ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: l� DATES OF OPERATION: / A TO � /3®/�I 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? np IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? 110 TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) ✓FOOD SERVICE V"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 FonnsT00DAPP 2020.doc t OWNER INFORMATION: /� C FULL NAME OF APPLICANT SOLE OWNER:O/NO D.O.B 1 9-7—1 OWNER PHONE #el— f ADDRESS o �Q C1O �l O 1 / M tD CORPORATE OWNER: CORPORATE ADDRESS: 133 t 0qI S- `10rove Ou- , M/t 0 ,)-6(,, q PERSON IN CHARGE OF DAILY OPERATIONS: -TCA- SISu�- 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.��Syn JiSC-t / �� / j- i, JuSt�� SISC,�9� / � � ,05— - 2. Cdwa�d -01&4 y ,,-9 /c)y /19/ 1 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to oaenine!! 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 I 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 FonnsTO0DAPP REV3-2019.doc f Bellaire, Dianna From: Danielle Siscoe <danielle.riverway@comcast.net> Sent: Thursday, April 29, 2021 3:19 PM To: Bellaire, Dianna Cc: Jason Siscoe Subject: Follow up. Re: 2021 Seasonal Food Permits-IMPORTANT Attachments: image001.png;ATT00001.htm; 2021 Town of Barnstable Health Dept Application.pdf; ATT00002.htm Hi Dianna, I just want to note that our mailing address has changed to 27 Trudy Lane, Cotuit 02635. It's not updated on the scanned application, but I changed it on the hard copy. - Thank you! Danielle Siscoe Office Manager (508) 398-2172 www.riverwayrestaurant.com On Apr 29, 2021,at 2:46 PM, danielle.riverway@comcast.net wrote: Hi Dianna, Attached is a scanned copy of our application and certifications. The hard copies and check will be in the mail tomorrow. Thank you, Danielle Siscoe Office Manager (508)398-2172 CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open; attachments or reply, unless you recognize the sender's'email address and know the content is safe'! i pFfNE tp�yFor Office[Jce Only• Initials: Town of Barnstable � Date Paid . �psl$ u�uaaessie Inspectional Services MAss. Public Health Division Check Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 314fl a J NEW OWNERSHIP RENEWAL_ NAME OF FOOD ESTABLISHMENT: 11Q )►yt u3 o a q (3a +� ADDRESS OF FOOD'ESTABLISHMENT:. lP� O 0 ce (+,4 l 5 M AAA--- Ca&Q 1 .. 277 1—rtitC�y LaAL MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 7 E-MAIL ADDRESS: �R �lY l� r; vef V)a Oct)iporr)ad_cV cbiuA +, TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( 0 ') 1$ 0-7 "1 TOTAL NUMBER OF BATHROOMS: 0 WELL WATER:YES_NO� (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: t/ DATES OF OPERATION / A TO � /3D/d-I I 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? no s IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? i 10 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*** REOUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-862-4644 Q1Application FormslFOODAPP 2020:doc OWNER INFORMATION: FULL NAME OF APPLICANT -Ta Cjo,\ S 1 S c.oe- C 2 SOLE OWNER: Y /NO D.O.B OWNER PHONE ADDRESS (?--1 CV to r f Co -�A 1 -� ✓tj.t 0 ab CORPORATE OWNER: 1 Wa U . CORPORATE ADDRESS: 133 V(;jCM OLAA M/4 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 Manners Expiration Date Allergen Awareness Expiration Date 119, )-1 SIGNATURE OF APPLICANT DATE ***FOOD POLICE'INFORMATION*** f SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openinLyl! Please call Health Div.at 508-8624644 to schedule your inspection. Please call at least(7),days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTowm by fax or mail prior to catering r event. You must complete a catering notice found at httn://www.townofbarnstable.us/healthdivisioii/applications asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. t l NOTICE Permits run annually from January l st to Dec.31'each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. 8 fl r Q\Application FormsTOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. HARNS ABM Paul J.Canniff,D.M.D. t16 � 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate ,5 � 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: 240 Issue Date: 01/01/2020 DBA: KALMUS BEACH SNACK BAR OWNER: RIVERWAY LOBSTER HOUSE, INC. Location of Establishment: 670 OCEAN STREET HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: aFtt�i'q� For Office Use Only: Initials: —Tb— Town of Barnstable �0Q4 Date Paid�`t=—h—&MW Pd$ ,,STABLE : Inspectional Services 039. Public Health Division Check# 119 L4 awl Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 r, APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE aZ NEW OWNERSHIP RENEWAL � NAME OF FOOD ESTABLISHMENT: �`Q I rn L c s 13oc( '�" t v ylot` 4 Bar ADDRESS OF FOOD ESTABLISHMENT: U-7® S r' Q�)n ISM 1 -1 O 1)"'(17 01 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): I V I t Lta ryy) OL'I tt') v1 �a� I E-MAIL ADDRESS: G�a l�r VG, 0 ve V✓Vt Co rn ca S TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( �) -7 TOTAL NUMBER OF BATHROOMS: WELL WATER: YES_NO -'S<... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:J/ f /X�O /301 �-o 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? r\ IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? 110 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 w COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV. FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q\Application FormsTOODAPP 2020.doc a' 1� OWNER INFORMATION: TO( Son FULL NAME OF APPLICANT S SOLE OWNER: YES/NO ,J D.O.B -I 15 OWNER PHONE # J�l/ u �O ( ✓o �D ADDRESS '�Ud L n Co 0"�� 00 3 CORPORATE OWNER: Ua o`j CORPORATE ADDRESS: 33 O D 1 S . yQ i'm 0 U 1 '1 , A oa(O VI PERSON IN CHARGE OF DAILY OPERATIONS: (60/1 List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date +14r9gatyl 0 1. TcjSOA S ►S 5 QSu,SiSW�- 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/heaIthdivision/applications.ast). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31s1 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. QaApplication FormsTOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. BARNSTABM John T. Norman MA&,4 200 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: 240 Issue Date: 03/01/2019 DBA: KALMUS BEACH SNACK BAR OWNER: RIVERWAY LOBSTER HOUSE, INC. Location of Establishment: 670 OCEAN STREET HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 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� 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: . t �oFtHe 1 For Office Use Only: Initials: o Town of Barnstable2 Date Paid) BARNSTABLE, r Inspectional Services p MASS. µ Public Health Division l Thomas McKean,Director ) C-� 200 Main Street, Hyannis,MA 02601 w�1 Office: 508-862-4644 Fax: 508-790-6304 ?-- i LAI PPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT E 2 DATE cJ � 111 NEW OWNERSHIP RENEWAL C,' NAME OF FOOD ESTABLISHMENT: 96t I ��`J p eac'hSna* Oar ADDRESS OF FOOD ESTABLISHMENT: Co-7 n OUOiSt Q n i 6 MAILING ADDRESS(IF DIFFERENT FROM ABOVE}: 13 g �.i' a Val (n o t/A IM/ E-MAIL ADDRESS: Cd Cast , Q TELEPHONE NUMBER OF FOOD ESTABLISHMENT: �) 7� TOTAL NUMBER OF BATHROOMS: _ b WELL WATER:YES NO �... (ANNUAL WATER ANALYSIS REQUIRED) r-� ANNUAL: . SEASONAL: DATES,.OF OPERATION:J Ll 11T0 �J 3 k NUMBER OF SEATS: INSIDE: U OUTSIDE: 0 TOTAL: 0 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BF APPROVED BY THE HEALTH DIV,AND LICENSING,AND MEET OUTSIDE DINING RE,QUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? n Ig IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? 1'l O I TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) N FOOD SERVICE ✓RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freczer) k BED &BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD ` i 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.:Upplication FormAFOODAPPUN2018.doc e i - - ------- ----- -- 1 i PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANTQ i SOLE OWNER: YES/ E NO D.O. 9 3 1��1 OWNER rHONE# ADDRESS a� r u Vl �� �O I �"` �T O oo CORPORATE OWNER: 1 VUW (_()bS FEDERAL ED NO. : v<4 u CORPORATE ADDRESS. t PERSON IN CHARGE OF DAILY OPERATIONS: J aS O✓l �l 5 y�L` f List 2 Certified Food Protection Managers AND at least 1 Allergen Awareness Certified Staff � ) t � � ) g All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. E F. **ATTACK[ COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date r en Awareness Expiration Date n S, s 5 , i �, an�o1 c�sn� 5�s C� , Ll , 0) 2.C,Ajvar �4; .4 �c cc 5 113 IX-) SIGNATURE OF APPLICANT DATE i ***FOOD POLICY INFORMATION*** 3 SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div, 4 prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. k 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 httpa/www.townofbarnstable,us/heaitlidivision/applications.asp. l 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. i NOTICE: Permits run amwally from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COWLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. �i Q\Application FormsTOODAPPREV2018.doc i pF THE rok- TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: - Page: of OFFICE HOURS BARN5fABLE. ` PUBLIC 2 0 MAIN STREET DIVISION 8:30-4:30A.M. Item Code C-Critical Item 3:3o-a:30a.M. DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �0m HYANNIS,MA 02601 MON.-FRS. a39. No Reference R-.Red Item PLEASE PRINT CLEARLY - n rED MP�p FOOD ESTABLISHMENT INSPECTION REPORT 508-862-464415ANk, Name - Date L" a of Type of Inspection F 3 Routine ef In I'll; Illy- Address Risk od Service Re-inspection Level Re al Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer Gneral Complaint Person in Charge(PIC) Time Bed&Breakfast ACCP" In: Othe Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision( 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 'j ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories 1v1'1�1 (1/V Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations \�1 Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No To Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating Y Y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ 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 Orion-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 C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8rion-critical violations=C. n 29.Special Requirements (590.009) y p 30.Other DATE OF RE!-INSPECTION: Inspector's Signature _ Print: 31.DLirnpster screened from public view r � Permit Posted? Y N' Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC'I nature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N ,J Dumpster Screen o Y N �„ � .-..�, �tr� ,-_..-ti.,r . ... ,�._��.--•,.may:.-�..�r �,.,-._-.�_..._r.- --" _:; -. - _-. .. - - -. - Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L 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 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties - - Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) * - - - EMPLOYEE'HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C)_ Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F PP 3=302.11(A) Food Protection 7-201.11 Separation-Storage*Applicants* * P g 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* 3-304.11 Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use* 590.00411 Variance Requirements 590.003(G) Reporting by Person in Charge* _ 7-203.11 Toxic Containers-Prohibitions* ( ) ance q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and AdulteReserrated for of Food* 7-204t12• Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a 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 Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-20216 Ice Made From Potable Drinking Water* - -_ 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eflf ctme 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) Park 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 temporary and - ide in cater- * Ratites-165°F 15 sec* in mobile food,tem or and residential Sources g, P ar3' 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* foodborne illness interventions and risk factors. 2-301.14 When to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* 3-401.11( )( )( ) practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 - Reheating for Hot Holding 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 23-30) 3-202.15 Package Integrity Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°17 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 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S: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. py°pIME rok� TOWN OF BARNSTABLE . ,HEALTH INSPECTORS Establishment Name: Date IR1 Page•_ _of` OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARN ABLE. • `V ^--,'- 200 MAIN STREET 3:30 4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified :'e q. �o� HYANNIS, MA 02601 MON.-FRI. No Reference. R.-Red Item. PLEASE PRINT C RLY_ 508-862A644 • L , rFD MP�� FOOD ESTABLISHMENT INSPECTION REPORT - Name Da jype of Type of Inspection p Routine Address Ris �ood:Servi Re-inspection Level e aRTT� Previous Ins ection Telephone i2:7 Residential Kitchen D r Mobile re-operatio Owner HACCP Y/N Temporary ss Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP tAl2 Z- av In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ LeKy C4 ' 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 Ws EMPLOYEE HEALTH PROTECTION FROM CHEMICALS IVA ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Addi ❑ 3.Personnel with Infectious_Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ^ ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/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: No ❑ � ❑ Yes Non -critical violations must be corrected immediately or _�� within 90 days as determined b the Board of Health. Overall Rating Y Y ❑ Voluntary Compliance. ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items El Embargo Emergency Closure El 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 4 non-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 6von-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 2 Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9.non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) receipt y within 10 days of of this order. violation,4 to 8 non-critical violations=C. -- 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Durpster screened from public view Ns4m Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's Si ature Prin Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N f/ Alm' 6 4AL 11--64hky_ Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS _ 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 1q Food or Color Additives „ Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* --*- - _19 PHF-Hot and Cold Holding_ 2-103.11 Person-in-Charge Duties - - - - - - - 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F _ 15 Poisonous or Toxic Substances 590:004(F) * - - -• EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Informations--;Ori oral Containers* 2 590.003(C) - Responsibility of the Person-in--Charge to_ __ Other* g g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 1 Common Name-Working Containers 3-501.16 A Roasts Held At or Above 130°F* Require Reporting by Food Employees and Contamination from the Environment _... * ( ) 7-201.11' Se azation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An _ _ _ 3-501.19 Time as a Public Health Control* 3-302,15 .__ _ Washing Fruits and Vegetables * 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).Retumed Food and Reservice 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* Pe 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 3-202.16 Ice Made From Potable Drinking Water* CONSUMER ADVISORY Concentration and Hardness* 3-401.11A(1)(2) Eggs 155°F 15 ser 22 3-603.11 Consumer Advisory Posted for Consumption of � . I 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 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* EUeCn°e mizooi 4-602.11 Cleaning Frequency of Utensils and Food - Animals-l55°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 3-201.15 Molluscan Shellfish from NSSP Listed Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations o ( )-( )in Section 590.009 A D cater- Chemical* Sources* Ratites-165'F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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 3-202.15 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 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite D Creation on Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Crreation 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 129. 1 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. �r �p IKE r, TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: Date: Page: of W OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. 200 MAIN STREET 3:30-4:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS.a3. �o HYANNIS, MA 02601 Mors.-FRI.508-862-4644 No Reference R-.Red,Item, PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT Name Dat ( Type of T e n ea ction 1j3Ktine Address Risk ood ServicBJ e-Inspection Leve Previous Inspection t Telephone Residential Kitchen Date: n I giL JA Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector aA , Out: tv i Each violation checked requires an explanation on the arrative 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 690.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands L t ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities W4'1- j EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 14571 ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives �I�e-l/ 9 (� ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals ( FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially zardous`FF oos)s) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures L\ f/ ❑ 5.Receiving/Condition ❑ 17.Reheating t ,/ G ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 9/ )�\-��-/► LAZA 1 !� ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding ,�J `r \ �� 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 i ❑ 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) � CIV� ` Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating ry p ❑ ❑ p ❑y y - -❑ Voluntary.Compliance Employee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ 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 9 re ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 4non-critical violations 26.water,Plumbing and waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot ' 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to anon-critical violations=C. 29.Spec/Reirements (590.009) within 10 days of receipt of this order. Inspector's Signature Print: 30.Othe DATE OF RE-INSPECTION: p 9 31.Dwneened from public view ` r /Permit Posted? N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N C's Si a Print: Or- Self Service Wait Service Provided Grease,Trap Size Variance Letter Posted Y N //�/" !.// 7 Dumpster Screen o Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in--Charge Duties -- - Cooked and RTE.Foods.* 3-302.14.' Protection fiom Unapproved Additives*' 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous o7 Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 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 * 20 Time as a Public Health Control 3-302:I1(A) Food Protection 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* * 3-302.15 Washing Fruits and Vegetables 7.202.12 Conditions of Use* Applicant To Report To The Person In Charge * - 590.004 11 Variance Requirements * 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) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of or Contaminated ---- - - - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources - "' - 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and - * 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served* 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and 3-201.13 -FluidMilk and Milk Products* - - - 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell-Eggs* _ _- _ Sanitization Temperatures* _ : TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water*'__ - - - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean,Utensils and Food Contact Surfaces of Eggs-Immediate Service 145'F 15 sec* Animal Foods That are Raw,Undercooked or 5-101,.1E Drinking Water from an Approved.S.ystem _ _ ___. __ * __ gg Not Otherwise Processed to Eliuuuate. Equipment i 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef cri°,1112001 _ 4-602.11 Cleaning Frequency of Utensils and Food ._ Animals-155°F 15 sec* 590.006(B)' Water Meets Standards iri 310 CMR 22.0* Contact Surfaces of Equipment* f 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 r f 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 Methgds of Sanitization-Hot Water and StuffingContainingFish,Meat,Poultryor 3-201.15 Molluscan Shellfish from NSSP_Listed Chemical* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved 13y 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* foodborne illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail. 590 004(C) Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* .. 3-403.11(B): Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) g Item Good Retail Practices FC 500.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F[0 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 •- 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 _ Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE - HEALTH INSPECTORS Establishment Name: Date: Page: of W OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified M63q . . HYANNIS, MA 02601 MON.-FRi' No Reference R-Red Item PLEASE PRINT CLEARLY rFDN1P` FOOD ESTABLISHMENT INSPECT ON REPORT 508-862-0644 6 - Name 16 Da T e o Type of Inspection O n s, Routine �' Address Ris ood Serves Re-inspection Level ta+l- Previous Inspection lax idxe, f Telephone Residential Kitchen Date: Mobile e-operatio Owner HACCP Y/N Temporary Suspe ness . Caterer General Complaint - - Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Irk L--- Out: C - Each violati n 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) r 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) s� ❑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 414 %f Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) _ Corrective Action Required: ❑ No ❑ es /Non-critical(N)violations must be corrected immediately or Overall Ratin �19 w g (D Within 90 days as determined by the Board of Health. ® Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension nC 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, z 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations g ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension-or revocation of the food 8=One critical violation and less than 4 non-critical violations re � if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. g p,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 . If critical water,sewage 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 Snon-critical violations. 1 critical refrigeration.a back-up, within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) Y p 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' Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N 5L �' L 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 11 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* ° 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 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* g7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-201.11 Separation-Storage* 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* 2p Time as a Public Health Control 590.003 F Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* O P ty3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sauitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Pe 7-206.13 Tracking Powders;Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentratiun and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* Eggs 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 Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef cti-tnrzooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)--(D)in cater- , Chemical Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing A 3-401.11 C 3 Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Authority Mushrooms Approved By 2-301.11 Cleanon on-Hands an Condition Hdd 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* 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 1 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 foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 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 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 1 16-301.12 1 Hand Drying Provision 129. 1 Special Requirements 1 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 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °F.H�E rop TOWN OF BARNSTABLE . HEALTH INSPECTOR'S Establishment Name: Date: Page: of ti OFFICE HOURS RN�rAB.E°- PUBC HEALTH 2 0 MAIN STREET SION 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. MON.-FRI. p .639. �• HYANNIS,MA 02601 sob-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY. lFD""aye FOOD ESTABLISHMENT INSPECTION REPORT Name ate Tvoe of Tyne of Inspection Operation(s) Routine44 v Address Riskr Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: e- Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint VVIL"ePerson in Charge(PIC) Time Bed&Breakfast HACCP Other In: Inspecto Out: Each violation checked-requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items ) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities O%N EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures '-- ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling . ❑ 7.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( SP) ❑ 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 / �J Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical° C violations marked must be corrected immediately. (blue&red items �^ ( ) Y ) . Corrective Action Required: ❑ No I'd 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 b a Board of Health member or its agent P 9 Y 9 A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have aright 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 anon-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to critical violations= 30.Other DATE OF RE-INSPECTION: Inspector's Signattureune C. 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 Wart 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 Law Cooled to 41°F/45°F Within 4 Hours* ( ) g14 Food or Color Additives 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from. 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45*F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 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* 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.I9 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* * 3590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Resumed Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition of or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) • Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 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 * Eggs Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eff°"°°tarzoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under 929-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-4 13.11(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 * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11 E) Remaining Unsliced Portions of Beef Roasts* ( g illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-501.14 A Cooling 3-202.18 Shellstock Identification ( ) g Cooked PHFs from 140°F to 70°17 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* 3-50114(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 520511 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* - . Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 16 M oF.Me ro TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name:-ADM fig 1 te: age: of P. o OFFICE HOURS BARNSTAB�E. � PUB200 MAIN LIc LSH EETSION � ;� 3::30 0-4:30 P.M.:30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified - MASS. $ MON.-FRI. HYANNIS,MA 02601 508-862-464a No Reference R-Red Item PLEASE PRINT CLEARLY 'FO MP+ FO D EST BLISHME T INSP REPORT Name Date a of Type of Ins ection I g Routine Address isk o d Sexy Re-inspection Level Previous InspectionAl Telephone Residential Kitchen Mobile Pre-operation 4. Owner HACCP Y/N Temporary Sus Illness Caterer General Complaint Person in C (PIC) Time Bed&Breakfast HACCP Other Inspector Each violation checked requires An explanation on the narrative age(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 f ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories U/1 S Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) r Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or I� within 90 days as determined by the Board of Health. Overall Rating r 1 1 ❑ 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 b a Board of Health member or its agent 24.Food and Food Preparation p 9 Y 9 A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations.9 or more non-critical violations, p (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. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility' (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. lion,4 to 8 non-critical lations C. \ 30.Other DATE OF RE-INSPECTION: ecto's Signatur �Qrd� 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 Assi ent of Responsibility* 8 Cross contamination 1q Food or Color Additives , Law Cooled to 41°F/45°F Within 4 Hours* ( ) ! 3-501.15 CoolingMethods 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 15 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140*F* 2 _ Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 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 3-304.11 Food Contact with Equipment and Utensils * ( ) q 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for 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* 3-801.1](D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* I Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* I Concentration and Hardness* 3-401.I IA(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 Equipment s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System * Eggs Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* effe cnm mizooi 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 3-401.1 I(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 Ratites-165°F 15 sec* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* - ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 10 Proper,Adequate Handwashing 3-401.11(C)( ) Whole-muscle,Intact P 3 I 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 PFIFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 * (Blue Items 23-30) 3-202.15 Package Integrity (C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 tHandwashing andwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained * onveniently 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 umbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 ocation and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 ccessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* upplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. HEALTH INSPECTOR'S Establishment Name:_ e&[jris.4 oG�.C.',�. Date: of THE ro�4o TOWN OF BARNSTABLE - HE OFFICE HOURS .�-� �6 Page:_ ARNSrAe�E. PUBLIC 2 0 MAIN STRDEETSION 3:30-4:30A.M. - 3:3o-a:3F P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS.. `�$ HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY. . 508-862-4644 'E"' FOOD ESTABLISHMENT INSPECTION REPORT Name �Vf Date De of T f ectio p r Address b D l �. Risk FO od ervi outispection -t M/ r r Level Previous Insp ction Telephone Residential Kitchen Date: 2 j�l� 6 All l U J J111 l/ Mobile Pre-o do Owner HACCP Y/N Temporary Suspect Illness nJo&-weNVC_4_L[11)QMI Caterer General Complaint L Person in Charge(PIC) Time Bed&Breakfast HACCP r-e T- v0 In: Other Inspector a� Out: 1.2-1 coolki- f 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) ❑ -Q re wzm o Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ \X fn n FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities _ N EMPLOYEE HEALTH PROTECTION FROM CHEMICALS / r Il ` 6 f✓ /I ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives r ❑ 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' .Y- ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations_ Critical(C)violations marked must be corrected immediately. (blue&red items) ; - Corrective Action Required: ❑ No [Mass Non-critical(N)violations must be corrected immediately or Overall Rating -within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection.today,t e'ems ❑ 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 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC.7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. viola' to on-critical viola'ons=C. 30.Other DATE OF RE-INSPECTION: Inspe is Sign a Pri 31.Dumpster screened from public view & 0 W, <4� Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N Print: PIC', i na re #Seats Outride Dining Y N 9 Observed Frozen Dessert Machines: Outs d g 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 Assi nment of Responsibility* S Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours* ( ) g14 Food or Color Additives 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 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* g g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers 3-501.16(A) Roasts Held At or Above 130°F* Applicants* - 7-201.11 Separation-Storage* PP 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15- Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* * Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* - -- 7-203.11 Toxic Containers-Prohibitions* - 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 Reated 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 Sodrees ' 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* _ 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY * Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water 3-401.I IA(1)(2) Eggs 155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg aiv 11112001 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency r f Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 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* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*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 Arms* Condition-Hands and A * ( )( ) P Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to as * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES' 3-202.15 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 _ 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Lu 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 itemEFood etail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. ment 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. d Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. nt and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. lumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. l Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. us or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Requirements 009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria*_ 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `oF• ro,,ti TOWN OF BARNSTABLE_ HEALTH wsPEcroRs Establishment Name: c C(n Date:-� � Page: of. a OFFICE HOURS - PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Itern Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS., .e HYANNIS,MA 02601 508 g62-44644 No Reference R.-Red Item PLEASE PRINT CLEARLY . A'F"' FOOD ESTABLISHMENT INSPECTION REPORT _ tN- ti r„ .�J✓1 e vt e Name y G Date T e o Rune of Inspection utine MI-Mg CA- Address Risk ood Servi Re-inspection Level a Previous I.W lion AA" d` 'yl r N`f ) �/ 1 Telephone Residential Kitchen Mobile Pre-operati0 AR `� a Owner HACCP Y/N Temporary ness 1 Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP p9 �, awi t In: Other ,l Inspector ✓(~ ( a Out: A4opf`' �/ C LP 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) ❑ G, v o Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands L ` ` ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ '�13.Handwash Facilities B 4l f t l' C m Q Q K EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives t)n n j r A k ln/i ❑ 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 I ❑ 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) ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP r- ` ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories M Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No es Non-critical(N)violations must be corrected immediately or Overall Rating Wtheitems 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 8=One critical violation and less than Orion-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. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have aright to a hearing. Your request must violations observed,7 to 8rion-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address viol 'on, 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. - 30.Other DATE OF RE-INSPECTION: Inspe_or's n ture /� 31.Dumpster screened from public view ,1� _ 0( 7 S V VV K (� W frV) �f Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC s ignature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter posted Y N Dumpster Screen? Y N 7L _,� .... R- .�,t•,�.r,4r -s..� v_«7.,�-_ .,F:. {..�_,.,e..`t - ,.� ., yti.S. - ` ':.ter-,,..�Y- � .. -r ... - .. _, _ _ _ - ... .t _. _. _ ..__.. . 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 Assi nment of Responsibility* 8 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours* ( ) g14 Food or Color Additives _ 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person--in-Charge Duties - Cooked and RTE Foods.* * - 19 - PHF Hot And Cold Holding, 3-302.14 Protection-from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment ( ) 7-102.11 Common Name-Working Containers 3-501.16 A Roasts Held At or Above 130°F* _ 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15. Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* * Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* - REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reted of Food* Chemicals for Washing Produce,Criteria* HSP HIGHLY SUSCEPTIBLE POPULATIONS 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or or Contaminated 7-204.12 Che g � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* - 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water I Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 scc* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-40 1.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective inrzooi 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11. Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-40L11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009 A - D Violations of Section 590.009 A - D in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) Vio ( ) ( ) Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 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 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 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products P 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) _ Cooling PHFs Made from Ambient * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention 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 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Forrnback6-2doc *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. 41, w I y b T 6u �1 00!-P /p e WN 4,A (f4tvz, CPA\ l � r� � Pit] « �C. J J 1 �LD 1 U p _ ss �-�- - '77 McKenzie, Marybeth From: Curley, Dave Sent: Friday, May 21, 2010 9:44 AM To: McKenzie, Marybeth Subject: Kalmus Concession Marybeth, Wanted to update you on items involving Kalmus concession -thanks. 1. Contracted with Reddy Rooter- had grease trap and outside containers cleaned. 2. Hood systems were cleaned professionally. 3. Had Al exterminator there who addressed mice problem. Thanks. 1 J ` ,w F, woe Slominski ' General Foreman BAFUMKAS&'A`g`Xg Town:_of Barnstable Department of Public Works Structures&'Grounds Division I 800 Pitchers Way, Hyannis, MA 02601- 1 (508)790-6320., Fax(508)790-6318 r 3Z3z� RECEIVED 3 2000 TOWN OF BARNSTABLE HEALTH DEPT. Kalmus Rear Pavillion 109'3 20'3 20'9 1119 T T SIB N Storage N r 1 Women's 2'6ED 23 "' 28,3� Room �' 4'8 - 11 4 co i snack ear 20'1 14'3 Men'S ED Storage 8 Room Lock-up\ _� "' Lifeguard's Room tr' N _ Main Public Corridor `' ack Bar " Supervisor's First Aid i �` .. off11'9 Recreation Maintenance 16'2 r Storage& j Room 1 Lock-up private Locked N P,.� bathroom I '4 80'11 Sk 109'3 3 a° Kalmus Beach House Front SIN r< o S�� k .rOl l (� V- '\,I Kalmus Kones At Kalmus Beach Snack Bar Sample Menu Scooped Ice Cream Cones & Dishes Assorted Toppings Milk Shakes Soft Drinks (no fountain) Packaged snacks & candy Hot Dog Roller i No._i Fee _ ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for Migogal Opgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(t/�Abandon( ) ❑Complete System C�dividual Components Location Address or Lot N Owner's n,Addressof andTel.r i b e Assessor's Map/Parcel ocr_�� �4��� 1 c c , a f0g1 Inst er's Name,Address,an4 Tel.No. Designer's Pjame,Address and el.No. . On A-Y) HO cRp% n pa to q r Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Inca A. S f,LP8 Design Flow_0 gallons per day. Calculated daily flow gallons. Plan Date i b� Number of sheets Revision Date ,� oVl aj _ Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answe when applicable) IV) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has be i A by 's d of 1 Date Application Approv b Date Application Disapproved for the following reasons Permit No. 2 —16 5 Date Issued �fVil t �o '1c,�! � i r , rJ4, ,, Fee —� 4 "`A t x' Entered in computer: HE COMMONWEALTH OF MASSACHUSETTSf f, P \\ Yes v PUBLICAEALTH DIVISION,=TOWN,OF BARNSTABLEs MASSACHUSETTS 2pplication for 0iipp of 60tem' torigtruction �erntit Application for a Permit to Construct�(i )Repair( )Upg!&7 Abandon( ) O Complete System ._C`1'lndividual Components . Location Address or Lot No. Ke U-S �3pa Owner's Name,Address and Tel.No. 4�-70 o� � � N�� -Tvcon o� -rv)s-�cb 12, Assessor's Map/Parcel �� 3a q, - �r�f 0 y Installer's Name,Address,and Tel.No. Designer's ame,Address and Tel.No. rr�n h� �I�►�sr ,Tnc . H ors�e kh.1 den you 600 o lP4lI7ls A b Type of Building: {v Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Shower( ) Cafeteria( ) Other Fixtures Sn a (1C }1�t f. Design Flow $,c Q O gallons per day. Calculated daily flow gallons. Plan' Date, If L-1 (Y-) Number of sheets Revision Date 1 a-2 )-7 Title r ' Size of Septic Tank E Type of S.A.S. . Description of Soil j Nature of Repairs or Alterations(Answer when applicable) YI C IA", /. .r . V l Wte-last inspected: Agreement:The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system ,.- in accordance with the provisions of Title 5.of the Environmental Code and not to place the system in operation until a Certifi- cate bf Compliance has be`r is ue by oard of! ealth� _ �-� igned, _,(��11 Date .._ � A `¢✓ Application ApprovtA b '� Date 7 6 /0?_ . Application Disapproved for the following reasons .Permit No. Date,Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS '4 Certificate of Compliance _ THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by PK1�'1 11 Yf,1 at bOD O U CL n -F' - KQG Iwc, ( has been constructed in accordance with the provisions of Title 5 and the four Disposal System Construction Permit No i dated Installer P rm �fWT 6L.+D S , IA- c_ Designer 111r j 1, .V1 t�l t /� The issuance of this "ermit 'hall not beetconstmed rass a guarantee that the syste will fuuyh�cttiilon A designed-��,� 1 Date -- lO AAA!l Inspector "Ay`�1/�../�' �fl 111yW4T 7ld dill l &LAL No. �— [jr-� -------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS J PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS ' Mi6pooaf *p5tem Construction Permit 4 Permission is hereby granted to Co,1struct( )Repair( )IU_pgrade(' f Abandon System located at W(� CL.I'1 ?'QPT Kt�— m,l.(,d � hwa_(�� a and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructi n must be completed within three years of the date of this e it. Date: Approved by _-T Town of Barnstable � �F SHE Tp� o Regulatory S6rvices Thomas F. Geiler, Director r BARNSTABLE, r MASS.39• - 0Public Health Division i639 �0 A'ED'AA�a Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: i W U / Sewage Permit# � Assessor's MaP\Parcel 2y Oql Designer: JJ691fY GOf jZ0(,p, �Y(f_ Installer: ) 1<fi4 Address: 90 fZ,U-1 E o o Address: ,32 k16 /14 I�Q�°)50 8)C-I3 � W�«r 11t VI/Il� oZs�� � ;06iViy15� �1�}' On ZS 0� ��� C(�L( 1�� was issued a permit to install a (date) (installer) q septic system at 010 C (.ram �t a — � (j 6tgb et on a design drawn by (address) - ULUy We J TW, 62UO dated Z3 01 ° 1V_ WJ(d 'S Z, 710 7 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. SN OF If ! ►�'e � FAT PIU ` < J LEE w (Installer's Signature) CPA . No.42824 '%�A t, o SSIONa A�®�� ( signer'sSignature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLUNCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-26-04.doc C/', XISTING LEACHING - \\\ PITS ABANDONED IN PLACE KALMUS BEACH REST ROOMS AND SNACK \ \ SHACK \ 1`0 Cn \ CT CLEANOUT TO GRADE (TYP) \ ob \\\\ \ 3cr. 1 ,000 GALLON GREASE TRAP to \ \ EONE GP 2014 GRINDER PUMP STATION C 3 \ \ COMPRESSION FITTING AND ISOLATION 0 \\\ \\ VALVE FOR SYSTEM FLUSHING (SEE TYPICAL EONE SYSTEM CROSS SECTION) 4x4 HANDHOLE WITH C CONTROL PANEL COVER TO GRADE cc WITH AUDIO AND--____ 1 SD VISUAL ALARM R 11 Y THE SEPTIC SYSTEM WAS FM TO EXISTING SEDPE FORCEMAIN INSTALLED BY PKM AS>oq�y .� WER MANHOLE CONTRACTORS, INC. ONo� OCTOBER 14-26, 2007. 4 SDR 35 PVC ' o FALEEU � DIMENSIONS TO SEPTIC < CIVIL KITCHEN FLOW TO COMPONENTS PROVIDED BY PKM GREASE TRAPNo .42e24 CONTRACTORS, INC. v Title: Project: Vrw*N r. Design by: 670 OCEAN STREET Town of Barnstable Horsley Witten Group,Inc. a Structures 8 Grounds Division AS—BUILT PLAN TOWN OF BARNSTABLE Department of Public Works Sustainable Environmental Solutions KALMUS BEACH SEPTIC UPGRADE 00 Route 6A � =o Project: Sheet: Date: c/o John Juros,AIA E 6138 1 11/14/07 BARNSTABLE, MASSACHUSETTS 800 Pitchers Way 508833Sandwic66 Ovo voice y Design By: Drawn By: Checked By: Hyannis,MA 508-833-3150 fax 2JEH ERK FPL . (, � '� r , 7: � f S t TOWN OF BARNSTABLE LOCATION ` pp-f- k SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. K SEPTIC TANK CAPACITYarj LEACHING FACILITY:(type) i) � (size) NO.OF BEDROOMS OWNER "TOGt�R � PERMIT DATE: 9 _ COMPLIANCE DATE: Separation Distance Between the: Maximur.:-Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) - Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY p _�����► 'j—�� 3= 13 3 .3' lay- P0(np TOWN OF BARNSTABLE LOCATION � Q ; � SEWAGE# rI-I VILLAGE ASSESSOR'S MAP&PARCEL �a`l dJ INSTALLERS NAME&PHONE NO. f K►i iMY!"�l t U�S,Jon SEPTIC TANK CAPACITY A'1-_ rT LEACHING FACILITY:(type) (size) i NO.OF BEDROOMS I OWNER 0 PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY i 131 3 =300 37 ' I000 pvPu�� sr��� 3 " 3 } _ 1 ! + ui, , .�.,. a»,.3 � rt £ w..`.. ,s E.�. $ Y� ¢ .m. .g� ... '-:vY 3 _w:. .� "uY �•. s , jy/ , ' 2 t.. .011 EN LA ' € f - vi- Li,.,mn r �W � }_ dt Sew ` !N 1.�:` : , „' i JL ON , z : q < a _ , t , g a s , f i yt r'4 z d . e : - iAj , e ^ �: ff „ pp. J t E a f a a n.e 17' Milk Shake Mixers Hand Wash Sink Water Heater (U Pepsi Cooler 0 a, 41 LL E f6 N U L o Q, V O o .. 12' X Work Table w N 0 N N LLCC C f0 N U U Shelf Shelf Shelf Serving Window with screens p Electrical Outlet Floor Plan — Ice Cream Window at Kalmus beach July 2019 r Kalmus Beach Snack Bar OLD OWNERS 1983-2012 IN ATTIC I _. - -___ / N _.. ....... ........... .w.__._.- __ ..._ ,___,.._..__ _ _ _. _..._._, __ ._. v____ XISTING LEA HING PITS TO BE BUOYANCY CALCULATIONS E DESIGN CRITERIA _._ �� _ / ,.�.,M_ ._. .�.�__ -__..�,._.., _.�.. . .._.r_. ,.._._.. __ _ _.._.._�,._..., . ��__ ...,._. _.._ ,._ ,_�._. . _.m .._,,,_,_ . __., _M_m SCHEDULE OF ELEVATIONS ABANDONED IN PLACE o USE;PUBLIC PARK, TOILET WASTE _. _.- ,_, _...___..... ._ _- _-_,.. ,._....__ . _ _ .-_,. ._ ._.. _ ._ _.._.-_ ._. j _,.._. _ . ._,..,.,._.._ ._.._n_ _..-......_ , w. _,.__ ,...w .__._.- .._.. _.. _ _. . _.,___ ,,.,..__ -.._,- ,.�,..._._.-._,.m.._ __ _,_... �.._..--_,�.__. , -_ _.- _._,.....� �GP2014 GRINDER PUMPSTATION .� :�� (SEE NOTE 21) � z ONLYINV. EL. _ ...,_. __.... ._ .._,.,. .._... _. .._. . ...._.. -., .,_. ...__ M.._.....^._ .._.._. _. ......_.._.-.. KAILM US BEACH REST 1 -- _ __ f o 0 _ _-_.__... .,. . ,. ... _ ..,.-_. _..-. .._. ..-__. _w ,.. .__- _...,_..._,. . ....... . ......_- ._..._ _. .. .._.,_ '. .. __._. -,,-,.� _ .._.-.-._ _ ..-..._. _,-.h._ .. . ...-._-... -.....,, STATION VOLUME CU FT 50 -- _ _� _. _.. co m __..._.. ��..,__. .M.. ....�.__ -- .,.. .._ .._.._..__ ..._..._ _...._.... _....._. .. ___ , -�, FLOW PER PERSON 5 GPD/PERSON , ROOMS AND SNACK `_ _ - _� - _.._-_....._,..._-_ ....._ _... ....--" _.___._..._.,._. _-.. .. ..._- W.-. ._,., . .,--__ _v.._. _._ ______ _......_. .-_.,_......... ......-...n _.__ ___...- PORTION OF STATION IN WATER AT SEASONAL HIGH GW 36% `. 0. _....,_, _: _ .,._, _ ._.,_, c NUMBER OF PEOPLE 180 PERSON SHACK CC7E '` o w.,. . .... ,,.,..._. ^ .._ ,_...._. _ K..,... ., .. _..., .._. ,_,..,. . ,.,ww.. .. m ..k. . ,_. _ �_.. . . . w EQUIVALENT WEIGHT OF WATER DISPLACED, LB. 1,099 , \ �} -- - cn N a (BASED ON 90 PARKING PERMITS AND TAGS ISSUED @ 2 TOP OF FOUNDATION 103 69 __., a.__,._..__ ..,__u._.a._._.. -,. ., .r_, ^_.. ..._ ,..� .. ._ _r_. _,._,. _ .._____t �,_ . . .:i I1�,E-_ - z �, ..,M._.... -..n..._ ..,.- _ . -_,--"... ._---m", -._ ..__._- ._ _, ... __ ,,.,,, ___ ,__... KALMUS BEACH w__�..___m _._..__W--. a_.r__w,._. _--_ a CLEANOUT TO GS �V. m PEOPLE PER CAR). EXISTING BUILDING SEWER, 99 22 - __..__ M _.__._ ,. _ ._. _.n.. _-_ ..._._ r__.�_._. !. ... ..,^.._,__,._ ,.,_._ _ .._..._. ,__._.. .-_ -....__",,-.-____�^.__..._ ._ ._.__.u- ,..--" -.^.,._.,m_ _._--_,._- � ._e.._�... ._.,_. ._^- _,.-_. _....,,,^_ �...... ......... ., ._..,.-. FLOW 902=GPD PROPOSED KITCHEN SERVICE 100.67 STATION WEIGHT LB 470 GRADE (TYP) ��= _,.,.... , _,....,.__� __..-... __.__.._ . _,..._ _, w..._. . __,___m _-... _ -.._..-_H_,___„_-•- _.,_...._____.. -.... ,__-- _-..._._..._, ....__-,. _--__ «__.___ -. ..'-..._.__ -.... ___.1 -_.._ _...._.. �.,,_,_...� 1ti ___._._^, _ ,. __..._. r_,_...._ _.. -. .-_ ^._ . __....._.__.._.. ,^_ ._ _.._. _ y � BALLAST REQUIRED BY MANUFACTURER, LB. , 4,500 � � o_ f0. __- --__ __,,. __._- .__. ._.. _._... .___.�_.. ..___._ .__.__�.-.___-__-. .,.,--__-________ ,_._._._.�.___ t _ Q ti _... ..._.. .w_.-�.._.w-.._.,..__ _..���_. _.__..__ .__._.,-_._... ._... . ._..�._ ..�_..._� -.... ....._ _- __.�..- _._.._�.,,. __ . __ ._..._..w-.-_. .. MEET XI TING CON R T WA K _-_-__ _�.._._... ..___,.._. ____..,_ �..�.. _^_ _ M TOTAL BALLAST LB 4,970 � E S C E E L USE RESTAURANT, FAST FOOD GREASE TRAP INLET 100 48 ..__�.._ .,._._.-- _...,__- _...-_, ` _ .,,,. / z i a __,..._ ___ w w t ..._ _...,.__. .._.„._..,, ,.,,.,,_r._ _. .-_ �_ .. _.__.. _. w_..., ^__„ .n..w, ..._,_. _ ._..._._, � _ __ m GREASE TRAP-OUTLET; 100.23-_,-.., -., - ...., ._.. I ° .�. `:. ' ... , __ U3 M FLOW PER PERSON; 20;GPD/PERSON _�._^____._____.. ..M�_ .__. ..._ ..... ....��_.., _.�. -_v_w ._...,.....�I .. ,_._,-_ .__.,_,_ -.,.. _._-._ -_..,_.._._ . .... __,�_.-.._,_ _._w._.�__.,_: - I _,.... . .._ _... _._.... .. .. .... ...__ . ,..� ..m. _,_ ,.. ,.. .,._._ ...� ,...._. _ ..,.. ..H. ...--_�-� _ BALLAST REQUIRED(TOTAL BALLAST BUOYANCY FORCE); 3 871 , ;,, SAW GUT EXISTING BITUMINOUS PAVEMENT '', NUMBER OF PEOPLE 66 PPERSON �_.- m..^.._.._„_��.___...... _,^,.. .._.._.,. . ...w.., n .__._..,m_ _ ,..,�,.,., _ -^. ... ._, i O o o . "--.... ,.. .__, .._-__._ ,...... .-,..__ .� .__.. _ ._-;.__.... ....... .._--l',. . __-.,._ ._._..r_.,,�.._ ,...._ _. .. .._._. , -.., ,_._. ,.. ,_ ......... �.^ ._._. _,- ..,..._..,_ - ..,_ t �\ to co r- m EONE STATION INLET 98.46 ._ ..__._ .._._._, w._ .___, -._._ ..._.___ �..._._ . .-..__. . .. ___._ ,__._._. _ ._,____. _,__,^ ___.._ ._ , N o I (BASED ON 66 SEATS) _ _.... _____._ __. . _-. ._ „.._ .. _x�... . _-_ __ _r�,,,_.^_,.., 3 V'� / _;; ,J 1,000 GALLON GREASE TRAP _._ m.._ __._.-_-.. __m. .._._.._ ___ . _..-__....^._.,.__. _�._ .._... _. .._-.._ .... _._.._,.. _.. __ _ � CONCRETE BALLAST REQUIRED, CU FT N/A vIII "; > M FLOW; 1,320=GPD EONS STATION OUTLET: 99.45 �,� ,._ vw., _._._ _,_.-._ ��.. ..__. ._.., _..... __...___ ,_w_.__.... w__.___ �w_ U ,_....._, ._ _..,.._..., __.._-. _ _._._._ _., .._.. ....._. _...,. _. ...__. .u__... _-_..__ _. .. _,._.. ., ._.. _. , _.... .- .- . -_._ _ EONS STATION R/M 103.46: _.__.. ._ .. ..__.... ......... .... ._......,.-- __. -._.-_-. ..__..._-___ __,.___ __..-__. _._ -_-.._. � , 11 \ a 4 SDR 35 PVC W_ N M ©� w , �,,-. __._. ,^, __. _ _._M_�_._. _-_,_.. .K. a .._._. _ ._v_. .,,_ _, .._...-,__ __ .^ __.. ... .._. . .__._.._..,, .__., _ I ._____.._.r._. _, _�. . ..... . . ....._..__..- �v__._ .,._.__-- .. :_._-, k..__--_. ,.... _.� __,-._._. . - ..., ,. . . NOTE NEGATIVE NUMBERS REQUIRE BALLAST �__ ` �� L=17.7, 5=9.5% TOTAL DESIGN FLOW 2,222=GPD EONS STATION-BOTTOM 95 67 ___.. __ ...-. __.._...__ _......_. ___.......... ... ....... ... _..._._ _-_ _. ___ A _. �.-. �- _... .._ - �_... . .. �,_. . ......_. ____.__ ...,..__-� --_. u..w .. _.. _.� r.,.. .__ �.. _.,, _._._._._. w._. r _ ....,._ _ _..._ _,..._ ._. _�,-_. . _. �.,,.,__. ,, BALLAST NOT REQUIRED > ; I _.� ._... -.,_,...._. ..,... . . _,... _-._. ,..._..._ .,,-."-" _,__.. - ... -_..__ _--.,_- __•,.._.._.._..�_ r ..�__ .._�_--m__�. ,.._.�_._��.- -..__.._..-_ ._..._ _ ...__,__ _..__.. .._,.___,�_ _.__."_ - __ __,_.� A _ �' - . „= ��. EONE GP 2014 GRINDER PUMP STATION EWER MANH LE EXI T G INLET .12 ......-...__ ..w__..-__ ._. ._..,.._- -. . ...........__ _._�. . ._ .'-. __..._._.,.-_..__ . . _ �, ,V 00 GREASE TRAP S O SIN 90 _,.. . ..,-"I- _._.-........_____.. -.,... �._. _ �,..._._ ,_ r....,_.._-_,., . _-......_ _ .__._.._ .. ,_..._._... . _......... ...... .____._ ..._-.....,..-,_. .. _ -....__, _,...__ _._.-.._. . _.___- _ * . I a 1000 GALLON GREASE TRAP RESTAURANT FLOW PER PERSON' 15 GPD/PERSON SEWER MANHOLE-EXISTING OUTLET: - 90.37 __..._ _..-_._-. . e _... _ _,.-.._,... _. _..._... _ ,. _...._-a_.��. .� ..__..-_. _.._., ..._w...-. __.. .. _..___ _ .__..-. ._w___.__ _�__ M.__ _.. _._....; _ _ ..._._. .. ,_.,..._.. __,._� _, . n .__ .. _ _._,r . . � MPRESSION FITTING AND ISOLATION % - TANK VOLUME, CU FT 262 A CO .,� 0 i{� NUMBER OF PEOPLE, 66'PEOPLE SEWER MANHOLE-PRROPOSED INLET 96.00;,_.__.._...__,.._ 4.._.,v. . _..W�_ . .__w__..... _ ........ .. ....m.. ...._...... _. ..._,_. _._...._.. .. ..._..__.....__w, 11 �, . E, I S ING ELECTRIC, BOX L � ..�.... ..... ... ....... w^ ...,,.. ._.. -..-__ ...,,._. ._._ �,^.. �.. ..._.,_..�. ..._.. .-_. :.w_.._.,........_�._,._��, _. m � o + � „ � - ,`�' ;�,/ VALVE FOR SYSTEM FLUSHING SEE ;.•� ,� �. s PORTION OF TANK IN WATER AT SEASONAL HIGH GW 50% i ( .. v l MIN. GREASE TRAP VOLUME< 990;GAL. EXISTING SEWER MANHOLE-RIM 99.37 _.. .,__.., ._..._m.. _.____., ___._,____....___„_., _..___.,___.__.__._ ,._.,_-_ w.�... _._._, ,i 1 �. .._.-....__ .___.._.. _,........_ _._..._.__. _w.__._-. -_-,___ _,- _^_.-.- ,V' __ .___. __M_ . .,__._..� ___... _. ,_.__.. __, ._._._..__,.._.. _-,..,... ..� . _�__.�....___m_ ...- ..-....--_ -....., -' -- I EQUIVALENT WEIGHT OF WATER DISPLACED, LB. + 8 252 -•-- _ t � TYPICAL EONE SYSTEM CROSS SECTION) / USE 1000 GALLON GREASE TRAP; ESHGW 98 50 -. __ _._..__-_ , ..-, _,_..-,-__�_ ..-.__...._..__.___-__.__-___ ..,_. ._._�__,__,___ - _-.__..._____.__, m_.^._ __......r._--. ,._.,�-_ _., _----_�_.,,._. .._m ,.._...11-1, . _.k._..-._ ...�- �....._._ .� .._,_.. _.._.....,..-,.., _... ..,.... .u -.-_- , �.. . ...... u.. _-,._.. _...... ................. .. _��_- ... .r... _. .; W CONTROL PANEL SOIL COVER VOLUME, CU. FT. # 84 i H 6..! .z f S �__....-._,,.,...,._-.._.,...,. ..,.._.._....,....,.,...-W..,..,...,.........._.,..,,.w..._,,,,.......,..,..., .,..�..__.-. ».----:..._..,,..,-- -.-.„.-,..........._.... -�.. ..�.__..._.,.____.....F _. rn .i'' . ..�? .. WITH AUDIO AND I c y ACa L OLD_ h __._�ti__ _ -.^.._.___ w^ _ tti-,_, 4x4 HANDHOLE WITH o m m /� ,.-_..-__�.._ _. _.,__ .__-.-- ^... __ ---,-._^_. _ ._^ ,�.._. _ -_ / E ONE GP 2014 CAPACITY WEIGHT OF SOIL COVER, L8. 8,820 I VISUAL ALARZM SEE .•. 4____`, •- ._..,.__._-- . ._.^_-.�__. .-.._,___- .,_-, ._.... .... _-----. . _.._r._.,. ._... _.__.__..-,._.., ___.�._..- ._.,___.._w.._„� ., ._-ri _._.-.___._..._.._ .___-_.___. __.. .w _- ._�_. .,...__. . ..._ _..___.-_._..... ,___,...__e.___�_..^.�_._ .,_., ___..w_ ( COVER TO GRADE O 9 3 .XCTIfi�C LEACHIIC PiT DESIGN FLOW 2,222`GPD �`-�� �� _ 1 SDR 11 HOPE FORCEMAIN -_- �_.-._..._.,_ ._- ,._ _....___u -..__._,.^. ........ . .......^-. ..r_.-.._ ......__., -_...,- -_..-".'.„ - -,_...,.._ ..,.�...� _ Y T N_,_.w _.._.-._, E-ONE GP-2014 CAPACITY I f ,-._-...__�......-....._.�__.-_. ,__._w -,-._..w_._._-�--,-,.______�.m.._�..___.�,�_�.a._�.._.�.._._-�. _w._, S S EM OTfES (2)) o 3,000 GPD TANK_ WEIGHT, LB. , 8,600 i : TO EXISTING SEWER MANHOLE y o `,ti _.� . _-_....� ,.�n ._. __., ._� . __._._. .... ,w. . �..._. , _ �,... _.. __... ...-__. , ___ ,_ ._.., -1___., , _., �.,__ k.-___. _...___- ____-.-___-__1.._____..__.�,___., _.�__ _. M11 .._,.___ ,--,-_. __.._._..-.-,__ ......-.._F __.,._� ..... --w•-W-...�; , --T...� ..� ,..�.. 4 `' `\ �' -- , ` TOTAL BALLAST(TANK+ SOIL) LB 17,420 i „ t"` �' ::.. - � � `"""'."' -.--.�.,_ aci E m _ PROPOSED 4 SDR 35 .-_ ,.. ",." ....-�-._...�^ -- � o --_. .,=�- .� a; 1111WEN FLOW TO 1 ------ --'....T._..�._, . = c " �`�` - - -- - u_._... .,., .__.. ...v_._ _,. PVC K ITCH I °° - - - -- - - '� 3 BALLAST REQUIRED(TOTAL BALLAST BUOYANCY FORCE) 9 168 i - GREASE TRAP � , d "' _ �' INSET 0 I REMOVE SECTION OF EXISTING WALKWAY IF 3 '� o 'o 0 K / .m � _ _. - ,_-.._M L=18.7 , S=1.0% NECESSARY AND REPLACE AFTER PUMP W aC ' "' �` I E l ,j¢��{; LE r !r I F j CONCRETE BALLAST REQUIRED, CU. FT N/A f 0 , , RE. T RCOMS AID \'_ _ STATION IS INSTALLED = = P \ q 1 NOTE NEGATIVE NUMBERS REQUIRE BALLAST .0 -to ._to cq o I A,C!< , ---'- Q' I > _ BALLAST NOT REQUIRED _ T ; E U) = .c Z '3 A A �, ' -=- _ / _ __. _ ... _._w_ .__ ti_._. .__.s_ _.._ __.w,w_ INSET L o b Q O y c oo ao I ` eI� _ / �11 „ , a o eaoo �. , � ,, .�, ,,,,, 8 ��.. / .� SCALE' 1 =20 _ � M (a U � o r` CLEANOUT TO GRADE (TYP) __ ! �:, / / LIC `' EXISTING -SMI _ - ___I `� 1 / E^`` --_ � f _-_ __. __ ._ RIM EL. 100,1 �'` --_I �� 1 4 SDR 35 PVC I / �i C-: -_.� U ��� INV. EL 01 .12 `� 11 p MATCH EXISTING BASE E� -w--__ 1 ,000 GALLON GREASE TRAP v' COURSE (95% COMPACTION) _-�....\ UCH--_---�. /`� `11 `~ �� [�� 1 r�. �------.... I ; AND PAVEMENT THICKNESS --A�`'``�---% ...�., �`�. _ - '�C`�____.__ I ., 4'� , I ,, F4 j _�.I 1 ►-===: F:14t:-- -.�'ls -- ; - �' `--' -I 7Q2 'U _ `` - CSC i `'" I ,x ---.EFL -EM=.-'- -- \ I 102.21 ` UCH _ ' a--- HAWES AVENU -- - - ---- - - -- - - -- - -J - -- -i4!' I + 101.32 -, PIPE (UiSlh�.��)r j-, t - (} i \ G� ! LCE- x r 100.00- c c, PK SET EL. 101.98 - "� - U - '' - - tAS v V l� a o ,1 ONE GP 2014 GRINDER �,-- f/ \, LEEVE FQRCEfv�AIN jC� -� - U W - ---a _ _ I 4 C EXISTlNC� WOOD PUMP STATION AW CUT EXISTING //� \ C \ '` C / �' Y ` `� 10 EITHER WAYS `` --_.__ s ; WALKWAY ) O -' PAVEMENT � � \ \ •11-I" _ _ B Pr, -- ,_�„-- % r Q' r b'`�y // r ,,..� ta� {p'� \q ' ' �„ .,..,,�_ Y m__ - ,,. .� _.._ ``-. E - �1 _ �J 4� '...., .<., g r' 1 /� �j``j _ V 'f " 0 .00 '� 10 ,.C)u _ °t �i _ -103.00--- 3 �J `` -.._ _, °NJ� M1 �. IO°3.fJC _ _ _ _ ��""`--` ,C?ram 1 ' Gc _� I t I !�, C-- _ ' - -, ;_ _ >- y`A , - s ,C IC' .00 A 'ril<-�� ),` - 1/4 ' SDR 11 , . JG .�� a. . -,�` c,l w 4 i ?G 0- 1 / �J -, .) _ __ _. ( HDPE FARCE O�g4�`.�...,` U�` (� V 4' \ _ ) / -_ � MA \ - _._ _..._ ._ _..... __104.00-- ---- / O IN p6° cad O // w Voup _� "'�I v� 3 -W --- -- __ _ _ .�, __ - �_ 7Q ! .ESA.& ,I".. ,x�. �� h» Hwy --_ a � � ,� 11 � ``a „� 4. `"- :, t _ �. Z , . I I � - EXISTING SMH -, _ r `'�� RIB EL. 9.37 C` - - II11v. EL. 90.37 '� �" 2 i ; � !' Q 19. CONTRACTOR SHALL BE RESPONSIBLE TO PAY AND OBTAIN ALL NECESSARY 1 Y GENERAL NOTES: 7. THE OWNER SHALL BE RESPONSIBLE FOR OBTAINING ALL Q� ap NECESSARY RIGHTS OF WAY AND EASEMENTS. THE CONTRACTOR TOWN PERMITS AND POLICE DETAILS. �. L-_ co 1. BELOW GRADE UTILITY INFORMATION IS BASED ON INFORMATION SHALL VERIFY THAT THE NECESSARY EASEMENTS HAVE BEEN _ `c _ PROVIDED BY EACH UTILITY. LOCATION OF PUBLIC UTILITIES SECURED BY THE OWNER. IT IS THE RESPONSIBILITY OF THE 20. CONTRACTOR SHALL VERIFY LOCATION OF ALL EXISTING SEWER PIPING AND _ CONNECT FORCEMAIN o. o. SHOWN AS ONLY APPROXIMATE AND MAY NOT BE COMPLETE. CONTRACTOR TO BE FAMILIAR WITH THE APPLICABLE PROVISIONS STRUCTURES AND REPORT ANY DISCREPANCIES TO THE DESIGN ENGINEER PRIOR PRIVATE UNDERGROUND UTILITIES SUCH AS, BUT NOT LIMITED TO, OF EACH EASEMENT AS THEY APPLY TO THE WORK PRIOR TO TO CONSTRUCTION. TO EXISTING SEWER SEWER LINES, WATER LINES AND BURIED ELECTRICAL SERVICE BIDDING AND ABIDE BY THOSE PROVISIONS DURING MANHOLE N ENTRANCES ARE NOT SHOWN . / . THE CONTRACTOR SHALL CONSTRUCTION. COPIES OF ALL RIGHTS-OF-WAY AND 21. ALL EXISTING SEPTIC COMPONENTS SHALL BE ABANDONED IN ACCORDANCE 1, EASCERTAIN THE LOCATION AND SIZE OF EXISTING UTILITIES IN EASEMENTS ARE AVAILABLE FOR REVIEW FROM THE OWNER. WITH TITLE 5, 310 CMR 15.354(3). I r EXi�C T 3( G SL:WAC�E LIFT STATION a? z THE FIELD WITH THE RESPECTIVE UTILITY COMPANY _ ,.r� t -; Y REPRESENTATIVE PRIOR TO COMMENCING WORK. TEST PITS MAY 8, OPEN TRENCHES MUST BE BACKFILLED AT THE END OF THE 22. THE CONTRACTOR IS RESPONSIBLE FOR COORDINATING, INSTALLING AND op BE REQUIRED. UTILITY CONTACTS ARE AS FOLLOWS: PAYING FOR THE REMOTE ALARM SYSTEM INCLUDING THE FIRST YEAR MONITORING �. Q o WORKDAY. � 2 `r' ch FEE. A 110V OUTLET SHALL BE INSTALLED IN CLOSE PROXIMITY TO THE REMOTE o � � , � DIG SAFE: pq w y �_ a ! coELECTRIC: 9. PARKING AREA SURFACES SHALL PITCH 1 4 INCH PER FOOT ALARM MONITORING UNIT. THE PLACEMENT OF THE OUTLET SHALL BE FIELD U. o 0 0 � 5 9 un NSTAR TEL: 1-888-344-7233 DETERMINED. - o O ONE NSTAR WAY KEYSPAN GAS: MINIMUM UNLESS OTHERWISE NOTED. m ��.r � t � .. y � O • WESTWOOD, MA 02090 TEL: 1-800-548-8000 10. THE CONTRACTOR SHALL COMPLY WITH ALL APPLICABLE 23. THE CONTRACTOR SHALL BE RESPONSIBLE FOR PIPING THE EXISTING KITCHEN g � o S REGULATIONS OF THE OCCUPATIONAL SAFETY AND HEALTH DRAINS TO THE PROPOSED GREASE TRAP. a q x a w 2. ALL EXISTING SEWER AND STORM DRAIN LINES ENCOUNTERED ADMINISTRATION (OSHA). �-.(-� v DURING CONSTRUCTION ARE TO REMAIN IN SERVICE. ANY 24. THE CONTRACTOR SHALL USE THE EXISTING PANELBOARD TO ;PROVIDE ALL s DURINGI IGCONSTRUCTIONRSHDRL I BELIREPANE OIREDUBYETHE TS DCONTRADCTOR _ REMOTECALARMYMONITORIN�RSYSTEM. O FETHEMEXISTATION, CONTROL PANEL AND 11 THE CONTRACTOR SHALL RESTORE ALL PRIVATE PROPERTY (STING PANEL BOARD IS NOT \ U) AT NO ADDITIONAL COST TO THE OWNER, EXCEPT WHEN IN TO ITS PRE CONSTRUCTION CONDITION. CAPABLE OF PROVIDING POWER TO THE E-ONE- PUMP STATION, CONTROL PANEL ' DIRECT CONFLICT WITH THE NEW SEWER OR WHEN NOT SHOWN 12. WHERE SEWER MAINS CROSS WATER MAINS THEY SHALL BE OR REMOTE ALARM MONITORING SYSTEM THE CONTRACTOR SHALL BE OR INDICATED. INSTALLED UNDER THE WATER MAIN WHENEVER POSSIBLE. A RESPONSIBLE FOR MAKING THE REQUIRED MODIFICATIONS. 3. NO GUARANTEE IS MADE THAT UTILITIES OR STRUCTURES WILL MINIMUM SEPARATION OF 18" BETWEEN THE BOTTOM OF THE L BE ENCOUNTERED WHERE SHOWN OR THAT ALL UNDERGROUND WATER LINE AND THE TOP OF THE SEWER SHALL BE MAINTAINED. PROJECT BENCHMARK: �\c m UTILITIES AND STRUCTURES ARE SHOWN. ALL LOCATIONS AND WHERE SITE CONDITIONS DICTATE LESS THAN THE ABOVE PROJECT BENCHMARK IS PK SET IN PARKING LOT AT ASSIGNED o I 00 SIZES OF EXISTING UTILITIES AND STRUCTURES SHALL BE REFERENCED 18" REQUIRED, ONE FULL LENGTH OF PIPE SHALL ELEVATION = 101 .98' n M PRIOR TO BE CENTERED AT THE POINT OF CROSSING TO LOCATE JOINTS AS y '� VERIFIED IN THE FIELD WITH TEST PITS IT REQUIRED FAR AS POSSIBLE FROM THE WATER MAIN. WHERE DIRECT GENERAL SITE GRADING NOTES: 'z s. co BEGINNING CONSTRUCTION OF NEW FACILITIES OR PIPING THAT MAY BE AFFECTED. THE CONTRACTOR WILL REALIGN NEW PIPE GRADE CONFLICTS OCCUR, THE CONTRACTOR SHALL RELOCATE 1. ALL AREAS THAT ARE EXCAVATED, FILLED, OR OTHERWISE DISTURBED BY THE M 0 THE WATER MAIN TO THE SATISFACTION OF THE WATER DISTRICT. '� LOCATIONS AS REQUIRED TO CONFORM TO EXISTING LINES AS CONTRACTOR SHALL BE LOAMED, GRADED, LIMED, (FERTILIZED, SEEDED AND � 1 Y APPROVED BY THE ENGINEER. MULCHED, UNLESS OTHERWISE NOTED. THE TOP 4 INCHES OF SOL SHALL BE � - S M � 13. THE CONTRACTOR IS TO TAKE SPECIAL CARE NOT TO N SCREENED LOAM. `� ` m � o g M >% 4. ALL STRUCTURES AND PIPELINES LOCATED ADJACENT TO THE DAMAGE TREES, BUSHES, PLANTS, FLOWERS, STONE WALLS, SYSTEM NOTES:-0 FENCES, OR WETLAND RESOURCE AREAS WITHIN THE TRENCH EXCAVATION SHALL BE PROTECTED AND FIRMLY 1. E-ONE STATION INSTALLATION SHALL BE CONSTRUCTED AS SPECIFIED BY o �� o 0 ti CONSTRUCTION AREA UNLESS THEY ARE NOTED TO BE REMOVED. v = k 4 SUPPORTED BY THE CONTRACTOR UNTIL THE TRENCH IS ENVIRONMENT ONE CORPORATION. a- � = '� o BACKFILLED. INJURY TO ANY SUCH STRUCTURES CAUSED BY, OR ' a e 0 = 0 �` 14. ANY PAVEMENT TO BE REMOVED SHALL BE SAWCUT PRIOR N RESULTING FROM, THE CONTRACTOR'S OPERATIONS SHALL BE 2. E-ONE STATION CONTROL PANEL SHALL BE EQUIPPED WITH GENERATOR l � n � al CA w w 4 TO REMOVAL. VARIANCES 1 M REPAIRED AT THE CONTRACTOR'S EXPENSE.„ ALL UTILITIES - RECEPTACLE AND WIRE DISCONNECT SO THAT THE STATION CAN BE OPERATED Registration: O REQUIRING REPAIR, RELOCATION OR ADJUSTMENT AS A RESULT - 15. THE CONTRACTOR SHALL REGRADE ALL DISTURBED AREAS DURING LOSS OF POWER. USE CONTROL PANEL MODEL T260 PNL ASM 240V NO VARIANCES FROM TITLE 5 OR THE BARNSTABLE HEALTH ! OF THE PROJECT SHALL BE COORDINATED THROUGH THE AS NECESSARY FOR POSITIVE DRAINAGE. VOICE DIAL, 4P GEN A-XFER, HR MTR. REGULATIONS ARE REQUIRED. I � �NOF ' `' c RESPECTIVE UTILITY. o`' yG ,11 i •� CONSTRUCTION PROTOCOL FATPIU N� C- 5. IN THOSE INSTANCES WHERE POWER OR TELEPHONE POLE 16. NEW PENETRATIONS THROUGH EXISTING STRUCTURE WALLS 1. SPOILS FROM THE FORCEMAIN EXCAVATION OUTSIDE OF THE PAVEMENT SHALL BE I I CIVIL h SUPPORT IS REQUIRED, THE CONTRACTOR SHALL PROVIDE A SHALL BE BY A CORING MACHINE. OPENINGS TO BE STORED TEMPORARILY ON THE PAVEMENT SIDE OF THE TRENCH PRIOR TO BACKFILL 1 COMPATIBLE WITH REQUIRED PIPING AND STANDARD FLEXIBLE ! � No.a28za I,*- MINIMUM MINIMUM 48-HOUR NOTIFICATION TO THE RESPECTIVE UTILITY WATERTIGHT BOOT SPECIFICATIONS. �'o � COMPANY. NO ADDITIONAL PAYMENT WILL BE PROVIDED FOR 2. TRENCH EXCAVATION SHALL BE A MAXIMUM OF 3 FT WIDE AND 2 FT DEEP. TEMPORARY BRACING OF UTILITIES. I cV 17. IT IS THE CONTRACTORS RESPONSIBILITY TO DISPOSE OF GRAPHIC SCALE ✓� ?�/ ch PAVEMENT IN COMPLIANCE WITH ALL STATE AND LOCAL 3. AFTER RESTROOMS AND KITCHEN HAVE BEEN CLOSED FOR THE WINTER THE O 6. DO NOT SCALE DRAWINGS UNLESS OTHERWISE NOTED. FORCEMAIN SHALL BE BLOWN CLEAN BY MEANS OF COMPRESSED AIR WITH THE 40 0 20 40 80 160 Project Number: f � WRITTEN DIMENSIONS AND STATIONING SHALL PREVAIL. REPORT REQUIREMENTS. FITTINGS PROVIDED. + 6138 1 aN ANY DISCREPANCIES TO THE ENGINEER IMMEDIATELY. I I tr_ 18. CONTRACTOR TO WORK WITH THE ENGINEER AND OWNER TO ! -a MAKE MINOR MODIFICATIONS IN THE E-ONE PUMP STATION 4. THE CONTRACTOR SHALL SUBMIT A DEWATERING PROTOCOL PRIOR'TO ( IN FEET ) Sheet Number: 0 LOCATIONS, BASED UPON ACTUAL FIELD CONDITIONS AS CONSTRUCTION. ENCOUNTERED. 4- 5. FORCEMAIN SHALL CONTINUE UPWARD FROM THE PUMP STATION TO THE ! 1 Of ,2 N d DISCHARGE MANHOLE. - - - f .- _..__ ----__._.- _.a _._ - _- - - _ ---_------ - - ---- _ - i I I I i ti CD E U o O N m E a o I o 30" DIA. PAVED AREA LANDSCAPED AREA ROADWAY SURFACE ACCESS 0 4)� � GRADE MUST COMPACTED GRANULAR FILL COMMON FILL/ 0° SLPOE AWAY FROM GRADEGRADE ORDINARY BORROW ( a STATION :4 LL DEPTH AND SURFACE _ = T THREADED CAP W m TREATMENT VARIES r ► ca STAINLESS STEEL °° o BRACKET AND\ a a M FASTENERS VARIES VARIES M 5 CORE HOLE IN �� �'r a©a a®a EXISTING MANHOLE COVER I I INVERT R. ';" " . e'�' '`/\f� a a �'`%'4a✓ m J OVER ►. a' e a 0 DISCH I I DEPTH , '� b. , ! // �f a / ✓,d °fr a) U_ IUI 1 1/4" INLET r ✓r.r • • - . VARIES ' PIPE ��!,�:�.�� 8 a a 'P° ��,� •.e � � ( e �, a ° � 93.5 ., fir/, i sti ( TRACER TAPE , % o : a s ° C o m an Bracket Detail a ti O 3 ,s/• i FLEXIBLE WATERTIGHT GASKET OR , °° y SLEEVE (KOR-N-SEAL OR p VARIES 'p _ APPROVED EQUAL) (TYP.) ;>` �'�� 51 E m RACKETS ET 2 O.0 (TYP.). 12 =o (SEE DETAIL) �•. a • r,'`��j 'r F z > N = ,� '°,a'" `� BALLAST MT ► .• PIPE � y r M o 40.3' e: �. DIAMETER \` " y \r, j COMPACTED GRAVEL N = o w A A N 31.5' ` P\ `' ' '`�`: L ;Q '= C a oMo oMo N \ \< 0 to to to a 4" SCH. 40 PVC , { / f �. %k%�`` A��,',�,��`�`•.`..,����,� ',• •, �,, ,a., ,. FORCEMAIN , EXTEND FORCEMAIN 6 (MIN) i, INVERT TO CHANNEL r^ DISCHARGE: 1-1/4 FEMALE INLET: EPDM GROMMET FOR IF NECESSARY PIPE THREAD 4" DWV PIPE (STANDARD) `C1'1 0 38.8• NOTES: 18" (TYP) COMPACTED SUBGRADE **SEE INSTALLATION INSTRUCTIONS FOR SPECIFIC DIAMETERS ;,,, ..,, ?..,. OUTLET 1. BACKFILL PLACED- IN UTILITY TRENCHES INCLUDING DISTURBED AREAS SURROUNDING '�i ►� AND HEIGHTS REQUIRED FOR PROPER CONTAINMENT ':p ,; ,.'.z : .. UTILITY TRENCHES SHALL BE PLACED AND COMPACTED IN 12" (MAX.) VERTICAL WHEN USING 2014 PRE-CAST BALLASTS 90' ELL/BEND (TYP. : . . ":., .h,.-.. LIFTS. NOTE A CONCRETE ANCHOR OF 4500 Ibs (29.9 cu ft) IS REQUIRED ON ALL MODEL 2014 93' STATIONS. •: :';:"`;7:;'.°:;`,;•w:. ::�'•.:� °.:.�:•: ;., 2. TRACER TAPE FOR NON-FERROUS PIPE SHALL BE CONSTRUCTED OF A METALLIC V FILL TO GRADE WITH CLEAN, COMPACTABLE BACKFILL, SUCH AS '�• '' u '• p • ' PEA GRAVEL OR CRUSHED STONE, 1/8' - 3/4' IN SIZE. _ CLAY AND SILTS ARE NOT ACCEPTABLE BACKFILL D O�•- na - b CORE BONDED TO PLASTIC LAYERS. THE METALLIC TRACER TAPE SHALL BE A POURED o$ yd ° MINIMUM 5mm THICK AND MUST BE LOCATABLE AT A DEPTH OF 18 INCHES WITH v� PRE-CAST IIT�LAC7= ` °- °�``* . g A � ORDINARY PIPE LOCATORS. ••�.Q.b•:: . •b .;b.Oa -'C":Y• .„m•o..;-o-_r�!;.:o.!J:•``��o; I� •! SEWER TRENCH DETAIL LMSTURBED NOT TO SCALE EARTH FORCEMAIN CONNECTION TO EXISTING SEWER MANHOLE DETAIL �, ON Qq s MIN NOT TO SCALE �+ ' CONCRETE • ' •' ANCHOR } . GRAVEL BEDDIN PROVIDE CURB BOX MOUNTED 4-INCH PVC ►� Q FLUSH WITH GROUND 4„ THREADED CAP ►yl i= r_ c CONTROL PANEL MOUNTED TO + BUILDING WITH AUDIO AND WATER TIGHT LID, FRP VISUAL ALARM AND 45 ACCESS WAY VENT GENERATOR RECEPTACLE PROVIDE ADAPTER TO DEGREE PVC BEND AT JOIN SEWER OR LATERAL AT END OF LINE DUAL WALL, CORRUGATED TO 4-INCH ELBOW WYE CONNECTION FOR o STRAIN RELIEF CORD IN LINE N CONNECTOR HDPE ACCESSWAY v� b M GP 2014 E-ONE c7 o POWER & ALARM CABLE 12-6 W/GND FINISHED GRADE STATION INTERNAL WELL VENT I CIO DIA. COVERATO GRADEITH � ELECTRICAL QUICK DISCONNECT TYPICAL CLEAN—OUT DETAIL o NEMA sP (EQD) NOT TO SCALE o CORE CONTROL COMPARTMENT BREATHER 1 HOSE QUICK DISCHARGE 1 1/4" FPT DISCONNECT FOR INLET, GROMMET . PVC TRUE UNION (304 S.S) SYSTEMi FLUSHING TO ACCEPT 4.50" O.D. BALL VALVE 2' MAX. PVC PIPE (STANDARD). DUST COVER SUPPLIED QUICK DISCONNECT ASSY. 1 " HDPE TEE WITH o FOR SHIPMENT (NOT (304 S.S.) THREAD ADAPTER SUITABLE FOR BURIAL) S.S. CAST BALL VALVE 1 J" SDR 11 1 J" BALL VALVE HDPE FORCEMAIN 1 1/4' DISCHARGE LINE J N,,._ KOR-N-SEAL OR LINK SEAL (304 S.S.) CONCRETE PIPE "" ` PIPE PENETRATIONS (TYP.) U CHECK VALVE SUPPORT WITH PIPE PVC ADAPTER/COUPLING " 42.8in (GLASS FILLED PVC) ANCHOR STRAP 'p. . •- _ (�,P� _ � - - � - - p - y� PROVIDE WATER TIGHT � DISCH J CRUSHED STONE BASE FOR _ _ _ - :,: _'p: a .. a _• _ _•' FROM GREASE �' y 9�' MIN COVER AND RISER TO o 31.Sin ALARM ANTI-SIPHON VALVE 1 DIA. WEEP HOLE CHECK VALVE p:- .p p _ TRAP :;�;:. 3 MAX GRADE (TYP.) g o g Y (GLASS FILLED PVC) DRAINAGE p - _ r 0 - — ON FOR DRAINAGE _ - _ n ' - - _• -p: - - •- p I -LOAM AND SEED= -- - - -— —— —- - - -- -- --_— --_— -- BACKFILL - - — —OFF OM° M c106sa1 — —— — — —— — _p _ - p _ • - •_ p I Iµ _ _ " _ 20.5in 16. in - p _ - _ - > _ .�. •- I I — — — » 9» —— — — —Ir Z -3o c N 74 sal 58 sal HDPE TANK _ - — •�—"_ p -D _ — _ _ _ _ _ _ . _ • _- PROPOSED ____.__ >- M 1/2' NOMINAL WALL THICKNESS -:_ a • ,.:'_; _ — ____ _ _ _ v) a w Q 15A,.GALLON CAPACITY _ '� _ !� JL- - KITCIHEN SERVICE r �1=100.48 - 1=100.23 p - -• 1=100.67t _t - 10' MINI E—= 24 MIN I Registration: - - - - p- - _ - - - - -- _ _� e o ! s p •- - — _—_- jv�OF 4- VL NSF 1�= = MINIMUM -- i PROVIDE 2 COATS OF e O Cip - --.� ASPHALT SEALER ON ��� yGNm .Q SEMI-POSITIVE DISPLACEMENT TYPE PUMP I _— 3" DROP NON-CORROSIVE- _ _ 4 FAT PI EACH DIRECTLY DRIVEN BY A 1 HP MOTOR TYPICAL E-ONE SYSTEM CROSS SECTION CLAMP _ _ 12" -_ OUTSIDE OF TANKS �6 co CAPABLE OF DELIVERING 9 gpm AT 138' T.D.H. ^ w NOT TO SCALE 6 OF 3 4 ( _�_ • __I I I cnn� O / „ No.42824 EONE GP 2014 GRINDER PUMP STATION COMPACTED _ , , CN NOT TO SCALE SEWER SYSTEMS CRUSHED STONE UNDISTURBED EARTH "I I P '�I�1 4� N vy 0 1000 GALLON GREASE TRAP DETAIL Project Number: NOT TO SCALE 6138 N PROPOSED 1000 GALLON CONCRETE GREASE TRAP 0 LENGTH: 7'-0" WIDTH: 7'-0" DEPTH: 6'-0" Q Sheet Number: E MODEL # ST1000 H-20 BY ROTONDO PRECAST OR EQUAL rn ,2 Of ,2 co