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HomeMy WebLinkAboutCRAIGVILLE GENERAL - FOOD,� i ;� �,� �, CgAIGVILLE GENERAL 628 CRAIGVILLE BCH•RD� HYANNISPORT C ( 5Bellaire, Dianna I(V� From: Wayne Hyman <whhyman@icloud.com> Sent: Thursday, May 19, 2022 10:01 AM To: Bellaire, Dianna; Soto, Kathryn Subject: Crai ville General Store Menu/ no stove to preparation. 9 pp P Breakfast Altai Bowl Alu breadfruit Waffles w/ ❑ fruit Muffins morning glory Frittata or souffle/microwave oven Smoked Salmon, caper, red onion, cream cheese in croissant Shakeshuka oven Breakfast Smoothies: Muay Thai, blueberry,pineapple/papaya Papaya fruit bowl: yogurt, mix fruit/blender . Treats/Deserts: Gelato Soft serve ice cream:vanilla, chozolate or twist PB&JELLY Hawaii-Style (honey coconut macadamia butter and raspberry preserve) Affagato LUNCH Artichoke w/lemon butter Hummus/olives w/pita bread corn on the cob/tinfoil oven Avacado w/olive medley warmed on Toast Shrimp spring roll w/peanut sauce Samosa lamb w/ sauce / oven Hummus wrap Ahi Tuna poke bowl Bahi Mi/crock pot 4 meat Cuban mix Korean Bulgogi w/kimchi OLD SCHOOL: hot dog/chil dog./ Green Olive and cream cheese sandwich SALAD: Avocado tomato cucumber w/soy sesame dressing Papaya salad/red onion Mixed seafood ceviche/ cold Soup Kettle / 2 soups a day from: seasonal type Turn Yum w/shrimp Green Curry soup 1 Soup of the season Potato leak Cream of asparagus Stracciatella soup Gazpacho (all summer offer) Capperberies, hearts of palm, Olives, exotic fruit , black olive tamponade w/pomegranate seeds Juices Cherry apple Guava Pineapple Apple Oj Homemade lemon aid w/mint Things to use in kitchen: Use watercress leaves Olive bread Pomegranate Pesto or pesto spread for sandwiches Sent from my iPhone 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! 2 �zaE Town of Barnstable . �, BARNS LE MAC Site Plan Review r . �. � . . f6 �' 200 Main Street Hyannis, MA 02601. 15139.014 ''JFn►aY° Y www:town,barnstable.m a.us Office: 508-86.2-4679 May 20., 2021 Craigville General Store 628 Craigville Beach Road. Centerville, MA 02630 SPR 041-21 Craigville General Store(Wayne.Hyman) 628 Craigville Beach Rd., Centerville Map/Par: 2461028 Zoning: RB/AP Proposal: To allow for food service with a kitchen. Countertop will accommodate 12.seats.. Dear Attorney Kirraine, At the informal site plan review meeting held on May 181h', 2021 it was determined by the Building Commissioner that the above proposal is not approvable at this time and should be continued to a future date after 6/8/2021. The Site Plan Review Committee made the following comments. • Kate Maldonado:Assistant Director of Planning and Development o The proposed use is not allowed in the zone in which it is located o You will need to establish that this development is a lawful pre-existing non- confirming use . o It will also have to be determined that the proposed use is an expansion of the existing use and not a new use, • COMM Fire Michael Grossman o If using cooktop, may need permits for hood, suppression and fire alarms.. a Applicant to maintain current access to the site o Dumpster needs to be 10 feet from building as well as screening. • Elizabeth Hartsgrove: Licensing Director o Confirmed no alcohol being proposed at this time. Applicant will need a common victualler license in addition to an appearance before the Licensing Authority. • Robert'Duffy: Plumbing and Gas Inspector o Interior grease interceptor is required as well as an external grease trap. 0 3 bay and mop sinks are required. o Defer exhaust hood requirements to COMM fire. o Single user non-gender restroom'is acceptable.. •. David Stanton: Chief Health Inspector o Confirmed bedrooms will not be eliminated. q Katherine Soto will be your health inspector o 3 bay, prep and mop sinks will all be required o Floor plans are needed for inspector review o Bathroo,m is shared with the tenant, needs to be addressed. o There is.an illegal bedroom on the first floor o Possibility'exists of open electrical work o Site is in the Saltwater Estuary; as a result the septic system is maxed out. There is.a possibility of 1 or seats. Septic flows need to be determined. o Add grease trap • Nathan Collins.:. Assistant-Town Engineer o Via email, sewer is coming in Spring,2023 to the location which will eliminate septic constraints. Applicant must obtain all other applicable permits, licenses and:approvals required. Sincerely, . Brian Florence,CBO Chairman Cc: Site Plan Review Committee oFIKE Town of Barnstable BARNWABLE. * Site Plan R`ev ew BAILISTA BLE MASS. Wu S C 3 V B0.u Wt ib q• :.� 20.0 M ,in r. H nni 'MA 2 2, _av s . a St eet, Ya s� 0 6Q www.town.barnstable.ma.us nffire:.50$=862.4679 May 20, 2621 Craigville General Store 628 Craigvil'le Beach Road.. - Centerville, MA 02630 SPR 041-21 Craigville:General Store(Wayne Hyman.) 628 Craigville Beach Rd., Centerville Map/Par: 246/028' Zoning:'RBIAP Proposal: To allow for food service with a kitchen. Countertop will accommodate 12 seats. Dear Attorney Kirraine,, At the informal site plan review meeting held on May 18`",2021 it was determined by the Building Commissioner that the above proposal is not approvable at this time and should becontinued to a future date after 6!$I2021. The Site Plan Review Committee made the following comments. • Kate Maldonado Assistant Director of Planning and Development The proposed use is not allowed inthe.zone in which it is located You will need to establish that this development is a lawful pre-existing non confirming use co Itwill also have to.be determined thatahe proposed,use :s an expansion of the existing.use and not a new use. - • COMM Fire: Michael Grossman o If using cooktop, may need permits for hood, suppression and fire alarms. Applicant to maintain current access to the site Dumpster needs to be 10 feet from building as well as screening. • Elizabeth Hartsgrove Licensing Director c Confirmed no alcohol being praposed.at this time., Applicant will need a common victualler license in addition to an appearance before the Licensing Authority. • Robert Duffy: Plumbing and Gas Inspector w Interior grease interceptor is required as well as an external grease trap. 0 3 bay and mop sinks are required. o Defer exhaust hood requirements to:COMM.fire. o Single uiser non-genderrestro.om is acceptable. David Stanton: Chief Health Inspector Confirmed bedrooms will not be eliminated: c Katherine Soto will be your health inspector a 3 bay;.prep and mop sinks willl.all be required Floor plans are needed for inspector review o Bathroom is shared with the tenant, needs to be addressed: o There is-:an illegal bedroom on,the first:floor o Possibility exists of open electrical work. o Site is in the Saltwater Estuary; as a result the'.septic system is coaxed out.There- is a possibility of 1 or 2 seats: ;Septic flows need to be determined:. a Add grease trap • Rathan Collins:.Assistant Town Engineer _D Via email, sewer js coming in spring, 2023 to the location which will`:eliminate septic constraints. Applicant must obtain all other applicable permits, licenses and approvals required. Sincerely, Brian Florence, CB0 Chairman Cc: Site Plan Review Committee i i Bellaire, Dianna From: Hartsgrove, Elizabeth Sent: Wednesday, October 20, 2021 8:16 AM To: Brigham, Anna Cc: Soto, Kathryn; Bellaire, Dianna; Logan, Erin; Flynn, Margaret Subject: FW: List I can sell w/retail license Anna—for backend history on convos I have had this week with Health regarding Mr. Hyman's proposal, below is the email chain—in case he reaches out to you since Maggie is out this week. Thanks L From: Hartsgrove, Elizabeth Sent: Wednesday, October 20, 2021 8:08 AM To: Soto, Kathryn Cc: Logan, Erin; Flynn, Margaret Subject: RE: List I can sell w/retail license I will respond Thanks Kathryn. It sounds like he needs to o to site Ian so we have a documented path for him to follow. I espo Y g p to him that there are multiple layers of oversight needed and I will shift him to Maggie to assist with getting his proposal aligned for informal site plan. Thanks for all your time looking into this matter, and forwarding this info. Its extremely helpful. Liz From: Soto, Kathryn Sent: Tuesday, October 19, 2021 6:07 PM To: Hartsgrove, Elizabeth Subject: RE: List I can sell w/retail license I researched the file and found there are several items that need to be addressed some before he starts and others continuing after. This includes installing sinks, flooring, new back door, equipment specs, becoming Servsafe and allergen certified, complete menu, contract for monthly frozen dessert testing and a potential grease trap or grease recovery device. I checked for building permits and there is not one pulled for all the interior work that needs to be done. There are notes in the file from his previous inspector Donna and Wayne where he even listed what he needs to do and dates they would be done by. So far none of this has been done but he is very aware of everything. There was another inspector that had spoken to him in the spring and I tried to reach out to see if they could add anything but I have not heard back from them today. That is what I was able to find out, hope it helps. I will be off tomorrow but back on Thursday. Take care, Kathryn From: Hartsgrove, Elizabeth Sent: Monday, October 18, 2021 8:58 AM 1 To: Soto, Kathryn; Bellaire, Dianna Cc: Logan, Erin Subject: RE: List I can sell w/retail license That would be great, and if you can ask within Health about the other inspector's discussions—that would be extremely helpful so I have the full picture. L From: Soto, Kathryn Sent: Monday, October 18, 2021 8:54 AM To: Hartsgrove, Elizabeth; Bellaire, Dianna Cc: Logan, Erin Subject: RE: List I can sell w/retail license Hi Liz, I I have not spoken with the owner Wayne. I know he has spoken with other inspectors in the office over the last couple of years, including this past spring. A couple months ago someone mentioned to me that he might be selling gelato because there was a sign in the window so I went down and checked. A DPW worker confirmed he hadn't been open all summer. I have heard a lot about this place and the interactions with the owner but I would have to look at the file to see the specifics. I am working from home today but will be going into the office. I can take a look through the file and let you know. Take care, Kathryn From: Hartsgrove, Elizabeth Sent: Monday, October 18, 2021 8:26 AM To: Bellaire, Dianna; Flynn, Margaret; Soto, Kathryn Cc: Logan, Erin Subject: RE: List I can sell w/retail license GM Kathryn, Can you take a look at the emails below and let me know if you have had any discussions with Wayne, so I am aligned before I respond? Thanks and happy Monday! L From: Bellaire, Dianna Sent: Monday, October 18, 2021 8:03 AM To: Hartsgrove, Elizabeth; Flynn, Margaret; Shea, Sally Cc: Logan, Erin Subject: RE: List I can sell w/retail license Kathryn Soto is the inspector for Wayne. I believe she has reached out to him. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 2 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us „ - The information containedin this electronic transmission("e-mail"),including any attachment(the"Information"),may be confidential or otheiwise exempt from disclosure.It is for the addressee only.This Information may be privileged and confidential.xvo.rk-product or a privileged and confidential commurucatior_.The Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only.The.Information may not be disclosed without the prior written consent of the Director of Public Health and/or the 'Town Attorneys Office of the Town of Barnstable.If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. From: Hartsgrove, Elizabeth Sent: Monday, October 18, 2021 6:24 AM To: Bellaire, Dianna; Flynn, Margaret; Shea, Sally Cc: Logan, Erin Subject: Fwd: List I can sell w/retail license Good morning, Can you let me know if you talked to Wayne already, and what was discussed? Don't want him going on a merry-go-round with responses and depts. Thanks L Sent from my iPhone Begin forwarded message: From: Wayne Hyman<wayne@craigvillegeneralstore.com> Date: October 18, 2021 at 5:15:24 AM EDT To: "Hartsgrove, Elizabeth" <Elizabeth.Hartsgrove@town.barnstable.ma.us> Subject: List I can sell w/retail license Hi Elizabeth, How are you? I spoke to several business owners and they all suggested I contact you for clarification re: soft serve ice cream, espresso, scoop up gelato. Can those 3 items be sold with a retail license? If not can any one? Can I get a copy of the list of items that can be sold with a retail License and common Vectualler license please? Thank you! Wayne Hyman Craigville General Store 628 Craigville Beach aria Centerville, MA 02632 508.896.6327 Sent from my iPhone 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! 3 Bellaire, Dianna From: Hartsgrove, Elizabeth Sent: Wednesday, October 20, 2021 8:17 AM To: Soto, Kathryn; Bellaire, Dianna Cc: Logan, Erin Subject: FW: List I can sell w/retail license Keeping you in the loop on the email I sent Mr. Hyman. L -----Original Message----- From: Hartsgrove, Elizabeth Sent: Wednesday, October 20, 2021 8:14 AM To: 'Wayne Hyman' Cc: Flynn, Margaret; Brigham,Anna; Logan, Erin Subject: RE: List I can sell w/retail license Good morning Mr. Hyman, I checked with several departments to verify any steps that intersect with Licensing as far as what you identified i.n.your email and we are recommending that it would be best to have all of us sit with you and discuss collaboratively so we can properly guide you and assist with creating a path for you to follow towards achieving your proposal. That type of team meeting, Informal Site Plan (ISP), happens with the assistance of our Permit Coordinator, Maggie Flynn who can help you. I know that she is on vacation this week but the Senior Planner Anna Brigham is the liaison while Maggie is out, and she can assist you. I look forward to seeing your proposal at a future ISP mtg and take care, Liz Liz Hartsgrove Deputy Director of Asset Management/Licensing Director Town of Barnstable 367 Main Street Hyannis, MA 02601 508-862-4068 Barnstable Mission: Protect the Town's quality of life and unique character; Engage our citizens; Enact policies that respond to and anticipate the needs of our community. For updated information on the Town of Barnstable's response and resources related to COVID-19 visit www.BarnstableHealth.com. Thank you for your patience and support as we continue adjusting to the COVID-19 outbreak. -----Original Message----- From: Wayne Hyman [mailto:wayne@craiRvillegeneralstore.com] Sent: Monday, October 18, 20215:15 AM To: Hartsgrove, Elizabeth Subject: List I can sell w/retail license Hi Elizabeth, 1 How are you? I spoke to several business owners and they all suggested I contact you for clarification re: soft serve ice cream, espresso, scoop up gelato. Can those 3 items be sold with a retail license? If not can any one? Can I get a copy of the list of items that can be sold with a retail License and common Vectualler license please? Thank you! Wayne Hyman Craigville General Store 628 Craigville Beach aria Centerville, MA 02632 508.896.6327 Sent from my iPhone 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! 2 ned Verizon LTE, - 6*15 AM Done Frozen Dessert Testin... Town of Barnstable 11 'Iervlces Pub , W . Division DA8.M MAM DiP0t1»Y t6)� 2(N ' is MA 02601 Offike: %8.8614 49 FAX W490-6304 DATE As a condition of my Frozen Dessert License, I agree to have my products tested bacteriologically on a monthly basis by an approved laboratory. I understand that if my products have a standard plate count in excess of 50,000 bacteria or exceed 0 for Coliform, l must obtain a re-test within seventy-two (72) hours. If the count exceeds 50,000 on the standard plate count or over 0 on the Coliforn , I will stop the sale of the contaminated product until counts are obtained that fall within the prescribed limits. In addition, I agree to conform to all the State of Massachusetts Health regulations contained in 105 CMR 500.000, Good Manufacturing Practices for Food. Monthly testing of the ice cream or frozen dessert mix is also required by 105 CMR 500.082 (B). Signature IIAA nn v� Name of En04401 ishpment Establishment dr ss Q: Health/Applications r en Dessert Testing.doc Bellaire, Dianna From: Miorandi, Donna Sent: Monday, August 03, 2020 9:33 AM To: 'Wayne Hyman' Cc: Bellaire, Dianna; Scali, Richard; Lauzon, Jeffrey Subject: RE: Criteria or pamphlet on retail w/food to sell vs going to licensing board Good Morning Wayne: I am just back from vacation. Sorry there is no pamphlet that you speak of. If you sell packaged food you receive a retail food permit. If you sell any TCS foods and process any open food handling then you shall receive a food service permit. The latter is what requires a Servsafe and Allergen certificate. I shall need cut sheets (manufacturer's specs) on all equipment. If doing food service you shall need a three bay sink,a separate handsink(hands free), a mop sink and potentially a prep sink depending on your menu. We shall need a menu from you. All floors, walls, and surfaces have to be washable and scrubbable As far as seating goes if you wish to have ten seats then you are required to obtain a common victuallers license with Licensing. You have not had one in the past nor were you ever approved for seating. The minute you have seating you must have bathrooms accessible for the patrons. They are not allowed to go through a food prep or food storage area. As I recall you only have one bathroom and you shall need a variance from the Board of Health for just one bathroom. Depending on your menu which we have not received you may need a grease trap. You must obtain permits for all the work performed in the building. You recently had a Stop Work order posted from the building dept. for work being done on the building without permits. You must comply with all building requirements. Your side outside door must be rodent proof. At the time of my last walk through inspection that door wasn't anywhere near being rodent proof. Remember there is no grandfathering. You are required to comply with the current Food Code of 2013. Any further questions please feel free to contact me via phone or email. Donna Z. Miorandi, R.S. Town of Barnstable Health Inspector Public Health Division 200 Main Street, Hyannis, MA 02601 The information contained in this electronic transmission ("e-mail"), including any attachment(the "Information"), may be confidential or otherwise exempt from disclosure. It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature. As such, it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable. If you have received this e-mail by mistake, please notify the sender and delete it from your system. Please do not copy or forward it. Thank you for your cooperation. -----Original Message----- From: Wayne Hyman [mailto:wayne@craigvillegeneralstore.com] Sent: Sunday,July 26, 2020 11:48 AM To: Miorandi, Donna; Brian F. Garner Subject: Criteria or pamphlet on retail w/food to sell vs going to licensing board Hi Donna.....How are you? Is there a written criteria or pamphlet for what can be sold with a retail w/food license? Requesting 10 seats inside is what triggered going infront of the licensing board? 1 4 z'criteria/ pamphlet would clarify as I took servesafe as you recommended to sell gelato, soft serve ice cream and sell food yet you never mentioned going infront of the licensing board. A pamphlet/criteria for what's allowed to sell with a retail w/food license would be helpful. It would educate me and I wouldn't have to email you on questions/criteria as I know you are very busy. Thank you Wayne Hyman Craigville General Store 508.896.6327 Sent from my iPhone 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 2 C t Tea C> oF 1 ,- h - (kS��-� / � I� l cc) w �_4v. � • l � � � .� r � s ., ` y ` y a I �� � � I r � � it ' ' Ili ` � � �• � �� .M} ,a t , - � � III � + ' , • � � � .. S_ ,� ,., .- ....,.-ir�4...�...�.o„f"4.r'.. ;� -� ...., i. a+l..,.e''"!!"�''-ev:..,�,y eyiV"�h•.!^�si%%G1`-•*�t��-v..' .-i+ky�^'"' -=--el '^ft'-..^y^_ -�,: -a..kT.`r.:,c,-.'+�--, .. -.- ...�� -.�r:- y -`_.r."'1r r. �. -•',.tr.. 't 2 - °F, r°,r TOWN OF BARNSTABLE, HEATH INSPECTORS Establishment Name:� t/I k.�l✓ at 'rage: _ of q OFFICE HOURS f / �- °� PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ' , 200 MAIN STREET . 3:30-4:30 P.M. Item Code C Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. - - MON.-FRI". HYANNIS,MA 02601 508-862-4644 No Reference R-Red.Item PLEASE PRINT CLEARLY r,.FOOD ESTABLISHMENT INSPECTIAON REPORT _ .t � g Name / "�~ /,v'' ,(� Date / Type of Type of Inspection / l l A Il 11'1ST, �'+lT 4 / Ooerationlsl Routine Al C / v Address. '!f jRisk It Food Service Re-inspection { r� leXveI Retail Previous Inspection -'-_ Telephone , Residential Kitchen Date: , _mac I / l - I"3 Mobile Pre-operation tfN :Owner HACCP YIN Temporary Suspect Illness ` V. � h Caterer General Complaint + A � Person in Charge(PIC) Time Bed&Breakfast HACCP v }, '/� r7 � _ !Other i� � / Inspector °1 I / �` Each violation checked requires anf explanation on the narrative page(s)nd-a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors Red Items)) Anti-Choking 590.009(E) ❑ /J Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ jJ _ Action.as determined by the Board of.Health. Allergen Awareness 590.009(G) ❑ I J j J j` 1 FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Handst! �j- l ❑.1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 7 �,� fi i Y •a.,..ax..r EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ' ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives M i ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals 1 ' - ( f - /` FOOD FROM APPROVED SOURCE' TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) �} /f ❑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 n ' rrxPROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control .eG.! _ r �y w ❑ 8..Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) t{., ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP - ❑ 10.ProperAdequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories / r - Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations (/�t I `,I L11 i(1 Critical(C)violations marked must be corrected immediately. (blue&red items) ` Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ElEmployee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:'Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo `Y ;❑ Emergency Closure Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number-of critical,results in an F. 25.Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 4von-critical violations if no critical violations observed,4 to 6 non-critical violations=B. Serious) Critical Violation=F is scored automaticallyIf no hot ,k 26.Water,Plumbing and Waste (FC-5)(590.006) establishment perrriit and cessation`of flood establishment operations. if y ' s 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and;less than 9 non-critical. If,.no critical water,sewage back-up,infestation of.rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non critical violations. If 1 critical refrigeration. . 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 # /- violation,4"to 8 non-critical violations=C. 29.Special Requirements. (590.009) within 10 days of receipt of this order. n d 30.Other DATE OF RE-INSPECTION: Inspecto°s Signature ko�emG1 �PPrint: } 31:Dumpster screened from public view PenniNPosted?. Y N Grease Trap Previous Pumping Date Grease Rendered Y N ' "' v #Seats Observed `Frozen Dessert'Machines: Outside'Dining Y N PIC's Signature Print: /} Self Service Wait Service Provided Grease Trap Size '',Variance Letter,Posted Dumpster Screen? Y N f v Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.*. 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 75 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-102.11 Common Name-Working Containers 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage*- Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg"""e uuzoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 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-Hat Water and 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* 10 Ratites-165°F 15 sec*Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201. 7 Wild Mushrooms ( )( )( ) 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 Coolin PHFs from 140°F to 70°F 3-202.18 Shellstock Identification t ( ) gCooked 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. 1 Special Requirements 1 .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* c 8-103.12 Conformance with Approved Procedures* S:590Fom7back6-2doc *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. crwsvktiy Bellaire, Dianna From: Miorandi, Donna Sent: Wednesday, June 24, 2020 2:15 PM To: Bellaire, Dianna Subject: Fwd: Re: Craigville General Store Fyi Sent from my tablet -------- Original Message -------- From:Wayne Hyman Sent:Wed, 24 Jun 2020 13:52:59 -0400 To:"Miorandi, Donna" Subject:Re: Craigville General Store Rydell Plumbing is on it.No cooking on property until grease pit installed; next summer. Wayne CGS 508.896.6327 Sent from my iPhone On Jun 24, 2020, at 12:21 PM, Miorandi, Donna<Donna.Miorandigtown.barnstable.ma.us> wrote: Hi Wayne: Just an fyi that you need to consult with the plumbing inspector on an inside grease trap. I also need to do a visual check inside before you move forward. JJc:ranu�. �/I/Gioranc(i, ��. Town of Barnstable Health Inspector Public Health Division 200 Main Street, Hyannis, MA 02601 The information contained in this electronic transmission ("e-mail"), including any attachment(the "Information"), may be confidential or otherwise exempt from disclosure. It is for the addressee only. This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.As such, it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable. If you have received this e-mail by mistake, please notify the sender and delete it from your system. Please do not copy or forward it.Thank you for your cooperation. i From: McKean, Thomas Sent: Wednesday, June 24, 2020 12:17 PM To: Miorandi, Donna; Stanton, David Subject: Re: Craigville General Store The board of Health policy doesn't require a grease trap for ice cream and frozen desserts using homogenized ingredients only. He will have to ask the plumbing inspector about an under-the-sink grease interceptor. From: Miorandi, Donna Sent: Wednesday, June 24, 2020 12:08 PM To: McKean, Thomas; Stanton, David Subject: Craigville General Store Hello just a question if this guy is going to do soft serve ice cream will be need a grease trap or grease interceptor? Donna Sent from my tablet 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!' 2 Bellaire, Dianna From: Miorandi, Donna Sent: Friday,June 19, 2020 11:05 AM To: Bellaire, Dianna Subject: Re: Craigville General Store Hi I would think Servsafe just like Salty Cow and others like the closed Annie's Frozen yogurt. They are handling an open food product and need to know how to wash rinse and sanitize Donna Sent from my tablet -------- Original Message -------- From:"Bellaire, Dianna" Sent:Fri, 19 Jun 2020 11:00:15 -0400 To:"Miorandi, Donna" Cc:"Bellaire, Dianna" Subject:Craigville General Store Donna; He has applied for a retail food permit. If he does get approved for the frozen dessert machines, does he need a Servsafe/Allergen just for that and do I have to switch him to full on food or is it treated like Cumby's with a retail food combo at a discounted price of$200.00? That is a tricky one. He didn't provide Servsafe/Allergen with his applications because he was retail before and I didn't know about the ice cream. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The information contained in this electronic transmission("e-mail"),including any attachment(the"Information"),may be confidential or otherWise exerript fronr d.i.sclosure.It..s for:the addressee only."Phis Information may be privileged and confidential worlt-product oar a privileged and confidential communication.The Information may also be deliberative and pre.-decisional in nature_its such,it is for internal use only.1h.e Information may riot.be disclosed vithout the priorwritten consent of the Director ofPublic health and/or.the. Town Attorney's Office of the'Town of Barnstable. If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it.'Thank you for your.cooperation.. 1 i ' Town of Barnstable SHE Tp Regulatory Services Barnstable Thomas F. Geiler, Director ;mericaCity BARNSrA�. r Public Health Division 1639. �0 zooms Ar�DN1PYA 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: NAME OF FOOD ESTABLISHMENT: r6t P '1 ADDRESS OF FOOD ESTABLISHMENT: Cp� J t► ��� V e-V U c (G-// V 'A _c > -LO Z�` MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) ESTABLISHMENT: FOOD ESTABL � TELEPHONE NUMBER OF (_� '� NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: %-I, q� TYPICAL HOURS OF OPERATION MON FRI: TO T l_ DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) , o IF SEASONAL: APPROXIMATE DATES OF OPERATION: ***REMINDER*** - SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR T OPENG TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY , =- ra F D SERVICE RETAIL FOOD BED & BREAKFAST i - CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN BILE FOOD t'' OBACCO SALES �` G lee"( ' FROZEN DAIRY DESSERT MACHINE CATERING OUTSIDE DINING (OVER) ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT ' SOLE OWNER: YES /NO I ffAA ,, ADDRESS �` -e )Ale PHONE # IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: —12 e IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION �� FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERVSAFE) EFFECTIVE JANUARY 1, 2004, AND ALLERGEN AWARENESS TRAINED STAFF EFFECTIVE OCTOBER 1, 2010. EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS (i.e. ServSafe) AND ONE ALLERGEN AWARENESS TRAINED.STAFF MEMBER. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NA F TH ESTABLISHMENT ON EACH OF THE CERTIFICATES*** 1• EXPIRATION DATE: / / 2• EXPIRATION DATE: 3• EXPIRATION DATE: / / 4• EXPIRATION DATE: / / SIGNATURE OF APPLICANT AND DATE Q\Health\Application FormsToodappl.doc P�OpSHE Tafyti Barnstable o� Town_ of Barnstable ` BARNSrABLE, ` $ Board of Health '6 SS. .0 "rfc raa'�°i 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi November 26, 2012 Mr. Wayne Hyman Craigville General Store 628 Craigville Beach Road Centerville, MA 02632 Dear Mr. Hyman, On August 21, 2012, you were present at the public meeting of the Board of Health. The meeting was scheduled because you requested a hearing before the Board of Health in order to request permission to sell improperly labeled expired sandwiches. The sandwiches were prepared at Wimpy's Restaurant. However, Wimpy's Restaurant does not possess a Wholesaler's License. Also, you admitted that the sandwiches were not properly labeled and were expired. Therefore, during the hearing, the Board determined that these sandwiches cannot be sold to the public. You are hereby informed that the improperly labeled and expired sandwiches, manufactured at Wimpy's Restaurant, cannot be sold at your store. Since y, W yne iller, M.D. Cha' an BOARD OF HEALTH TOPWN OF BARNSTABLE Q:\WPFILES\GeneralStoreHyman2Ol2.doc ` r J / AN"711 i IMP AWAM FAF al I ,04 "fflm� WALL. /t LIB Li'.� L �' i .fLL� �► _� / ' _� / �)_ L � ', � C �• - / - ,:�/• � .+r vim u ! mam .L_ i/ ♦ /�._��� J .�/I oFINE TOWN OF BARNSTABLE HEALTH INSPECTOR,s Estabiisnment Name: Date: / age: of q OFFICE HOURS tT °� PUBLIC HEALTH DIVISION 8:00-9:30 A.M. ! 30 BARNSTABLE. = 200 MAIN STREET 3:MON. 0 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified sos-s 08-8 - HYANNIS,MA 02601 FRI. s2-asaa No Reference R-Red Item PLEASE PRINT CLEARLY rForA"� FOOD ESTABLISHMENT INSP TION REPORT n Name l "Date Type of Type of Inspection _. Ooerationfsl Routine �" Risk Foo rvice Re-inspection Address J JN~ /' ";r�I ii /' r l r v :�1 Previous Inspection / Level . e aI P Telephone L' Residedal Kitchen Date: p Mobile Pre-operation 0 ti V Owner HACCP Y/N Temporary Sus ec Illne 9 ( Caterer arieral Compla / Person in Charge PIC Bed&Breakfast 'HAGCP----- ) Time Other t� I n r- r Inspector � Z-214.6 , � I ( ut:-I v U li 1. Each violation checked requires an explanation on the narrativelpage(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) ❑ /f2_ V, � /:: Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ OTECTION MANAGEMENT F­] 12.Prevention of Contamination from Hands 1.PIC PR Assigned(Knowledgeable/Duties ❑ 13.Handwash Facilities ' _..,� EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ) I f ❑ 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 ❑ r _)16.Cooking Temperatures - /Y j `t f'✓ 7 ! f ❑ 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 1 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 YJ�� ' / ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories l v t Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Crilioal(C)violations-marked mull he uurrected immediately. (blue&red ilenrs) critical(N)violations must be corrected immediately or days as determined by the Corrective Action Required: L_I No ❑ Yes *in 90 Board of Health.. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23..Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 4po water,sewage back-up,infestation of rodents or insects,or lack of n-critical. If no critical 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address Viol tons ions observed,7 to 8 no�i-criticyal violations=C. refrigeration. t within 10 days of receipt of this order. 29.Special Requirements (590.009) 30.Other DATE OF RE-INSPECTION: I sp' ctor's Si! ✓ /�, qPrint: Print: rt } v' • q !9 '/ 31.Dumpster screened from public view Permit Posted o Y N Grease Trap Previous Pumping Date Grease Rendered Y #Seats Observed Frozen Dessert Machines: N PIC's Signature / / �•. \` / Outside Dining Y / Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen o Y N \ / i �I-Mffi v p MA� PAY MAMMA_ �. MOO' 1LL.� op FRAN M. / `IW.. .��i RMA ........... ----- mmd _ I_ 1/ 1� r, W, %.% � .. � f �, ;,,i ' A� �' } .i_ ;. 1 ,. i- L .�. , 1 i 1 � f 1 Town of Barnstable Regulatory Services aaRtvsrnBL& Thomas F. Geiler, Director 0r&039.iA Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 14, 2010 Steven C. Lundberg 32 Brigham Rd. y Berlin, MA. 01503 NOTICE TO ABATE VIOLATIONS OF SECTION 353-5, TOWN OF BARNSTABLE CODE. The property co-owned by you located at 628 Craigville Beach Road (Craigville General Store) in Hyannisport was inspected on 10/13/2010 by Donald Desmarais, RS, Health Inspector for the Town of Barnstable because of a complaint. The following violation of Section 353-5 of the Town of Barnstable Code was observed: 0 Outdoor rubbish and garbage storage area are visible to the public view. You are ordered to comply with this Code by: Completely screening in the outdoor rubbish and garbage storage area(s) within ninety (90) days of your receipt of this order letter. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Please be advised that failure to comply with an order will result in a fine of $100.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas McKean;RS, CHO Health Agent Citizen Web Request Page 1 of 1 I r 1a,e.%ssrneLI.;•; Ll.tiSt. Citizen Request Management - Internal Use ...�fD jl F.,.•.: J Request ID: 32334 Created: 10/12/2010 10:41:38AM Status: Closed Assigned To: Desmarais, Donald Health Office Anonymous: No Category: General s E.C. Date: 10/26/2010 Created By: Citizen Citations: Time Worked: 0.10 Response Time: 0.10 a �'Requestor Details: Email: Request Location: Craigville General Store 628 CRAIGVILLE BEACH ROAD Centerville, Ma 02632 Parcel Number: Map: 246 Block: 028 Lot: 000 Request: Unfenced dumpsters no screening,between General Store next to Craigville Pizza. Request Work History: Entered on 10/27/2010 8:18:18 AM by Desmarais, Donald not applicable right now. Internal Note History: System entry on 10/12/2010 10:41:38 AM: Assigned to Crocker,Sharon System entry on 10/12/2010 1:56:15 PM: Assigned to Desmarais,Donald System entry on 10/27/2010 8:18:50 AM: Request Closed by desmarad http://issgl2/lntemalWRS/)N'RequestPrint.aspx?ID=32334 8/22/2017 Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. BARNsTARLr- Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F. • Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 61 Issue Date: 06/17/2020 DBA: CRAIGVILLE GENERAL STORE OWNER: WAYNE H. HYMAN Location of Establishment: 628 CRAIGVILLE BEACH ROAD CENTERVILLE MA 02632 Type of Business Permit: RETAIL FOOD Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 _ FEES --- ----- - - ^� FOOD SERVICE ESTABLISHMENT: YEAR. 2OLO RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: -- - - -- MOBILE-FOOD: MOBILE-ICE CREAM: ' FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: 4n P of For Office Use Only: Initials: Town of Barnstable Date Paid Amt Pd$ NRNSTABLE, Inspectional Services s 1639. `e� Public Health Division check# cash Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 0 Office: 508-862-4644 Fax: 508-790-6304 ro APPLICATION FOR PERMIT TO OPERATE A/FOOD ESTABLISHMENT DATE WAO NEW OWNERSHIP RENEWAL t NAME OF FOOD ESTABLISHMENT: r CA,1010 1 ` Q ADDRESS OF FOOD ESTABLISHMENT: CrC�� ( <cJ MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Z4gr E-MAIL ADDRESS: ,r j v 1k C' " TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: I WELL WATER: YES_NO V ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: V/ DATES OF OPERATION: I/9�'AO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) OOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD VFROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV. FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:Wpplication FormsWOODAPP 2020.doc OWNER INFORMATION: A 1� FULL NAME OF APPLICANT V ����� •'\ SOLE OWNER: ES NO OWNER PHONE # r lQ J ADDRESS lQ 0 d� V i 1 oz-6� 61 CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: C/V 11 ` VVi VV 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 �� 0 gC Id 2. om D SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openine!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/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 Ist to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC lst. QAApplication FormsTOODAPP REV3-2019.doc BOARD OF HEALTH � Town o Barnstable John T.Norman ,l Board of Health Donald A.Gaudagnoli,M.D. kk: BARNSTABM Paul J.Canniff,D.M.D. ti1v\ DA-1K F.P. Thomas Lee Alternate �Artc '� 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790 6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 61 Issue Date: 06/17/2020 DBA: CRAIGVILLE GENERAL STORE OWNER: WAYNE H. HYMAN Location of Establishment: 628 CRAIGVILLE BEACH ROAD CENTERVILLE MA 02632 Type of Business Permit: RETAIL FOOD Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2020 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE - ICE CREAM: GQ� 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: oF�NE r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name:� �'I`/V 1 ate: age:4 of OFFICE HOURS AnnsrAe�e.o: PUBLIC 2 0 MAN STREET 3:30-4:30P.M. DIVISION /� : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. �p ,639,n�0� HYANNIS,MA 02601 506-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY rFoM OOD ESTABLISHMENT INSPE10MON REPORT A Name to o Type of Inspection J Operations) Routine Address62 a20kf,�D;`" k Food Service Re-inspection C Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness n fi Caterer General Complaint Person in Char a(PIC) Time Bed&Breakfast HACCP Other Inspector3 IN t: Each violation checked requires a explanation on the narrative a s an citation of specific provision(s)s violated. i q P P9.( ) P P ( ) Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE 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 a r ❑ 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 Violation ^�(� Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 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 l than 9 non-critical. If critical ' water,sewage 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right.to a hearing. Your request must ons and an non-cr no 9a back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 n Iola 'cal violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to Snon-critical violati`ns= 29.Special Requirements (590.009) within 10 days of receipt of this order. /� 30.Other DATE OF RE-INSPECTION: Ins P s Si nature e t: 31.Dumpster screened from public view. Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y IN #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Waft Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Lo Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41`F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* _ 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102:11 Common Name-Working Containers* * Other* 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* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage*g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An _ 3-302.15_ 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control Washing Fruits and Vegetables * ' Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) 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 or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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* 4-561.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* - Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.1IA(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145'F 15 sec* Animal Foods That are Raw,Undercooked or . � Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff c ire 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* - Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed _ Stuffing Containing Fish,Meat,Poultry or Chemical* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165'F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 11 3-201.17 Game Animals* 17 Reheating for Hot Holding Good Hygienic Practices 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) 3-202.11 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* Lu Proper Cooling of PHFs following sections of the Food Code and 705 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41'F/45'F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures I 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 Specialized Processing Methods* 1 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 1 Conformance with Approved Procedures* S:590Fonnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. t : °p,NE row TOWN OF BARNSTABLE HEATH IN Establishment Name: Date: Ic Page: of q 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 MON.-FRI. p ,639,p`00 HYANNIS, MA 02601 508-862-46" No Reference R-Red Item PLEASE PRINT CLEARLY .. FOOD ESTABLISHMENT INSPECTION REPORT C,t;-t l ✓ Cil✓1 Name Date p Type of Tvoe of Inspection C !` v Ooeration(s) Routine ,�G�� t)�/ Addressi #Zisk Food Service Re-inspection P K• Level ai Previous Inspection Telephone l tial Kitchen Date: - 72Mobile -operation Owner HACCP YIN Temporary Hess - Caterer Gen"efal Complaint C Person in Charge(PIC) �� �,t,� Time Bed&Breakfast HACCP Otherr �l C-;,In: Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑,i 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 v ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals v \ FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardou 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 Itemsl Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo Emergency Closure ❑ Voluntary Disposal Other: ❑ 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 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 4Hon-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no:hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack.of violations observed,7 to anon-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 violation,4 to 8Hon-critical violations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. = 30.Other PATE 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 YN PIC's Signature : Self Service Waft Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen Y N ✓ Violations related to Foodborne Illness Violations Related to Foodborne Illness`Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.). FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 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* * fY g g 3-501.16 A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to Other 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 7-20A1.11'''" Se aration-Stora e* Applicants* 3-302.11(A) Food Protection* 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* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 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 Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Equipment 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* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eJ/crivc uuzoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* f Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* When 3-401.11 2-301.14 Wh to Wash* A 1 All Other PHFs-145*F 15 sec* Other 590.009 violations relating to good retail ( )( )�) 3-201.17 Game Animals* 11 Good Hygienic Practices 1 7 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 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* 113 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashin Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification* g ( ) 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 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 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. °p THE rqy TOWN OF BARNSTABLE = HEALTH INSPEcroRs Establishment Name: )Date: Page: of b OFFICE HOURS 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 � �0� HYANNIS,MA 02601 -FRI. '659. 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY p�FU MAy° 8-8 FOOD ESTABLISHMENT INSP CTI N REPORT Name I Type of InIpection L Oneration(s) Routine Address ) Nan'k Risk F rvice' e-inspection Level tail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives x ❑ 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 1717.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: o El 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 to Otheitems, ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. JP)17ignaitur, , _ 8 itical violations=C. 30.Other PATE OF RE-INSPECTION: n Pri (vzy" 31.Dumpster screened from public view 7 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N '- Print: Self ServiceWait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N `� �/ Violations related to Foodborne Illness Violations Related to Foodborne Illness,lnterventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cone) 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 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41 EMPLOYEE HEALTH - - 3-302:11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to * 2 Other* 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-Stma e* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control .. 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPT17BLE 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 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* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 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* sf/""°e uuzooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 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 11 3-201.17 Game Animals* Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. g Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 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* 113 I Proper Cooling of PHFs following sections of the Food Cade 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 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 1 Specialized Processing Methods* 130. 1 Other 3-502.12 1 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. T 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. , �� l 1 g f THE/p TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: .�I GI'1I`V � (�` ate: 11 Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified � 63 q. �0� HYANNIS,MA 02601 MON.-FRL No Reference' R-Red Item PLEASE PRINT CLEARLY iOfFO MPS°' FOOD ESTABLISHMENT INSPECTION REPORT 508-862-4644 Name C � ��p ` D ��J�S Tyne of T e Ins ection Operation(s) Routine Address n117. C ;�1 1 �' Risk Food-Service Re-inspection F` Level amp Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness S' Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other �-M�Q- 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) ❑ A Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands (� ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) V\ ❑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) =E Corrective Action Required: No El Yes Non-critical(N)violations must be corrected immediately or Overall Rating Z within 90 days as determined by the Board of Health. Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled El Emergency Suspension C N Official Order for Correction:Based on an inspection t day,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ Emergency Closure Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4 non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9pon-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 29.Special equirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspec re 31.Dum ster 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 PI�gnature Print: Self Service Wait Service Provided Grease TrapSize Variance Letter Posted Y IN t � �33 � y- Dumpster Screen? Y N 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 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-]03.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 75 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 Infonna[ion-Original Containers* * 2 590.003 C Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F ( ) P Y7-102.11 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 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(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 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or 3-306.14(A)(B)Returned Food and Reted of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-80L11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs 3-202.16 Ice Made From Potable Drinking Water* CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 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 Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game * e ecme 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I 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 e ide in ca[er- 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 foodbthe appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* Other 90 illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other es shoo violations relating to good retail 590.004(C) Wild Mushrooms practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 77 Reheating for Hot Holding Requirements. 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11 A&D PHFs 165°F 15 sec* $ Receiving/Condition ( ) ( ) . 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food 140°F* (Blue Items 23-30) 3-202.15 Package Integrity* - Critical and non-critical violations,which do not relate to the foodborne * 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 3-101.11 Food Safe and Unadulterated 6 Tags/Records:Shellstock [5-203.11 90.004(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 Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Tags/Records:Fish Products Nuers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 -204.II 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* -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. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ' F� r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishmenty OFFICE HOURS Name: r���v/('� (2?✓1 P IrrA � y� Date: Page: of_� PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3: FRI.P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified N.- HYANNIS,MA 02601 MON. sos-as2-as4a No • Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT S Date v Type of a Ins ection C O + C Name E'/1 f H Operation(s) ou" Address 1 I Risk Fe ervice Re-inspection a V'. v Level Retail Previous Inspection Q U� Telephone i ential Kitchen Date: Mobile Pre-operation rp r.. Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other 1 e n v c �+ Inspector S Q Out: ` C i I` Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) - - Non-critical(N)violations must be corrected immediately or Corrective Action Required: o ❑ Yes within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusio ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. [10 Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must water,sewage back-up,infestation of rodents or insects,or lack of C=2 critR 21essth 4 non-critical. If no critical.28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violaritical violations=C. refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspect P n 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N i//�� V #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's nature �`;V Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen Y N Ile,//"." �.,,r,.-,,•-:w...-.-..•L..�.,�.-•._, ._'„�-,.r`:.-.-:r..:+ti� .�"..i--.. f''i.-../'•+-.s"'"."p,--�-'�-'` ..�+-"'*•.-c-- •.wr--�,�'.a`,.+..''...�"�.Y..n-/'�'- ','�^'�� "o-r�.,,r�.�.�--.......--r3--..k-.:..,.-..�.:'sue.-..r.«-'-tir --j%`-�'^.�.: .,,..,....V. � .�v;.-.-.`.r-:-� "ti,'. Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 7 5 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from EachIdentifying * 590.004(F) 7-]Ol.11 Information-Original Containers 2 590.003(C) Responsibility of the Person-in-Charge to Other* g 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits Restriction-Presence and Use*its and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 590. 3-304.11 Food Contact with Equipment and Utensils* * 590.004(11) Variance Requirements Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions 003(G) Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and AdulteReserrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* I Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* I Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 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 i 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1112001 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 P 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in ca[er- 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 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* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 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 * 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* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140*F to 70°F 3-203.12 Shellstock Identification Maintained" Conveniently Located and Accessible - Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 2 . Food and Food Protection FC-3 .00 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients[0 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: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. op�Herok TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: I vi �V1e / Date: b Page: of V .�. OFFICE HOURS -� on' PUBLIC 0 HEALTH N STREETDIVISION 8:00-9:30 A.M. 3:MON.-F30 P.M. eAPa E Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.- RI. HYANNIS, MA 02601 508-662-4644 No Reference R-Red Item PLEASE PRINT CLEARLY rFD MA+ FOOD ESTABLISHMENT INSP C ION REPORT "a Name - v� Date / Type of section Operation(s) Routi Address f Risk I Food Service Re-inspection cl-rl i4il, Level etail Previous nection t Telephone I ential Kitchen Date: , Mobile Pre-ope ti nl Owner HACCP Y/N Temporary Suspect Illness v Caterer General Complaint Person in Charge(PI ) Time Bed&Breakfast HACCP In: Other Inspector v S Out: f 13 Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. ' r � , P Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 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 O O u ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4..Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.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) Non-critical(N)violations must be corrected immediately or Overall Rating Corrective Action Required: No Yes within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclu Sion/ ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the iOde. checked indicate violations of 105 CMR 590.000/Federal Food C ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations. n no critical violations observed, 25.Equipment and Utensils 9 or more non-critical violations=F. (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 water,sewage back-up,infestation of rodents or insects,or lack of C=2 critic olatiAed, d less than 4 non-critical. If no 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 violat' ns o 7 to 8 non-crit al violations=C. g 29.Special Requirements (590.009) within 10 days of receipt of this order. Inspecto Signa re Pri 30.Other DATE OF RE-INSPECTION: 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 ature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N ��r �-�r_�..h..-, -.+�'1.'.�.�....-.,:--�•-�'_`r-.--`'.'�''"-.,.... �^...+c4•.r'1t.-Rio.-.-,....-�.�„y...1. �:.�,`...-....,...:-�+T._,..-••�-'_-�`'.'r�`,"�'�y a'`.Y..7.._�_.�'ti...'+`..r=•--'-.�..-`-�-...•..�J'..-�"`-,�..��-,'v't.- -�. ." .-""`a'-._`. ..._��•_` w _ - - -.�.- _�--..� ..-.. e:'"�-�,-... ..-. .. .� olatiorrs-.related to Foodborne ll/Hess Violations Related-to Foodborne Illness Interventions Interventions=and Risk;FdCtors,(Red Items,1=22) and Risk Factors(RedItems.1-22) (Cgnt.) TO.OD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According,to 1 590.003(A) Assignment ofResponsibi_lity* 8 Cross-contamination 14 Food.or Color Additives Law Cooled[0 41°F/45°F'Within_4 Hours* 590.003(B) Demon_stra_tion:cfvKnowledge* 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 ColdALo_k'.w 2-1.03.1'1 Person-in-_Charge'Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or$elow 41IT/45 F. .. 15 ;Poisonous or Toxic Substances �:EMPLOYEE:HEAL•TH• -• 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590i003(C) Responsibility J the'Person-:in--Charge to Other* Y g7-102.11 Common Name-Working Containers* 3-501.1,6(A) Hot PHFs Mairitained At or Above L40°,F*Require=Reporting-by Food?Employees and• Contamination,from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11_(A) Food Protection* 20 Time_asaPyblir:NealthControl 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as-a Public Health Control* Applicant To Report.To TheiPerson.In Charge* - * 7.202.12 Conditions of Use* 590.004 1 * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( 1) Variance Requirements 590.003(G) Reponing.by Person imCharge Contamination from the Consumer 3 590.003(D) Exclusions:and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and=Restrictions- - g ( ) Disposition ofAdulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOU 21 RCE 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 i9 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 3-20112 Food in a`rHernieticall Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y * P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid'Milk:and Mi1k:Products 4-501.112. Mechanical Warewashing-Hot Water Monitoring 3-202.13 Shell-Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(l)(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 Equipment* Not Otherwise-Processed to Eliminate 590.006(A) Bottled'Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* EJf"rive 11112001 4=602.11 Cleaning Frequency of Utensils and Food animals-155°F 15 sec* 590.006(B) Water-Meets Standards in 310-CMR 210* 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* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.14 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 NSS15 Listed Chemical* Ratites-165°F 15 sec* Sources* Proper,Adequate Handwashing ing'mobile food,temporaryand residential 10 ' Game and Wild`Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Re#ulatoryA'uthority 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 Shdllstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 3-201.17 Game Animals* Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received atProper Temperatures* 2-401.42 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 foodbore 3-101.11 Food Safe and Unadulterated* 2 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:'Sfiellstock 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 RetafLPractices V-5 590000 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 003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection 004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste 006 590.004(J) 'Labeling of Ingredients* Supplied with Soap and hand Drying Devices / 27 Physical Facility .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 Fond Code or 105 CMR 590,000. HEALTH INSPECTOR'S Establishment Name: V/ I Date: Page: of tHE) i TOWN OF BARNSTABLE _ --� OFFICE:HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. * 200 MAIN STREET 3: FRI.P.M.MON. Item Code -C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 9 MASS. N.- �, t6}9•A 0 HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY rEO MPS FOOD ESTABLISHMENT INSPECTION REPORT Name Date TvDe of of Inspection C fq h 1'e "e�� Operation(s) I Routin Address ) Risk Food Service e-inspection ' rr r I/df Level r4ga-b Previous Inspection t71 41 ry do esrdential Kitchen Date: Telephone Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC Time Bed&Breakfast HACCP Al d J f r11In: Other Inspector in �` � n Out: _ 3 2 �. . Qvi 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) ❑ W A i\ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ r Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ ^( \ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands D F ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 01W e EMPLOYEE HEALTH PROTECTION FROM CHEMICALS IVS1 41 1 =RVr f ji,14 ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No Yes Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations. n no critical violations observed, and Utensils FC-4 590.005 9 or more non-critical violations=F. 25.Equipment ( )( ) 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 s water,sewage back-up,infestation of rodents or insects,or lack of C=2 critical o nd less than 4 non-critical. If no critical refri eration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violatio s obsery ,7 to 8 non- itical violations=C. 9 29.Special Requirements (590.009) within 10 days of receipt of this order. Inspector' Sign r Pr'lAvird 30.Other DATE OF RE-INSPECTION: ^n, s 31.Dumpster screened from public view V" �V, Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signa ure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N -,.,f'.:r. -�..:-'"--...--.._y..-�, .• .-_..��-..-..� ...�.•�_,--._ -.r-- .�-- �. --w.�!�,;.r- ...v .�" �-.s. -.�.-.. -L.sc�.""r'`�.....�,,.r^.-v..�:<a,��..a:.r•q-c.�r.--yw..•-.�-..-.a,.^�"'�+�,�-a.,.�•-•,.r--c-_.--�,..:�,r�'-�:�. ...- •� �..-..:. .....^�1-....+� .4.. .- v y r. ��•�/^.. Violationsi etated�to'-FoodbtFrne Himess Violations=Related tozFogdkgmtJeJflness InterypnAOns lntervvndans�and Risk Faictors:(Red Items 1.22) and Rfsk;Factors tF&ed Items 1.=22) (Pont) Fg9D P,ROTEeTIQN MANAGEMENT ':PROTECTION FROM CONTAMINATION P-ROTEC 10.FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures Accordingxo 1 590.003(A) Assignment of,Responsibility* 8 Cross-contamination 1q Food.or Color Additives Law,CooledloAi°'F/45°FWthin433oprs* 590:003('B) Demonstnation:ofKnowledge* - 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for`PF1Fs Cooked and;RTE Foods.* 79 ,PHF11ot,and-C9jdsHattlirZg 2-103.11 Person-in-Cbtarge:Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold l-,,Fs Maii tamed At orBelow:41 F/45 F. _ 590.004(F) - :�EMRLAYEE=HEALIF7 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibiljty of the person-;in Charge to Other* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers* eguireRepoiting'by F.00d.Employees and Contamination from the Environment 3-501.1.6(A) Roasts Held At or Above 130°F * 7-201.11 Separation-Storage* APPlloants 3-302.11(A) Food Protection* 20 Time;as�Publiclleeltf+CoAirol 7-202.11 Restriction-Presence and Use* 590:003(F) J2esponsibliq of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Re tot To'�%he1Persom-In.Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590,004.(1I) Variance Requirements 590.00 1" eporting;by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590:003(D) `Exclusions,-tnd Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rratedor of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590:003(E) -Removaj ofExclysionsland•Restrictions -' Disposition of Adulterated or Contaminated g ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOO FROM APPROVEDD'SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* q Food and Water From R.egulatedS,ources ,9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A=1B) Compliance with Food Law* 4b501.111 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 wHermeticall 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 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 'Shell'Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption.of 5-101.11 Drinking Waterfrom an Approved System* Eggs 4-601.14(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* NobOtherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg cti e 1112001 4-602.11 Cleaning Frequency of Utensils and Food animals-155°F 15 sec* 590.006(B) Water Meets Standards in'310 CM'R 22 0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shel�shandFish From am Approved Source 3-40L11(B)(1)(2) Pork and Beef Roast-130°F121min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught'Molluscan Contact Surfaces of Equipment* Shellfish* 4-703:11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 'Molluscan Shellfish from NSSP Listed Chemical* g ry 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 9U 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* RegalatoryAuthority, 3-401.12 Raw Animal Foods Cooked in Microwave the appropriate sections above if related to 3-202.18 Shellstock identi'ft>;ation'Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590:004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590M09 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Radices should be debited under#29-Special 5 ReFC61vinglC'orldition 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/Recoias:shells'tock 590.004('E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 3-501.14 A 3-202.18 Shellstock Identification 13 Hiridwashing Facilities ( ) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification�Maintalned * Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F Item Good.Retail-Practices FC "590t000 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 Supplied with Soap and hand Drying Devices 590.004(J) Labeling of Ingredients' / 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 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. °FVErq� TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: d'e,�4�°(( � �'o Pfu��f��Date: l Page:_�of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. ` 200 MAIN STREET 3:30-4:30 P.M. BARNSTABLE. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mass. MON.-FRI. p .679•A 0� HYANNIS, MA 02601 508-8624644 No Reference R-Red Item PLEASE PRINT CLEARLY 'FD MPS FOOD ESTABLISHMENT INSPECTION REPORT 4- At:fAf L n An Name Date Tvoeofof Type of Inspection (, Q r f 2 t l - Operation(s) _od.&e once Re x Address Risk Fo ce Re-inspection C"��r V' �!`�/ Level etai Pre us speration1JA C � Telephone ential Kitchen Date:�� Mobile Pre-operl3tli n r Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint d Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector � InJ �� �� Out: 0 Each violation checked requires an explanation on the narrative pages)and a citation of specific provision(s)violated. 0 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) ❑ AA I c FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 6 pin in d EMPLOYEE HEALTH PROTECTION FROM CHEMICALS �:A 0,1 7L Of ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals d �� FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures t r I rr ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ,f r ❑ 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) t d ❑ 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 Violations Related to Good Retail Practices(Blue Itemsi Total Number of Critical Violations A Critical(C)violations marked must be corrected immediately. (blue&red items) %Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No es within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must or insects,or lack of C=2 critical violations and less than 4non-critical. If no critical water,sewage back-up,infestation of rodents 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations rve to 8 non-critical violations=C. refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's S natur Print 31.Dumpster screened from public view �, 0 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signa ure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N i:Violation,s-,related,to-iFoodborneallness Y1olatjons:Related^to<FoQdbor(teIllness lntery�f ons ,Interventions,and Riskfaetors,fR,ed9tenls 1=22,) and Risk Factors,(Red_/;emst1-;�2) (font) FPQD PROTECTION MANA•GE11VIENT :PROTECTION FROM CONTAMINATION PROTECTIQW..FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures Accordingito 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) Demonstrgtion..Qf�nowledge* - 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods forJ'kIFs Cooked and RTE Foods.* * 19 P iFJiot andigglddialldteg 2-103.L1 Person-in-•CFiarge Duties 3-302.14 - Protection from Unapproved Additives - Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintatned At cir'Betow:41°F/45°F 590.004(F) t EMPL9YEE HE7�LTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 596.003(C) -'Respgnsibjljty of=the Person-ja-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140'F - - - RegwreRepolYi/tg by;Food ftployees and Contamination•from the Environment 3-501.16(A) Roasts Feld At or Above HOT* * 7-201.11 Separation-Storage* Applicants 3..302.11(A) Food Protection* 20 Timers a Publlo,Health.Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responslbtlity of A Food fjmployee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public{fealth:Control* A pltcaia,To Rep-Qr3 T'P law Peison.I,n Charge* 7.202.12 Conditions of Use* - 3-304.11 Food Contact with Equipment and Utensils* 590.004.{11) Variance Requirements 590.0.03.(G) Reporting byFerson in C Contamination from the Consumer harge* 7-203.11 Toxic Containers-Prohibitions* _ 3 590.003(D) Exciusionsynd Restrictjnris* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 1590.003(E) ,Removal of:Eatcluaons 4nd-Restrictions` g ( ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Waterfrom Rggulated Sources si, Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) CoWpkance 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 3-201.12 Food in alHermetically Sealed Contaiper Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid.-Milk and Milk Products* 4-501.112 Mechanical`Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell'Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 76 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 4-601.1.1(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* r Eggs Not Otherwise Processed to Eliminate Equipment 590.006(A) Botded-Drinking-Water* 4-602.11 Cleaning Frequency of Utensils and Food 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* 4d c'i"11112001 ,590.OD6($ animals-155°F 15 sec*) Water Meets Standards 310 CMR 22.,0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish FromanApproved 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 Caugbt Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.41 Methods of Sanitization-Hot Water and Stuffing ContainingFish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ry 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 90 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Garinatfie aafy Aul YNushrooins Approved By 2-301.11 Clean Condition-Hands and Arms* RegulataryJlr/thoiity 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms * 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Ga(i1e Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Coaaition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHIF's Received at-Proper Temperatures* 2-401A 2 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercial) Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity y Critical and non-critical violations,which do not relate to the 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 g Tags/Recdfds:'SFiellstoek 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 Item Good�RetailPractices 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 () 9 9 / 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.006 3-502.11 Specialized Processing'Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback&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.HE r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: age: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3: FRI.o P.M. Item Code C-Critical Item - DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MON. MAC HYANNIS,MA 02601 MON.- t679•pie 508-862-4644 No . Reference R-Red Item PLEASE PRINT CLEARLY 'F0 MP` FOOD ESTABLISHMENT INSPEtCTION REPORT r Name - ate a of �e of Inspection Ooeration(s) Routine Addres k Food Service Re-inspection "el Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP m Other Inspecto / O Each violation checked requires an explanation on the narrati a 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 o ,_ ❑ 1.PIC Assigned/Knowledgeable/Duties 13.Handwash Facilities (/J�cM_P/ EMPLOYEE HEALTH PROTECTION FROM CHEMICALS vu ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 1� ❑ �e 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) X4.Food and Water from Approved Source ❑ 16.Cooking Temperatures 4p .Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans �;O. 9.Hot and Cold Holding a PROTECTION FROM CONTAMINATION 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 I� Critical(C)violations marked must be corrected immediately. (blue&red items) I_J Yes Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No ❑ 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food-Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility i (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less thn 4 h-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of refri eration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address tions observed,7 to 8 n-c ti 1 violations=C. g 29.Special Requirements (590.009) within 10 days of receipt of this order. ' 30.Other ' DATE OF RE-INSPECTION: ns cto i tur Q Pri' 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 I s t Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) ' FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous Identifying Information-Original Containers Poisonous or Toxic Substances 3=501.16('B) Cold PHFs Maintained-At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* PP * ' A licants 7-201.11 Separation-Storage*3-302.11(A) Food Protection* 20 Time as a Public Health Control 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(F) Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* 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 Sanitizers,Criteria-Chemicals* I 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 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* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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* i 3-401.11A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* - 3 401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef dive 1/IROOI 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* Eggs* 3-20L14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* - 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or ' 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* � g g ry' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Proper,Adequate-Handwashing Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Game and Wild Mushrooms Approved By ( • )(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.11C3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14, When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 77 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe,and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found.in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs P 9 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 10°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 () 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 1 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. Op IHE r \�/} TOWN OF BARNSTABLE _ _ _ HEATH.INSPECTORS Establishment Name: Date: age: Of @C OFFICE HOURS PUBLIC MAIN HEALTH DIVISION : 0- :30 M.3:30-4:3o RM. 2O ET Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified "'".�S HYANNIS,MA 02601 08-8 -FRI. �A t639•a`0 111 - 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEA L rFO MA'S OOD ESTABLISHMENT INSP CT)ON REPORT Name ate T3112e of bite of Inspection J O era ions Rou' Address (.« k F rvice e-tnsgec Io vet etas spection I IF Telephone ential Kitchen Date:_ Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illnessn7r Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspector_ A Each violation checked requires an explanation on the narrativ 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 I On 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 "r- ❑ 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 Q 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 v PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 1.0.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices Blue Items) � Total Number of Critical Violations Critical(C)violations rnaiked must be corrected Immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No TO Yes 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and.Food Preparation -(FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils FC 4 590.005 9 or more non-critical violations=F. ( )( ) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 26.Water,Plumbing and Waste r (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 water,sewage back-up,infestation of rodents or insects,or lack of C=2 critical violations and less than 4 on-critical. If no 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 violations observed,7 to 8 on- " cal violations=C. g 29.Special Requirements (590.009) within 10 days of receipt of this order. nature 0ct ig /J Pri 30.Other DATE OF RE-INSPECTION: sp 0 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 sMure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y, N Dumpster Screen? Y N f ..�h,.•-.-..�.��,-..-4..�a.......r �-�r. ..,,�.J,.�_.....,r-..]rK'wy.�.,•^�_d.-. ....-.r :::.:.�•J..:...e.e��cavl.....c sr .ter.-..}"?,y.- Y ... � -..� »--i..._.-..-._ �- ,. s Y 1t Violations related to Foodbome Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT _ PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 19 PHF Hotand.Cold Holding i' 3-302.14 Protection from Unapproved Additives* ti Contamination from Raw Ingredients 15 Poisonous or Toxic Substances i 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 590.004(F) p 7-101.11 Identifying Information-Original Containers* 2 590.003(C) _Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* pP * Alicants � � 3-302.11(A) Food Protection* - .- 7-201.11 Separation-Storage* 20 Time as a Public Health.ConUol 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* ti 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* 3.306.14(A)(B)Returned Food and Reservice of Food* REQUIREMENTS FOR 590.003(E) I Removal of Exclusions and Restrictions - I 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 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 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* - 4-501.112 ' Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'F 15 sec 22 3-603.11 i Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from An Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective!///2001 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 - 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs W'SPECIAUREQUIREMENTS �r 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" - Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Game and Wild Mushrooms ApprovedB 3401.11Cy ( )(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under RegulatoryAuthority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18- Shellstock Identification-Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 ' - - Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g• g g 3 403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 13-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbore 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsticed 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 590.0003-202.18 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 ?r.FC-2­1 lmf .003 "+ 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .00.4 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 WasteFC=51 y .006-. 590.004 J Labeling of Ingredients* Supplied with Soap and hand Drying Devices O 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Fonnback6-2doc `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical itcm in the federal 1999 Food Code or 105 CMR 590.000. ME TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: age: of `OFT r�W,t, OFFICE HOURS - P ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:MON. 0 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 508-8 08-8 -62-4644 No Reference R-Red Item HYANNIS,MA 02601 FRI. PLEASE PRINT CLEARLY `EDN1P` FOOD ESTABLISHMENT INSP TION REPORT Name Date T e o Type of Inspection Operation(s) Routine Address i Foo ice Re-inspection L' a al Previous Inspection Telephone ial Kitchen Date: IMW Mobile Pre-operation _ Owner HACCP Y/N Temporary Sus ec Caterer a eral Complain Person in Charge(PIC) Time Bed&Breakfast Other Inspect r -7,m 1 ' 9 . -07�A - -1 y ut: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS MR r i ❑ 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) ON ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures In 7DO ❑ 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 SUSCEPTIBL LPOPULWO-NS(HSP) _ 11 f ❑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) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No ❑ Yes within 90 days as determined b the Board of Health. Overall Rating Y Y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled El Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6 590.007 aggrieved by this order,you have a right to a hearing. Your request must water,sewage back-up,infestation of rodents or insects,or lack of y )( ) be in writing and submitted to the Board of Health at the above address C=2 critical violations and less th . 4 n -critical. If no critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 iola I s observed,7 to 8 n n-.Cr,. � I violations=C. 590.009 within 10 days of receipt of this order. : 29.Special Requirements ( ) Print- - s ctor's ign tur � 30.Other DATE OF RE-INSPECTION: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N Signature Print:, #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N �� `,( \!� .-- (A/ "kD Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodbome Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45`F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3,501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and.Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances - 3-501.16(B) Cold PHFs Maintained At or-Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 590.004(F) _ _ _ _ __ _ _ 7-101.11 Identifying Information-Original Containers 2 590.003(C) Responsibility of the Person-in-Charge to 'Other* * 3-50LI6(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* PP * A licants 7-201.11 Separation-Storage*3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) (Responsibility ofAFood Employee or An 3= 7-202.11 Restriction-Presence and Use*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 Sanitizers,Criteria-Chemicals* 3-306.14(A)(B)Returned Food and Reservice of Food* I REQUIREMENTS FOR 590.003(E) i 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* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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 o * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* f f 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* Ef cri"11112001 4-602.11 Cleaning Frequency of Utensils and Food 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* Animals-155°F 15 sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(13)(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* Eggs* 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 tE 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Cfiemical* g g ry 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* in mobile food,temporary and residential 10 _ Proper,Adequate Handwashing g• P azY Game and Wild Mushrooms Approved By 3401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3401.12 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* 2-3.01.14 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* I Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140`F to 70°F 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 6-301.11 Handwashing Cleanser,Availability 28. Physical Facility FC-6 .008 7 Conformance with Approved Procedures/ g y 28. Poisonous or Toxic Materials ' FC-7 008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 61 BOARD OF HEALTH PERMIT TO OPERATE_A.,FOOD ESTABLISHMENT In accordance with regulatiops.,pro lulgated,q� 6-,211t hority of Chapter 94, ' a.» ermit is hereby ranted to: Section 395A and Chapter'1,�1, ect�on.„fie#tk Genll p Y g WAYNE HYMAN D�BA s - CFfVILLE GENERAL STORE Whose place of business is 2C A „ 2632 A Type of business and any restrictid .Af ETA EODD4 �' LISHMEJ < To operate a food establishment in the 10 1'01=`� Af N, ' kT3LE RESTRICTIONS IF ANY: qp -- SEATING: 0 ANNUAL SEASONAL: YES TEMPORARY; >E E S yRO OF HEALTH RETAIL FOOD STORE: 100 00 1f I�rn Miller, M.D., Chairperson FOOD SERVICE ESTABLISHMENT: x RESIDENTIAL KITCHEN FOR RETAIL SALE.'- , auY.!`10 Canniff, D.M.D. �chi Sawayanaqi RESIDENTIAL KITCHEN FOR BED+BREAKFAST MOBILE FOOD UNIT: ei#>'XIA'eS. (� TOBACCO SALES: D�,eter It 3'-,' � FROZEN DESSERT: � .tea* ' Thomas A. McKean, RS, CHO CATERER: -� - A Director of Public Health Town of Barnstable .. &�60 I rvb °FTHE T�� Regulatory Services Barnstable -�� P� Thomas F. Geiler, Director A&Amenlea GRYoff® * BARNSTABLE, * �� MASS. �$ c -Public Health Division y 1639. 2007 A'Ep 6. Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 ; 1 - �n IV Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: TZA1 IM 4 . MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) TELEPHONE NUMBER OF FO ST ISHMENT: NUMBER OF SEATS: INSIDE. OUTSIDE: TOTAL: �l TOTAL NUMBER2,0F BATHROOMS: _ - . •i2,° ��a and � ANNUAL`OR SEASONAL OPERATION: GC ty . �� Nam/ TYPICAL HOURS+OF OPERATION MON-FRI: TO DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) S 4A S I' 1d f IF SEASONAL: APPROXIMATE DATES OF OPERATION. rl / TO ***REMINDER*** a SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING ch TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY 5 A-Z OD SERVICE ti/ RETAIL FOOD k 730 :,!BED'& BREAKFAST 1 [ Y�/S�� CONTINENTAL BREAKFAST L ' O I 1 ) RESIDENTIAL KITCHEN s MOBILE FOOD �� � � y ` �� Pam TOBACCO SALES -1 � J� FROZEN DAIRY DESSERT MACHINES � V ' CATERING J��` OUTSIDE DINING ,� (OVER) Q:\Health\Application Forms\Foodappl.doc `' ***REMINDER*** i :., CIF'OfJTSIDE DINING, YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLI T y`� ��� ► ►l '"'C SOLE OWNER: YES / O ADDRESS UCynizwldle': Z� PHONE # (SO ) IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF.(I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, AND ALLERGEN CEI D STAFF EFFECTIVE OCTOBER 1, 2010. EACH FOOD SERVICE ESTABL ENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTI D STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQIMMD ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE ME OF THE ESTABLISHMENT ON THE CERTIFICATES*** 1. EXPIRATION DATE: / ' / 2. EXPIRATION DATE: 3. EXPIRATION DATE: 4. EXPIRATION DATE: / / SIGNATURE OF APPLICANT AND DATE Q:\Health\Application Fonns\Foodappl.doc I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments M 628 CRAIGVILLE BEACH RD Property Address WEBSTER FIRST FED CREDIT UNION Owner Owners Name information is required for CENTERVILLE MA 02632 2-22-14 every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out c T g q 'o forms on the v--L— computer, use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the } information reported below is true, accurate and complete as of the time of the ins� ction. Thepirispfion .,a ,.p was performed based on my training and experience in the proper function and mintenance::af on she sewage disposal systems. I am a DEP approved system inspector pursuant to"Section 115-.340V Title 5(310 CMR 15.000).The system: , o ® Passes ❑ Conditionally Passes ❑ Fails F r ❑ Needs Further Evaluation by the Local Approving Authority f r .'�--- 2-22-14 Inspector's Sig ture Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does.not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 628 CRAIGVILLE BEACH RD Property Address WEBSTER FIRST FED CREDIT UNION Owner Owner's Name information is required for CENTERVILLE MA 02632 2-22-14 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or.in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM HAS HAD VERY LITTLE USE SINCE IT WAS INSTALLED 13) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): �I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection: Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 628 CRAIGVILLE BEACH RD Property Address WEBSTER FIRST FED CREDIT UNION Owner Owners Name information is required for CENTERVILLE MA 02632 2-22-14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 628 CRAIGVILLE BEACH RD Property Address WEBSTER FIRST FED CREDIT UNION Owner Owner's Name information is required for CENTERVILLE MA 02632 2-22-14 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cost.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspggl ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection `Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 628 CRAIGVILLE BEACH R M C D 50� Property Address WEBSTER FIRST FED CREDIT UNION Owner Owner's Name information is required for CENTERVILLE MA 02632 2-22-14 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than75 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D.. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M , 628 CRAIGVILLE BEACH RD Property Address WEBSTER FIRST FED CREDIT UNION Owner Owner's Name information is required for CENTERVILLE MA 02632 2-22-14 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? P ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): SEE PLAN Number of bedrooms(actual): SEE PLAN DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): SEE PLAN t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts a . Title 5 Official Inspection pect on Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 628 CRAIGVILLE BEACH RD Property Address WEBSTER FIRST FED CREDIT UNION Owner Owner's Name information is required for CENTERVILLE MA 02632 2-22-14 every page. City/Town State Zip Code Date of Inspection D. System Information Description: SYSTEM CONSISTS OF A 1500 2 COMP TAND D-BOX AND 2 500 GALLON CHAMBERS SEE PLAN FOR DESIGN FLOW Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: PROPERTY HAS BEEN MOSTLY VACANT WATER USAGE HAS BEEN MINIMUM Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: APARTMENT UP AND GENERAL STORE DOWN Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water.meter readings, if available: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 628 CRAIGVILLE BEACH RD Property Address WEBSTER FIRST FED CREDIT UNION Owner Owner's Name information is required for CENTERVILLE MA 02632 2-22-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): PROPERTY HAS APPARTMENT UP STAIRS AND A GENERAL STORE DOWN STAIRS General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy [] Shared system (yes or no) (if yes, attach previous inspection records, if any) El Innovative/Alternative technology. Attach'a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 628 CRAIGVILLE BEACH RD Property Address WEBSTER FIRST FED CREDIT UNION Owner Owner's Name information is required for CENTERVILLE MA 02632 2-22-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: SYSTEM WAS INSTALLED IN 2010 OR 2011 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): {Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 2-COMP Sludge depth: TRACE t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments wM 628 CRAIGVILLE BEACH RD Property Address WEBSTER FIRST FED CREDIT UNION Owner Owner's Name information is E MA 02632 2-22-14 required for CENTERVILL l every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? WOODEN POLE Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK WAS CLEAN AT TIME OF INSPECTION WITH ALL TEES IN PLACE Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 f Commonwealth of Massachusetts - Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 628 CRAIGVILLE BEACH RD Property Address P Y WEBSTER FIRST FED CREDIT UNION Owner Owner's Name information is required for CENTERVILLE MA 02632 2-22-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments M , 628 CRAIGVILLE BEACH RD Property Address WEBSTER FIRST FED CREDIT UNION Owner Owners Name information is required for CENTERVILLE MA 02632 2-22-14 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX LEVEL NO SIGNS OF LEAKAGE OR FAILURE Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 628 CRAIGVILLE BEACH RD Property Address WEBSTER FIRST FED CREDIT UNION Owner Owner's Name information is required for CENTERVILLE MA 02632 2-22-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): CHAMBERS WERE DRY AT TIME OF INSPECTION WITH NO SIGNS OF FAILURE Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 628 CRAIGVILLE BEACH RD Property Address WEBSTER FIRST FED CREDIT UNION Owner Owner's Name information is required for CENTERVILLE MA 02632 2-22-14 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 628 CRAIGVILLE BEACH RD Property Address WEBSTER FIRST FED CREDIT UNION Owner Owner's Name information is required for CENTERVILLE MA 02632 2-22-14 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 628 CRAIGVILLE BEACH RD Property Address WEBSTER FIRST FED CREDIT UNION Owner Owner's Name information is required for CENTERVILLE MA 02632 2-22-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: GREATER THAN 5 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: ATTACHED Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 16 of 17 I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM , 628 CRAIGVILLE BEACH RD Property Address WEBSTER FIRST FED CREDIT UNION Owner Owner's Name information is required for CENTERVILLE MA 02632 2-22-14 every page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION fi.`C�i C Coin V,II P lea-,r��C� SEWAGE# VILLAGE(der%J)p ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.*_N, Vc A _&=w J�N1C, SEPTIC TANK CAPACITY ISM :!,irnM LEACHING FACILITY:(type) (SiZO) I+►I X 23 XI It.XC NO.OF BEDROOMS OWNER G11,&�betw PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility J g 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 lest • ditty) - Feet FURNISHED BY CAP ON n z-13 3_rs 1 _ W-20,s P c ,5--17.S Z M �.-10�S � I m p 3- 31,S y htt„•/Am7,Tw tnwnnfhsrnstable_us/Assessing/HMdisnlay.asD?mannar=246028&seQ=1 2/20/2014 97.52 100.4 7 - -100 -EXISTING CONTOUR ® r 99.. 9 x 100.98 EXISTING SPOT GRADE r � 100.00 -W-EXISTING WATER SERVICE LAKE�� __ \ i LOCUS : J j7\ 10S 489 32 10 E edge of ovemen7-h 100.90 'EXISTING GAS SERVICE ve 63.91' -U-UNDERGROUND WIRES AllO a poler OVERHEAD WIRES 100.78 ® TEST PIT b BENCHMARK / 99.69 \ 3 LEGEND Crel Mlle I Q) P CRAIGNLLE BEACH 7� C >; 97.4 2 99.64 LOCUS MAP Paved,Parking NOT TO SCALE p I� +� � °w 99.55 \ 3 98.77'Q I /� `> ed a or 99.67 \ 100.40 GENERAL NOTES: e ovemenf yY� �\ 100'00. 5 04 1,ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL h 100.76 100 10 �26 ip M, ' ' x BOARD OF HEALTH AND TIME DESIGN ENGINEER. A 100.25 -10012 98.47 �.N x_]0041 �� / S/BI 2.ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENV I N NTAL CODE, TITLE V, AND ANY APPLICABLE 2 q ,�r''`�} Storo e o y"0.40 LOCAL RULES AND REGULATIONS. PROPOSED SEPTIC TANK ) t� Sired I/. x' j �/ a 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR CONTRACTOR SHALL LOCATE, PUMP, 00�1 ji/ /�/'^ I E I DE INSPECTION AND APPROVAL 8Y THE BOARD OF HEALTH AND THE 21' 00.88 DESIGN ENGINEER. EXISTING CESSPOOL (opprox.) /,', E� 100.57 _ / ��,/ p a 4.ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FILL WITH SAND AND ABANDON r �'-V O / ' EXISTING/ // / z ° G FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN OR REMOVE, SEE NOTE 11. 1-10' / ( �// -k ENGINEER BEFORE CONSTRUCTION CONTINUES. .66 -� / BUILDING 628 i j 100.96 / I • / 0 3 a 5:ALL ELEVATIONS BASED ON ASSUMED DATUM. ••P-12 101.02 '1st Floor-Retall.Store 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF IN. THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF Id A Nl< %2st Floor-2 BR Apf./. HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 100i. iN !7 J�1.04ov meet /;'(Crawl Space)/::/�, ea, v N t 1. p ,../ y� w a c 7.WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. ///�_... E o c`- ; ;, VENT 'IIr Q ',7 '�O' / / i/f 101.43 c 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. a `�'I �' I / /' '/ / 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS e I 'I 1�1.2 :e•==. / AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 0.51 e 9 I. ""I"'olk ;1; y DIRECTED BY THE APPROVING AUTHORITIES. 100.90 /}t--11.2=1 00.88 0 _ 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 101,49 101.71 101.14 Q.101.03 ,�^ �.;� it , THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING . CONSTRUCTION. Paved Parking a 101.30 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS !/ .g I OF 1149 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE✓ S.A.S. AND S 101.32 s S/ a �� J' REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). E c„P 'C S`S? .°' APN 246-028 '2 PETER T. dG 12, AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE J?° v o ✓ Benchmark Set \ 1119ofS, SIGN 101.33 � McENTEE INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. Y Orange Paint/Conc, Pad F < .F. 10I,66 ` CIVIL 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND EL.=101.24 (Assumed) 101.94 Cn w D IP' 0. 35109 IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 3 51.50' 10157 E((i4 �Q IC THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC y sidewolk 101. 6 N 88'48'05" E 101.SB sidewolk SYSTEM COMPONENTS WHICH MAY EXIST ON THE PROPERTY. 101.27 101.63 entconce opron IQ1.3o PROPOSED SEPTIC SYSTEM UPGRADE PLAN 101.43c11b I01.59 edge of`p vement y 101.35 L� 628 CRAIGVILLE BEACH ROAD, CENTERVILLE MA "\ * Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 CRAIGVILLE BEACH ROAD OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. F DATA - LUNDBERG, STEVEN C & IA' FIRM RM PANEL 250001 0008 D M ARLENE ROBERTS. Engineering Works 1"=20' P.T.M. 150-10 REVISED JULY 2, 1992 32 BRIGHAM ROAD 12,West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. ZONE C' BERLIN, MA 01505 (508) 477-5313 5/26/10 P.T.M. 1 of 2 I PERMIT NO: TOWN OF BARNSTABLE ISSUE DATE 61 BOARD EALTH 04/01/2018 ' PERMIT TO ���ABLISHMENT �._ In accordance lgtioga ftzu- ority of Chapter 94, Section 395A andteil ec a"�ermit is hereby granted to: GORDON MARK LI[ B lr �F AIGVILLE A ORE Whose place of business i i RAIG_ s ,. CENT _ L kA 02632 b Type of business and any eAtr�t s: BLISHA To operate a food establish eA 114the ABLE V, v . RESTRICTIONS IF ANY: 5'F rp ..a Y Fib. ��dbac' aCX BS Ate:C � G[�r � • SEATING: 0 ANNUAL{ SEASONAL: YES TEMPO I? : i _ � „a 3r - E E S OF HEALTH RETAIL FOOD STORE: $ 0.00 ? J.Canniff, D.M.D.Chairperson FOOD SERVICE ESTABLISHMENT: RESIDENTIAL KITCHEN FOR RETAIL SALE: _ ichi Sawayanagi ` <, RESIDENTIAL.KITCHEN FOR BED+BREAKFA ;a onald A.Guadacjnoli, M.D MOBILE FOOD UNIT: e TOBACCO SALES: gpp FROZEN DESSERT. ~`` Thomas A. McKean R$ CHO CATERER: Director of Public Health PERMIT NO: TOWN OF BARNSTABLE ISSUE DATE I!,I 61 BOARC��_.R LTH 12/28/2016' PERMIT TO - �,�TABLISHMENT I[ In accordance wifh e' ul t pn ; _ at ' 'ridelliWlhqxity of Chapter 94, y e Section 395A and Chapter >z lr �ctie �s t#a ei 'a �xs q'{3 ymit is hereby granted to: IP GORDON MARK LIBBE'Y _='_'" Dl #AIGVILLE GNAll LTORE Whose place of business is: - ', $'CRAIGVJ1 -i _, CENTEt� �tE M� 02632 Type of business and any resricfidiis TA1I BLISHMEN`F� To operate a food establishment-:in the _- T _l LE F, RESTRICTIONS IF ANY: '- SEATING: 0 ANNUAL: : SEASONAL: YES E s _ '0OARD OF HEALTH RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT: Canniff, D.M.D.Chairperson -�'= a `JOichi Sawayanagi RESIDENTIAL KITCHEN FOR RETAIL SALE: in `"t �_ F ` _ _F i E " "�_?� .•- " DDonald A.Guadagnoli,M.D RESIDENTIAL KITCHEN FOR BED+BREAKFASTS `%._ - _�'�.j,� q�,c� r:�-�; c..,-= _r- MOBILE FOOD UNIT: z'�•�'t �J �F-�rF S' r* � � �/7 TOBACCO SALES: j $50.bB< FROZEN DESSERT: - :: � Thomas A.-McKean, RS, CHO CATERER: Director of Public Health oFs"E Town of Barnstable G52 5� Regulatory Services A�T • ten Richard V. Scah, Director BARNSTABLE o; a � Public Health Division �� '�3fi39-2014 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fag: 508-790-6304 s APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT u, DATE: NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT:6d_6 E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS*: INSIDE: OUTSIDE: TOTAL: * Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: C ANNUAL OR SEASONAL OPERATION: TYPICAL HOURS OF OPERATION MON-FRI: -7 : CX>,o TO f p DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) 0 IF SEASONAL: APPROXIMATE DATES OF OPERATION: q 16-1 0 TO 10 ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT:, PLEASE CHECK ALL THAT APPLY FOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO,MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. X TOBACCO SALES . FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED.FOR OUTSIDE DINING? NO IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? �J® CONTACT INFORMATION: FULL NAME OF APPLICANT L-, 3a/ SOLE OWNER: /NO ADDRESS 1 S� PHONE# CO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** ' LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) 1• EXPIRATION DATE: / / 2. EXPIRATION DATE: / / EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** LIST THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. 1. EXPIRATION DATE: / SIGNATURE OF APPLICANT AND DATE Q:\Application Forms\Foodapp2.doc 0 Town of Barnstable Regulatory Services Department - BARNSPABM ;� � Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-790-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $50.00 MAIL TO:TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 Main Street HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$50.00 APPLICATION FOR A TOBACCO SALES PERMIT LAST NAME OF APPLICANT FIRST NAME MIDDLE INITIAL DB/A STREET ADDRESS TELEPHONE # FID# Do you currently possess a state license to sell tobacco products? Yes X No Each employee who sells tobacco products must receive and understand the Sections VII b. and VII c. of the Board of Health Prohibition of Smoking Regulation, (copy provided herein) and the Massachusetts General Law Chapter 270, Section 6.00 (a copy is provided on the next page). Each employee who sells tobacco products must sign the Employee Signature Form (provided herein). Signature Date Q:\Application Forms\TOBACCO APP.docx PERrNT NO: TOWN OF BARNSTABLE April 15,2016 61 BOARD OF HEALTH PERMIT TO OP_ �_@� STABLISHMENT In accordance wi a •* 1w -�`a r`.' hority of Chapter 94 I Section 395A and C 'p. rct�r e a e ermit is hereby granted to: GORDON MARK B � ]� � ILL GENERAL STORE Whose place of business is/s _ IGVI E L02632 Type of business and any e t s: F t. BLISH j J`fi To operate a food establifillient 1 Ithe T ABLE 4F = RESTRICTIONS IF ANY: t If SEATING: 0 ANNUAL t ►. .�, `� SEASONAL: YES TEMPORI�(: $ ' �. ' E E S � 2OF HEALTH RETAIL FOOD STORE: $ .00 $ .' '� �,� - . l y Miller, M.D., Chairperson FOOD SERVICE ESTABLISHMENT: c RESIDENTIAL KITCHEN FOR RETAIL SALE: .ram °� � 8 J. Canniff, D.M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFA�`� r nichi Sawavanacii MOBILE FOOD UNIT: N TOBACCO SALES: $ ' _.. FROZEN DESSERT: ' Thomas A. McKean, RS, CHO CATERER: Director Of Public Health Town of Barnstable °FINE top, Regulatory Services ti Richard V. Scali,Director BARNSTABI,E . r r S^ MASS. ' Public Health Division 9 STA SFRNSWA -CENTERVILLS•CMIT•xYFNN15 RRASi0.Yi MILLS•OSiEN6U:-W6i BARNSTPEIE 1639-2014 i639• ArEDMA'�a Thomas McKean,Director3�g . 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: NAME OF FOOD ESTABLISHMENT: V►�-�+= ADDRESS OF FOOD ESTABLISHMENT: °`tlJO0 E-MAIL ADDRESS: A�`i o+ �y�- 33�>/o�c�a Mai GO` TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 2-1100 NUMBER OF SEATS*: INSIDE: OUTSIDE: TOTAL: * Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: ���-' TYPICAL HOURS OF OPERATION MON-FRI: IN TO DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) o�� IF SEASONAL: APPROXIMATE DATES OF OPERATION: TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO, MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) r ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE HEALTH DIVISION AND VICENSING AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? X CONTACT INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: S / O ADDRESS PHONE # IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) 1. EXPIRATION DATE: 2, EXPIRATION DATE: / / EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE"* * LIST THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. 1, EXPIRATION DATE: / / SIGNATURE OF APPLICANT AND DATE Q:Vlpplication Forms\Foodappldoc c r OFFICIAL USE Q' Certified Mail Fee Extra ServiCes&Fees(check box,add fee as eppropdate) p�',+' `� r i �� ❑Return Receipt(hardcopy) $ .! ❑Return Receipt(electronic) $ ,'�Postmark - � Certified Mall Restricted Delivery $ ��Y /I^^Here. �' O []Adult Signature Required $ �• rt.Y []Adult Signature Restricted Delivery$ O Postage N $ Total Postage and Fees N Ln Sent r-I C3 S-- nd o. d 1 4 A ................... '"-'- -------- . tre orP r� mate, T. Ciry- �a �. WN :rr •. r �r r..•.. Certified Mail service provides the following benefits: •A receipt(this portion of the Certified Mail label), for an electronic return receipt,see a retail ■A unique identiAer for your mallpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. , USPS®-postmarked Certified Mail receipt to the, ■A recorl,of delivery(including the recipient's retail associate. 1_ signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders. Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which` ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age. International mail. and provides delivery to the addressee specified ■Insurance coverage Is notavallable for purchase by name,or to the addressee's authorized agent; with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the •To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a- certain Priority Mail items. USPS postmark If you would like a postmark on-■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mall item at a Post Office'for the following services: postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature).( of this lapel,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appmpilale postage,and deposit the mailpiece. electronic version:For a hardcopy return receipt, complete PS Forrn38.11,Domestic,Retum V it Receipt attach PS Form 3&,11,to your mailpiece; IMPOkAlt1:•Save this recelpt for your records. PS Form 3800,Apra 2015(R&Me)PSN.7530-02-0O0�7 � } J ��tTti Town of Barnstable Regulatory Services anfuvs-rneie Richard Scali, Director D Public Health Division prf MA'S A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 17, 2017 Wayne Hyman 628 Craigville Beach Road Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF SECTION 353-5,TOWN OF BARNSTABLE CODE. The property owned by you located at 628 Craigville Beach Road (Craigville General Store) in Centerville was inspected on 7/14/2017 by David W. Stanton, RS, Health Inspector for the Town of Barnstable because of a complaint. The following violation of Section 353-5 of the Town of Barnstable Code was observed: • Outdoor rubbish and garbage storage area is visible to the public view. You are ordered to comply with this Code by: Completely screening in the outdoor rubbish and garbage storage area(s) within ninety (90) days of your receipt of this order letter. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Please be advised that failure to comply with an order will result in a fine of $100.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH a�McK�ean, S, CHO Health Agent i } Postal Service CERTIFIED t3 . ■ O �� •. Only a pip 7 3r USE Er Q- Certified Mail Fee it cr $ Extra Services&Fees(check box,add fee as appropriate) ❑Return Receipt(hardcopy) $ �� ❑Return Receipt(electronic) $ Postmark C O ❑ o o Certified Mail Restricted Delivery $ Here 1-3 l ❑Adult Signature Required $ []Adult Signature Restricted Delivery$ 0 C-3 Postage -- mom r- Total Postage and Fees ri ra I $ Ln ul Sent you �� Stre nd o.,or-W,Am. -an------------------------- ------------- r%- �j City, tate, I PS Form 3800,April r r r rr.. a a- I 61 BOARD OF HEALTH PERMIT TO OPERAT OOD ESTABLISHMENT In accordance with Ir ' u authority of Chapter 94,t I Section 395A and C cc he a a permit is hereby granted to: GORDON MARK B _ I L E GENERAL STORE y Whose place of business is- IGVI D CE A 02632 Type of business and any ABLIS To operate a food establi ent i the a ABLE RESTRICTIONS IF ANY: SEATING: 0 .ANNUA . SEASONAL: YES TEMPO Y: RNSTABLE F E ES OF HEALTH RETAIL FOOD STORE: 100.00 At= I Miller, M.D., Chairperson FOOD SERVICE ESTABLISHMENT: p RESIDENTIAL KITCHEN FOR RETAIL SAL + Wa J. Canniff, D.M.D. RESIDENTIAL KITCHEN FOR BED+BREAK S nichi Sawayanagl MOBILE FOOD UNIT: S TOBACCO SALES: FROZEN DESSERT: e CATERER: Thomas A. McKean, RS, CHO Director of Public Health III i °p\NE row TOWN OF BARNSTABLE HEALTH OFFICE ou INSPECT Establishment Name: C r �P ,e jt rc, c ��Date: / Page:�_of PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ' 200 MAIN STREET 3:MON.-o I. - Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p 6jq.a a� HYANNIS,MA 02601 MON.-FRI. spa-86246aa No Reference R-Red Item PLEASE PRINT CLEARLY 'FON1�` FOOD ESTABLISHMENT INSPEC ION REPORT Name Date �; a of Type of Inspection Operation(s) Routine Address I e'll Risk Re-inspection ?F vi Level etail 1 Ld Previous Inspection ua P r -U Telephone Residential Kitchen Mobile re-operation I , Owner >�� H HACCP Y/N Temporary Suspec ness Caterer General Complaint � .. cyttw Person in Ch rge(PIC) �/ �, Time Bed&Breakfast HACCP In: Other *� Inspector A Out: 6- W2 Each viol atio checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. 4 / Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ t O Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures 42 r N ^ f ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling /y ❑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) Non-critical(N)violations must be corrected immediately or Corrective Action Required: No ❑ Yes within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection todWheftems checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot ` 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must water,sewage back-up,infestation of rodents or insects,or lack of C=2 critical violations and less than 4npn-critical. If no critical 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violatio s obse d,7 to 8 non-critical violations=C. refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. Pr' t:Signa r 30.Other DATE OF RE-INSPECTION: Inspect 31.Dumpster screened from public view is Vy4,- �f / Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N //// ,,1 #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si pa a re Print: ; Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N �/3 Dumpster Screen Y N „��' _ �___, :_��--•. � ,..� - '-- - ,a �- . "s-, _ ,�,� � � -_. _� _- T..--....---,-...---•-- _ _.ate-r .. _ - _ .�-- ram-- z�-.;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 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 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F * 7-102.11 Common Name-Working Containers 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 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR. . 3-306.14(A)(B)Returned Food and Rated or of Food*Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures- __ Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(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 3-401.11A(1)(2) Eggs-155°F 15 sec � 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* Equipment* gg Not Otherwise Processed to Eliminate !i 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* se Prue Processed 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 1112001 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 Chemical Stuffing Containing Fish,Meat,Poultry or 590.009 ( )-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed * (A)-(D) Violations of Section 590.009 A 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 Requirpracticeement s osld be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (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 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 3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 1590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Within 4 Hours* 23. Management and Personnel FC-2 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils ♦ FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .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: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 e' 61 BOARD OF HEALTH PERMIT TO OPERATE A.FOOD ESTABLISHMENT In accordance with re uta o.as. .rannfl' ated,, rider�wthority of Chapter 94 Section 395A and Chapt� I11;Seet><on oe►tarahaw,h1er7it is hereby granted to: 1 . c GORDON MARK LIBPY ` /�l�AFtatrt,x ILLGENERAL STORE Whose place of business is: �68 t'GVILLEA IUD a CENTEI�'�III �IA02632 Type of business and any res�triOWNPi. R OO.O I MWISHM' c� To operate a food establishmept in the TO i IST BLE F RESTRICTIONS IF ANY: SEATING: -0 ANNUAL j. SF SEASONAL: YES TEMPORAL-Y= } E SIR¢c7F HEALTH RETAIL FOOD STORE: 00 FOOD SERVICE ESTABLISHMENT: € E} r �3�1�j �►R� Oiler, M.D., Chairperson r. 2 ti `P'avF•J; Canniff D.M.D. RESIDENTIAL KITCHEN FOR RETAIL SALE: . k = = x 4 RESIDENTIAL KITCHEN FOR BED+BREAKFASrt ithi Sawavanaqi y�y gc MOBILE FOOD UNIT: Yam.: 1 ` @��IIt' ^{.1ros Y ' TOBACCO SALES: g50 00eQ�n FROZEN DESSERT: r - 4y Thomas A. McKean, RS, CHO CATERER: �,� w;,�. = Director of Public Health }. r CA Town of Barnstable OpSHE l ti Regulatory Services Barnstable I!4V Richard V. Scali, Interim Director mericaCily SARNSTABLE 1 I � . �0� Public Health Division z���, � ArFO µA•�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 1 o l `q NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: C-' "'v��� t �`�• MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP:2 PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS: INSIDE: � OUTSIDE: `T TOTAL: TOTAL NUMBER OF BATHROOMS: U ANNUAL OR SEASONAL OPERATION: L- TYPICAL HOURS OF OPERATION MON-FRI: : DUB TO 7 :� DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) v`' �- L*'1 IF SEASONAL: APPROXIMATE DATES OF OPERATION: q l),5 TO 4?- /3 %f --- �— M! ;n ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE ✓ RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? k)d IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT �'o R-�v^� ���'' - ` g`�",/ SOLE OWNER.(Yp NO ADDRESS 176 PHONE # (2 ) 36 IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERVSAFE) EFFECTIVE JANUARY 1, 2004, AND ALLERGEN AWARENESS TRAINED STAFF EFFECTIVE OCTOBER 1, 2010. EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS (i.e. ServSafe) AND ONE ALLERGEN AWARENESS TRAINED STAFF MEMBER. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** 1, EXPIRATION DATE: / / 2. EXPIRATION DATE: / / 3, EXPIRATION DATE: / / 4, EXPIRATION DATE: / / SIGNATURE OF APPLICANT AND DATE Q\HealthWpplication FormsToodappl.doc I Tr+e Town of Barnstable of r� _ .. P� o Regulatory Services Thomas F. Geiler, Director BARNSrABLE, * Public Health Division MASS.9�A ��'q Thomas McKean, Director 200 Main Street Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 FEE: $50.00 MAIL TO: TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 MAIN STREET HYANNIS,MA 02601 FAX: 508-790-6304 PLEASE INCLUDE THE REQUIRED FEE OF S50.00 APPLICATION FOR A TOBACCO SALES PERMIT LAST NAME FIRST NAME MIDDLE INITIAL C'�� 1 (v0 C' � -U .tom D/B/A 2 GOILEJ C- t- b v w-e-, Vt CLCs4 7 L&J.STREET ADDRESS ADDRESS TELEPHONE NUMBER a "= Do you currently possess a state license to sell tobacco products? Yes No Each employee who sells tobacco products must receive and understand the Sectlons VIIb. and VHc. of the Board of Health Prohibition of Smoking Regulation, (copy provided herein), and the Massachusetts General Laws Chapter 270, Section 6.00 (a copy is provided on the next page). Each employee who sells tobacco products must sign the Employee Signature Form (providedherein). Signature Date q:\tobacco\wp files\tobacco forms\tobaccoapp.revised 10.3 1.2006.doe �— TOBACCO SALES PERMIT ACKNOWLEDGMENT This form must be initialed and signed by the owner/operator of the establishment applying for a Barnstable Board of Health Tobacco Sales Permit. No permit will be issued until this checklist has been initialed and signed. I have read and understand all subsections within Barnstable Board of Health Regulations regarding the sale and distribution of tobacco products. Initials CU^(,- I understand that it is against the law to sell cigarettes or any tobacco product to anyone less than eighteen (18)years of age,regardless of how old the person looks. Initials I understand that the Barnstable regulation requires anyone selling tobacco products to conclusively establish the customer's age. This means the clerk must ask for and see identification proving the person is at least eighteen(18)years of age. Initials I understand that the Barnstable Tobacco Control Program conducts frequent compliance checks of all tobacco merchants'businesses to ensure that tobacco products are not being sold to minors. This means: a. The Barnstable Tobacco Control Program will send minors into my establishment to attempt the purchase of tobacco. b. These minors will not possess any identification,but will respond truthfully when asked their age. c. Any reported confrontational behavior towards the minor or the enforcement agent during or after the compliance check may result in a permanent revocation of the tobacco sales permit. Initials UA I understand that if I am caught selling tobacco products to minors,I will be subject to a warning,fine, and/or permit suspension as set forth in the Board of Health Tobacco Sales Regulations. Initials L' I understand that the Barnstable regulations prohibit self-service displays of all tobacco products from which any tobacco products may be selected.J Initials I understand that my tobacco sales permit must be posted at all times in a manner conspicuous to the public. Initials I understand that my Tobacco Sales Employee Signature Form must be read and signed by all employees selling tobacco products,kept on site at all times,and be in a known location by all employees for inspection. Initials By signing this form,I acknowledge that I have read and understand all of the above statements,,and I further understand that failure to abide by these conditions may jeopardize my Tobacco Sales Permit. (Name of Business) (Owner/O erator Signature) (Date) Establishment TOBACCO SALES - Employee Signature Dorm This.form is.for official use to indicate.that the employee(s) of this establishment received and understood sections. V11b. and VIIc. of the Bamstable. Board of Health Prohibition of Smoldng Regulation and the enclosed copy of Chapter 270 Section 6.of the Massachusetts General Laws.which describes the penalties, for selling and/or giving tobacco.products to.any person under.the.age of eighteen(18). Below are sections. VIlb_and VIIc. of the Bain table.Board of Health Regulation: SECTION VII—SALE AND DISTRIBUTION.OF TOBACCO.PRODUCTS b_ Sales.To Minors.-In conformance.with the.Massachusetts General Laws Chapter 270,Section 6, no person, firm,corporation,establishment,or agency shall sell tobacco.products to.a minor.. Each employee working in an establishment licensed to.sell tobacco.product shall be.required to receive a copy of the Board of Health regulations.and State Law regarding the sale.of tobacco and sign a form indicating that such regulations/laws have.been received and understood, a copy of which must be.placed on file, in the. office. of the. employer and retained_ Such signed forms must be. made.available.for inspection,during the.license.holders.normal business hours,upon request of an agent of the.Board of Health.. c. All distributors/retailers. of tobacco. products. or. tobacco. merchandise. must require that, if a customer appears to.possibly be.under 25.years.of age, the customer present a valid State issued picture identification card or drivers. license with appropriate photograph to. confirm that the customer is.of legal age.to.purchase.the.tobacco.product.. The. following employee(s).received and understood section VIlb_ and VIIc_ of the. Barnstable Board of Health Prohibition of Smoldng Regulation and Chapter.270.Section 6 of the.Massachusetts.General Laws: NA"- - Signa466 Printed Name. Date. Signature Printed Name. Date Signature Printed Name Date Signature. Printed Name, Date. Signature. Printed Name Date Signature. Printed Name Date Signature Printed Name. Date. Q:V EALTMTOBACCO\WP Files\Tobacco Forms\Tob Sales-Emp sig form.doc 1 � �1�' 1�atG TOWN OF BARNSTABLE HEALTH lNSPecTOR s Establishment Name: e: 0 Pa ge: of ... . ._. � . - :" OFFICE HOURS , PUBLIC HEALTH DIVISION 8:00 s:3oAM. BARNSTABLE. 200 MAIN STREET 3:30 4:30 P.M. mass MON.-PRI. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 508-862-4644 No Reference R=-Red Item PLEASE PRINT CLEARLY - ` FOOD ESTABLISHMENT INSPECTION REPORT Name �'� / Dated Type of Tou ns ection U Cry Ooeration(s) Address /�, Risk Food-Service Re-inspection Level Previous Inspection Telephone. Residential Kitchen Date: Mobile Pre-operation Owner HACCP 'Y/N Temporary Suspect Illness _ Caterer General Complaint Person in Charge(PIC) Time Bed.&Breakfast HACCP In: Other' a Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. CL oiations Related to FoodborneI F Itemsi Anti-Choking Tobacco folations marked may.pose an imminent health hazard and require immediate corrective ❑ ❑ _ Action as determined by the Board of Health. 590.009(E) 590.009(F) C-0o � ; 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 Einployees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals i FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 77-1 ❑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 20.7iime As a Public Health Control C] 8.Separation/Segregation/Protection IREQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact.Surfaces.Cleaning and Sanitizing 21.Food and Food Preparation for HSP 10.Proper Adequate Handwashing ONSUMERADVISORY 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories olations Related to.Good Retail Practices(Blue Items) Total Number of Critical Violations Critical C violations marked must be corrected immediately.( ) Y blue 8 red items Corrective Action'Re uired. No Yes - or Non critical(N)violations must be corrected immediately Overall Rating within 90 days as de he Board of Health. determined b t _ Y y � F] Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re inspection Scheduled Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other; 23..Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations: If no critical.violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have aright to a hearing. Your request must C=2 critical violations and less than 4 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,lack of 28.Poisonous or Toxic Materials (FC77)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations=.C. refrigeration,or no PIC or alternate P1C present. 29.Special Requirements (590.009) within 10 days of receipt of this order. 3.0.Other DATE OF RE-INSPECTION: Inspe� 's g t e 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 Si a re Print: A _ Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N N 9�1 �.u'a�R _ .`'�rr�„a„r-..-,.-..-�r-.�, •r......./y-•^ari'o`r�...,..,--- ,.�,,..�.--..��, i�-"`:_.+�•�.'.•-<• .._-...�='.-�:ti�rs .�-,r .�x-+..�i: ^-�•,.:�,�,.�...,1!-'-' '."'�-r'y-�- ""-�.r+.�-�^''-°�v'--"�i"".�_ �a%;v� Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 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 3-202.72 Additives* 3-501.15 Cooling Methods for PHFs h 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* ` 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B)- Cold PHFs Maintained At or Below 41°F/45°F } . * EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 590.004(F) - 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 C 3-501.16(A) Hot PHFs Maintained At or Above 140°F* { Require Reporting by Food Employees and Contamination from the Environment ommon 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 7-202.11 Restriction-Presence and Use* - 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* _ Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Valiance 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* 3-306.14(A)(B)Resumed Food and Reservice of Food* REQUIREMENTS FOR -- ` 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* I 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 I 3-201.12 Food in a Hermetically Sealed Container* f ' Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* r- 1 i - 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11, Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 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 crave///noo/ 4 590.006(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* , 4-702.11 Frequency of Sanitization of Utensils and Food Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* Shellfish* 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* Ratites-165°F 15 sec* in mobile food,temporary and residential 10 Proper,Adequate Handwashing g� P �' Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* P 3-401:12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors: 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 11 Good Hygienic Practices practices should be debited under#29-Speci 3-201.17 Game Animals* 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* q 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* Critical and non-critical violations,which do not relate to the foodbome 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 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 its the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1$ Proper Cooling of PHFs P 9 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 * 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3�02.11 Parasite Destruction* 5-204.11 Location and Placement g t * 5-205.11 Accessibility,O eration and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention p Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices Ph 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability. 27. ysical Facility FC-6 .007 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* r > S:590Formback&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. I`�1C TOWN OF BARNSTABLE EALTH INSPECTOR'S Establishment Name: __. Date: Page: of �OfH 0 OFFICE HOURS PUBLIC HEALTH DIVISION - a:00-9:30A.M. } 3:30-4:30P.M. BARN57ABLE. ` 200 MAIN STREET I Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYA A NNIS,M 02601 MO8 -FRI. �63q. �0 � sos-ss2-0644 No Reference R-Red Item. P SE PRINT CLEARLY �ArFD MP�� FOOD ESTABLISHMENT INSP TON REPORT Name to Tvoe of -Type of Inspection Q Operation(s) Routine 4 Address �'/ 4 Wz�6 q 2 9fi Fo ervice Re-inspection �-t" el Retal - Previous Inspection NP At Telephone esidential Kitchen Date: Mobile re operation Owner HACCP Y/N Temporary use ness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspector :2Q UA, 4�-' Each violation checked requires an explanation on the narrativ page(s)and a citation of specific provision(s)violated. iftliolations Related to Foodborne Illness Interventions and Risk Factors Red Items) ( Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective Action as determined by the Board of Health. 590.009(E) ❑ 590.009(F) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands 1.PIC Assigned/Knowledgeable/Duties ❑ g g ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 41 ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION.FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑'10.Proper Adequate Handwashing CONSUMER ADVISORY 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately.or Corrective Action Required: I❑ No ❑ Yes within 90 days as determined by the Board of Health: Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal. ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(596.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than anon-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils (FC-4)(590:005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical,violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less th n.4 n-critical. If no critical water,sewage back-up,infestation of rodents or insects,lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) � ations be in writing and submitted to the Board of Health at the above address observed,7 to 8 n -crif I violations=C. refrigeration,or no PIC or alternate PIC present. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: s cto 's Signature O 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' Signature Print: �� f Self Service Wait Service Provided Grease Trap.Size Variance Letter Posted Y N - J j Dumpster Screen? Y N V OL YA �S°+t'�'2+"...'""'49i4i+'+4^.r'.+kra�r"'�.,,a,n'�,+"'tiy�" --.r� .�.----,•.-.� ...;---..r _. _ -._ ... r- -�.-.,. t _.._ _ � _-,---_._- -,.-_-•.f..�-....._, . ....,. ��- -..- ,.--.. _ �.-.�- n+r .. ..�--. .-... _' � _ .�. _yam '�, Violations related to Foodborne Illness Violations Related to Foodbome Illness Interventions E 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 4 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assigmnent 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* l 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* -19 PHF Hot and Cold Holding a Contamination from Raw Ingredients 1 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15 Poisonous or Toxic Substances 590�(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* t Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* PP * - A licants - 3-302.11(A) 7-201.11 Separation-Storage*• Food Protection* 20 . -Time as a Public Health Control 3-302.15 590.003(F) Responsibility of A Food Employee or An 1 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control*7-202.11 Restriction-Presence and Use* 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 1 3 590.003(D) 3-306.14(A)(B)Resumed Food and Reservice of Food Exclusions and Restrictions* * 7-204.11 - Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Waring Labels* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.411 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* P 7-206.13 Tracking Powders,Pest Control and - 37201.13 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. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 _ Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* EJjccti a 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 Shel�sh 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 ces of qui 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 Chemical ( )-(D)in cater- Sources* - N , - Ratites-165°F 15 sec* in mobile food,temporary and residential 10 j Proper,Adequate Handwashing g+ PY Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Othei PHFs-145°F 15 sec* Other 590.009 violations relating to good-A lk * 1 11 Good Hygienic Practices i practices should be debited under#29-Spec 3-201 r17 ' Game Animals _ 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* * (Blue Items 23-30) 3-202.15_ Package Integrity g g - 3-403.11(C) Commercially Processed RTE Food-140°F 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 1596.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel r FC-2 t - .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. Records,Creation and Retention* Within 4 Hours* 26. Water,Plumbing and Waste e. FC-5- .006 590.004(J) labeling of Ingredients' Supplied witthh Soap and hand Drying Devices 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 27. Physical Facility FC-6 .007 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 3-502.11 Specialized Processing Methods* 30. 009 Special Requirements 0. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* i" S:590Fomtback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. , `- y r; .�... 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °p THE r°� TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name 1 l'D_ c l Date: 4� Page: of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSfABLE. 200 MAIN STREET 3:30-4:30 P.M. MASS. g. MON.-FRS. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified .e,v. .• HYANNIS,MA 02601 508-as2�saa No Reference R-Red"Item PLEASE PRINT CLEARLY �A'EON1P'' FOOD ESTABLISHMENT INSPECTION REPORT Nam \ �� Dates Type of j)yMUf Inspection Operation(s) -Address Risk. F ervice Re-inspection c ►1io Level, Previous Inspection Telephone Residential Kitchen Dater Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer- General Complaint Person in Charge(PIC) Time Bed&.Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. gft,yiolations Related to Foodborne Illness Interventions and Risk Factors Red Items) I Anti-Choking Tobacco iolations marked may pose an imminent health hazard and require immediate corrective Action as determined by the Board of.Health. 590.009(E) ❑ 590.009(F) ❑ 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 Foo&Employees and PIC ❑ 14.Approved Food.or Color Additives ❑3.Personnel with infectious Restficted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE . TIME/TEMPERATURECONTROLS(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) Non-critical(N)violations must be corrected immediately or Corrective Action Required: No ❑ Yes within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusi ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of'105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9 or more non-critical violations=F. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no,critical violations observed,4 to 6 non-critical violations=B. seriously Critical Violation=F is scored automatically if no hot 27.Physical Facility . (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 4 non-critical. If no critical `Hater,sewage back-up,infestation of rodents or insects,lack of 28.Poisonous or Toxic Materials (F6-7)(590.008) be in writing and submitted to the Board of Health at the above address violations erved,7 to Snon-critical violations=C. refrigeration,or no PIC or alternate PIC present. 29.Special Requirements (590.009) within 10 days of receipt of this order. DATE OF RE-INSPECTION: Insp o ig at e 30.Other \� 31.Dumpster screened from public view Permit Posted? Y N. Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' i nature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N .� �.'?+�Fsje�.�.•.ri.«a.v"".....:.,�;a-•.T�ke'�vr:-_'-frpw.arr--i: ,..-„Q, ...� _ ... ,•rT:,`SA:,e,°w.��P::�L.r' �>.-, _. _.y�w,.ti..�--'.^-,;r .., -,�-..,,-. ,„.. ,..-•�- .-, -.�.tv""'--.'4i__+w,..a-.."-�"..r.�ir�x„-..oy.. 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* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 = PHF Hot and Cold Holding f Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 590.004(F) P 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 7-201.11 Separation-Storage* PP 3-302.11(A) Food Protection* 20 :Time as a Public Health Control 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* * 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) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* 3-306.14(A)(B)Returned Food and Reservice of Food* REQUIREMENTS FOR 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 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* * Raw Seed Sprouts Not Served* Y Sanitization Temperatures 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* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 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* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155*F 15 sec* faces of Equipment* 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 Chemical ( )-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* in mobile food,temporary and residential 10 Proper,Adequate Handwashing g• P Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 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 retaAj,, 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Spec 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g� g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* - 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food_140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41*F/45°F Item Good Retail Practices FC 590.000 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 n' Within 4 Hours* 26. Water,Plumbing and Waste FC-5- .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 6-301.11 Handwashing Cleanser,Availability 27.8. Physical Facility FC-6 .008 7 Conformance with Approved Procedures/ g n' 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8103.12 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. I nre TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Cek, /r.'ll. (,Ph Date: `ZY10tE Page: - of OFFICE HOURS: 7 PUBLIC HEALTH DIVISION 8:00-9:30 A.M. ? i 200 MAIN STREET 3:30-4:30 P.M. MON.-FRI: Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 1659.��� HYANNIS,MA02601 508-862-4644 No. Reference R-Red Item PLEASE PRINT CLEARLY MFr � Date "n t Z f >N Name Cf-y Q J- �, Type of Ins ection Operation(s) Routine Address Cr" V, Risk Fo d Service previous Inon spection J - Level aI - Telephone ential Kitchen Mobile ��G�rXcness 4­6 Owner HACCP Y/N Temporary Caterer Person in Charge (PIC) Time r Complaint Bed&Breakfast HACCP In: Other Inspector I �, W S Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. lations Related to Foodborne Illness Interventions and Risk Factors Red Items)Anti-Choking Tobacco olations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ Action as determined by the Board of Health. ` 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 1120. Time As a Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULA IONS(HSP) 119. Food Contact Surfaces Cleaning and Sanitizing 1121. Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing ❑ 11.Good Hygienic Practices CONSUMER ADVISORY AMations Related to Good Retail Practices Blue Items ❑ 22• Posting of Consumer Advisories I(C)violations marked must=be corrected immediately. Non- Total Number of Critical Violations / Cal(N)violations must be corrected immediately or (blue&red items) within 90 days as determined by the Board of Health. c N Overall Rating 23.Management and Personnel (FC-2)(590.003) Official Order for Correction: Based on an inspection today,the items Corrective Action Required: ❑ No Yes 24.Food and Food Protection (FC--3)(590.004) checked indicate violations of 105 CMR 590.000/federal Food Code. 25.Equipment and Utensils (FC-4)(590.005) This report,when signed below by a Board of Health member or its ❑Voluntary Compliance ❑ Employee Restriction/Exclusion ❑Re-inspection Scheduled ❑ Emergency Suspension agent constitutes an order of the Board of Health. Failure to correct 26.Water, Plumbing and Waste (FG s)(sso.00s) violations cited in this report may result in sus-pension or revocation of ❑Embargo ❑ Emergency Closure ❑Voluntary Disposal ❑Other: 27. Physical Facility (FC-6)(590.007) the food establishment permit and ces-sation of food establishment 28. Poisonous or Toxic Materials (FC-7)(590.008) operations. If aggrieved by this order,you have a right to a hearing. A= Zero critical violations and no more than 3 n -critical violations.' F= 3 or more critical violations. If no critical violations observed, 29.Special Requirements (590.009) Your request must be in writing and submitted to-the Board of Health at 9 or more non-critical violations=F. the above address within 10 days of receipt of this order. 6= One critical violation and les th 4 non al violations. 30. Other If no critical v' ations a ed, to 6 noon-n- 'tical violations=B. Seriously Critical Violation= F is scored automatically if no hot water, 31. Dumpster screened from public view DATE OF RE-INSPECTION: C= 2 critical viol tions and les than non-criti I. If no critical violations sewage back-up, infests' n of rodents or insects, lack of refrigeration, or Y N Grease Trap Previous Pumping Date Grease Rendered? Y N Permit Posted? observed,7 8 non-critic viol tions=C. no PIC or alternate PIC sent. Frozen Dessert Machines: Outside Dining Y N Inspector's Sign u " Print: C #Seats Observed 1 Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N PIC's Signature Dumpster Screen? Y N � ,.,. ..�., _..v_____ .. ...`. is- N -,.r. ✓ -_ -r-+.+ya .� -.� � _ r _..a•.-�, a �_ _- _ � .. .. .. ,w- � a r „-vr.c. .tee.--s-�- a ..�. ,. :.w-- �. .�...-�-z. -�-+r�- -_., Violations Related to Foodbome Illness Interventions and Risk Factors(Red Items 1-22) 3-501.14(C) PHFs Received at TemperaturesViolations Related to Foodbome Illness Interventions and Risk According to Law Cooled to PROTECTION FROM CONTAMINATION Factors(Red Items 1-22) (Cont.) 41°F/45°F Within 4 Hours. FOOD PROTECTION MANAGEMENT FS Crosscontamnation PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 1 590.003 A Assi enI of Responsibility' 3-302.1 I(A)(1) Raw Animal Foods Separated from 590.003 B Demonstration of Knowledge* Cooked and RT 19E Foods* 14 Food or Color Additives PHF Hot and Cold Holding 2-103.1 l Person in charge-duties Contamination from Raw/ngretfents 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-302.11(Ax2) Raw Animal Foods Separated from Each 3-302.14 Protection from Unapproved Additives* 590.004(F) 41°/45°F* EMPLOYEE HEALTH Other* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment 7-1.01.1 1 Identifying Information-Original 140oF.* require reporting by food employees and 3-302.11 A Food Protection* Containers* 3-501.16(A) Roasts Held at or above 130°F. applicants* 3-302.15 Washing Fruits and Vegetables 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 590.003(F) Responsibility Of Food Employee Or An 3-304.11 Food Contact with Equipment and 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Utensils* 7-202.11 Restriction-Presence and Use* 590.004(1i) Variance Requirement Charge* Contamination from the Consumer 7-202.12 Conditions of Use* 590.003 G Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food* 7-203.1 1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 3 590.003 D Exclusions and Restrictions* Disposition of Adulterated or Contaminated 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 590.00 Removal of Exclusions and Restrictions Food 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.1 1(A) Unpasteurized Pre-packaged Juices and 3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* FOOD FROM APPROVED SOURCE Food` - 3-801.1 I(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.1 1 Restricted Use Pesticides,Criteria* 3-801.1 1(D) Raw or Partially Cooked Animal Food and 590. A-B Compliance with Food Law* 4-501.11 1 Manual Warewashing-Hot Water 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.* 3-201.12 Food in a Hermetically Sealed Container* Samtization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-801.1 1(C) Unopened Food Package Not Re-served. 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Sanitization Temperatures* Monitoring* 3-202.13 Shell Eggs* CONSUMER ADVISORY 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 1 Ice Made From Potable Drinking Water* concentration and hardness.* 16 Proper Cooking Temperatures Animal Foods That are Raw,Undercooked or 4 601.11 A Equipment Food Contact Surfaces and Pe 9 peratures for 5-101.11 Water from an Approved S stem• ( ) � � PHFs Not Otherwise Processed to Eliminate 590. A Bottled Drinking Water* Utensils Clean* 3401.11A(1)(2) Eggs- 155°F 15 Sec. Pathogens.*E"`""' 590. Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food-` Eggs-Immediate Service 145°F 15sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* Shefrrslt and Fish From an Approved Source Contact Surfaces and Utensils 3-401.1 I(A)(2). Comminuted Fish,Meats&Game 4-702.11 Frequency of Sanitization of Utensils and * SPECIAL REQUIREMENTS 3-201.14 Fish and Recreationally Caught Molluscan Animals-155°F I5 sec. Food Contact Surfaces of Equipment* Shellfish' 3-401.11 B 1 2 * 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 4-703.11 Methods of Sanitization-Hot Water and ( )( )O Pork and Beef Roast-130°F 121 min 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 3-401.11(A)(2) Ratitcs,Injected Meats-155°F 15 sec. catering,mobile food,temporary and Sources* t0 Proper,Adequate Handwashing * residential kitchen operations should be Game and V"d Mushrooms Approved by , 3-401.11 A 3 Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Regulatory Authority 2-301.11 Clean Condition-Hands and Arms ( )( ) 2-301.12 CI Procedure* Stuffing Containing Fish,Mcat, above if related to foodbome illness 590.0 4( WildShell us Identification Present * Poultry or Ratites-165°F 15 sec.• interventions and risk factors. Other 590. C Wild Mushrooms* 2-301.14 When to Wash n' 3-201.17 Game Animals' 1t Good Hygienic Practices 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 5 ReceivinglCondition 2401.11 Eating, or Using Tobacco. 145°F* practices should be debited under#29- 3-202.11 PHFs Received at Proper Temperatures* 2A01.12 Discharges From the Eyes,Nose and 3-401.12 Raw Animal Foods Cooked in a Special Requirements. 3-202.15 Package Integrity* Mouth* Microwave 165°F 3-30112 Prevent Contamination When Tact' * 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec.' VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-101.11 Food Safe and Unadulterated (Blue Items 23-30) 6 Tags/Records:Shelhdock 12 Prevention of Contamination from Hands 17 Reheating for Hot Holding 3-202.18 Shellstock Identification• 590.004(E) Preventing Contamination from 3-403.11(A)&(D) PHFs 165°F 15 sec.* Critical and non-critical violations,which do not relate to the Employees* foodbore illness interventions and risk factors listed above,can be 3-203.12 Tags/rock Identification Maintained` 3-403.11(B) Microwave-165°F 2 Minute Standing found in the following sections of the Food Code and 105 CMR Tags/Records:Fish Products 13 Handwash Facilities Time* 590.000. Conveniently Located and Accessible 3-403.1 I C Commercial) Processed RTE Food- Item Good Retail Practices FC 590.000 3402.11 Parasite Destruction' ( ) Y 3-402-12 Records,Creation and Retention* 5-2031 1 Numbers and Capacities* 140°F* Ire Management and Personnel FC-2 5 03 5-204.11 Location and Placement' 590. J Labeling of Ingredients* 3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 q Conformance with Approved Procedures 5-205.11 Accessibihty,Operation and Maintenance Roasts* 25. Equipment and Utensils FC-4 .005 /HACCP Plans Supplied with Soap and Hand Drying 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-502.11 Specialized Processing Methods- Devices 3-501.14(A) Cooling Cooked PI lFs from 140°F to 27. Physical Facility FC-6 .007 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 28, Poisonous or Toxic Materials FC-7 .008 8-103.12 Conformance with Approved Procedures` 6-301.12 Hand Provision 70°F Within 2 Hours and From 70°F 29_ Special Requirements oog to 41°F/451F Within 4 Hours.* 30. Other 3-501.14(B) Cooling PHFs Made From Ambient sswrcwme ar-na Temperature Ingredients to 41°F/45°F Within 4 Hours* •Dames 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 �j C �t� ( ,G� Pa _� dF'"Era� TOWN OF BARNSTABLE OFFICE HOURS: Establishment Name: f�tdvc t?_ c�Qn: Date: Page: of / Si PUBLIC HEALTH DIVISION 8:00-9:30 A.M. „ ,,1B1a i 200 MAIN STREET 3:30-4:30 P.M. Cnti C Co de Item oe - ca lltem MON.-FRI. It DESCRIPTION OF VIOLATION/PLAN OF CORRECTION, Date Verified 1639, HYANNIS,MA02601 508-862-4644, No. Reference R-Red Item PLEASE PRINT CLEARLY Name Date a Type of g!Ro".t7ne .,/, section C e^ Operation(s) �<< Address ( Ris F Service C`� t/i Level s Inspectioneta 13 Telephone ,dential KitchenMobile ra i ' � IOwner HACCP Y/N Temporary Hess / a Tlme Caterer General Complaint L ✓_ ` il°1 u� f G✓� Person in Charge (PIC) Bed&Breakfast HACCP - In: . Other ` d. Inspector FAv Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. lations Related to Foodborne Illness Interventions and Risk Factors Red Items Anti-Choking Tobacco lations marked.may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ Action as determined by the Board of Health. 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 Restricte&Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 16. Cooking Temperatures 115. 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 Asa Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 119. Food Contact Surfaces Cleaning and Sanitizing 1121. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices rations Related to Good Retail Practices (Blue Items) ❑ 22• Posting of Consumer Advisories acal(C)violations marked must be corrected immediately. Non- Total Number of Critical Violations critical(N)violations must be corrected immediately or (blue&red items) within 90 days as determined by the Board of Health. C N Overall Rating 23.Management and Personnel (FC 2)(590.003) Official Order for Correction: Based on an inspection today,the items Corrective Action Required: No ❑ Yes 24.Food and Food Protection (Fc-a)(ss0,00a) checked indicate violations of 105 CMR 590.000/federal Food Code. This report,when signed below by a Board of Health member or its ❑Voluntary Compliance ❑ Employee Restriction/Exclusion ❑Re-inspection'Scheduled ❑ Emergency Suspension 25.Equipment and Utensils (FC-4)(590.005) agent constitutes an order of the Board of Health. Failure to correct 26.Water, Plumbing and Waste (FC-5)(590.006) violations cited in this report may result in sus-pension or revocation of ❑Embargo ❑ Emergency Closure ❑Voluntary Disposal ❑Other: 27. Physical Facility (FC-6)(590.007) the food establishment permit and ces-sation of food establishment 28. Poisonous or Toxic Materials (FC-7 590.00a operations. If aggrieved by this order,you have a right to a hearing. )( ) A= Zero critical violations and no more than anon-critical violations. F= 3 or more critical violations. If no critical violations observed, 29.Special Requirements (590.009) Your request must be in writing and submitted to the Board of Health at B= One critical violation and less than 4 non-critical violations. 9 or more non-critical violations=F. 30. Other the above address Within 10 days of receipt of this order. If no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation= F is scored automatically if no hot water, 31. Dumpster screened from public view DATE OF REANSPECTION: C= 2 critical violatio s an ss han 4 non- ritical. If no critical violations sewage back-up, infestation of rodents or insects, lack of refrigeration, or Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered? Y N observed, 7 to non-cri al ioIations= no PIC or alternate IC present. #Seats Observed Frozen Dessert Machines: Outside Dining Y N Inspector's Signatu J Print1 I, D\C Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N �� PIC's Signat ,. Print: Dumpster Screen? Y N - Violations Related to Foodbome Illness Interventions and RisK Factors(Red Items 1-22) 3-501-14(C) PHFs Received at Temperatures Violations Related to Foodbome Illness Interventions and Risk According to Law Cooled to PROTECTION FROM CONTAMINATION Factors(Red Items 1-22) (Cont.) 41°F/45°F Within 4 Hours. FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003 A Assi ent of Responsibility* 3-302.11(AX1) Raw Animal Foods Separated from PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 590.003 13 Demonstration of.Knowl e* Cooked and RTE Foods' 14 Food or Color Additives 19 PHF Hot and Cold Holding 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-302.14 Protection from Una 590.004(F) 410/450 F* 3-302.11(AX2) Raw Animal Foods Separated from Each Unapproved Additives* EMPLOYEE HEALTH Other' 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 2 590.003(C) Responsibility of the person in charge to Contarninabon from the Environment 7-101.1 1 Identifying Information-Original 140°F.* require reporting by food employees and 3-302.1 1 A Food Protection* Containers* 3-501.16(A) Roasts Held at or above 130°F. applicants* 3-302.15 Washing Fruits and Vegetables 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 590.003(F) Responsibility Of Food Employee Or An 3-304.11 Food Contact with Equipment and 7-201.11 Separation-Storage* 3-501.19 Time as a Public health Control* Applicant To Report To The Person In Utensils* 7-202.1 1 Restriction-Presence and Use* 590.004(H) Variance Requirement Charge* Contamnation htrm the Consumer 7-202.12 Conditions of Use* 590.003 G Reporting by Person in Charge* 3-306.14 A B Returned Food and Recervice of Food* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 3 590.003 D Exclusions and Restrictions* Dispostion of Adulterated or Contaminated 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 590.00 Removal of Exclusions and Restrictions Food 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.1 1(A) Unpasteurized Pre-packaged Juices and 3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* FOOD FROM APPROVED SOURCE Food` « 3-801.1 1(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants IP 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801-1 1(D) Raw or Partially Cooked Animal Food and 590. A-B Compliance with Food Law* 4-501.111 Manual Warewashmg-Hot Water 7-206-12 Rodent Bait Stations* Raw Seed Sprouts Not Served.* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Tem tures* 7-206.13 Tracking Powdcrs,Pest Control and 3-801.11(C) Unopened Food Package Not Re-served. 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water s Sanitization Temperatures* Monitoring* .. 3-202.13 Shell Eggs* CONSUMER ADVISORY 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, TIMErrEMPERATURE CONTROLS 22. 3-603.1 1 Consumer Advisory Posted for Consumption of * concentration and hardness.* Animal Foods That are Raw,Undercooked or 3-202.16 Ice Made From Potable Water 16 Proper Cooking Temperatures for 4-601-11(A) Equipment Food Contact Surfaces and 5-101.11 Water from an Approved S stem` PHFs Not Otherwise Processed to Eliminate 590. A Bottled Drinking Water' Utensils Cleans 3401.11 A(l)(2) Eggs- 155°F 15 Sec. I Pathogens.*EleOive,n xl 590. Water Meets Standards in 310 CUR 22-0* 4-602.11 Cleaning Frequency of Equipment Food- Eggs-Immediate Service 145°FI5sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* ShemFsh and Fish From an Approved Source Contact Surfaces and Utensils 3-401.I I(A)(2) Comminuted Fish,Meats&Game 4-702.11 Frequency of Sanitization of Utensils and * SPECIAL REQUIREMENTS 3-201.14 Fish and Recreationally Caught Molluscan Animals-155°F I5 sec. Food Contact Surfaces of Equipment* ( )( ) Violations of Section 590.009(A)-(D)in Shellfish* 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* 590.009 A-D 4-703.11 Methods of Sanitization-Hot Water and 3-201-15 Molluscan Shellfish from NSSP Listed s 3-401.1 I A 2 catering,mobile food,temporary and _ Chemical ( )( ) Ratites,Injected Meats-I55°F 15 sec. Sources 10 Proper,Adequate Handwashing * residential kitchen operations should be Game and Wild Mushrooms Approved by debited under the a ro riate sections Regulatory Aulh 2-301.11 Clean Condition-Hands and Arms' 3-401.1 1(A)(3) Poultry,Wild Game,Stuffed PHFs, PP P s Stuffing Containing Fish,Meat, above if related to foodborne illness 3-202-18 Shellstock Identification Present: 2-301-12 Cl Procedure g g « interventions and risk factors. Other 590. C Wild Mushrooms* 2-301-14 When to Wash' Poultry or Ratites-165°F 15 sec. 3-201.17 Game Animals* 11 Good Hygienic Practices 3-401.1 I(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 5 ReceivinglCondition 2401.11 Eatmg,Drinking or Using Tobacco* 145°F* practices should be debited under#29- , 3-202.11 PHFs Received at Proper Temperatures. 2-401.12 Discharges From the Eyes,Nose and 3-401.12 Raw Animal Foods Cooked in a Special Requirements. 3-202.15 Package Integrity* Mouth* Microwave 165°F 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When T s 3-401-1 1(A)(1)(b) All Other PHFs-145°F 15 sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 6 Tags/Records:Shellstock 12 Prevention of Contarrti Blue Items 23-30nation from Hands 17 Reheating for Hot Holding ) 3-202.18 Shellstock Identification* 590-004(E) Preventing Contamination from 3-403.1 1(A)&(D) PHFs 165°F 15 sec.* Critical and non-critical violations,which do not relate to the Employees* foodborne illness interventions and risk factors listed above,can be 3-203.12 Shellstock Identification Maintained* 3-403.11(B) Microwave-165°F 2 Minute Standing found in the following sections of the Food Code and 105 CHI? Tags/Records:Fish Products 13 Handwash FadOties Time* Conveniently Located and Accessible 590.000. 3�02.11 Parasite Destruction' 3-403.1 1(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 3402.12 Records,Creation and Retention` 5-203.1 1 Numbers and Capacities* 140°F" Ite_21 Management and Personnel FC-2 5 03 590. J labeling of Ingredients' 5-204-11 Location and Placement' 3-403.11(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 Conformance with Approved Procedures 5-205.11 Accessibility, lion and Maintenance Roasts* 25. Equipment and Utensils FC-4 .005 /HACCP Plans Supplied with Soap and Hand Drying 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-502.11 Specialized Process Methods* Devices 3-501.14(A) Cooling Cooked PHFs from 140°I=to 27. Physical Facility FC-6 .007 3-502.12 Reduced oxygen packaging,criteria' 6-301.11 Handwashin Cleanser,Availability28. Poisonous or Toxic Materials FC-7 .008 70°F Within 2 Hours and From 70°F 8-103.12 Conformance with Approved Procedures* 6-301-12 Hand Provision to 41°F/451F Within 4 Hours.* 29. Spheral Requirements .009 3-501.14(B) Cooling PHFs Made From Ambient Temperature Ingredients to 4I°F/45°F Within 4 Hours* •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. dE a I TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: i- of OFFICE HOURS: PUBLIC HEALTH DIVISION 8:00-9:30 A.M. �(' / 'r 200 MAIN STREET 3 moN.s FRinn. Item Code C�Cntleal(tern DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date Verified ,� --� f '' HYANNIS,MA02601 i6 q.��� S08-862-4644 PLEASE PRINT CLEARLY vv � � '� No.:: ': Reference= R=fled Item�� - Name Date Type of jX29-2L!psipection Operation(s) < Routine Address Risk Metail ce e-mspection Level Previous Inspection Telephon l Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge (PIC) a Time Bed & Breakfast HACCP In: Other A Inspector Out: Each violation c cked requires an explanation on the Harr ive pages) and a citation of specific provision(s)violated. dons Related to Foodborne Illness Interventions and Risk Factors Red Items Anti-Choking Tobacco Vn ons marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑as determined by the Board of Health. oq FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities o EMPLOYEEHEALTH PROTECTION FROM CHEMICALS 77121 112. 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 Asa Public Health Control ❑ 8. Separation/Segregabon/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POP LATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing 4 ❑ 11.Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisorie O F ons Related to Good Retail Practices (Blue Items) (C)violations marked must be corrected immediately. Non- Total Number of Critical Violations critical(N)violations must be corrected immediately or (blue&red items) within 90 days as determined by the Board of Health: Overall Rating Corrective Actfon Required: [ No ❑ Yes c N 23.Management and Personnel (FC-2)(590.003) Official Order for Correction: Based on an inspection today,the items ❑Re-inspection Scheduled ❑ Emergency Sus checked indicate violations of 105 CMR 590.000/federal Food Code. ❑Voluntary Compliance ❑ Employee Restriction/Exclusion p g y pension 24.Food and Food Protection (FC�)(590.004) This report,when signed below by a Board of Health member or its 25.Equipment and Utensils (FC-4)(590.005) agent constitutes an order of the Board of Health. Failure to correct 26.Water, Plumbing and Waste (FC-5)(590.006) violations cited in this report may result in sus-pension or revocation of ❑Embargo ❑ Emergency Closure ❑Voluntary Disposal ❑Other: 27. Physical Facility (FC-6)(590.007) the food establishment permit and ces-sation of food establishment Y Y A= Zero critical violations and no more than 3 non-critical violations. F= 3 or more critical violations. If no critical violations observed, 28. Poisonous or Toxic Materials (FC-7)(590.008) operations. If aggrieved by this order,you have a right to a hearing. 9 or more non-critical violations=F. Your request must be in writing and submitted to the Board of Health at B= One critical violation and less than anon-critical violations. 29.Special Requirements (590.009) the above address within 10 days of receipt of this order. If no critical violations observed, 4 to 6 non-critical violations= B. Seriously Critical Violation = F is scored automatically if no hot water, 30. Other C= 2 critical violations and less than 4 non-criti I. If no critical violations sewage back-up, infestation of rodents or insects, lack of refrigeration, or DATE OF RE-INSPECTION: d, 7 to 8 non-critical violati s= no PIC or alternate PIC present. Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered? Y N Insp tor' ur riot: #Seats Observed Frozen Dessert Machines: Outside Dining Y N Self Service Grease Trap Size Variance Letter Posted Y PI tg t e Print: Wait Service Provided P Violations Related to Foodborne illness 3-501.14(C) PHFs Received at Temperatures Interventions and Risk Factors(Red Hems 1-22) Violations Related to Foodbome Illness Interventions and Risk According to Law Cooled to PROTECTION FROM CONTAMINATION Factors(Red Items 1-22) (Cont.) 41°F/45°F Within 4 Hours. FOOD PROTECTION MANAGEMENT 8 Cross-contamination s PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 1 590.003 A Assi ent ofR Responsibility* 3-302.11(Axl) Raw Animal Foods Separated from 19 PHF Hot and Cold Holding 590.003 B Demonstration of Knowledge* Cooked and RTE Foods* 14 Food or Color Additives Contarrrina6on born Raw Ingredients 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 2-103.11 Person in charge-duties g 590.004(F) 4I0/450 F* 3-302.11(Ax2) Raw Animal Foods Separated from Each 3-302.14 Protection from Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above EMPLOYEE HEALTH Other* 15 Poisonous or Toxic Substances Contamination from the Environment 7-101.11 Identifying Information-Original 140°ts 2 590.003(C) Responsibility of the person in charge to � g g 3-5111.l6(A) Roasts Held at or above 130°F.* require reporting by food employees and 3-302.11 A Food Protection* Containers* applicants* 3-302.15 Washing Fruits and Vegetables 7-102.t 1 Common Name-Working Containers* 20 Time as a Public Health Control 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and 7-201.1 1 Separation-Storage* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Utensils* 7-202.t 1 Restriction-Presence and Use* 590.004(H) Variance Requirement Charge* Contamination from the Consumer 7-202.12 Conditions of Use* 590.003 G Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food* 7-203.1 1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 31 590.003D Exclusions and Restrictions* Disposition of Adulterated orContaminated 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 590.00 Removal of Exclusions and Restrictions Food 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.1 1(A) unpasteurized Pre-packaged Juices and 3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* FOOD FROM APPROVED SOURCE Food* 7-205.1 1 Incidental Food Contact,Lubricants* 3-801.1 1(B) Use of Pasteurized Eggs* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.1 1 Restricted Use Pesticides,Criteria* 3-801.1 1(D) Raw or Partially Cooked Animal Food and 590. A-B Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.* 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-801.1 1(C) Unopened Food Package Not Re-served: 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* CONSUMER ADVISORY 3-202.14 Eggs Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH TIME/TEMPERATURE CONTROLS 22 3-603.1 1 Consumer Advisory Posted for Consumption of ' concentration and hardness.* Animal Foods That are Raw.Undercooked or 3-202.16 Ice Made From Potable Water* 16 Proper Cooking Temperatures for 5-101.11 Water from an Approved System* 4 6(11.11(A) Equipment Food Contact Surfaces and PHFs Not Otherwise Processed to Eliminate Utensils Clean* Pathogens-*en n e uraoo, 590. A Bottled Water* 3-401.I I A(1)(2) Eggs- 155°F 15 Sea 4-602.11 Cleaning Frequency of Equipment Food- 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* 590. Water Meets Standards in 310 CMR 22.0* * Eggs-Immediate Service 145°PI Ssec* Contact Surfaces and Utensils 3-401.1 I A 2 Comminuted Fish,Meats&Game Shelfish and Fish From an Approved Source ( )( ) 4-702.11 Frequency of Sanitization of Utensils and * SPECIAL REQUIREMENTS 3-201.14 Fish and RecreationallyCaught MolluscanEquipment* Animals-t of R I5 sec. � Food Contact Surfaces of590.009(A)-(D) Violations of Section 590.009(A)-(D)in Shellfish* 3-401.1 I(B)(I)(2) Pork and Beef Roast-130°F 121 min* 4-703.11 Methods of Sanitization-Hot Water and catering,mobile food,temporary and 3-201.15 Molluscan Shellfish from NSSP Listed Chemicals 3-401.1 I(A)(2) Ratites,Injected Meats-I55°F 15 sec. residential kitchen operations should be IO Proper,Adequate Handwashin9 debited under the appropriate sections Game and Wkt Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHhs, R ula A 1 Stuffing Containing Fish,Meat, above if related to foodborne illness 3-202.18 Shellstock Identification Present* 2-301.2-301.14 Cl Procedure*When to Wash* Poultry or Ratites-165°F 15 sec.« interventions and risk factors. Other 590. C Wild Mushrooms* ai Good Hygienic Practices 3-401.1 1(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 3-201.17 Game Animals , 145°F« practices should be debited under#29- 5 ReceivinglCondition 2401.11 Ea i orU ' Tobacco Special Requirements. 3-202.11 PHFs Received at Pr Temperatures* 2-401.12 Discharges From the Eyes,Now and 3-401.12 Raw Animal Foods Cooked in a P 9 Mouth* Microwave 165°F 3-202.15 Package Integrity* 3-301.12 PreventingContamination When Tasting* 3-401.11(A)(i)(b) All Other PHFs-145°F 15 sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-101.11 Food Safe and Unadulterated* Blue Items 23-30 IZ . Prevention of Contamination from Hands 17 Reheating for Hot Holding ( ) 6'; Tags/Records:Shellstoek Critical and non-critical violations.which do not relate to the 590.004(E) Preventing Contamination from 3-403.11(A)&(D) PHFs 165°F 15 sec. 3-202.18 Shells[ock Identification* joodborne illness interventions and risk factors listed above,can be * Employees* 3-403.11(B) Microwave-165°F 2 Minute Standing 3-203.12 Shellstock Identification Maintained found in the following sections ojr the Food Code and/OS CAR Tags/Records:Fish Products 13 Handwash Facilities Time* 590.000. Conveniently Located and Accessible 3�02.11 Parasite Destruction* 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 3402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 140°F* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-403.1 1 E Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 590. J Labeling of Ingredients' ( ) g Contormance with Approved Procedures to 5-205.11 Accessibility, lion and Maintenance Roasts* 25. Equipment and Utensils FC-4 .005 IHACCP Plans Suppled with Soap and Hand Drying 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 * Devices• . 27. Physical Facility FC-6 .007 3-502.11 Specialized Methods 3-501 t4(A) Cooling Cooked PHFs from 140°F to 6-301.11 Handwashin Cleanser,Availability28. Poisonous or Toxic Materials FC-7 .008 3-502.12 Reduced oxygen ,criteria* 70°F Within 2 Hours and From 70°F 8-103.12 Conformance with Approved Procedures* 6-301,12 Hand aying Provision « 29. Special Requirements .009 to 41°F/451F Within 4 Hours. 30. 1 Other 3-501.14(B) Cooling PHFs Made From Ambient s s„imme,cu• ac Temperature Ingredients to 41°F/45°F Within 4 Hours* i *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 OW tee EALTH INSPECTOR'S djqL o* 'O+q `TOWN OF BARNSTABLE OFFICE HOURS: Establishment Name: Date: . Page: ( of r UBLIC HEALTH DIVISION 8:00-9:30 A.M. G 200 MAIN STREET �VT 3:30-4:30 P.M. 0 ,_, �. .�' HYANNIS,MA02601 MON.-FRI. Item Cie G=Cntical Item ESCRIPTION OF VlOLATIONTPLAN OF CORRECTION = DateVertfied p ► © 508-862-4644 N0. = Refefence R-Red Item BLEA$EPRINTCLEARLY _ Name D to Type of Type of Inspection sk Operation(s) Routine Address ervice- Rein ec Telephone ever nesi ' us revio Inspec411 on-IN tio ential Kitchen Mobile Owner HACCP Y/N Pre-operation Temporary Suspect Illness Caterer General Complaint Person in Charge (PIC) Time HACCP Bed 8 Breakfast In: Other Inspector ut: ach violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. wMatiorlS Related to FOOdborne Illness Interventions and Risk Factors (Red Items)to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ �' Action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employees and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 16. Cooking Temperatures ❑ 5. Receiving/Condition ❑ 17. Reheating ❑ 6. Tags/Records✓Accuracy of Ingredient Statements ❑ 18. Cooling ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time Asa Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) E39. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashin e9 9 ❑ 11.Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories rations Related to Good Retail Practices (Blue Items) r d Critical(C)violations marked must be corrected immediately. Non- Total Number of Critical Violations l critical(N)violations must be corrected immediately or (blue&red items) within 90 days as determined by the Board of Health. ( Overall Rating v' c N Corrective Action Required No ❑ Yes 23.Management and Personnel (FC-2)(590.003) Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/federal Food Code. ❑Voluntary Compliance ❑ Employee Restriction/Exclusion ❑Re-inspection Scheduled ❑ Emergency Suspension 24.Food and Food Protection FC-3 590.004 9 Y P eCti ( >( ) This report,when signed below by a Board of Health member or its 25.Equipment and Utensils (FC-4)(590.005) agent constitutes an order of the Board of Health. Failure to correct 26.Water, Plumbing and Waste (FC-5)(590.006) violations cited in this report may result in sus-pension or revocation of ❑Embargo ❑ Emergency Closure ❑Voluntary Disposal ❑Other: 27. Physical Facility (FC-6)(590.007) the food establishment permit and ces-sation of food establishment operations. If aggrieved by this order,you have a right to a hearing. A= Zero critical violations and no more than anon-critical violations. F= 3 or more critical violations. n no critical violations observed, 28. Poisonous or Toxic Materials (FC-7)(590.008) Your request must be in writing and submitted to the Board of Health at B= One critical violation and less than 4 non-critical violations. 9 or more non-critical violations=F. 29.Special Requirements (590.009) the above address within 10 days of receipt of this order. If no critical violations observed, 4 to 6 non-critical violations= B. Seriously Critical Violation = F is scored automatically if no hot water, 30. Other C= 2 critical violations and less t an on-critical. If no critical violations sewage back-up, infestation of rodents or insects, lack of refrigeration, or DATE OF RE-INSPECTION: rved, 7 to 8nOn-critical iol =C. no PIC or alternate PIC present. Q, Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered? Y N In a e Print: #Seats Observed Frozen Dessert Machines: Outside Dining Y N Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y P nature Print: _._,_..- «. _. -.-�- - -� ___. .- .. � _-�._�....-._-•-`�+^'C3!a�'r..-�+'i-`.,-.-r""��^�.``cr- ---•-----^-�-�•-+.ram--�---+-� -��- -�---- S ( 4 1 Vlolations Related to F e Illness 3-501.14(C) Received at Temperatures Interventions and Risk F (Red Hems 1-22) Violations Related to Foodbome lllnOnterventions and Risk 141coFI,45'F ding'to Law Cooled to PROTECTION FROM CONTAMINATION Factors(Red Items 1-22) (Cont.) Within 4 Hours. FOOD PROTECTION MANAGEMENT 8 Cross-contamination 3-501.15 ng Methods for PHFs 1 590.003 A Assi ent of R nsibili • 3-302.11 A 1 Raw Animal Foods S ted from PROTECTION FROM CHEMICALS( x ) epara 19 Hot and Cold Holding 590.003 Demonstration of Knowledge* Cooked and RTE Foods* 14 Food or Color Additives 2-103.11 Person in charge-duties Contannation from Raw Ingredients 3-202.12 Additives* 590.00 3-501.4(F) 41°/45°F* Cold PI Maintained at or below 3-302.14 Protection from Unapproved Additives* - 3-302.11(Ax2) Raw Animal Foods Separated from Each PP 3-501.16(16(A) Hot PHFs Maintained at or above � EMPLOYEE HEALTH Other* 15 Poisonous or Toxic Substances 140°F * 2.' 590.003(C) Responsibility of the person in charge to Contamination from the Environment 7-101.1 1 Identifying Information-Original require reporting by food employees and 3-302.11 A Food Protection* Containers* 3-501.16(A) Roasts Held at or above 130°F. applicants* 3-302.15 Washing Fruits and Vegetables 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and 7-201.1 1 Separation-Storage* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Utensils* 7-202.1 1 Restriction-Presence and Use* 590.004(4) Variance Requirement Charge* Contamnation from the Consumer 7-202.12 Conditions of Use* 590.003 G R rtin b Person in Charge* 3-306.14 A B Returned Food and Reservice of Food* 7-203.1 1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 3.j. 590.003D Exclusions and Restrictions* Disposition of Adulterated or Contaminated 7-204.11 Sanitizers,Criteria-Chemicals* POP(A) Unpasteurized k I , 590.00 Removal of Exclusions and Restrictions Food 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-R01.1 I(A) Unpasteurized Pre-packaged Juices and 3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* FOOD FROM APPROVED SOURCE Food* 7-205.11 Incidental Food Contact,Lubricants* 3-801.I I(B) Use of Pasteurized Eggs* 4` Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.1 1(D) Raw or Partially Cooked Animal Food and 590. A-B Compliance with Food Law` 4-501.111 Manual Warewashing-Hot Water 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. Sanitization Temperatures*3-201.12 Food in a HermeticallySealed Container* 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-served. 3-201.13 Fluid Milk and Milk Products* 4-501.112- Mechanical Warewashing-Hot Water Monitoring* Sanitization Temperatures* CONSUMER ADVISORY 3-202.13 Shell Eggs* • *4-501.114 Chemical Sanitization-temp.,pH 22 3-603.1 1 Consumer Advisory Posted for Consumption of 3-202.14 E s and Milk Products,Pasteurized TIME/TEMPERATURE CONTROLS 3-202.16 Ice Made From Potable Water` concentration and hardness. 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or 5-101.11 Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and PHFs Not Otherwise Processed to Eliminate n""�""' Utensils Cleans 3-401.1IA(1)(2) Eggs- I55°F IS Sec. Pathogens.*E 590. A Bottled Drinking Water* 4-602.11 Cleanin Frequency of Equipment Food- » 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* * g �i Y FA Pm Eggs-Immediate Service 145°FlSsec 590. Water Meets Standards in 310 CUR 22.0 Contact Surfaces and Utensils* 3-401.1 1(A)(2) Comminuted Fish,Meats&Game She9fish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and * SPECIAL REQUIREMENTS 3-201.14 Fish and RecreationallyCaught MolluscanEquipment* Animals- 155°F 15 sec. � Food Contact Surfaces of590.009(A)-(D) Violations of Section 590.009(A)-(D)in Shellfish* 3-401.1 I(B)(I)(2) Pork and Beef Roast-130°F 121 min* 4-703.11 Methods of Sanitization-Hot Water and catering,mobile food,temporary and 3-201.15.`= Molluscan Shellfish from NSSP Listed Chemical* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. residential kitchen operations should be Sources* 1p;! Proper,Adequate Handwashing debited under the appropriate sections Game and Md Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* 3-401.1 1(A)(3) Poultry,Wild Game,Stuffed PHFs, R ula Auth 2-301.12 Cl Procedure• Stuffing Containing Fish,Meat, above if related to foodbotne illness 3-202.18 Shellstock Identification Present* Poultry or Ratites-165°F 15 sec.* interventions and risk factors. Other 590. C Wild Mushrooms* 2-301.14 When to Wash* 590.009 violations relating to good retail 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks g g 3-201.17 Game Animals* 11 Good Hygienic or Practices * 145°F» practices should be debited under#29- 5 ReceivingWAm dition 2-401.1 Eating, or Eyes, Tobacco Special Requirements. 3-202.11 PHFs Received at Pr Temperatures* 2-001.12 Discharges From the Eyes,Nose and 3-401.12 Raw Animal Foods Cooked in a P 9 Mouth* Microwave 165°F• - I - 1 0 3-202.15 Package In 3-301.12 PreventingContamination When Tasting* 3-401.1 1(A)(1)(b) All Other PHFs-145°F 15 sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-101.11 Food Safe and Unadulterated• (Blue Items 23-30) Prevention of ConWntinatbn from Hands 1'7 Reheating for Hot Holding 6:' TagslReeords:Shellstock LIL Critical and non-critical violations,which do not relate to the 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-403.1 1(A)&(D) PHFs 1 Microwave- 15 sec. Employees* foodborne illness interventions and risk factors listed above,can be 3-403.1 1(B) Microwave-165°F 2 Minute Standing found in the following sections o the Food Code and 105 CMR 3-203.12 Shellstock Identification Maintained• 13 Handwash Fadllfies Time* f j 8 f Tags/Records:Fish Products 590.000. 02.11 Conveniently Located and Accessible 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 3 Parasite Destruction` 34 5-203.11 Numbers and Capacities*02.12 Records,Creation and Retention* 140°F* 23. Management and Personnel FC-2 .003 590. J Labelingof 1 redlente 5-204.11 Location and Placement* 3-403.1 1(E) Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 5-205.11 Accessibility, lion and Maintenance Roasts* 25. Equipment and Utensils FC-4 .005 Confortmance with Approved Procedures IHACCP Plans Supplied with Soap and Hand Drying 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-502. 1 -S iahzied Methods• Devices 3-501.14(A) Cooling Cooked PHFs from 140°F to 28. Physical Facility FC-6 .008 6-301.11 Handwashin Cleanser,Availability28. Poisonous or Toxic Materials FC-7 .008 70°F Within 2 Hours and From 70°F 3-502.12 Reduced oxygen ,criteria` 29. Special Requirements 009 8-103.12 Conformance with Approved Procedures 6 301.12 Hand Provision • to 41°F/451F Within 4 Hours.* 30. 1 Other 3-501.14(B) Cooling PHFs Made From Ambient S5'r1f.m ko-2. Temperature Ingredients to 41°F/45°F Within 4 Hours* *Dots critimi item in the federal 1999 Food Code or 105 CMR 590.000. t •Denotes critical iteq in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE HEALTH INSPECTOR'S Date: Page: Establishment Name: )�Y ��`�''�' BOARD OF HEALTH OFFICE HOURS: 200 MAIN STREET 8:00-9:30 A.M. • 1:00-2:00 P.M. item Code C-Cntl�ai Mein Q S�RIPTI N . 1/IC�L�kT10 /PLAN O C�RRECTI4tV pateVerlflsd ' s"""s'"s'� ' HYANNIS,MA 02601 noes - MON.-FRI. .�� so8�s2 4saa No Reieranoe R Red item; ntAsr ijanvT Ctat1Lv FOOD ESTABLISHMENT INSPECTION REPORT Name �� Type of Type of Inspection Address Ris Operation(s) Routine Food Service a inspection Level etail Previous Inspection , A Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Person in Charge (PIC Time Caterer General Complaint Bed&Breakfast y n: Other � I � Inspector Out-INOI Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Alft'haticins Related to Foodborne Illness Interventions and Risk Factors Red Items Anti-Choking. Tobacco olations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ Action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 12. Prevention of Contamination from Hands 1.PIC Assigned/Knowledgeable/Duties 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 2. Reporting of Diseases by Food Employees and PIC 14. Approved Food or Color Additives 3.Personnel with Infectious Restricted/Excluded 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 4.Food and Water from Approved Source 16. Cooking Temperatures 5.Receiving/Condition 17. Reheating 6.Tags/Records/Accuracy of Ingredient Statements 18. Cooling 7.Conformance with Approved Procedures/HACCP Plans 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION 20. Time As a Public Health Control 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) 9.Food Contact Surfaces Cleaning and Sanitizing 21. Food and Food Preparation for HSP 10.Proper Adequate Handwashing CONSUMER ADVISORY 11.Good Hygienic Practices 22. Posting of Consumer Advisories ations Related to Good Retail Practices(Blue Ftems) Number Critical(C)violations marked must be corrected immediately. Violated Provisions Related To ber bee of of Illnesses Interventions Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. and Risk Factors(Red Items 1-22): c N Official Order for Correction: Based on an inspection today, the 23.Management and Personnel (FC-2)(590.003) items checked indicate violations of 105 CMR 590.000/federal 24.Food and Food Protection (FC-3)(590.004) Food Code.This report,when signed below by a Board of Health 25. Equipment and Utensils (FC-4)(590.005) member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in sus- 26.Water, Plumbing and Waste (FC-5)(590.006) pension or revocation of the food establishment permit and ces- Correc..Ve Action Regprred ] No { Yes 27. Physical Facility (FC-6)(590.007) sation of food establishment operations. If aggrieved by this order, 28. Poisonous or Toxic Materials (Fa7)(590.008) you have a right to a hearing. Your request must be in writing and 29. Special Requirements (590.009) submitted to the Board of Health at the above address within 10 Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled. ❑ Emergency 30. Other days of receipt of this order. DATE OF RE-INSPECTION: ❑ Embargo ❑ Emergency Closure ❑ oluntary Disposal ❑ Other: Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered? Y N Ins or' \+ P - t: #Seats Observed_ Frozen Dessert Machines: Outside Dining Y N PIC's Si Print Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Violations Related to Fe Illness • • 3-501.14(C) T HFs Received at Temperatures Interventions and Risk Factors(Red Items 1-22) Violations Related to Foodbome Illness Interventions and Risk ccording to Law Cooled to PROTECTION FROM CONTAMINATION Factors(Red Items 1-22) (Cont.) 1°F/45°F Within 4 Hours.+ FOOD PROTECTION MANAGEMENT 8 Cross-contamination 3-501.15 Cooling Methods for PHFs 1 590.003 A Assignment of R nsibili , 3-302.1I(Ax1) Raw Animal Foods Separated from PROTECTION FROM CHEMICALS 590.003 B Demonstration of Knowledge* Cooked and RTE Foods' 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501. 2-103.11 Person in charge-duties Contarninadon from Raw/ngredents 3-202.12_, ___ Additives* 590.00 4(F) 41°/45°F* Cold PHFs Maintained at or below 3-302.11(Ax2) Raw Animal Foods Separated from Each 3-302.14 Protection from Unapproved Additives* 16(A.1 EMPLOYEE HEALTH Other' 15 Poisonous or Toxic Substances 3-501 ) Hot PHFs Maintained at or above Contamination from the Environment 7-101.1 1 Identifying Information-Original 140°F.+ 2 590.003(C) Responsibility of the person in charge to fY g g� require reporting by food employees and 3-302.11 A Food Protection* Containers* 3-501.16(A) Roasts Held at or above 130°F. applicants* 3-302.15 Washing Fruits and Vegetables 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and 7-201.1 1 Separation-Storage* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Utensils' 7-202.1 1 Restriction-Presence and Use* ' 590.004(H)- I Variance Requirement Charge* Contamination from the Consumer 7-202.12 Conditions of Use* 590.003 G Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 3 590.003 D Exclusions and Restrictions* Disposition of Adulterated or Contaminated 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 590.00 Removal of Exclusions and Restrictions Food 7-204.12 1 Chemicals for Washing Produce,Criteria* 21 3-801.1 I(A) Unpasteurized Pre-packaged Juices and 3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* FOOD FROM APPROVED SOURCE Food* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 4 Food and Water From Regulated Sources 9 Food Confect Surfaces 7-206.1 1 Restricted Use Pesticides,Criteria* 3-801.1 1(D) Raw or Partially Cooked Animal Food and 590. A-B Compliance with Food Law* 4-501.111 Manual Warewashmg-Hot Water 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.* Sanitization Temperatures* 3-801.11(C) Unopened Food Package Not Re-served. 3-20I.12 Food in a Hermetically Sealed Container* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* CONSUMER ADVISORY 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH TIME/TEMPERATURE CONTROLS 22 3-603.1 1 Consumer Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or 3-202.76 Ice Made From Potable concentration and hardness.'Water* 16 Proper Cooking Temperatures for 4601.1 I(A) Equipment Food Contact Surfaces and PHFs Not Otherwise Processed to Eliminate 5-101.11 Water from an Approved System* Utensils Clean' Pathogens.*En arm lnaa°, 590. A Bottled Water' 3-401.I IA(1)(2) Eggs- 155°F IS Sec. * 4-602.11 Cleaning Frequency of Equipment Food- Eggs-Immediate Service 145°F 15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* 590. Water Meets Standards in 310 CMR 22.0 gg Contact Surfaces and Utensils* 3-401.1 I A 2 Comminuted Fish,Meats&Game Shelrish and Fish From an Approved Source 4702.11 Frequency of Sanitization of Utensils and ( )( ) Animals-155°F 15 sec. eq y * SPECIAL REQUIREMENTS 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Shellfish* 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* 4703.11 Methods of Sanitization-Hot Water and catering,mobile food,temporary and 3-201.15 Molluscan Shellfish from NSSP Listed * -401. A 2 Chemical 3 11( ) Ratites,Injected Meats-I55°F 15 sec. Sources* 10 proper,Adequate Handwashing • residential kitchen operations should be Game and WM Mushrooms Approved by , 3-401.11 A 3 Poultry, debited under the appropriate sections R ula A 2-301.11 Clean Condition-Hands and Arms ( )O ry,Wild Game,Stuffed PHFs, 2-301.12 CI Procedure' Stuffing Containing Fish,Meat, above n related to foodbrisk factors. t rs illness 3-202.18 Shellstock Identification Present * Poultry or Ratites-165°F 15 sec.* interventions and risk factors. Other 590. C Wild Musbrooms* 2-301.14 When to Wash ry 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 3-401.1 1(C)(3) Whole-muscle,Intact Beef Steaks S 5' ReceivlrrglConditlon 2401.11 Eating,Drinking or Using Tobacco* 145°F* practices should be debited under#29- 2401.12 Discharges From the Eyes,Nose and 3-401.12 Raw Animal Foods Cooked in a Special Requirements. 3-202.11 PHFs Received at Temperatures* 3-202.15 Package Integrity* Mouth' Microwave 165°F 3-101.11 Food Safe and Unadulterated' 3-301.12:- Preventing Contamination When T * 3-401.11(A)(I)(b) All Other PHFs-145°F 15 sec.+ VIOLATIONS RELATED TO GOOD RETAIL PRACTICES u.;: Preventhm of Contamination from Hands 17 Reheating for Hot Holding (Blue Items 23-30) 6" Tags/Records:Shellstock Critical and non-critical violations,which do not relate to the 3-202.18 Shellstock Identification' S90.004(E) Preventing Contamination from 3-403.1 l(A)&(D) PHFs 165°F 15 sec.* Em to ees' 3-403.1 1(B) Microwave-165'F 2 Minute Standing foodborne illness interventions and risk factors listed above,can be 3-203.12 ShcUstock Identification Maintained* 13. Handwash Facilities * g found in the following sections of the Food Code and 105 CAR Tags/Records:Fish Products Time 590.000. Conveniently Located and Accessible 3�02.1 t Parasite Destruction* s 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 5-203.1 l Numbers and Capacities* 140°F+ _ 3�02.12 Records,Creation and Retention* * 23. Management and Personnel FC 2 .003 -2 t' d Placement* 5 04.1 I Location an P1 semen 3-403.1 1 E Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 590. J Labeling of Ingredients' ( ) g :. Conformance vAM Approved Procedures 5-205.11 Accessibility, lion and Maintenance Roasts* 25. Equipment and Utensils FC-4 .005 /HACCP Plans Supplied with Soap and Hand Drying 18 3-501.14(A) Cooling Cooked PHFs from 140°F to Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 3-502.11 Specialized Methods Devices 27. Physical Facility FC-6 .007 6-301.11 Handwashin Cleanser,Availabili 28. Poisonous or Toxic Materials FC-7 .008 3-502.12 Reduced oxygen ,criteria* 70°F Within 2 Hours and From 70°F 6 301.12 Hand Provision 29. Special Requirements 009 8-103.12 Conformance with Approved Procedures* to 41°F/45°F Within 4 Hours. , 30. Other r1o 1.14(B) Cooling PHFs Made From Ambient ss'nrecke-z.a°c Temperature Ingredients to 41°F/45°F Within 4 Hours* *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. �y TOWN OF BARNSTABLE M 8 20® HEALTH INSPECTOR'S Establishment Name yc �X"' Fete: '� " Page: dry W • BOARD OF HEALTH OFFICE HOURS: ' q 200 MAIN STREET 8:00-9:30 A.M. • + HYANNIS,MA02601 t MONOFRIN Item CQdB G40MCa1.lt JTt I7 GRIPTIEJI�I�F t/IOLATIQ)�V PI�AN:O�C(3RFtECTCON. [3ateVei-tflsd •613A .� soa-a62�saa ::No :Reference R.--Red lfein. :.;' ,' pLlrasEPA T cties+nLv _: FOOD EST LISHM NT INSPECTION REPORT 1 Name D Upe of Tvoe of Inspection ` Address @ Risk l Food S09 ervice ) Routine Food Service Re-inspection Level Retail Previous Inspection O Q Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge (PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Isch violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. iolations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco KT Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ Action as determined by the Board of Health. 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/Segregatiort/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 Aiolaftions Related m Good Retail Practices(Blue hems) Number of Violated Provisions Related Critical(C)violations marked must be corrected immediately. Non-critical(N)violations must be corrected immediately or To Foodborne Illnesses Interventions within 90 days as determined by the Board of Health. and Risk Factors(Red Items 1-22): C N Official Order for Correction: Based on an inspection today, the 23.Management and Personnel (FCr2)(59o.om) items checked indicate violations of 105 CMR 590.000/federal 24.Food and Food Protection (FC-3)(590.004) Food Code.This report,when signed below by a Board of Health member or its agent constitutes an order of the Board of Health. 25. Equipment and Utensils (FC-4)(590.005) Failure to correct violations cited in this report may result in sus- 26.Water, Plumbing and Waste (FC-5)(590.006) pension or revocation of the food establishment permit and ces- Correcttve J4ctrott RegPrce;# ❑ No tics 27. Physical Facility (FC-6)(590.007) sation of food establishment operations. If aggrieved by this order, 28. Poisonous or Toxic Materials (F�7)(sso.00a) you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address within 10 ❑ Voluntar o plia c ❑ oyee Restriction/Exclusion ❑ Re-inspection Scheduled. ❑ Emergency 29. Special Requirements (590.009) days of receipt of this order. 30. Other DATE OF RE-INSPECTION: E b ❑ Emer ency Closure ❑ Voluntary Disposal ❑ Other: Permit Posted? V Y N Grease Trap Previous Pumping Date Grease Rendered? Y N Ins t s n t Print: #Seats Observed Frozen Dessert Machines: Outside Dining Y N Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N PIC's Signature Print: Violations Related to F*F7,(Red e Illness 3-501.14(C) eceived at Temperatures Interventions and Risk Ileums 1-22) Violations Related to Foodbome Illness Interventions and Risk According to Law Cooled to PROTECTION FROM CONTAMINATION Factors(Red Items 1-22) (Cont.) 41°F/45°F Within 4 Hours. FOOD PROTECTION MANAGEMENT 8. Cross-contamination 3-501.15 Cooling Methods for PHFs i I 590.003 A)TAss_igmnent of R nsibih * 3-302.11 A 1 Raw Animal Foods Separated from PROTECTION FROM CHEMICALS ( x ) S "d 19 PHF Hot and Cold Holding 590.003 B Demonstration of Ynowl e* Cooked and RTE Foods* 14 Food or Color Additives 2-103.1 I Person in charge-duties Contamination from Raw Ingredients 3-202.12 Additives* 3-501.590.00 4(F) Cold PHFs Maintained at or below 3-302.14 Protection from Unapproved Additives* 41°/45°F' 3-302.11(AX2) Raw Animal Foods Separated from Each FP 3-501.16(16(A) Hot PHFs Maintained at or above EMPLOYEE HEALTH Other* 15 Poisonous or Toxic Substances * Contamination from the Environment 7-101.1 1 Identifying Information-Original 140°F. 2 590.003(C) Responsibility of the person in charge to �' g g require reporting by food employees and 3-302.1] A Food Protection* Containers* 3-501.16(A) Roasts Held at or above 130°F. applicants* 3-302.15 Was Fruits and Vegetables 7-102.1 1 Common Name-Working Containers* 20 Time as a Public Health Control 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and 7-201.1 1 Separation-Storages 590.0 Time as a Public Health Control* Applicant To Report To The Person In Utensils* 7-202.11 Restriction-Presence and Use" 90.004(H) Variance Requirement Charge* t • - Contamination hom the Consumer 7-202.12 Conditions of Use* 590.003 G Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food* 7-203.1 1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 3.1 590.003D Exclusions and Restrictions* Disposition of Adulterated or Contaminated 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 590.00 Removal of Exclusions and Restrictions Food 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* • FOOD FROM APPROVED SOURCE Food* 7-205.11 Incidental Food Contact,Lubricants* 3-801.1 1(B) Use of Pasteurized Eggs* AL Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and 590. A-B Compliance with Food Law* 4-501.111 Manual Warewashmg-Hot Water 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-801.1 1(C) Unopened Food Package Not Re-served. 3-201.13 Fluid Milk and Milk Products* 4-501.1 l2 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* CONSUMER ADVISORY 3-202.14 1 Eggs and Milk Products,Pasteurized 4-501.114 Chemical Sanitization-temp., 22 3-603.11 Consumer Advisory Posted for Consumption of * p'•PIS TIME/TEMPERATURE CONTROLS ry p concentration and hardness.* Animal Foods That are Raw,Undercooked or 3-202.16 Ice Made From Potable Water* 16 Proper Cooking Temperatures for 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and PHFs Not Otherwise Processed to Eliminate s Utensils Clean* 3-401.11A(l)(2) Eggs- 155°F 15 Sec. Pathogens.*E""tfrviB111�w1 590. A Bottled Water 4-602.11 Cl Frequency of Equipment Food- * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* 590. Water Meets Standards in 310 CUR 22.0* Cleaning y Eggs-Immediate Service 145°F15sec Contact Surfaces and Utensils* A 2 Sheltfrslh and Fish From an Approved Source 3-401.1 1( )( ) Comminuted Fish,Meats&Game 4-702.11 Frequency of Sanitization of Utensils and * SPECIAL REQUIREMENTS 3-201.14 Fish and Recreationally Caught MolluscanEquipment* Animals-I55°F 15 sec. Food Contact Surfaces of ui ents 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Shellfish' 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min' 4-703.11 Methods of Sanitization-Hot Water and catering,mobile food,temporary and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. ;10 Proper,Adequate Handwashing * residential kitchen operations should be Sources* E Game and VWd Mushrooms Approved by 3-401.1 I(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections R ula A 2-301.1 2-301.12 Clean Condition-Hands and Arms* above if related to foodborne illness 3-202.18 Shellstock Identification Present* 2-301.14 W W Procedure* Stuffing Containing Fish,Meat,hen to Wash s Poultry or Ratites-165°F IS sec.* interventions and risk factors. Other 590. C Wild Mushrooms* is Practices 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 3-201.17 Game Animals* it c'OOd s I45°F s practices should be debited under#29- 5 ReceivinglCondidon 2-401.11 Ea , - or Using Tobacco Special Requirements. 3-202.11 PHFs Received at Temperatures* 2-401.12 Discharges From the Eyes,Nose and 3-401.12 Raw Animal Foods Cooked in a P 9 Mouth' Microwave 165°F* 3-202.15 Package Integrity* s 3-401.1 1 A 1 b " VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When T ( )( )O All Other PHFs-145°F 15 sec. (BlueItems 23-30 j2,;;; Prevention of Contantriation from Hands 17 Reheating for Hot Holding ) 6 Tags/Records:Shellstock Critical and non-critical violations,which do not relate to the 590.004(E) Preventing Contamination from 3-403.1 1(A)&(D) PHFs 165°F 15 sec. 3-202.18 ShelLtilock Identification* foodborne illness interventions and risk factors listed above,can be Em to ees* 3-403.11(B) Microwave-165'F 2 Minute Standing 3-203.12 Shellstock Identification Maintained* 13' ��a�Facilities Time* found in the following sections of the Food Code and 105 CMR Tags/Records:Fish Products - 590.000. 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-403.11(C) Commercially Processed RTE Food- I Good Retail Practices EF5 590.000 3402.12 Records,Creation and Retention* 5-203.11 Numbers and ties* 140°F* Management and Personnel .003 590. J Labeling of Ingredients' 5-204.11 Location and Placement* 3-403.11(E) Remaining Unsliced Portions of Beef Food and Food Protection .004 CoMormarice with Approved Procedures 5-205.11 Acce=bih lion and Maintenance Roasts* Equipment and Utensils .005 MACCP Plans SupP6ed with Soap and Hand Drying lg Proper Cooling of PHFs Water,Plumbing and Waste .006 Devices Physical Facility .007 3-502.11 S alized Pr Methods* 3-501.14(A) Cooling Cooked PHFs from 140°F to poisonous or Toxic Materials .008 6-301.11 Handwashin Cleanser,Availability 3-502.12 Reduced oxygen ,criteria* 6 301.12 Hand Provision 70°F Within 2 Hours and From 70°F Special Requirements 009 9-103.12 Conformance with Approved Procedures* to 41°F/45°F Within 4 Hours.* . Other 3-501.14(B) Cooling PHFs Made From Ambient ss•r*�m�wz.a� Temperature Ingredients to 41°F/451F Within 4 Hours* *Denotes critical @an 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. ZME T TOWN OF BARNSTABLE HEALTH INSPECTOR'S OFFICE HOU � '� ate: RS: Establishment Name: �.,f�e age: of PUBLIC HEALTH DIVISION • 8:00-9:30 A.M. lop, RA��� , 200 MAIN STREET 1:00-2:00 P.M. RNSrMAIM e$ HYANNIS, MA 02601 a MON.-FRI.163 1✓--GlclE11 C ��Rip' IEN ?F YIC9UlTIC31lgPLAI dFCETif� tlatet@[id 508-862-4644 .t e ,,. I e IPJE7t; 1 ' ♦ t FOOD ESTABLISHMENT INSPECTION REPORT PfAbifltiTtlAFiLY 101- °° ` Name ; - 1- Date�j" Me of Operation(s) T e of Ins ection � '"�� r TOrg ❑ Food Service outine Addre49 Risk 0 O� 4 Retail ❑ Re-inspection ma�0_011 Tele hone y Level ❑ Residential Kitchen Previous Inspection ' a p P - •� "! , i/ L^ ! ❑ Mobile Date: �� t' C Lv Owner HACCP YIN ❑ Temporary ❑ Pre-operation �- ❑ Caterer ry ❑ Suspect Illness 49' 4l�0, Person in Charge(PIC) TimeO�f ❑ Bed&Breakfast ❑ General Complaint ) In: ❑ HACCP ter? Inspector Out: Permit No. I violation checked requm an explanation on the narratnre pages) ecific a citation of sp proviston(s)violated. Non-compliance with: C ations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking Tobacco !� Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F)❑ Action as determined by the Board of Health. 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 00, ❑ 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 ❑ 5.Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating '�y. ❑ 7.Conformance with Approved ProceduresMACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑ 20. Time As a Public Health Control ❑ 9.Food Contact Surfaces Cleaning and Sanitizing REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10.Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP 1411.Good Hygienic Practices CONSUMER ADVISORY lations Related to Good Retail Practices(Blue Items) ❑ 22. Posting of Consumer Advisories Critical(C)violations marked must be corrected immediately. Number of Violated Provisions Related Non-critical(N)violations must be corrected immediately or To Foodborne Illnesses Interventions within 90 days as determined by the Board of Health. and Risk Factors(Red Items 1-22)• =_ Official Order for Correction: Based on an inspection today, 23. Management and Personnel (FC-2)(590.003) the items checked indicate violations of 105 CMR 590.000/federal 24. Food and Food Protection (FG3)(590.004) Food Code.This report,when signed below by a Board of Health 25. Equipment and Utensils (FC•4)(590.005) member or its agent constitutes an order of the Board of Health. 26 Failure to correct violations cited in this report may result in sus R.c; ? �r K Water,Plumbing and Waste (FC-5)(590.006) pension or revocation of the food establishment permit and ces Ct�rC&GtIY+Et ik hilt ufretf 27. Physical Facility (FC-6)(590.007) sation of food establishment operations. If aggrieved by this or 28. Poisonous or Toxic Materials (FC-7)(590.008) der,you have a right to a hearing. Your request must be in writ- ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension 29. Special Requirements (590.009) ing and submitted to the Board of Health at the above address 30. Other within 10 days of receipt of this order. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: DATE OF RE-INSPECTION: In s • nature Pr' Permit Posted? Y N Grease Trap Previous PumpWingat Grease Rendered? IN#Seats Observed Frozen Dessert Machines: Outside Dining NPIC's Sig PrinSelf Service Wait ServiceProvided Grease Trap Variance Letter Posted Y N _, � t _ ._\ __ _ - r Y-. �i-y. �.s ._ - - _ � _ .+y l � w r..✓..'�r � r.- r ..1 F _ - w- _ Violations Related to F e Illness 3-501.14(C) PH eceived at Temperatures Interventions and Risk Factors(Red Items 1-22) Violations Related to Foodbome Illness Interventions and Risk According to Law Cooled to PROTECTION FROM CONTAMINATION Factors(Red Items 1-22) (Cont) 41°F/45°F Within 4 Hours. FOOD PROTECTION MANAGEMENT 8 Cross-eontamhtadon 1'.;, 590.003 A Assi ant of R bili * 3-302.11 A 1 Raw Animal Foods Separated from PROTECTION FROM CHEMICALS 3-501.1 S Cooling Methods for PHFs ( X-) SePaz"d 19 PHF Hot and Cold Holding 590.00 Demonstration of Knowl e* ' Cooked and RTE Foods* 14 Food or Color Additives 2-103.11 Person in charge-duties Contamination frown Raw Ingredents 3-202.12 Additives* - t 3-501. Cold PHFs Maintained at or below 3-302.I 1(Ax2) Raw Animal Foods Separated from Each 3-302.14 Protection from Unapproved Additives• 590.004(F)(F) a 41°/45°F• t ' 3-501.16(A) Hot PHFs Maintained'at or above EMPLOYEE HEALTH ♦ Other* 15 Poisonous or Toxic Substances - 2. 590.003(C) - Responsibility of the person in charge to, $ Contamination from the Environment 7-101.1 1 Identifying Information-Original - 140°F.* ' require reporting by food employees and 3-302.11 A Food Protection* Containers* 3-501:16(A) 'Roasts Held at or above 130°F. licants', 3-302.15 . Was � Fruits and V etables 7-102.1 1 Common Name-Working Containers* 20 Time as a Public Health Control 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 'Applicant To Report To The Person In Utensils* 7-202.11 Restriction-Presence and Use*• 590.004(H) Variance Requirement Charge.* Contamination from the Consumer 7-202.12 Conditions of Use* 590.003 G R b Person in Charge* 3-306.1 A B Returned Food and Reservice of Food* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS,FOR HIGHLY SUSCEPTIBLE 31 590.00 Exclusions and Restrictions* t Disposition of Adulterated or Contaminated 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 590.00 Removal of Exclusions and Restrictions FOod 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.1 1(A) Unpasteurized Pre-packaged Juices and • 3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* FOOD FROM APPROVED SOURCE Food* 7-205.1 1 Incidental Food Contact,Lubricants* 3-801.1 1(B) Use of Pasteurized Eggs* Food and Water From Regulated Sources 9.: Food Contact Surfaces 7-206.1 1 Restricted Use Pesticides,Criteria* 3-801 A I(D) Raw or Partially Cooked Animal Food and 4 590. A-BCompliance with Food Law* 4-501.III Manual'Warewashing-Hot Water 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served. 3-201.12 Food in a Hennetically Sealed Container* Sanitization T ttures* 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-served. 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell s* Sanitization Temperatures* CONSUMER ADVISORY 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 '" Chemical Sanitization-temp.,pH TIME/TEMPERATURE CONTROLS 22 3-603.1 1 Consumer Advisory Posted for Consumption of concentration and hardness.• Animal Foods That are Raw,Undercooked or 3-202.16 Ice Made From Potable Water* 16 Proper Cooking Temperatures for 4-601.11(A) Equipment Food Contact Surfaces and. PHFs Not Otherwise Processed to Eliminate 5 101.11 Water from an Approved S stem*• * Pathogens.*En�'naw' _ Utensils Clean 3-401.I I A(1 H2) Eggs- 155°F I S Sec. 590. A Bottled Water* 4-602 11 CI F of Equipment Food * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* 590. Water Meets Standards in 310 CUR 22.0* �8 Frequency E9u Eggs-Immediate Service 145°FI Ssec ShedFsh and Fish From an Approved Source Surfaces and Utensils! 3-401.1 I(A)(2) Comminuted Fish,Meats&Game 4 702.11 Frequency of Sanitization of Utensils and . SPECIAL REQUIREMENTS 3-201.14 Fish and Recreationally Caught Molluscan Animals-155°F 15 sec. Food•Contact Surfaces of Equipment* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Shellfish' 3-401.11(B)(Ix2) Pork and Beef Roast-130°F 121 min*4-703.11 Methods of Sanitization-Hot Water and catering,mobile food,temporary and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 3401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. Sotnces* Adequate Handwasht * residential kitchen operations should be Game and KW Mushrooms Approved by lU Proper,Adeq , 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections 2-301.11 Clean Condition-Hands and Arms R ula A *' above if related to foodborne illness * 2-301.12 CI Procedure* Stuffing Containing Fish,Meat 3-202.18 Shellstack Identification Present Poultry or Ratites-165°F I S sec.* interventions and risk factors. Other 590. C Wild Mushrooms* 2-301.14 When to Wash* 590.009 violations relating to good retail 3 2011 ni 7 Game Amals* 11. Good Hygienic Practices 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks g 2�01.11 Fa tin � or Using Tobacco* 145°F* practices should be debited under#29- 5; ReceivinglCondttl°o 3401.12 Raw Animal Foods Cooked in a Special Requirements. 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* Microwave 165°F 3-202.15 Package In * * 3-401.1 l A 1 b VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting- ( x )O AlAll Other PHFs-145°F I5 sec. T ecords:Shellstodt Prevention of Conaan ination from Hands 17 Reheating for Hot Holding (Blue Items 23-30) 6 agsrtt ( �( ) Critical and non-critical violations,which do not relate to the 590.004(E) Preventing Contamination from 3-403.11 A D PHFs 165°F 15 sec.* 3-202.18 Shellstock Identification* Emip1 ces* 3403.11 foodborne illness interventions and risk factors listed above,can be 3-203.12 Shellstock Identification Maintained* - 11(B) Microwave-165°F 2 Minute Standing found in the following sections ojrhe Food Code and 105 CMR Tags/Records:Fish Products 13: ash Factiities Time* 590.000. 3402.11 Parasite Destruction* Conveniently Located and Accessible 3403.11(C) Commercially Processed RTE Food- E25. Equipment d Retail Practices FC 590.000 3-402.12 Records,Creation and Retention* 5 203.11 Numbers and cities* 140°F* agement and Personnel FC-2 .003 590. J Labeling of Ingredients• 5-204.11 Location and Placement* 3-403.11(E) Remaining Unsliced Portions of Beef d and Food Protection FC-3 .004 CoMom►arrce with Approved Procedures 5-205.11 Accesdbili lion and Maintenance Roasts* ipment and Utensils FC-4 .005 MACCP PMrn Supplied►AUi Soap and Hand Drying 18 Proper Cooling of PHFs er,Plumbing and Waste FC-5 .006 Devices sical Facility FC-6 .007 S ialized Methods* 3-501.14(A) Cooling Cooked PHFs from 140°F to onous or Toxic Materials FC-7 .008 6-301.11 Handwas Cleanser,Availability3-502.12 Reduced o en criteria* 70°F Within 2 Hours and From 70°F cial Requirements .009 . Hand Provision8-103.12 Conformance with ved Procedures* to 41°F/45°F Within 4 Hours.* r 3-501.14(B) Cooling PHFs Made From Ambient s:s.o, s z.ea Temperature Ingredients to 41°F/45°F - ; Within 4 Hours* •D®ates ai.l it..in the federal 1999 Food Code or 105 CMR 590.000. h .- •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. a * Town of Barnstable 1HE rqs� Regulatory Services Thomas F.Geiler,Director BAMSTAMASS. Ev ��$ Public Health Division ATED 39. A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO COMPLIANCE CHECK FORM SECTION I: Establishment Survey Participants Name: Craigville General Store Name of purchaser: r /'j emale Address: 628 Craigville Beach Rd. Box 445 Age: ❑ Male F West Hyannisport, MA 02601 Name of Adult Escort/Data Collector: City: Time of Check: Z %S3 ❑ AM kPM Type of Establishment: ❑ Chain X Independent ❑ Not Known Date of Check: Style of Establishment(Check Only One): AConvenience Store ❑ Pharmacy/Drug Store ❑ Gas Mini-Mart ❑ Gas Station Only ❑ Grocery Store ❑ Liquor Store ❑ Department Store ❑ Bar ❑ Private Club(VFW,Legion,etc.) ❑ Restaurant(Bar Area) ❑ Restaurant(Other Area) ❑ Other(Tobacco Shop,Pro Shop,etc.) SECTION II: Did the youth enter the premises and attempt to purchase a tobacco product? �(Yes ❑ No If yes, continue on to the next question, if no,please skip this section and go to Section IIL How was tobacco marketed? Over-the-counter:youth asks the clerk for the product. ❑ Over-the-counter: youth selects the product from a self-service display. ❑ From a vending machine with a lockout device. ❑ From a vending machine without a lockout device. Was the purchaser asked for ID? Kyes ❑ No Was ID accurately checked? ❑ Yes ❑ No kN/A Was the purchaser asked his/her age? ❑ Yes �No ? Sex of Clerk: ❑ Male Female Approximate age of clerk: Did the Clerk say anything to you when the purchase attempt was made? .1 ` Sor(T_ �vt�`� SP�I w/U 1�- Type of tobacco asked for: Cigarettes ❑ Chew/Dip ❑ Cigars Brand ❑ Other Was the sale made? ❑ Yes X No (if yes,how much did the product cost: $ ) SECTION III: If the youth did not enter the premises or did not attempt to purchase tobacco products,check here: ❑ and indicate why below: ❑ closed for the day ❑ couldn't locate business ❑ buyer knows clerk/merchant ❑ admission charge closed for the season ❑ no longer in business ❑ establishment inappropriate for youth ❑ other ❑ closed to the public ❑ doesn't sell tobacco ❑ unsafe establishment 0 unsafe area 0 denied admission at door ❑ vending machine broken Town of Barnstable Regulatory Services Thomas F.Geiler,Director • BARNSTABM. MASS. ,ter Public Health Division arEo �a Thomas McKean,Director 367 Main Street, Hyannis,MA 02-601 Office: 508-862-46.44 Fax: 508-790=6304 TOBACCO COMPLIANCE CHECK FORM Establish SurveyPartici ants Name: Craigville General Store Name of Purchaser: w.. or ID# Address: Age: 11 Sex: ❑Male Female 62.8 Cragville Beach Rd. Box 445 Did a second person go into the establis ent? Yes ❑ No West Hyannisport, MA 02601 If Yes,what was the second persons: City: Age: Sex: ❑ Male ❑Female Time of Check: am 0 pm❑ , /I Date of Check: Vain-- Name of Adult Driver/Escort: GV , 10te— Type of Establishment Check Only One nvenience Store ❑ Pharmacy/Drug Pharmacy/Drug Store ❑ Gas Mini-Mart ❑ Gas Station Only ❑ Grocery Store. 0 Liquor Store Q..,De artment Store ❑ Bar ❑ Private Club VFW,Legion etc: ❑ Restaurant Bar Area ❑ Restaurant Other Area ❑ Other(bowling alley, golf club,etc.): Is this establishment within'/z mile of a school? Yes ❑ No ❑ Don't Know Is this establishment between'/2 mile and.1 mile of a school? Yes 0 No 0 Don't Know Is this establishment between'/2 mile of a youth center(Boy's/Girl's Club)? Yes ❑ No ❑ Don't.Know Is this establishment between'/2 mile and 1 mile of a youth center(Boy's/Girl's Club)? Yes ❑ No ❑ Don't Know .4s.this establishment within'/2 mile of an outdoor recreational site(park,ball field,etc.)? Yes ❑ No ❑ Don't Know I.s.this establishment between''/2 mile and 1 mile of an outdoor rec.site(park,ball field)? Yes ❑ No 0 Don't Know Tobacco Purchase Attempt: Was the purchase of tobacco attempted: Yes ❑ No, If No,please explain why not: • \ �G 540 ICY— Was the sale made? Yes ❑ No Q Brand Purchased: Price: $ Type of Tobacco purchased attempted. Cigarettes ❑ Chew/Dip.❑ How was tobacco sold? ❑ Clerk was required-to select tobacco Purchaser requested. 0 purchaser was able.to place tobacco on the counter. Was the Purchaser asked for ID? Yes ❑ No ❑ Was the.Purchaser asked his/her age? Yes 0 No ❑ Was there any tobacco advertising(logos,posters or other promotional displays?) Yes ❑ No ❑ Were any loose(single)cigarettes for sale? Yes ❑ No ❑ Don't Know❑ Sex of.Clerk: Male.0 Female ❑ Approximate Age of Clerk: Did the Clerk say anything to you when the purchase attempt was made? j Other Comments: How was the merchant informed of the results of the compliance check? ❑ By an adult supervisor immediately after youth has/have left the premises. ❑ Notified after all-compliance checks were complete. ❑ Merchant was not notified 0 Other please specify #or 2001 Permit? Tobacco Sales Permit Inspection Report Form TOWN OF BARNSTABLE BOARD OF HEALTH Business Name Date I J Business Telephone Location ` n Time: In Out �ZS two i� &_acuff Pelf + Initial ictRGUL ATIorT'. COMPLIANCE Rerttarks or Iles No Reeomeue dati°ons { Signs Posted [MGL 270/61 Permit Posted [VIIa] - �D-.G..R. License f I v6aCCv Employee Signed Forms /IV -fpvry PN �� Kept On File [VIIb] ` / �,;,� 4,'V"x V J Self-service Displays On Counter and Within J 5 Ft. of a Clerk [VIId] i No. Floor Displays [VIId] No Tobacco Products Free of Charge [VIIc] i i Inspector: „ Person Interviewed: � q:health:tobinsp l� dF"'E TOWN OF BARNSTABLE HEALTH INSPECTOR'S L l�,v _QkK�-Z�V Pa OFFICE HOURS: Establishment Name. � Date: 9e of / • PUBLIC HEALTH DIVISION 0 8:OD-9:30A.M. 367 MAIN STREET t MpN?-PRIM XMM HYANNIS,MA 02601 862-4644Za t EIt6f`d@tt) ��a .R 431.pi711 1 PLAA1 � RRETfCN ltelet FOOD ESTABLISHMENT INSPECTION REPORT Name Dat a F Type of Operation(s) T e of Ins �•GY� � AL,� Z _-XP Inspection Q Iff F d Service ❑ Routine Addressed, n � Risk tail ❑ Re-inspection Telephone Level P �� � � ❑ Residential Kitchen Previous Inspection ❑ Mobile Date: Owner a HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Ro Time, ❑ Bed&Breakfast ❑ General Complaint Ins ector In: ❑ HACCP Out: Permit No. ❑ Other Each violation checked requires an explanation on the na s)and a citation of specific provision(s)violated. Non-compliance with: /J Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking Tobacco 4� Violations,marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F)❑ Action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14. Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals - FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source 0 5.Receiving/Condition ❑ 16. Cooking Temperatures - ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑ 20: Time As a Public Health Control ❑ 9.Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10.Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP ❑ 11.Good Hygienic Practices CONSUMER ADVISORY " -` Violations Related to Good Retail Practices(Blue Items) ❑ 22• Posting of Consumer Advisories Critical(C)violations marked must be corrected immediately. Number of Violated Provisions Related Non-critical(N)violations must be corrected immediately or To Foodborne Illnesses Interventions within 90 days as determined by the Board of Health. and Risk Factors(Red Items 1-22): o Official Order for Correction: Based on an inspection today, 23. Management and Personnel (FC-2)(590.003) the items checked indicate violations of 105 CMR 590.000/federal 24. Food and Food Protection (FC-3)(590.004) Food Code.This report,when signed below by a Board of Health 25. Equipment and Utensils (FC-4)(590.005) member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in sus 26. Water,Plumbing and Waste (FC-5)(590.006) pension or revocation of the food establishment permit and ces 6CttV+cal+ ttir y 27. Physical Facility (FC-6)(590.007) sation of food establishment operations. If aggrieved by this or- 28. Poisonous or Toxic Materials (FC-7)(590.008) der,you have a right to a hearing. Your request must be in writ- ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension 29. Special Requirements (590.009) ing and submitted to the Board of Health at the above address 30. Other within 10 days of receipt of this order. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: DATE OF RE-INSPECTION: IV Inspec e5lignature Print: Permit Posted? Y V N Grease Trap Previous Pumping Date Grease Rendered? Y Z N Y � #Seats Observed ��/1a� Frozen Dessert Machines: Outside Dining Y N PIC's Signatur Print: Self Service ��Wait Service Provided `� Grease Trap Size Variance Letter Posted Y N Violations Related to Foodbome//fness 3-50 1.14(C) PHFs Received at Temperatures Interventions and Risk Factors(Red Items 1-22) Violations Related to Foodbome Illness Interventions and Risk According to Law Cooled to PROTECTION FROM CONTAMINATION I Factors(Red Items 1-22) (Cont) 41°F/45°F Within 4 Hours. FOOD PROTECTION MANAGEMENT 8 Cross corttaminabon 3-501.15 Cooling Methods for PHFs 1 590.003 A Assi ent of R nsibili s 3-302.11(AX 1) Raw Animal Foods Separated from PROTECTION FROM CHEMICALS 19 PHF Hot and Cold Holding 590.003 B Demonstration of Knowledge* Cooked and RTE Foods* 14 Food or Color Additives 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-202.12 Additives* 3-501.590.00 4(F) 41°/45°F*Cold PHFs Maintained at or below 3-302.11(Ax2) Raw Animal Foods Separated from Each 3-302.14 Protection from Unapproved Additives* EMPLOYEE HEALTH Other* 15 Poisonous or Toxic Substances 3-501.16(6(A) Hot PHFs Maintained at or above 2 590.003 C Responsibility of the Contamination from the Environment 7-101.11 Identifying Information-Original 140°F. ( ) spo y person in charge to fy $ $� require reporting by food employees and 3-302.11 A Food Protection* Containers* 3-501.16(A) Roasts Held at or above 130°F. applicants* 3-302.15 Washing Fruits and Vegetables 7-102.1 1 Common Name-Working Containers* 20 Time as a Public Health Control 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and 7-201.1 1 Separation-Storage* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Utensils* 7-202.1 1 Restriction-Presence and Use* 590.004(H) Variance Requirement Charge* Contamination from the Consumer 7-202.12 Conditions of Use* 590.003 G Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food* 7-203.1 1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 31 590.003D Exclusions and Restrictions* Disposi6onof Adulterated orContaminated 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 590.00 Removal of Exclusions and Restrictions Food 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.1 I(A) Unpasteurized Pre-packaged Juices and 3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* FOOD FROM APPROVED SOURCE Food* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.1 1 Restricted Use Pesticides,Criteria* 3-801 A 1(D) Raw or Partially Cooked Animal Food and 590. A-B Compliance with Food Law* 4-501-111 Manual Warewashing-Hot Water 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.* 3-201.12 Food in a Hermetically Sealed Container* Sanitizatr°n Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-801.1 1(C) Unopened Food Package Not Re-served. 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water I Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* CONSUMER ADVISORY 3-202.14 Eggs and Milk Products,Pasteurized* TIME/TEMPERATURE CONTROLS 4-501.114 Chemical Sanitization-temp.,pH, 22 3-603.1 1 Consumer Advisory Posted for Consumption of .* Animal Foods That are Raw,Undercooked or 3-202.16 Ice Made From Potable concentration and hardness. 16 Proper Cooking Temperatures for 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and PHFs Not Otherwise Processed to Eliminate Utensils Clean* 3-401.11A I 2 Pathogens.*Enedive,na°o, 590. A Bottled Water OO Eggs- I55°F 15 Sec. 590.0 Water Meets Standards in 310 CUR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Eggs-Immediate Service 1450F15sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw She Eggs* Shet<fish and Fish From an Approved Source Contact Surfaces and Utensils* 3-401.11(A)(2) Comminuted Fish,Meats&Game 4-702.11 Frequency of Sanitization of Utensils and Animals-155°F 15 sec.* SPECIAL REQUIREMENTS 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Shellfish• 3-401.1 1(B)(I)(2) Pork and Beef Roast-130°F 121 min* 4703.11 Methods of Sanitization-Hot Water and catering,mobile food,temporary and 3-201.15 Molluscan Shellfish from NSSP Listed Chemicals 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. Sources* Adequate Handwashi s residential kitchen operations should be Game and Wild Mushrooms Approved by 10 2-301.11 Clean C ion-Hands and Arms* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Regulatory Idea above if related to foodborne illness 3-202.18 Shellslock Identification Present* 2-301.12 Cl Procedure' Stuffing Containing Fish,Meat, 590. C Wild Mushrooms• 2-301.14 When to Wash* Poultry or Ratites-165°F 15 sec.* interventions and risk factors. Other 3-201.17 Game Animals* 11 Good Hygienic Practices 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 5 Receiving/Condition 2401.11 Eating, or Using Tobaccos 145°F* practices should be debited under 429- 3-202.11 PHFs Received at Proper Temperatures* 21301.12 Discharges From the Eyes,Nose and 3-401.12 Raw Animal Foods Cooked in a Special Requirements. s Mouth* Microwave 165°F 3-202.15 Package hi s 3-401.11 A l b s VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-101.1 I Food Safe and Unadulterated• 3-301.12 Prevent Contamination When T ( )( )( ) All Other PHFs-145°F 15 sec. b` TagslRecords:Shellstock 12.: Prevention of CorttaMrwtlon from Hands 17 Reheating for Hot Holding Blue Items 23-30 590.004(E) Preventing Contamination from 3-403.11(A)&(D) PHFs 165°F 15 sec.* Critical and non-critical violations,which do not relate to the 3-202.18 Shellstock Identification• foodborne illness interventions and risk factors listed above,can be Stdi 3-203.12 Shellstock Identification Maintained* Em 10 � 3-403.11(B) Microwave-165°F 2 Minute anng found in the following sections of the Food Code and 105 CMR Tags/Records:Fish Products 13 Handwash Facilities Time* Conveniently Located and Accessible 590.000. 3402.11 Parasite Destruction* 3-403.11(C) Commercially Processed RTE Food- Item Good Retail Practices FC 590.000 s . 140F 31}02.12 Records,Creation and Retention 5-20311 Numbers and Capacities- ° • 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-403.1 1 E Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 590. J Labeling of ingredierts' ( ) $ Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance Roasts* 25. Equipment and Utensils FC-4 .005 IHACCP Plans Suppied widr Soap and Hand Drying 18 Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 s Devices 27. Physical Facility FC-6 .007 3-502.11 Specialized ProcessingMethods 3-501.14(A) Cooling Cooked PHFs from 140°F to 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 70°F Within 2 Hours and From 70°F 28. Poisonous or Toxic Materials FC-7 .008 6-301.12 Hand Provision 29. Special Requirements 009 8 103.12 Conformance with Approved Procedures- to 41°F/45°F Within 4 Hours.* 30. Other 3-501.14(B) Cooling PHFs Made From Ambient s:swrcQ,.eo Temperature Ingredients to 41°F/45°F Within 4 Hours* *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. _J 13 CRITICAL FOOD HANDLING VIOLATIORS Full item Descriptions 1. Food from an unappria or unknown source or food which*or may be Food adulterated, contaminated or otherwise unfit for human consumption C1 Food Source, approved, wholesome is found in a food establishment. _ 2 Containers. properly labelled Food Protection 2. Potentially hazardous food that is held longer than necessary for C3 Potentially hazardous foods at proper temperatures: 140OF or above, 450F or below, ooF; Y g Y rapid cooling of cooked foods within 4 hours preparation or service at a temperature which Is greeter than 450 F C4 Facilities to maintain product temperature (-=7o C) (in the case of cold food) or less than 1400 F (6000 (in CS Unwrapped and potentially hazardous foods not re-served the Case of, hat f_cd) 6 Damaged, spoiled, returned foods segregated ../• T Food protected during storage, preparation, display, dispensing, service, transportation g Thermometers provided, Conspicuous, accurate 9 No cross-contamination 3. The food establishment's facilities are insufficient to maintain 10 Potentially hazardous foods properly thawed, cooked. and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel Emploees customers is re-served unless such re-service is allowed under C13 Hands was with infections restricted C1� Hands was and clean; good hygienic practices section 105 CMR 550.006(G)• 15 Clean clothes, hair restraints Equipment g Utensils 5. A person infected with a communicable disease that can be C16 equipment, utensils sanitized (automatic and manual methods) transmitted by food is working as a food handler in a food 11 Food contact surfaces: design, constructed, installed, maintained, located lg :on contact surfaces, design, constructed, installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dish/Warpweshing facilities, designed, constructed, maintained, installed, located, hygiene which may result in the potential transmission of illness operated through food is employed in a food establishment. 23 Pre-flushed, scraped, awaked g24. Wash/Rinse water clean. clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food-contact surfaces are not cleaned and 26 Storage, handling of clean storagequipme, 21 Single service articles, atorbge, dispensing sanitized effectively and may contaminate food during preparation, 2e No re-use of single service articles storage or service. Sanitary Facilities C29 Water source; approved, hot9cold under pressure S. Sewage or liquid waste is not disposed of in sn approved and C30 Sewage and waste water ditnosal C31 No n cross-connections, back siphonese, backflow sanitary manner, or the sewage or liquid waste contaminates or may C32 Teets i Handwashingi number, accessible, design, installed contaminate any food areas used to store or prepare food, or any c33 No insects or rodents; harborage prevented 3+ Plumbing; installed, maintained areas frequented by customers or employees. 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handwashing areas supplied with soap and towel dispensers, proper waste receptacles 9. Toilets and facilities for washing hands are not provided, properly 31 Garbage and refuse: containers covered, adequate number. Insect/rodent resistant, frequency, installed or designed, accessible or convenient. 3e Oucstee area: Oumpster Covered, construction, clean 39 Outer openings protected 40 Pesticides and rodenticides. proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not, use single service Physical Facilities 41 Floors constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded �� Rooms and equipment vented as required 11. A defect exists in the system supplying potable water that may :5 Dressing. locker areas provided used, clean result in the contamination of the water. Other 12. Insects, rodents or other animals are present on the premises cq6 ro properly -treed. labelled, vary (unless allowed by Section 105 CMR 590.027(F)(3))• person III Preemm s ises 1lfree, unnece-earl articles, cleaning maintenance equipment properly stored. Authorized personnel 45 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored. labelled, dispensed Notes In addition to the items listed above, any other violation of the 52 Salad bar operations prepared, refrigerated, displayed, protected Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall aftef-written notice to the permit holder constitute a critical violation. , °F� 'Ojyt TOWN OF BARNSTABLE • HEALTH INSPECTOR'S s OFFICE HOURS: Item No. In the SO below describe all violations checke� Page of 's •3• a BOARD OF HEALTH 8:00-9:30 A.M. '4,,E ••w 367 MAIN STREET MON.-FRI. ` ��++4p �+ pHpYANNIIS, MA 0260011 790-6265 FOOD ESTABLISHMENT BLISHMEN 1 INSPECTION REPORT �" �-� Guc. Establishment Name -tv\ wj 4!` 1 L+T(U t'Ir.S)y l Date C9 7 ?�!r r��� M I .Tim Address � �� L�+ 1 � � � Out Telephone Type of Establishment Purpose Owners Name Food Service Routine Retail Food Follow-up Residential Kitchen Complaint Person in Charge Mobile Unit Investigation ` c Temporary Food Service Other Inspector's Name J Caterer Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000.Each item is followed by the applicable section of the Massachusetts regulation.Noncritical violations are marked under column'N'and critical violations are marked under column'C".Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s).This report serves as official notice of violated provisions and official notice to correct said violations. Food N C WT Sanitary Facilities N C WT 1. Food Supply 002 4 29. Water Source .015 4 2. Food Containers .002 1 30. Sewerage .016 4 Food Protection 31. Cross Connections .017 4 3. PHF Temperatures .004 4 32. Toilets/Handwashing .018&.019 4 4. Facilities,Hot&Cold Storage .004 2 33. Insects/Rodents .021 4 5. PHF Re-service .006 4 34. Plumbing .017 1 6. Spoiled/Damaged Foods .003 1 35. Toilet Rooms .018 1 2 7. Food Protected .003 4 36. Handwashing Areas .019 2 8. Food Thermometers .004 2 37. Garbage/Refuse .020 2 9. Cross Contamination .005 2 38. Outside Disposal .021 1 10. PHF's thawed,cooked&cooled .005 2 39. Outer Openings .021 2 11. Food Handling .005 2 40. Pesticide/Rodenticide Application .021 1 12. Dispensing Utensils .006 1 Physical facilities Personnel 41. Floors .022 2 13. Employee Infections .008 4 42. Walls,Ceiling .022 2 14. Employee Hygiene .009 4 43. Lighting .023 1 15. Employee Clothing .006 1 44. Ventilation .024 2 Equipment&Utensils _ 45. Dressing Rooms .025 1 16. Equipment/Utensil Clean&Sanitized .013 2 Other 17. Food Contact Surfaces .013 1 46. Toxics .026 4 18. Non-Food Contact Surfaces .013 1 47. Premises .027 1 19. Food Contact Surfaces Clean .013 1 48. Living Areas .027 1 20. Non-Food Contact Surfaces Clean .013 1 49. Linen .027 1 21. Wiping Cloths .013 1 50. Pets .027 1 Discussion with Management 22. Dish/Warewashing Facilities .013 1 51. Bulk Foods .031 1 Al 411 L S A441" (f( 23 Pre-Scraped, Soaked .013 1 52. Salad Bars .032 1 1 F- vL ` 24. Wash/Rine Water .013 1 25. Thermometers/Test Kits .013 1 No.of 13 Critical Items Violated 26. Equipment/Utensil Storage .014 1 These items require immediate attention. 27. Single Service Articles .014 1 �. 28. Single Service -Use .012 1 SCORE Permit Posted. 7Y Y N Grease Trap Previous Pu i g Date /" Grease Rendered?�Y N -- #Seats Observed? Frozen Desert Machines: mutside Dinin Y N Self Service Wait Service Provided Variance Granted Y ✓N Variance ance Letter Posted Y ✓ N Inspected by- / Received by C JO>e • *or 2001 Permit? moo.^ S� _,, -/o/ Tobacco Sales Permit Inspection Report Form TOWN OF BARNSTABLE 1 BOARD OF HEALTH Business Name Date t 6 P � Business Telephone 7Zj_- y/ � Location Time: In Out I'ct i 1/ C'GiL , Person in .... nr Yes No Recoammenda al Signs Posted [MGL 270/61 Permit Posted [VIIa] D.O.R. License Employee Signed Forms Kept On File [VIIb] Self-service Displays On Counter and Within 5 Ft. of a Clerk (VIId] No Floor Displays [VIId] No Tobacco Products Free of Charge (VIIc] Inspector: Person Interviewed: q:health:tobinsp .... ._ _ �*,�.•:e-..�...y. ..y.. r,,.,,J•..�. "Lr. Fc tits;� _;�., .. .. _ � .. . i J WFor 2001 Termit? YJ � ,�L.>/,- -Tobacco Sales Permit Inspection Report Form r, TOWN OF BARNSTABLE BOARD OF HEALTH Business Name Date Business Telephone Location Time: In Out Person in Charge Initial REGIILATIUN CCIMPLIANCE Remarks or. Y+aB No R+aeouaaendat�ons Signs Posted [MGL 270/61 Permit Posted [VIIa] D.O.R. License Employee Signed Forms F Kept On File [VIIb] Self-service Displays On Counter and Within 5 Ft. of a Clerk [VIId] - u . No Floor Displays [VIId] No Tobacco ProductsIN Free of Charge [VIIc] Inspector: Person Interviewed: i q:health:tobinsp S For LOO Permit? .. -rite Tobacco Sales Permit Inspection Report Form TOWN OF BARNSTABLE BOARD OF HEALTH Business Name i/ Da / vAh=f v� Q Business Telephone Location Time: In Out Initial REGULATION COML� INCE Remarks or Yee No Rcommendati'ons. Signs Posted [MGL 270/61 Permit Posted [VIIa] , / ��3 D.O.R. License V Employee Signed Forms r/ Kept On File [VIIb] Self-service Displays On Counter and Within 5 Ft. of a Clerk [VIId] No Floor Displays [VIId] No Tobacco Products Free of Charge [VIIc] Inspector: Person Interviewed:..y q:health:tobinsp 13 CR CAL FOOD HANDLING VIOLATIONS Full item Descriptions 1. Food from an unap oved or unknown source or food wh1eis or may be Food 0 or human consumption el Food Source�oved, wholesome adulterated, contaminated or otherwise unfit f ption 2 Containers. properly labelled is found in a food establishment. Food Protection 2. Potentially hazardous food that is held longer than necessary for C3 Potentially hazardous foods at proper temperatures: 140OF or above. 45OF or below, OoF; Y g Y rapid cooling of cooked foods within 4 hours preparation or service at a temperature which is greeter than 450 F C4 Facilities to maintain product temperature 0-:70 C) (in the case of cold food) Or less than 1400 F (600C) (in C5 Unwrapped and potentially hazardous foods not re-nerved t►� no co of hnt. f__.,\ 6 Damaged, spoiled, returned foods segregated •• c .•/ • T Food protected during storage, preparation, display, dispensing, service, transportation g Thermometers provided, conspicuous, accurate 9 No cross-contamination 3. The food establishment's facilities are insufficient to maintain 10 Potentially hazardous roods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4- Potentially hazardous food or unwrapped food that has been served to Personnel C13 Employees with infections restricted customers is re-served unless such re-service is allowed under C14 Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 clean clothes, hair restraints Equipment g Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic end manudl methods) transmitted by food is working as a food handler in a food IT Food contact surfaces: design, constructed, installed, maintained., located 10 Non-food contact surfaces( design, constructed, installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dish/Werpwashing facilities: designed, constructed, maintained, installed, located, hygiene which may result in the potential transmission of illness operated Pre-riusheped. soaked through food is employed in a food establishment. 2i d Wash/ginsewatera clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food-contact surfaces are not cleaned and 26 Storage, handling of clean equipment/utensils 21 Single service articles, storage, dispensing sanitized effectively and may contaminate food during preparation, 2e No re-use of single service articles storage or service. Sanitary Facilities C29 Water source; approved, hotbcold under pressure 8. Sewage or liquid waste is not disposed of in on approved and C30 sewage and waste water dienosal C31 No cross-connectlons, back siphonaae, beckrlow sanitary manner, or the sewage or liquid waste contaminates or may C32 Toilets & Handwashing, number, accessible, design, installed contaminate any food areas used to store or prepare food, or any C33 No Insects or rodents; harborage prevented 34 Plumbing; installed, maintained areas frequented by customers or employees. 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handwashing areas supplied with soap and towel dispensers, proper Waste receptacles 37 change and refuse: containers corer.•, adequate masher. insect/rodent resistant,.frequency, 9. Toilets and facilities for washing hands are not provided, properly installed or designed, accessible or convenient. 3e Outside area: dumpeter covered. construction, clean 39 Outer openings protected + 40 Pesticides and rodenticides. proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not, use single service Physical Facilities 41 Floors constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded 11. A defect exists in the system supplyingotable water that may 44 Dress and equipment vented id required Y P Y 45 Dressing, locker areas provided used, clean result in the contamination of the water. Other ed 12. Insects, rodents or other animals are present on the premises c46 Tories properly -treed, labelled, vart y ( Y 5 590.02 7( )(3))• 4T Premises litter-free. unneeesa■ri articles, cleaning maintenance equipment properly stored. unless allowed b Section 10 CMR F Authorized personnel 45 Living/sleeping quarters and laundry separate 49 Linen properly stored { 13• Toxic items are improperly labeled, stored Or used. 50 No pets or other live animals except guide dogs <<d 51 Bulk foods stored, labelled, dispensed y Note: In addition to the items listed above, any other violation of the sz Salad bar operations prepared, refrigerated, displayed, protected Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall after written notice to the permit holder constitute a critical violation. r HEALTH INSPECTOR'S .�F °wc TOWN OF BARNSTABLE OFFICE HOURS: Item No. In the s below describe all violations checked. Page of BOARD OF HEALTH 8:00-9:30 A.ML Y 367 MAIN STREET MON.-FRI. hEO HYANNIS, MA 02601 790-6265 Glac_._�-2iJ ra pvt -FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name C �F> d� Date J ��K C �- v (� Address d I Time: f I ut Telephone Type of Establishment Purpose Owner's Name Food Service Routine V� Retail Food Follow-up Residential Kitchen Complaint Person in Charge Mobile Unit Investigation ��rr ��"" Temporary Food Service Other Inspector's Name &-t - Gt i.r �, Caterer Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000.Each item is followed by the applicable section of the Massachusetts regulation.Noncritical violations are marked under column"N"and critical violations are marked under column"C".Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s).This report serves as official notice of violated provisions and official notice to correct said violations. Food N C WT Sanitary Facilities N C WT 1. Food Supply .002 4 29. Water Source .015 s_ 4 2. Food Containers .002 1 30. Sewerage .016 4 Food Protection 31. Cross Connections .017 4 3. PHF Temperatures .004 4 32. Toilets/Handwashing .018&.019 4 4. Facilities,Hot&Cold Storage .004 ':ti 2 33. Insects/Rodents .021 4 5. PHF Re-service .006 4 34. Plumbing .017 1 6. Spoiled/Damaged Foods .003 1 35. Toilet Rooms .018 2 7. Food Protected .003 4 36. Handwashing Areas .019 2 8. Food Thermometers .004 2 37. Garbage/Refuse A�✓S .020 2 9. Cross Contamination .005 2 38. Outside Disposal .021 1 10. PHF's thawed,cooked&cooled .005 2 39. Outer Openings .021 2 11. Food Handling .005 2 40. Pesticide/Rodenticide Application .021/15 1 12. Dispensing Utensils .006 1 Physical facilities Personnel 41. Floors .022 2 13. Employee Infections .008 4 42. Walls,Ceiling .022 2 14. Employee Hygiene .009 4 43. Lighting .023 1 15. Employee Clothing .006 1 44. Ventilation .024 2 Equipment&Utensils 45. Dressing Rooms .025 1 16. Equipment/Utensil Clean&Sanitized .013 2 Other no- 17. Food Contact Surfaces .013 1 46. Toxics .026 4 18. Non-Food Contact Surfaces .013 1 47. Premises .027 1 19. Food Contact Surfaces Clean .013 1 48. Living Areas .027 1 20. Non-Food Contact Surfaces Clean .013 1 49. Linen .027 1 sio ith Management 21. Wiping Cloths .013 1 50. Pets .027 1 Discus� g 22. Dish/Warewashing Facilities .013 1 51. Bulk Foods .031 1 23 Pre-Scraped, Soaked .013 1 52. Salad Bars .032 1 24. Wash/Rince Water .013 1 25. ThermometerslTest Kits .013 1 No.of 13 Critical Items Violated 26. Equipment/Utensil Stoae--"'"-' .014 1 These items require immediate attention. df 27. Single Service Awti" e s .014 1 28. Single Service Rg-Use .012 1 SCORE Permit Posted? '�Y N Grease Trap Previous Pumping ate Grease Rendered? 7 Y N " #Seats Observed? � Frozen Desert Machines: Ibutside inin Y� N Self Service A/ Wait Service Provided N Variance Granted Y Variance Letter Posted Y _ N Inspected by ' Received by 13 ITICAL FOOD HANDLING VIOLATIONS Full Item Descriptions 1. Food from an un proved or unknown source or food >a!!!ch is or may be Food adulterated, contaminated or otherwise unfit for human consumption CI Food Source, approved, wholesome 2 Containers, properly labelled 1 is found in a food establishment. Food Protection 2. Potentially hazardous food that is held longer than necessary for C3 Potentially hazardous roods at proper temperatures: 140OF or above. 45OF or below, ooF: rapid cooling of cooked foods within s hours S preparation or service at a temperature which is greeter than 450 F Cr Facilities to maintain product temperature (`` O O O CS Unwrapped and potentially hazardous foods not re-served =7 C) (in the case of Cold food) Or legs than 140 F (60 C) (in 6 Damaged, spoiled, returned foods segregated •• —N• T Food protected during storage, s segregateate display, dispensing, service, transportation ' 8 Thernmeetero provided, conspicuous. accurate 1 9 No cross-contemination 3. The food establishment's facilities are insufficient to maintain 10 Potentially hazardous foods properly thawed, cooked, and cooled i product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Parson.el customers is re-served unless such re-service is allowed under C13 Employees with infections restricted 1 section 10 CMR cis Hands washed and clean; good hygienic practices 5 590.006(G)• 15 Clean clothes, hair restraints Iy • Equipment i Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manual methods) transmitted by food is working as a food handler in a food 17 Food contact surfaces: design, constructed, installed, maintained, located establishment. 1g Non-food contact iurfacest design, constructed, installed, maintained, located 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dish/Yarpwashing faoilitlesf designed, constructed, maintained. Installed. located, hygiene which may result in the potential transmission of illness operated through food is employed in a food establishment. 23 Pre-flushed, scraped, soaked 2s Wash/Rinse water clean, temperature � 25 Accurst* thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food-contact surfaces are not cleaned and 26 Storage, handling or es. 3 oragegequipmedi/utensils 1 21 Single service articles, atorege, dispensing E sanitized effectively and may contaminate food during preparation, 23 No reuse or single service articles 1 storage or service. sanitary Fge111tisa C29 Water source; approved, hot&cold under pressure 8. Sewage or liquid waste is not disposed of in 7n approved and C30 sewage and waste water disposal C31 No cross-connections, back aiphonage, backrlow sanitary manner, or the sewage or liquid waste contaminates or may C32 Toilets i Handwashing: numberg accessible, design, Installed contaminate any food areas used to store or prepare food, or any C33 No insects or rodents; harborage prevented areas frequented by customers or employees. 34 Plumbing; installed, maintained 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handwashing areas supplied with soap and towel dispensers, proper waste receptacles 9. Toilets and facilities for washing hands are not provided, properly 37 cis:•s* and refuse: containers covered, adequate number. insect/rodent rasiet&nt, frequency, installed or designed, accessible or convenient. 3e outside area: dumpscer covered, construction. clean 39 outer openings protected 40 Pesticides and rodentieides. proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single service Physical Facilities 41 Floors constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, ceiling, attached equipment: constructed, maintained. clean 43 Lighting provided as required, fixtures shielded 11. A defect exists in the system supplyingotable water that may �4 Rooms and equipment vented as required Y p Y s5 Dressing. locker &roes provided used, clean result in the contamination of the water. Other 12. Insects, rodents or other animals are present on the premises cab PremTories properly afore., labelled, Hare sT Premises litter-free, unnecesaarl articles. cleaning maintenance equipment properly stored. (unless allowed by Section 105 CMR 590.027(F)(3)). Authorized personnel 48 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored. labelled, dispensed Note: In addition to the items listed above, any other violation of the si Salad bar operations prepared. refrigerated, displayed, protested Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall • after" written notice to the permit holder constitute a critical violation. 0*INA 7 TOWN OF BARNSTABLE HEALTH INSPECTOR'S : •0 OFFICE HOURS: Item No. In the s below describe all violations checked.f Page of BOARD OF HEALTH 8:00-9:30 A.M. 1 367 MAIN STREET MON.-FRI. HYANNIS, MA 02601 790-6265 FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name Dat 1-4 Address me: ----aid V o. Out Telephone Type of Establish ent Purpose Owner's Name Food Service Routine J. Retail Food Follow-up 1 Residential Kitchen Complaint Person in Charge Mobile Unit Investigation Temporary Food Service Other Inspector s Name )ON6hq I �� =,N-14 Caterer Li Based on an inspection today,the items ch flow indicate the violated provisions of 105 CMR 590.000.Each item is followed by the applicable section of the Massachusetts regulation.Noncritical violations are marked under column°N°and critical violations are marked under column'C°.Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s).This report serves as official notice of violated provisions and official notice to correct said violations. Food N C WT Sanitary Facilities N C WT 1. Food Supply .002 4 29. Water Source .015 4 2. Food Containers .002 1 30. Sewerage .016 4 Q Food Protection 31. Cross Connections .017 4 3. PHF Temperatures .004 4 32. Toilets/Handwashing .018&.019 4 4. Facilities,Hot&Cold Storage .004 2 33. Insects/Rodents .021 4 Joy 5. PHF Re-service .006 4 34. Plumbing .017 1 6. Spoiled/Damaged Foods .003 1 35. Toilet Rooms .018 2 7. Food Protected .003 4 36. Handwashing Areas .019 2 8. Food Thermometers .004 2 37. Garbage/Refuse .020 2 9. Cross Contamination .005 2 38. Outside Disposal .021 1 10. PHF's thawed,cooked&cooled .005 2 39. Outer Openings .021 2 11. Food Handling .005 2 40. Pesticide/Rodenticide Application .021 1 12. Dispensing Utensils .006 L_j1 Physical facilities Personnel 41. Floors .022 2 13. Employee Infections .008 4 42. Walls,Ceiling .022 2 �. 14. Employee Hygiene .009 4 43. Lighting .023 1 15. Employee Clothing .006 1 44. Ventilation .024 2 �. Equipment&Utensils 45. Dressing Rooms .025 1 16. Equipment/Utensil Clean&Sanitized .013 2 Other 17. Food Contact Surfaces .013 1 46. Toxics .026 4 18. Non-Food Contact Surfaces .013 1 47. Premises .027 1 19. Food Contact Surfaces Clean .013 1 48. Living Areas .027 1 20. Non-Food Contact Surfaces Clean .013 1 49. Linen .027 1 21. Wiping Cloths .013 1 50. Pets .027 1 Discussion with Management 22. Dish/Warewashin Facilities .013 1 51. Bulk Foods .031 1 23 Pre-Scraped, Soak d .013 1 52. Salad Bars .032 1 f' 24. Wash/Rince Water .013 1 25. Thermometers/Test Kits .013 1 No.of 13 Critical Items Violated 26. EquipmenWtensil Storage 014 1 These items require immediate attention. 27. Single Service Articles .014 1 28. Single Service Re-Use .012 1 [SCORE A. Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered? Y N p #Seats Observed? Frozen Desert Machines: Outside Dining Y NL (71 Self Service Wait Service Provided Variance Granted Y N Variance Letter Posted Y N Inspected by ived by 13 CR ICAL FOOD HANDLING VIOLATIONS Full Jte■ Descriptions 1. Food from an una oved or unknown source or food who is or may be Food adulterated, contaminated or otherwise unfit for human consumption ct Food Source, approved, wholesome is found in a food establishment. 2 Contalnera, properly labelled Food Protection 2. Potentially hazardous food that is held longer than necessary for C3 Potentially hazardous foods at proper temperatures: 140°F or above, 45°F or below, 0°F; rapid cooling of cooked foods within 4 hours preparation or service at a temperature which is greeter than 450 F Ce Facilities to maintain product temperature (=70 C) (in the case of cold food) or less than 1400 F (600C) (in C5 Unwrapped and potentially hazardous foods not re-served o cese the f hn+ f:_a� 6 Damaged, spoiled, returned foods segregated -•• - - �•i • T Food protected during storage, preparation, display, dispensing, service, transportation S Thermometers provided, conspicuous, accurate 9 No cross-contamination 3. The food• establishment's facilities are insufficient to maintain 10 Potentially hazardous roods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel customers is re—served unless such re—service is allowed under c13 employees with Infections restricted C14 Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 Clean clothes, hair restraints Equipment g Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manudl methods) 17 Food contact surfaces: design, constructed, installed, maintained, located transmitted by food is working as a food handler in a foot! 1S Non-food contact eurfacest design, constructed, installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths: clean, use restricted 1 6. A person not practicing strict standards of cleanliness and personal 22 Dish/Warpwashing facilities: designed, constructed, maintained, installed, located, hygiene which may result in the potential transmission of illness operated through food is employed in a food establishment. 23 Pre-flushed, scraped, soaked 24 Wash/Nines water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food—contact surfaces are not cleaned and 26 Storage, handling of es. s orage. dispensing 1 21 Single service articles, storage, dispensing sanitized effectively and may contaminate food during preparation, 28 No re-use or single service articles storage or service. Sanitary Fac111L1u C29 Water source; approved, hot&cold under pressure 8. Sewage or liquid waste is not disposed of in orl approved and C30 Sewage •nd waste water dirposal C31 No cross-connections, back siphonege, Dackrlow sanitary manner, or the sewage Or liquid waste contaminates or may C32 Toilets g Handwashingt number, accessible, design, installed contaminate any food areas used to store or prepare food, or any C33 No insects or rodents; harborage prevented areas frequented by customers or employees. 34 ToilePlumbt installed, maintained g good repair, clean, signs 35 Toilet rooms enclosed, self-closing doors, fixtures 36 Handwashing areas supplied with soap and towel dispensers, proper waste receptacles 9. Toilets and facilities for washing hands are not provided, properly 37 Garbage and refuse: containers covered, adequate number, insect/rodent resistant, frequency, $ P ► p P Y clean installed or designed, accessible or convenient. 38 Outside area: dumpster covered, construction, clean 39 Outer openings protected . 40 Pesticides and rodenticides. proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single service PDysical Facilities 41 Floors constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded uired 11. A defect exists in the system supplyingotable water that may 44 goose and equipment .anted as d used. Y p Y 45 Dressing. locker areas provided used, clean result in the contamination of the water. other 12. Insects, rodents or other animals are present on the premises c46 Toxics properly stored, labelled, ased ( Y 5 5 ( )(3))• 47 Premises litter-free, unnecessary articles, cleaning maintenance equipment properly stored. unless allowed b Section 10 CMR 90.027 F Authorized personnel 46 Living/sleeping quarters and laundry separate 13. Toxic items are improperlylabeled stored or used. 49 Linen properly scored a 50 No pets or other live animals except guide doge a 51 Bulk foods stored. labelled, dispensed Note: In eddition to the items listed above, any other violation of the 5? salad Dar operations prepared, refrigerated, displayed, protected Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall after written notice to the permit holder constitute,a critical violation. TOWN OF BARNSTABLE OFFICE HOURS: t 8:15 - 9:30 A rn Item No. In the s below describe all.violations checked Page of ' 0 - BOARD OF HEALTH 367 MAIN STREET \ HYANNIS, MASS. 02601 790-6265 EXT.265: FOOD ESTABLISHMENT INSPECTION REPO PT Establishment Name ats Address lk� ime:11 t Telephone Type of Estabiishment: Purpose: Food Service Owners Name Retail Food Routine Residential Kitchen Follow-up Person in Charge Mobile Unit Complaint Temporary Food Service Investigation Inspectors Name 4Z Caterer Other Based or1 an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. Food N C WT.Sanitary Facilities N C Wf, 1. Food Supply .002 " 29, Water Source 015 4 2. Food Containers .002 30. Sewage 016 G 31. Cross-Connections .017 4 Food Protection 32. Toilets/Handwashing .018 8 .019 4 3. PHF Temperatures .004 33. Insects/Rodents 021 2 4. Facilities. Hot 8 Cold Storage .004 2 34. Plumbing 017 1 5 PHF Re-service 006 1 35, Toilet Rooms .018 2 6, Spoiled/Damaged Foods .003 a 36. Handwashing Areas .019 2 7 Food Protected .003 37. Garbage/Refuse 020 2 8. Food Thermometers 004 38. Outside Disposal .020 1 T Cross Contamination .005 39. Outer Openings .021 2 10 PHFs thawed,cooked 8 cooled .005 2 40. Pest icicle/Rode nticide Application 021 1 11. Food Handling .005 2 12 Dispensing Utensils .006 1 Physical Facilities 41. Floors .022 2 Personnel 42. Walls. Ceiling .022 2 13. Employee Infections .008 4 43. Lighting .023 1 14 Employee Hygiene .009 4 44. Ventilation .024 2 15. Employee Clothing .010 1 45. Dressing Rooms 025 1 Equipment 8 Utensils Other 16, Equipment/Utensil Clean 8 Sanitized .013 2 46. Toxics .026 4 17 Food Contact Surfaces .013 1 47, Premises 027 1 18 Non-Food Contact Surfaces .013 1 48. Living Areas .027 1 19 Food Contact Surfaces Clean .013 2 49. Linen .027 1 Discussion with Management 20 Non-Food Contact Surfaces Clean .013 1 50. Pets .027 1 21. Wiping Cloths .013 1 51. Bulk Foods 031 1 22, Dish/Warewashing Facilities .013 1 52, Salad Bars .032 1 23. Pre-Scraped, Soaked .013 1 24 Wash/Rinse Water .013 1 No. of 13 Critical Items Violated _ 25 Thermometers/Test Kits 013 1 These items require immediate attention. 26 Equipment/Utensil Storage 014 1 f x 27 Single Service Articles .014 1 28 Single Service Re-Use .012 1 Grease Trap: In Ground: In Line: Capacity: SCORE In by QuLL ived by seating: Frozen Dessert Machines: Pumped: 13 CRIZICAL FOOD HANDLING VIOLATIONS 1. Food from an una oved or unknown] source or food who is or may be Full ]tea Descriptions Fooe adulterated, contaminated or otherwise unfit for human consumption Foci Food Source, approved, wholesome —� Is found in a food establishment. 2 Containers. properly labelled Food Protection 2. Potentially hazardous flood that is held longer than necessary for C3 Potentially hazardous foods at proper temperatures: 140OF or above, 450F or below, OOF; rapid cooling or cooked foods within 4 hours preparation or service at a temperature which is greater than 450 F C4 Facilities to maintain product temperature (=70 C) (in the case of cold food) 'or less than 1400 F (6000 (in C5 Unwrapped and potentially hazardous foods not re-served = th._ of h nt. f—A N 6 Damaged, spoiled, returned foods segregated _ P ; -•• -Ca S e - "/ • 7 Food protected during storage, preparation, display, dispensing, service, transportation 6 Thermometers provided, conspicuous, accurate 9 No crross-contamination 3. The food establishment's facilities are insufficient to maintain 10 Potentially hazardous roods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel j customers is re-served unless such re-service is allowed under C13 Employees with Infections restricted Cl; Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 Clean clothes, hair restraints j Equipment g Uteoslla 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manudl methods) s transmitted by food is working as a food handler in a food 17 Food contact surfaces: design, constructed, installed, maintained, located establishment. 18 Non Foo-food contact surfaces: design, constructed, installed, maintained, located 19 d contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted ° 6. A person not practicing strict standards of cleanliness and personal 22 D13h/Warpwashing facilities: designed, constructed, maintained, installed. located, hygiene which may result in the potential transmission of illness operated through food is employed in a food establishment. 23 Pre-flushed, scraped, soaked 24 Mash/Pinse water clean, temperature 25 Accurate thermometers, chemical test kits provided; Instructions posted 7. Equipment, utensils and food-contact surfaces are not cleaned and 26 Storage, handling of clean /utensils • 21 Single service articles, storageorage,, di dispensing 1� sanitized effectively and may contaminate food during preparation, 26 No re-use or single service articles storage or service. SaeiLary FaeiliLlu C29 Water source; approved, hot&cold under pressure 8. Sewage or liquid waste is not disposed of in and approved and C30 Sewage and waste water dicoosal C31 Ho cross-connections, back siphonase, backrlow sanitary manner, or the sewage or liquid waste contaminates or may C32 Toilets g Handwashings number, accessible, design, Installed contaminate any food areas used to store or prepare food, or any C33 No insects or rodents; harborage prevented \ areas frequented by customers or employees. 34 Plumbing; installed, maintained g good repair, clean, signs 35 Toilet rooms enclosed, self-closing doors, fixtures 36 Handwashing areas supplied with soap and towel dispensers, proper waste receptacles 9. Toilets and facilities for washing hands are not provided, properly 37 Garbage and refuse: containers covered, adequate number. Insect/rodent resistant, frequency, installed or designed, accessible or convenient. 38 Outside area: dumpster covered, construction, clean 39 Outer openings protected 40 Pesticides and rodenticides, proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single service Physical Facilities 41 Floors constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, ceiling, attached equipment; constructed, maintained. clean 43 Lighting provided as required, fixtures shielded 11. A defect exists in the system supplyingotable water that may 44 Nooms and lockeequipr Our rented as d used. Y p Y 45 Dressing. locker areas provided used, Olean result in the contamination of the water. Other 12. Insects, rodents_ or other animals are present on the premises C46 Taxies properly stored, labelled, •,sed (unless allowed b Section 10 CMR 47 Premises litter-free, unnecessari articles, cleaning maintenance equipment properly stored. Y 5 590•.027(F)(3)). 4 Authorized personnel 48 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, _stored-or used. 50 No pets or other lire animals except guide dogs 51 Bulk foods stored. labelled, dispensed Note: In addition to the items listed above, any other violation of the 52 Salad bar operations prepared, refrigerated, displayed, protected Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall aftet written notice to the permit holder constitute a critical violation. Qo TOWN OF BARNSTABLE OFFICE HOURS: BOARD OF HEALTH • 8:15 - 9:30 A.M. Item No. In the s below describe all violations checked Page-of - _ ' �jJ7 � 367 MAIN STREET IIJJ HYANNIS, MASS. 02601 790-6265 EXT.265; FOOD ESTABLUS I- MENT INSPECTION REPORT Establishment Name Date101 elk-# �2A / oil Address me:Inj 01st Telephone ��-- Type of stablishment: Purpose: Food Service Owner's Name Retail Food Routine Residential Kitchen lox, Follow-up Person in Charge -� Mobile Unit Complaint Temporary Food Service Investigation Inspectors Name Caterer Other Based or an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and - official notice to correct said violations. Food N C V I Sanitary Facilities N C 1h7. , t. Food Supply .0020714Y9. Water Source .015 4 2. Food Containers .002 30. Sewage .016 4 31. Cross-Connections .017 4 Food Protection 32. Toilets/Handwashing .018 8 .019 4 l e 3. PHF Temperatures 004 33. Insects/Rodents 021 2 a. Facil ties. Ho?& Cold Storage 004 34, PlumGin g 017 1 5 PHF Re-service .006 4 35. Toilet Rooms .018 2 6. Spoiled/Damaged Foods 003 36. Handwashing Areas .019 2 -ills OC 7 Food Protec e-d- _003 37. Garbage/Refuse 020 ' 8. Food Thermometers 00 38. Outside Disposal .020 i 9. Cross Contamination .005 39. Outer Openings .02t 2 0, 10 PHF s thawed, cooked 8 cooled .00K 2 40. Pesticide/Rodent icide Application 021 1 11. Food Handling .005 2 12. Dispensing Utensils .006 1 Physical Facilities 41. Floors .022 2 Personnel 42. Walls, Ceiling .022 2 13. Employee Infections .008 4 43 Lighting .023 1 14. Employee Hygiene .009 4 44. Ventilation .024 2 0 CD 15, Employee Clothing .010 1 45. Dressing Rooms 025 1 Equipment 8 Utensils Other 16 Equipment/Utensil Clean 8 Sanitized 013 2 46, Toxics 026 N 4 17. Food Contact Surfaces .013 1 47, Premises 027 1 18 Non-Food Contact Surfaces .013 1 48. Living Areas .027 1 19 Food Contact Surfaces Clean .013 2 49. Linen .027 1 Discussion with Management 20 Non-Food Contact Surfaces Clean .013 1 50. Pets 027 1 21 Wiping Cloths 013 1 51, Bulk Foods .031 1 22. Dish/Warewashing Facilities .013 1 52, Salad Bars .032 1 23. Pre-Scraped, Soaked .013 1 77 24 Wash/Rinse nse Water .013 1 No. of 13 Critical Items Violated _ 25 Thermometers/Test Kits .013 1 These items require immediate attention. 26 Equipment/Utensil Storage 014 1 27 Single Service Articles 014 1 28 Single Service Re-Use .012 1 Grease Trap: In Ground: In Line: Capacity: SCORE Inspected by Z;&"ZZLAV&iived b Seating: Frozen Dessert Machines: Pumped: 13 CUM.CAL FOOD H"MING VIOLATIONS qW Full Item Descriptions 1. Food from an unapproved or unknown source or food rabic is or may be Food adulterated, contaminated or otherwise unfit for human consumption c1 Food Source, approved, wholesome is found in a food establishment. 2 Containers, properly labelled Food !roteetion 2. Potentially hazardous food that is held longer than necessary for C3 Potentially hazardous foods proper temperatures: 140°F or above, 450F or below, 00F; rapid cooling of cooked foods within hin 4 hours preparation or service at a temperature which is greeter than 450 F C4 Facilities to maintain product temperature (`=7o C) (in the case of cold food) or less than 1400 F (600C) (in C5 Unwrapped and potentially hazardous foods not re-served the -Case of hn+ fn.A� 6 Damaged, spoiled, returned foods segregated - -.•/ . T Food protected during storage, preparation, display, dispensing, service, transportation e Thermometers provided, conspicuous, accurate 9 No cross-contemination 3. The food establishment's facilities are insufficient to maintain 10 Potentially hazardous foods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel C13 Employees with Infections restricted customers is re-served unless such re-service is allowed under C14 Hands :•shed and clean; good hygienic practices section 105 CMR 590.006(G). 15 elf.C. uluthce, hair restraints Equipment & Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manudl methods) transmitted by food is working as a food handler in a food 17 Food contact surfaces: design, constructed, Installed, maintained, located 10 Non-food contact surfacest design, constructed, installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dish/Warpwashins fSCillties: designed, constructed, maintained, Installed, located, hygiene which may result in the potential transmission of illness operated through food is employed in a food establishment. 24 Pre-flushed, scraped, soaked 24 Wash/Rinse water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food-contact surfaces are not cleaned and 26 Storage, handling or clean rage, di/utensils 27 Single service articles, storage, dispensing sanitized effectively and may contaminate food during preparation, 28 No reuse of single service articles storage or service. Sanitary Fae11zt1ea C29 Water source; approved, hot&cold under pressure 8. Sewage or liquid waste is not dispo&ed of in an approved and C30 Sewage .nd waste water dieoosal C31 No cross-connections, back siphonaae, backflow sanitary manner, or the sewage or liquid waste contaminates or may C32 Toilets A Handwashingi number, accessible, design, installed contaminate any food areas used to store or prepare food, or any c33 No Insects or rodents; harborage prevented areas frequented b customers or employees. 34 Plumbing; Installed, maintained q Y35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handwashing areas supplied with soap and towel dispensers, proper waste receptacles 37 cleanse and refuse: containers covered, adequate number, insect/rodent resistant, frequency, 9. Toilets and facilities for washing hands are not provided, properly installed or designed, accessible or convenient. 38 outside area: dumpster covered, construction, clean 39 outer openings protected 40 Pesticides and rodentieldes, proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single service Physical Facilities 41 Floors constructed, maintained, clean articles and/or bottled water from an approved source. 4z Walls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded 11. A defect exists in the system supplyingotable water that may 44 Dress and equipment .anted as required Y P Y 45 Dressing, locker areas provided used, clean result in the contamination of the water. Other 12. Insects, rodents or other animals are present on the premises C46 Towles properly stored, labelled, Card 41 Premises litter-free, unnecessarl articles, cleaning maintenance equipment properly stored. (unless allowed by Section 105 CMR 590.027(F)(3)). Authorized personnel 48 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, dispensed 52 Salad bar operations prepared, refrigerated, displayed, protected Note: In addition to the items listed above, any other violation of the Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall after' written notice to the permit holder constitute a critical violation. a TOWN OF BARNSTABLE OFFICE HOURS: - oFt ,o 8:15 - 9:30 A.M. Item No. In the s e below describe all violations checked- Page of BOARD OF HEALTH „ ee' 367 MAIN STREET 39. HYANNIS, MASS. 02601 790-6265 EXT.265: E .,FOOD ESTABLISHMENT INSPECTION REPORT , Establishment Name Date } Time: In Out Address Telephone Type of Establishment: Purpose: Food Service Owners Name Retail Food Routine Y Residential Kitchen Follow-up Complaint Person In Charge Mobile Unit Investigation Temporary Food Service , Inspectors Name Caterer Other Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and t critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation j checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. Food N C �Sanitary Facilities N C WT. r 1. Food Supply 002�4 29. Water Source 015 4 '' 2. Food Containers 002 30. Sewage .016 4 � 31. Cross-Connections .017 4 ' Food Protection 32. Toilets/Handwashing .0188 .019 4 3. PHF Temperatures .004 4 33, Insects/Rodents .021 2 4. Facilities, Hot 8 Cold Storage .004 4 34. Plumbing .017 1 r 5. PHF Re-service .006 35. Toilet Rooms .018 2 6. Spoiled/Damaged Foods .003 1 36. Handwashing Areas 019 2 7. Food Protected .003 4 37. Garbage/Refuse .020 2 8. Food Thermometers .004 2 38. Outside Disposal .020 1 9. Cross Contamination .005 2 39. Outer Openings rf .021 2 10. PHFs thawed,cooked 8 cooled .005 2 40. Pesticide/Rodenticide Application .021 1 C , 11. Food Handling .005 2 r 12. Dispensing Utensils .006 1 Physical Facilities ae 41. Floors .022 2 Personnel 42. Walls, Ceiling .022 2 13. Employee Infections .008 U4 43. Lighting .023 1 14. Employee Hygiene .009 4 44 Ventilation .024 2 15. Employee Clothing .010 1 45. Dressing Rooms .025 1 Equipment 3 Utensils Other ? 16. Equipment/Utensil Clean 8 Sanitized 013 2 46. Toxics .026 4 a 17. Food Contact Surfaces .013 1 47. Premises .027 1 i 18. Non-Food Contact Surfaces .013 1 48. Living Areas .027 1 19. Food Contact Surfaces Clean .013 2 49. Linen .027 1 Discussion with Management Al�t 20. .Non-Food Contact Surfaces Clean .013 1 50. Pets .027 1 •21, Wiping Cloths .013 1 51. Bulk Foods .031 1 22. Dish/Warewashing Facilities 013 ; 52, Salad Bars .032 1 23. Pie-Scraped, Soaked 013 24 Wash/Rinse Water 013 1 No. of 13 Critical Items Violated 25, Thermometers/Test Kits 013 1 These items require immediate attention. 26. Equipment/Utensil Storage .014 1 i 27 Single Service Articles .014 1 'r 28, Single Service Re-Use .012 1 j t Grease Trap:In Ground: In Line: Capacity: SCORE Inspected by Received by Seating: Frozen Dessert Machines: Pumped: j 13 CRAL FOOD HANDLING VIOLATIONS F item Descriptions 1. Food from an unapproved or unknown source or food whin is or may be Food 0 adulterated, contaminated or otherwise unfit for human consumption CI Food Source, approved, wholesome is found in a food establishment. 2 Containers, properly labelled Food Protection 2. Potentially hazardous food that 18 held longer than necessary for C3 Potentially hazardous foods at proper tempersturesi 140OF or above, 450E or below. ODF; rapid cooling of cooked foods within s hours preparation or service at a temperature which is greater than 450 F Cr Facilities to maintain product temperature (``=7° 0 (in the case of cold food) or less than 1400 F (60°C) (in CS Unwrapped and potentially hazardous foods not re-served the C cza of hnit f^—A N 6 Damaged, spoiled, returned foods segregated _ ..� • 7 Food protected during storage, preparation, display, dispensing, service, transportation 8 Thermometers provided, conspicuous, accurate 9 No cross-contamination 3. The food establishment's facilities are insufficient to maintain to Potentially hazardous foods properly thawed, cooked, and cooled product temperature. /1 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel C13 Employees with infections restricted customers is re—served unless such re—service is allowed under C143 Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 Clean clothes, hair restraints Equipment g Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manudl methods) transmitted by food is working as a food handler in a food IT Food contact surfaces: design, constructed. Installed, maintained, located 18 Non-food contact eurfacest design, constructed, installed, oslntained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free or all cleansers 21 Wiping cloths; clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dish/Warpwashing facilities: designed, constructed, maintained, Installed, located, hygiene which may result in the potential transmission of illness operated through food is employed in a food establishment. 23 Pre-flushed, r. e, soaked 8 24 Wash/Rinse wattee clean, r clean, temperature 25 Accurate thermometers, chemical test kits provided; Instructions posted cle7. Equipment, utensils and food—contact surfaces are not cleaned and 26 Storage, handling or es. s equipment/utensils 27 Single service articles, storage, dispensing sanitized effectively and may contaminate food during preparation, 28 No re-use of single service articles storage or service. Sanitary Facilities C29 Water source; approved, hot8eold under pressure 8. Sewage or liquid waste is not dispo&ed of in an approved and C30 Sewage .nd waste water dienosal C31 No cross-connections, back alphonaae, backflow sanitary manner, or the sewage or liquid waste contaminates or may C32 To, a Handwashingi number, accessible, design, Installed contaminate any food areas used to store or prepare food, or any C33 No Insets or rodents; harborage prevented 34 Plumbing; installed, maintained areas frequented by customers or employees. 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handveshing areas supplied with soap and towel dispensers, proper Waste receptacles 9. Toilets end facilities for washing hands are not provided, properly 37 Garbage and refuse: containers covered, adequate number. insect/rodent resistant, frequency. P r P P er Y clean installed or designed, accessible or convenient. 36 Outside area: dumpster covered, construction, clean 39 outer openings protected 40 Pesticides and rodenticides, proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single service Pbysical Facilities M1 Floors constructed, maintained, clean articles and/or bottled water from an approved source. s2 calls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided es required, fixtures shielded 11. A defect exists in the system supplyingotable water that may eM Rooms and equipment vented as required Y P Y :5 Dressing, locker areas provided used. clean result in the contamination of the water. Other 12. Insects, rodents or other animals are present on the premises c 47 Tortes properly stored, labelled, saes Premises le, unnecessarl articles, cleaning maintenance equipment properly stored. (unless allowed by Section 105 CMR 590.027(F)(3)). Authorized personnel 48 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, d13ptnsed 5f Salad bar operations prepared, refrigerated, displayed, protected Note: In addition to the items listed above, any other violation of the Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall aftet written notice to the permit holder constitute a critical violation. r TOWN OF BARNSTABLE it OFFICE HOURS: oF1HE0 • 8:15 9:30 A M. Item No. In th ce below describe all violations checks Page-of 0 12:45 - 2:00 P.M. 4Fc ��nASL e BOARD OF HEALTH ,` ,• 367 MAIN STREET.. _ n TED MPy HYANNIS, MASS. 02601 790-6265 EXT.265 FOOD ESTABLISHMENT INSPECTION REPORT EstabllshmentName ICJ"r Datevf� �� 1 Address Time: In Out 1 Telephone - Type of Establishment: Purpose: Food Service Owner's Name Retail Food Routine Residential Kitchen Follow-up Person In Charge Mobile Unit Complaint Temporary Food Service Investigation Inspectors Name -Z ` Caterer Other Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. Food N C WT Sanitary Facilities N C WT. 1. Food Supply .002�J 1 P9. Water Source 015 4 2. Food Containers .002 30. Sewage .016 4 31. Cross-Connections .017 4 Food Protection 32. Toilets/Handwashing 018&.019 4 3. PHF Temperatures .004 2 33. Insects/Rodents .021 2 4. Facilities, Hot&Cold Storage .004 34 Plumbing 017 1 5. PHF Re service .006 4 35. Toilet Rooms .018 2 ;�; 6. Spoiled/Damaged Foods .003 1 36. Handwashing Areas .019 2 7. Food Protected .003 4 37. Garbage/Refuse .020 2 8. Food Thermometers .004 2 38. Outside Disposal .020 1 0- 9. Cross Contamination .005 2 39. Outer Openings .021 2 10. PHFs thawed,cooked&cooled .005 40. Pesticide/Rode nticide Application 021 1 11. Food Handling .005 2 { 12. Dispensing,Utensils .006 1 Physical Facilities 41. Floors .022 2 Personnel 42. Walls, Ceiling .022 2 13. Employee Infections .008 4 43. Lighting .023 1 14. Employee Hygiene 009 4 44. Ventilation .024 2 15. Employee Clothing .010 1 45, Dressing Rooms .025 1 ' Equipment& Utensils Other 16. Equipment/Utensil Clean& Sanitized .013 2 46. Toxics .026 4 17. Food Contact Surfaces .013 1 47. Premises .027 1 18 Non-FoodlContact Surfaces .013 1 48. Living Areas 027 1 19 Food Contact Surfaces Clean 013 2 49. Linen 027 1 Discussion with Management 20, Non-Food Contact Surfaces Clean .013 1 50, Pets .027 1 21. Wiping Cloths .013 1 51. Bulk Foods .031 1 1�2. Dish/Warewashing Facilities 013 1 52, Salad Bars 032 Li 1 2�. Pre-Scraped, Soaked .013 1 y 4 2 Wash/Rinse Water .013 1 _1 7 1 No. of 13 Critical Items Violated I 25. Thermometers/Test Kits .013 These items require immediate attention. 26. Equipment/Utensil Storage .014 1 i 27 �ingle Service Articles .014 1 k 28 S ngle Service Re-Use .012 1 Grease Trap:.In Ground: In Line: Capacity: „, SCORE i I Inspected by Received by Seating: Frozen Dessert Machines: Pumped: 13 C=1CAL FOOD HANDLING VIOLATIONS Full Item Descriptions 1. Food from an unapproved or unknotm source or food wP is or may be Food 0 0 adulterated contaminated or otherwise unfit for human consumption C1 Food Source, approved, wholesome is found in a food establishment. 2 Containers, properly labelled Food Protection 2. Potentially hazardous food that 18 held longer than necessary for C3 Potentially hazardous foods at proper temperatures: 140OF or above, 450F or below, OOF; Y g Y rapid cooling of cooked foods within 4 hours preparation or service at a temperature which is greeter than 450 F C4 Facilities to maintain product temperature (=7° 0 (in the case of cold food) or less than 1400 F (600C) (in C5 Unwrapped and potentially hazardous foods not re-served 6 Damaged, spoiled, returned foods segregated th-- ..ocu of hnt. F:_.1) ..�• T Food protected during storage, preparation, display, dispensing, service, transportation S Thermometers provided, conspicuous, accurate 9 No cross-contamination 3. The food establishment's facilities are insufficient to maintain 10 Potentially hazardous roods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel C13 Employees with infections restricted customers is re—served unless such re—service is allowed under C14 Hands Washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 Clean clothes, hair restraints Equipment g Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manudl methods) transmitted by food is working as a food handler in a food IT Food contact surfaces: design, constructed, installed, maintained, located is Non-food contact surfaces: design, constructed, installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of ell oleansers 21 Wiping cloths; clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dish/Warpwashing racilities: designed, constructed, maintained, installed, located, hygiene which may result in the potential transmission of illness operated through employed h food is em to ed in a food establishment. 23 Pre-flushed, scraped, , eked 24 Wash/Rinse eater clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 7. Equipment, utensils and food—contact surfaces are not cleaned and 26 Storage, handling or clean oregetequipmedisutensils 2T Single service articles, storage, dispensing sanitized effectively and may contaminate food during preparation, 28 No re-use of single service articles storage or service. Sanitary Facllltlea C29 Water source; approved, hot&cold under pressure 8. Sewage or liquid waste is not disposed of in 3n approved and C30 Sewage .nd waste water dtsoosal C31 No cross-connections, back siphonase, backflow sanitary manner, or the sewage or liquid waste contaminates or may C32 Toilets g Handwashing: number, accessible, design, installed contaminate any food areas used to store or prepare food, or any c33 No insects or rodents; harborage prevented 34 Plumbing; installed, maintained areas frequented by customers or employees. 35 toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 HandWashing areas supplied with soap and towel dispensers, proper Waste receptacles 9. Toilets and facilities for washing hands are not provided, properly 3T Garbage and refuse: containers covered, adequate number, insect/rodent resistant, frequency, 8 P r P P Y clean installed or designed, accessible or convenient. 38 Outside area: dumpster covered, construction, clean 39 Outer openings protected 40 Pesticides and rodenticides, proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single service Physical Facilities 41 Floors constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded 44 Rooms and equipment vented as required 11. A defect exists in the system supplying potable water that may 45 Dressing, locker areas provided used, clean result in the contamination of the water. Other 12. Insects, rodents Or other animals are present on the premises C46 Togics properly stored, labelled, -ised ( Y 5 590.027(F)(3)). 4T Premises ltter-free, unnecesaar) articles, cleaning maintenance equipment properly stored. unless allowed b Section 10 CMR Authorized personnel 48 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 bulk foods stored, labelled, dispensed 52 Salad bar operations prepared, refrigerated, displayed, protected Note: In addition to the items listed above, any other violation of the Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall after' written notice to the permit holder constitute a critical violation. TOWN OF BARNSTABLE OFFICE HOURS: 8:15 5:3U A.M. t ,t Item,No. In th a below describe all violations checke Page- BOARDBOARD - _ OF HEALTH 12:45 - z:°° F M - �, ' 367 MAIN STREET TED MPY r HYANNIS, MASS. 02601 790-6265 EXT.265; FOOD ESTABLISHMENT INSPECTION REPORT: -`. Establishment NameLiCA ate Address Time: fit but' f't Telephone Type of E ablishment: Purpose: fi Food Service Owner's Name '} Retail Food Routine Residential Kitchen Follow-up s Person in Charge Mobile Unit Complaint �,v ® Temporary Food Service Investigation , Inspector's Nams Oio" Caterer Other Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of;violated provisions and official notice to correct said violations. Food N C WT Sanitary Facilities N C WT, 1. Food Supply 002� 29. Water Source 015 4 2. Food Containers 002 130. Sewage .016 4 31. Cross-Connections .017 4 p Food Protection 4 32. Toilets/Handwashing .018 8 .019 4 t r s 1 PHF Temperatures .004 33, Insects/Rodents 021 2 2s 4. Facilities. Hot&Cold Storage .004 4 34 Plumbing .017 1 ` 5. PHF Re-service .006 35. Toilet Rooms .018 2 ,} 6.v,'`Spoiled/Damaged Foods .003 1 36. Handwashing Areas 019 2 7 Food Protected 003 4 37. Garbage/Refuse .020 2 8. `Food Thermometers .004 2 38. Outside Disposal .020 1 9. Cross Contamination .005 2 39. Outer Openings .021 2 ? eXp 10. PHFs thawed,cooked&cooled 005 2 40. Pest icide/Rodenticide Application 021 1 r <? 11. Food Handling .005 2 12. Dispensing Utensils 006 1 Physical Facilities 41. Floors .022 2 Personnel 42 Walls, Ceiling .022 2 13. Employee Infections .008 4 43. Lighting 023 1 14. Employee Hygiene .009 4 44. Ventilation .024 2 15. Employee Clothing .010 1 45. Dressing Rooms .025 1 Equipment 8 Utensils Other . 16. Equipment/Utensil Clean& Sanitized .013 2 46, Toxics .026 4 17. Food Contact Surfaces .013 1 47. Premises .027 1 18. Non-Food Contact Surfaces .013 1 48. Living Areas .027 1 3.:. 19. Food Contact Surfaces Clean .013 2 49. Linen .027 1 Discussion with Management 1T 20, Non-Food Contact Surfaces Clean .013 1 50. Pets .027 1 '1 21. Wiping Cloths .013 1 51. Bulk Foods .031 1 + 22.' Dish/Warewashing Facilities .013 1 52 Salad Bars .032 1 r 2P. Pre•Scrapedt Soaked .013 1 - 24 Wash/Rinse Water .013 1 No. of 13 Critical Items Violated 25 Thermometers/Test Kits .013 1 These items require immediate attention. 26 Equipment/Utensil Storage 014 1 27 Single Service Articles 014 1 ! 28. Single Service Re-Use 012 1 O Grease Trap:In Around: In Line: Capacity:p ty: SCORE Inspected by Received by ��4_e4k- Seating: Frozen Dessert Machines: Pumped: J 13 CRITTft FOOD HANDLING VIOLATIONS Full Item Descriptions 1. Food from an unapproved or unknown source or food which or may be Food- adulterated, contabinated or otherwise unfit for human consumption c1 Food Source, approved, wholesome 0 2 Contalnera, properly labelled is found in a food establishment. Food Protection 2. Potentially hazardous food that is held longer than necessary for C3 Potentially hazardous foods at proper temperatures: 14OOF or above. 450F or below, OoF; Y g Y rapid cooling of cooked foods within 4 hours preparation or service at a temperature which is greeter than 4g0 F C4 Facilities to maintain product temperature (-7o 0 (in the case of cold food) or less than 1400 F (600C) (in c5 Unwrapped and potentially hazardous foods not re-served the _ocu of, hot f^_c:d)• 6 Damaged, spoiled, returned foods segregated , 1 Food protected during storage, preparation, display, dispensing, service, transportation 6 Thermometers provided, conspicuous, accurate 9 No cross-contamination 3. The food establishment's facilities are insufficient to maintain 10 Potentially hazardous foods properly thawed, cookedv and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel C13 Employees with infections restricted customers is re-served unless such re-service is allowed under C14 Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 Clean clothes, heir restraints Equipment 3 Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manudl methods) transmitted by food is working as a food handler in a food 17 Food contact surfaces: design, constructed. Installed, maintained, located I$ Non-food contact surfaces: design, constructed, installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dish/Warpwashing facilities: designed, constructed, maintained, Installed, located, hygiene which may result in the potential transmission of illness operated through food is employed in a food establishment. 23 Pre-flushed, scraped, soaked g24 Wash/Rinse water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted Equipment, utensils and food-contact surfaces are not cleaned and 26 Storage, handling of clean seutensils • 21 Single service articles, stooragerage dispensing , dispensing sanitized effectively and may contaminate food during preparation, 2e No re-use of single service articles storage or service. ' Sanitary Faculties C29 Later source; approved, hot&cold under pressure 8. Sewage or liquid waste is not disposed of in an approved and C3O Sewage •nd waste water dizoosal C31 No cross-connections, back siphonaae, backflow sanitary manner, or the sewage or liquid waste contaminates or may C32 Toilets i Handwashing: number, accessible, design, installed contaminate any food areas used to store or prepare food, or any C33 No Insects or rodents; harborage prevented 34 Plumbing; installed, maintained areas frequented by customers or employees. 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Hand.rashing areas supplied with soap and towel dispensers, proper waste receptacles 9. Toilets and facilities for washing hands are not provided, properly 37 Garbage and refuse: containers covered, adequate number, Insect/rodent resistant, frequency, 8 P , P P Y clean installed or designed, accessible or convenient. 36 Outside area: dumpster covered, construction, clean 39 Outer openings protected 40 Pesticides and rodenticidea. proper application 10. The supply of water is not from an approved source or is not under ilities pressure and the food establishment does not. use single service Physical Flo Floors constructed, 41 Floors constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded 11. A defect exists in the system supplyingotable water that may 44 Dress and lockerequipm rented as required Y P Y 45 Dressing, locker areas prodded used, clean result in the contamination of the water. Other 12. Insects, rodents or other animals are //present on the premises C46 Tories properly stored, labelled, -:sed ( Y 5 590.027\F)(3))• 41 Premises litter-free, unnecessarl articles, cleaning maintenance equipment properly stored. unless allowed b Section 10 CMR Authorized personnel 45 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, dispensed Note: In addition to the items listed above, any other violation of the sz salad bar operations prepared, refrigerated, displayed, protected Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall after written notice to the permit holder constitute a critical violation. TOWN OF BARNSTABLE OFFICE HOURS: oF'""avti 8:13 - 9:30 A.M. Item No. In the a below describe all violations checked Page Of *BOARD OF HEALTH • 12:45 - 2:00 P.M. .t - V �STABLZ �y"sa gee 367 MAIN STREET HYANNIS, MASS. 02601 790-6265 EXT.2651 FOOD ESTABLISHMENT INSPECTION REPORT F hment Name DatesTlme: In Out T e of Establishment:ne "� ' YP Purpose: ,tip ' Food Service k, _ Owners moms Retail Food Routine Residential Kitchen Follow-up , «- r Person In Charge Mobile Unit Complaint Temporary Food Service Investigation °` - Inspectors Name Caterer Other IL Based on an inspection today,the items checked below indicted he violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulafion. Non-critical violations are marked under column"N"and '4v critical violations are marked under column"C". Descriptions'of each item appear on the back of this form. Each violation j '' - checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and At official notice to correct said violations Food N C WT Sanitary Facilities N C WT. 1. Food Supply .002� 29. Water Source .015 4 2. Food Containers .002 1- 30. Sewage .016 4 >, 31. Cross-Connections .017 4 � � f k Food Protection 4 32. Toilets/Handwashing .018 8.019 4 ! 3. PHF Temperatures .004 33. Insects/Rodents .021 2 , Y 4. Facilities, Hot 8 Cold Storage .004 2 34. Plumbing .017 1 / 5. PHF Re-service .006 4.1 35. Toilet Rooms .018 2 ` 6. Spoiled/Damaged Foods .003 1 36. Handwashing Areas .019 - 2 s 7. Food Protected .003 2 37. Garbage/Refuse .020 2 { 8. Food Thermometers .004 I c 38. Outside Disposal 020 1 9. Cross Contamination . .005 2 39. Outer Openings 021 H 2 4. 10. PHFs thawed,cooked 8 cooled .005 2.. 40. Pesticide/Rodent icide Application 021 11. Food Handling .005 2� 12. Dispensing Utensils 006,.- 1 Physical Facilities 41. Floors .022 2 Personnel "" 42 Walls,Ceiling .022 2 I' / 13. Employee Infections .008 4- 43. Lighting .023 1 ,g 14. Employee Hygiene .009 4 44. Ventilation .024 2 15. Employee Clothing .010 U 1, 45. Dressing Rooms .025 1 Equipment& Utensils - Other ?� 16. Equipment/Utensil Clean 8 Sanitized .013 2 46. Toxics 026 4 17. Food Contact Surfaces .013 1' 47. Premises .027 1 ) 18. Non-Food Contact Surfaces .013 1 48. Living Areas .027 1 19. Food Contact Surfaces Clean .013 2 4% Linen .027 1 Discussion with Management 20. Non-Food Contact Surfaces Clean .013 1 50. Pets 027 1 lei 4- 21. Wiping Cloths .013 1' 51. Bulk Foods .031 1 22. Dish/Warewashing Facilities .013 1, 52 Salad Bars .032 1 ` 11 23. Pre-Scraped, Soaked .013 1CL 24 Wash/Rinse Water .013 1. NO. of 13 Critical Items Violated 25. Thermometers/Test Kits .013 1' These items require immediate attention. J° 26. Equipment/Utensil Storage .014 1. 27, Single Service Articles .014 1 28 Single Service Re-Use .012 1 Grease Trap: In Ground: In Line: Capacity: SCORE Inspected y� ffs ?� s '.et�'T Received by Seating: Frozen Dessert Machines: Pumped: - .. j I:V • Item No. In he s below describe all violations checked _ Page_of T • � Y if e - 91 j �� FOOD ESTABL14AMENT INSPECTION REPORT K Establishment Name Date- 0 T e• 1 Out Address k ' S Telephone /7� Type of Establishment: rpose: Food Service t d,r j z Owners Name Retail Food Routine Residential Kitchen. Follow-up . Person In Charge Mobile Unit Complaint -Temporary Food Service Investigation , Inspectors No yJ. 'R sue' Caterer Other? <: ti Based on an inspection today,the items checke below indicate the violated provisions of 105 CMR 5110.000. Each item is { followed by the applicable section of the Mas husetts regulation. Non-critical violations are marked under column"N"andny , critical violations are marked under column ". Descriptions of each item appear on the back of this form. Each violatiorT i ....... checked requires an explanation'or+,the narrative page(s)- This report serves as official notice of violated provisions and official notice to correct said violations.. 1. rF ; C N C WT. C Food` ,I t<� � = .1 # N .Sanitary Facilities �� , 1. Food Supply 002 29 Water.Source; 015 4 r� 2. Food Containers 002 1 }^30 - .Sewage ` s 016 4• _ 31 Cross-Connections 9 017 4 Food Protection ToiletiLHandwashing <. ,018 8, 019 4 / t 3. PHF Temperatures :_` 004 4' 33F Insects/Rodents 021 2 4. Facilities. Hot 8-Cold Storage Q04 a 34 t?lumbinj °`'- Oi 7 1 5. PHF Re-servicie 006 _'35 Toilet Rooms 018 •2 ti 6. Spoiled/DamagedToods' 0.03 � 4'f36 HandwashingAreas " ` Ot9 2 _ 7. Food Protected a `., y003 37 -. GarbageLR.efuse 4 r° 020 2 t 8. Food Thermometers 004 2 38 �Outside'Disposaf, t s 020 1 h_ 9. Cross Contamination ,. 0052 39X `Outer,Openings �' `� 02 2 C 10. PHFs thawed,"cooked 8 tooted '- 1.005 ,':?- 40 Pesticide%Rodenticide Application 1 i 11. Food Handling. -.005 �2 12. Dispensing Utensils. .006 ��1 Physical Facilities ; r r 41. Floors. i� - _ 022 2 ' Personnel -.42. Walls, Ceiling .022 2 fi• �. 13. Employee Infections 008 4 43. Lighting .023 - 1 S > 14. Employee.Hygiene 009 -4 44. Ventilation " .024 2 '•t r. 15. Employee Clothing 010�1.,` 45. Dressing Rooms .Y. .025 1 T Y 9 ` i r Equipment&Utensils; _- Other i 16. Equipment/Utensil Clean 8 Sanitized 013 " 2. 46.= Toxica = 026 4 17. Food Contact Surfaces .013 1 47 Premises r k °- 027 1 c 18. Non-Food Contact Surfaces .013'� 1 48. Living Areas .027 1 Discussion with Manage_rtment 19. Food Contact Surfaces Clean { .013 2 '49. Linen x •• .027 1 rf 20:' Non-Food Contact Surfaces Clean .013' 1-p 50• - pets 027, 1 21. Wiping Cloths .013 1 51.`,. Bulk Foods .031 1 P 22. Dish/Wa rewash ing Facilities 013 1�52 Salad Bars 032LJ 1 f 23. Pre Scraped, Soaked- .013 1 , 24. Wash/Rinse Water 013 1 No.of 13 Critical Items Violated _ 25. Thermometers/Test Kits .013 1 These items require immediate attention. 26. Equipment/Utensil Storage 014 1 y 27. Single Service Articles .014 1 I 28. Single Service Re-Use .012 Ll1 Inspected b r Received by Full Item Descriptions Food CA Food Source, approved, wholesome 2 Containers, properly labelled Food Protection Potentially hazardous foods at proper temperatures: 140OF or above, 45OF or below, OOF; rapid cooling of cooked foods within 4 hours C4 Facilities to maintain product temperature C5 Unwrapped and potentially hazardous foods not re-served 6 Damaged, spoiled, returned foods segregated Food protected during storage, preparation, display, dispensing, service, transportation 8 Thermometers provided, conspicuous, accurate 9 No cross-contamination 10 Potentially hazardous foods properly thawed, cooked, and cooled 11 Food handling minimized 12 Dispensing utensils stored Personnel C13 Employees with infections restricted C14 Hands washed and clean; good hygienic practices 15 Clean clothes, hair restraints Equipment & Utensils C16 Equipment, utensils'sanitized (automatic and manual methods) 17 Food. contact surfaces: design, constructed, installed, maintained, located 18 Non-food contact surfaces: design, constructed, installed, maintained, located 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 22 Dish/Warewashing facilities: designed, constructed, maintained, installed, located, operated 23 Pre-flushed, scraped, soaked 24 Wash/Rinse water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 26 Storage, handling of clean equipment/utensils 27 Single service articles, storage, dispensing 28 No re-use of single service articles Sanitary Facilities C29 Water source; approved, hot&cold under pressure C30 Sewage and waste water disposal C31 No cross-connections, back siphonage, backflow C32 Toilets & Handwashing: number, accessible, design, installed C33 No insects or rodents; harborage prevented 34 Plumbing; installed, maintained 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handwa3hing areas supplied with soap and towel dispensers, proper Waste receptacles 37 Garbage and refuse: containers covered, adequate number, insect/rodent resistant, frequency, clean 38 outside area: dumpster covered, construction, clean 39 Outer openings protected 40 Pesticides and rodenticides, proper application Physical Facilities, • 41 Floors constructed, maintained, clean 42 Walls, ceiling, attached equipment; constructed, maintained, clean . 43 Lighting provided as required, fixtures shielded 44 Rooms and equipment vented as required 45 Dressing, locker areas provided used, clean Other C46 Toxic3 properly stored, labelled, used 47 Premises litter-free, unnecessary articles, cleaning maintenance equipment properly stored. Authorized personnel j48 Living/sleeping quarters and latundry—separate 49 Linen properly stored 5o No pet-, or other live animals except guide dogs 51 Bulk foods stored, labelled, dispensed 52 Salad bar operations prepared, refrigerated, displayed, protected 13 CRI=CAL FOOD RANDLING VIOLATIONS • Full Item Descriptions 1. Food from an unap owed or unknown source or food whis is or may be Food- 0 adulterated, contablinated or otherwise unfit for human consumption c1 Food Source, approved, wholesome 2 Containers. properly labelled is found in a food establishment. Food Protection 2. Potentially. hazardous food that is held longer than necessary for c3 Potentially hazardous rooms it proper temperatures: 140°F or above. YS°F or below, 0°F; y $ Y rapid cooling of cooked foods within 4 hours preparation or service at a temperature which is greeter than 450 F c4 Facilities to maintain product temperature (=7o 0 (in the case of cold food) or less than 1400 F (600C) (in C5 Unwrapped and potentially hazardous foods not re-served the case of hot fo_AA � 6 Damaged, spoiled, returned foods segregated T Food protected during storage, preparation, display, dispensing, navvies, transportation 6 Thermaneters provided, conspicuous, accurate 9 No cross-contamination 3• The food establishment's facilities are insufficient to maintain 10 Potentially hazardous foods properly thawed, cooked, and cooled product temperature. 11 Food handling minimized 12 Dispensing utensils stored 4. Potentially hazardous food or unwrapped food that has been served to Personnel C13 Employees with infections restricted customers is re-served unless such re-service is allowed under C14 Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 Clean clothes. hair restraints Equipment t Utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (automatic and manudl methods) transmitted b food is as a food handler in a food 17 Food contact surfaces: design, constructed, Installed, maintained, located y oo s working 16 Non-food contact surfacest design, constructed, installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 6. A person not practicing strict standards of cleanliness and personal 21 Wiping rrwas; clean, use restricted p p $ p 22 Dish/war washing facilities: designed, constructed. maintained, installed, located, hygiene which may result in the potential transmission of illness operated h food is employed in a food establishment. 23 Pre-flushed, scraped, soaked through 24 Nash/Ainse water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 26 Storage, handling of clean equipment/utensils 7. Equipment, utensils and food-contact surfaces are not cleaned and 27 Single service articles. storage, dispensing sanitized effectively and may contaminate food during preparation, 28 No re-use of single service articles storage or service. Sanitary Facilities C29 Water source; approved, hot3cold under pressure 8. Sewage or liquid waste is not disposed of in an approved and C30 Sewage rnd waste water dtzposal C31 No cross-connections, back siphonage, backflow sanitary manner, or the sewage or liquid waste contaminates or may C32 Toilets a Handwashingt number, accessible, design. installed contaminate any food areas used to store or prepare food, or any C33 No Insects or rodents; harborage prevented 34 Plumbing;.Installed, maintained areas frequented by customers or employees. 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handwashing areas supplied with soap and towel dispensers, proper waste receptacles 37 Garbage and refuses containers covered, adequate number. inaeet/rodent resistant. frequency. 9• Toilets and facilities for washing hands are not provided, properly clean installed or designed, accessible or convenient. 36 Outside area: dumpster covered, construction. clean 39 outer openings protected 40 Pesticides and rodenticides. proper application 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single service Pb1 Flocal Facilities clean $ ed maintained p 41 Floors construct , articles and/or bottled water from an approved source. 42 Walla, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded 44 Rooms and equipment vented as required 11. A defect exists in the system supplying potable water that may 45 Dressing. looker areas provided used. clean result in the contamination of the water. Other 12. Insects rodents or other animals are resent on the remises C46 Toxles properly stored, labelled, ased p p r p p 47 Premises litter-free, unnecesserl articles, cleaning maintenance equipment properly stored. (unless allowed by Section 105 CMR 590.027(F)(3)). Authorized personnel 48 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, "stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored. labelled, dispt:nsed 5? Salad bar operations prepared, refrigerated, displayed, protected Note: In addition to the items listed above, any other violation of the Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall after" written notice to the permit holder constitute a critical violation. P F�Her TOWN OF BARNSTABLE OFFICE HOURS: 6:30 - 9:30 A.M. - :I BOARD OF HEALTH Item No. In the s below describe all violations checked 12:45 2.00 P.M. '� o � 367 MAIN STREET �EONP� HYANNIS, MASS. 02601 790-6265 EXT.265; 0,7 FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name Date fi_- 1! Address �n ( Time: 1n Out Telephone '_7 < 1 f '� Type of Establishment: Purpose: ood Service F Owners Name Retail Food � Routine Residential Kitchen Follow-up Person In Charge Mobile Unit Complaint Temporary Food Service Investigation Inspectors Name Q _ Caterer Other `.y V Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. Food N C fit.Sanitary Facilities N C fit. 1. Food Supply .002 4 29. Water Source ,` .015 1 2. Food Containers .002F, 1 30. Sewage .016 4 31. Cross-Connections .017 1 Food Protection 32. Toilets/Handwashing .018&.019 2 3. PHF Temperatures 004 4 33. Insects/Rodents .021 "? 2 4. Faci'ities. Hot&Cold Storage .004 4 34. Plumbing .017 1 5. PHF Re-servicle .006 '`` 4 35. Toilet Rooms .018 1 6. Spoiled/Damaged Foods . .003 1 36. Handwashing Areas .019 2 7. Food Protected .003 4 37. Garbage/Refuse .020 2 8. Food Thermometers .004 1 38. Outside Disposal .020 j 2 9. Cross Contamination .005 2 39. Outer Openings .021 1 10. PHFs thawed,cooked&cooled .005 4 40. Pesticide/Rodent icide Application .021 1 it. Food Handling .005 2 12. Dispensing Utensils .006 1 Physical Facilities 41. Floors .022 1 Personnel 42. Walls, Ceiling .022 1 13: Employee Infections 008 P 4 43 Lighting .023 1 14. Employee Hygiene 009 4 44. Ventilation .024 1 15, Employee Clothing 010 1 45. Dressing Rooms .025 1 Equipment&Utensils Other 16. Equipment/Utensil Clean& Sanitized .013 ` 4 46. Toxics .026 4 17, Food Contact Surfaces .013 1 47. Premises .027 1 18. Non-Food Contact Surfaces .013 1 48. Living Areas .027 1 Discussion with Management 19, Food Contact Surfaces Clean .013 2 49. Linen .027 1 20. Non-Food Contact Surfaces Clean .013 1 56. Pets .027 1 21, Wiping Cloths .013 1 51. Bulk Foods .031 1 22. Dish/Warewashing Facilities .013 1 52, Salad Bars .032 2 23. Pre-Scraped. Soaked .013 1 24 Wash/Rinse Water .013 1 No.of 13 Critical Items Violated _ 25. Thermometers/Test Kits 013 1 These items require immediate attention. 26, Equipment/Utensil Storage .014 1 i 27 Single Service Articles .014 1 ` n/ I e �ry 28. Single Service Re-Use 012 1 SCORE Inspected by � _45 J--'r Received by �- 1 - y,,,. Item No. In the sinliMbelow describe all violations checked page of FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name Date q'7 9' ) Address / �G r X�w Time:-In out Telephone "�c f'� Type of Establishment: Purpose: Food Service Orvlrners Name Retail Food ws Routine Residential Kitchen Follow-up Person In Charge ` Mobile Unit Complaint Lj Temporary Food Service investigation Inspectors Name Caterer Other Ali IJ Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked undercolumn"N"and - critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation - checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. Food N C Sanitary Facilities INC 1. Food Supply .002 29. Water Source .015 2. Food Containers .002 30. Sewage .016 31. Cross-Connections .017 "s Food Protection 32. Toilets/Handwashing .018 8.019 3. PHF Temperatures 00411113--1 33. Insects/Rodents .021 4. Facilities. Hot 8 Cold Storage .004 34. Plumbing .017 5. PHF Re-service .006 35. Toilet Rooms .018 y 6. Spoiled/Damaged Foods .003 36. Handwashing Areas ' .019 7. Food Protected .003 37. Garbage/Refuse .020 8. Food Thermometers .004 38, Outside Disposal .020 9. Cross Contamination .005 39. Outer Openings .021 10. PHFs thawed,cooked 8 cooled .005 40. Pesticide/Rode nticide Application .021 11. Food Handling .005 12. Dispensing Utensils .006 Physical Facilities 41. Floors .022 Personnel 42. Walls, Ceiling .022 13. Employee Infections 008 43. Lighting .023 14. Employee Hygiene 009 44. Ventilation .024 15. Employee Clothing 010 45. Dressing Rooms .025 Equipment&Utensils Other 16. Equipment/Utensil Clean 8 Sanitized .013 46. Tonics .026 17. Food Contact Surfaces .013 47. Premises .027 18. Non-Food Contact Surfaces .013 48. Living Areas .027 Discussion with Management 19'- Food Contact Surfaces Clean .013 49. Linen .027 20. Non-Food Contact Surfaces Clean .013 50. Pets 027 - 21. Wiping Cloths .013 51. Bulk Foods .031 22. Dish/Warewashing Facilities .013 52. Salad Bars .032 23. Pre-Scraped,Soaked .013 24. Wash/Rinse Water .013 No.of 13 Critical Items Violated _ 25. Thermometers/Test Kits .013 These items.require immediate attention. 26. Equipment/Utensil Storage .014 - 28. Single Service Articles .012 28. Single Service Re-Use 012 ✓/.,ter ..- Inspected by �� /y,�e,. '� Received by 13 CR=ICAL FOOD HANDLING VIOLATIONS Full Item Descriptions • 1. Food from an unap owed or unknown source or food whois or may be Food• 0 adulterated, contaminated or otherwise unfit for human consumption c1 Food Source, approved, wholesome 2 Containers. properly labelled is found in a food establishment. Food Protection 2 Potential! hazardous food that is held longer than necessary for C3 Potentially hazardous foods it proper temperatures: 140°F or above, YS°F or below, 0°F; y g Y rapid cooling of cooked foods within 4 hours preparation or service at a temperature which is greater than 450 F c4 Facilities to maintain product temperature (=7° 0 (in the case of cold food) or less than 1400 F (60°C) (in c6 unwrapped and potentially hazardous foods not re-served 6 Damaged, spoiled, returned foods segregated the case of hot f c c d%• 7 Food protected during storage, preparation, display, dispensing, service, transportation 6 Thermometers Provided, conspicuous, accurate 9 No cross-contamination 3 The- food establishment's facilities are insufficient to maintain 10 Potentially hazardous foods properly thawed, cooked, and cooled product temperature. 12 handling Food minimized Dispensing 4• Potentially hazardous food or unwrapped food that has been served to Personnel C13 Employees with infections restricted customers is re-served unless such re-service is allowed, under C14 Hands washed and clean; good hygienic practices section 105 CMR 590.006(G). 15 clean clothes, hair restraints Equipment 1 utensils 5. A person infected with a communicable disease that can be C16 Equipment, utensils sanitized (construct and natal! methods) a fooint! 17 Food contact surfaces: design, transmitted by food is working as a food handler i constructed, installed, maintained, located 18 Non-food contact surfacest design, constructed, installed, maintained, located establishment. 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 6. A person not practicing strict standards of cleanliness and personal 22 Dish/Warpwashing facilities: designed, constructed, maintained, installed, located, hygiene which may result in the potential transmission of illness operated 23 Pre-flushed, scraped, soaked through food is employed in a food establishment. 24 Wash/Rinse water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 26 Storage, handling of clean equipment/utensils 7. Equipment, utensils and food-contact surfaces are not cleaned and 27 Single service articles, storage, dispensing sanitized effectively and may contaminate food during preparation, 26 No re-use of single service articles storage or service. Sanitary Facilities C29 Water source; approved, hot&cold under pressure C30 Sewage and waste water dim?osal S. Sewage or liquid waste is not dispaead oZ in srl approved and backflow C31 No cross-connections, back siphonege, sanitary manner, or the sewage or liquid waste contaminates or may C32 Toilets 6 Handwashing: number, accessible, design, installed contaminate an food d to or food, or an C33 No insects or rodents; harborage prevented y oo areas use o store prepare oo ' y 34 Plumbing; installed, maintained fixtures good repair. clean signs areas frequented by customers or employees. 35 Toilet rooms enclosed, self-closing doors. fixtures P 36 Handwashing areas supplied with eoep and towel dispensers, proper waste receptacles 37 Garbage and refuses containers covered, adequate number, insect/rodent resistant. frequency, 9. Toilets and facilities for washing hands are not provided, properly clean installed or designed, accessible or convenient. 38 outside area: dumpster covered, Construction, clean 39 outer openings protected 40 Pesticides and rodentieides, proper application o 10. The supply of water is not from an approved source or is not under pressure and the food establishment does not. use single 41 le service Physical 41 Floors Facilities ors constructed, maintained, clean articles and/or bottled water from an approved source. 42 Walls, ceiling, attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded 44 Rooms and equipment vented as required 11. A defect exists in the system supplying potable water that may 45 Dressing. locker areas provided used, clean result in the contamination of the water. • other 12. Insects rodents or other animals are resent on the remises c47 Toem s properly stored, labelled, Dare , p P 47 Premises litter-free, unnecessary articles, cleaning maintenance equipment properly stored. (unles's allowed by Section 105 CMR 590.027(F)(3)). Authorized D ersonnel 48 Living/sleeping quarters and laundry separate 49 Linen properly stored 13. Toxic items are improperly labeled, stored or used. 50 No pets or other live animals except guide dogs 51 Bulk foods stored, labelled, dispensed Note: In addition to the items listed above, any other violation of the 5? Salad bar operations prepared, refrigerated, displayed. protected Massachusetts Food Establishment Regulations determined by local health officials to have the potential to seriously affect the public health shall after" written notice to the permit holder constitute a critical violation. 0*1 o,, TOWN OF BARNSTABLE OFFICE HOURS: NP�_-�!'o\ - 8:30 - 9:30 A.M. BOARD OF HEALTH • 12:45 - 2:00 P.M Item No. In the lifte below describe all violations checked l9NAN\tiTAIS1.F:.I•/ ... �� C MASS, m 367 MAIN STREET HYANNIS, MASS. 02601 775-1120. EXT. 182 FOOD ESTABLISHMENT INSPECTION. REPORT Establishment Name �, �ALI � Date, ,��� In- Address 40 Telephone s 4 ` 2 , y 4 IfType of Establishment: Purposo: r Food Service OwneesNams ��//�! Retail Food 'Routine Residential Kitchen Follow-up Person in Charge " ' Mobile Unit Complaint Temporary Food Service Investigation Inspectors Nome a 4 Caterer Other Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions,of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and _ official notice to correct said violations I Food ccN�C�I HT.sanitary Facilities N C WT, 1. Food Supply •002� 1 29.' Water Source .015 ` 4 2. Food Containers .002 30. Sewage .016 11.1101 4 31. Cross-Connections .017 '"° 4 Food Protection 32. Toilets/Handwashing .018 8.019 2 3. PHF Temperatures .004 4 33. Insects/Rodents .021 F7T 2 4. Faci!ities. Hot 8 Cold Storage .004 4 34. Plumbing .01 7 1 5. PHF Re-servicle .006 '' 4 35• Toilet Rooms. .018 1 6. Spoiled/Damaged Foods .003 1 .36. Handwashing Areas .019 2 7. Food Protected .003 4 37. Garbage/Refuse .020 2 8. Food Thermometers .004 1 38. Outside Disposal .020 2 9. Cross Contamination .005 2 39. Outer Openings, .021 1 10. PHFs thawed,cooked&cooled .005 4 40. Pesticide/Rodent icide Application .021 1 it. Food Handling .005 2 12. Dispensing Utensils .006 1 Physical Facilities 41. Floors .022 1 Personnel 42. Walls, Ceiling .022 1 13. Employee Infections 008 4 43. Lighting .023 1 14. Employee Hygiene 009 4 44. Ventilation .024 1 15. Employee Clothing O10 1 45. Dressing Rooms .025 1 Equipment& Utensils Other 16. Equipment/Utensil Clean 8 Sanitized .013 4 46. Toxics .026 4 17.' Food Contact Surfaces .013 1 47. Premises .027 1 ' 18. Non-Food Contact Surfaces .013 1 48. Living Areas .027 I Discussion with Management of 19. Food Contact Surfaces Clean .013 2 49. Linen t .027 1 ` - 20. Non-Food Contact Surfaces Clean .013 1 50. Pets A27 1 21, Wiping Cloths .013 1 51. Bulk Foods .031 1 22. Dish/Warewashing Facilities .013 1 52. Salad Bars .032 2 23. Pre-Scraped,Soaked .013 1 24, Wash/Rinse Water .013 1 No..of 13 Critical Items Violated 25. Thermometers/Test Kits .013 1 These items require immediate attention. 26. Equipment/Utensil Storage 014 ] 2T Single Service Articles .014 ] j 28, Single Service Re-Use .012 1 SCORE Ins ected by �no-171�7 Received by \ � 1 � .• � y ff'J Item No. In the s below describe all violations checked Page/ of �! FOOD ESTABLISHMENT INSPECTION REPORT � a�� �� _� Establishment Name , ��p,�,,��� �• Dats � .-�: ; Address / ' G Tlme: in Out Telephone Type of Establishment: Purpose: ' � Food Service i, Owner*Name ` �� Retail Food t. Routine Residential Kitchen Follow-up Person in Charge i, ✓i Mobile Unit Complaint Temporary Food Service Investigation Inspectors Name �� Caterer Other Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Noncritical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. Food N C Sanitary Facilities N C 1. Food Supply .002 29. Water Source .015 2. Food Containers .002 30. Sewage .016 -'% 31. Cross-Connections .017 Food Protection 32. Toilets/Handwashing .018 8.019 3. PHF Temperatures .004 33, Insects/Rodents .021 4. Facilities..Hot 8 Cold Storage .004 34. Plumbing .01 7 5. PHF Re-service .006 35. Toilet Rooms .018 6. Spoiled/Damaged Foods .003 36. Handwashing Areas .019 7. Food Protected .003 37. Garbage/Refuse .020 8. Food Thermometers .004 38. Outside Disposal .020 9. Cross Contamination .005 39. Outer Openings .021 10. PHFs thawed,cooked 8 cooled .005 40. Pesticide/Rodenticide Application .021 11. Food Handling .005 12. Dispensing Utensils .006 Physical Facilities 41. Floors .022 Personnel 42. Walls,Ceiling .022 13. Employee Infections .008 "_ 43. Lighting .023 14. Employee Hygiene .009 44. Ventilation .024 15. Employee Clothing .010 45. Dressing Rooms .025 Equipment 3 Utensils Other 16. Equipment/Utensil Clean 8 Sanitized .013 46. Toxics .026 17. Food Contact Surfaces .013 47. Premises .027 18. Non-Food Contact Surfaces .013 48. Living Areas .027 Discussion with Management 19. Food Contact Surfaces Clean .013 49. Linen .027 20. Non-Food Contact Surfaces Clean .013 50. Pets .027 21. Wiping Cloths .013 51. Bulk Foods .031 22. Dish/Warewashing Facilities .013 52. Salad Bars .032 23. Pre-Scraped, Soaked .013 24. Wash/Rinse Water .013 No.of 13 Critical Items Violated _ 25. Thermometers/Test Kits .013 These items require immediate attention. 26. Equipment/Utensil Storage .014 27, Single Service Articles .014 • 28. Single Service Re-Use .012 Inspected`by -�i.ir�/Lr✓ ✓ s �' *"1 Received by 1 • _ • Item No- In the below describe all violations checked Page of r ' FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name _ Date Address Time: In Out Telephone -• -f Type of Establishment: �. Purpose: Food Service Owners Name Retail Food Routine Residential Kitchen 77 Follow-up Person in Charge Mobile Unit Complaint Temporary Food Service Investigation Inspectors Name r Caterer Other Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Noncritical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation q checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. Food N C Sanitary Facilities N C 1. Food Supply .002 29. Water Source .015 2. Food Containers .002 30. Sewage .016 k 31. Cross-Connections .017 Food Protection 32. Toilets/Handwashing .018&.019 3. PHF Temperatures .0041611 33, Insects/Rodents .021 4. Facilities..Hot&Cold Storage .0041aj 34. Plumbing .017 5. PHF Re-servicle .0060 1 35. Toilet Rooms .018 6. Spoiled/Damaged Foods .003 36. Handwashing Areas .019 7. Food Protected .003 37. Garbage/Refuse .020 8. Food Thermometers .004 38' Outside Disposal .020 9. Cross Contamination .005 39. Outer Openings .021 10. PHFs thawed,cooked&cooled 005 40. Pesticide/Rode nticide Application .021 11. Food Handling .005 12. Dispensing Utensils .006 Physical Facilities 41. Floors .022 Personnel 42. Walls, Ceiling .022 13. Employee Infections .008 43. Lighting .023 14. Employee Hygiene .009 = 44. Ventilation .024 15. Employee Clothing .010 45. Dressing Rooms .025 Equipment& Utensils Other 1 16. Equipment/Utensil Clean& Sanitized .013 46. Toxics .026 17. Food Contact Surfaces .013 47. Premises .027 _ 18. Non-Food Contact Surfaces .013 48. Living Areas .027 Discussion with Management 19. Food Contact Surfaces Clean .013 49. Linen .027 20. Non-Food Contact Surfaces Clean .013 50. Pets .027 _21. Wiping Cloths .013 51. Bulk Foods .031 22. Dish/Warewashing Facilities .013 52. Salad Bars .032 23. Pre-Scraped, Soaked .013 24. Wash/Rinse Water .013 No.of 13 Critical Items Violated _ 25. Thermometers/Test Kits .013 These items require immediate attention. 26. Equipment/Utensil Storage .014 27. Single Service Articles .014 28. Single Service Re-Use .012 Inspected by Received by Alk ERMIT NO: TOWN OF BARNSTABLE . May 28, 2010 61 BOARD OF HEALTH PERMIT TO OPERATE A"FOOD ESTABLISHMENT In accordance with rq,90'atiotrsp►omt�lgatecl under attthot.ity of Chapter 94, Section 395A and Chap(e� >;#f,S �x e n 5 af`the Oen�ra] Lai S,a permit is hereby granted to: STEVEN C. LUNDB RGr< u Dll �t s CRAIGILLE:GE.NERAL STORE Whose place of business is: GVILLF. #iYANf 11! � t,,, A 02672 ::ses 'S'q f( " % Type of business and any resirltlok RILOIA ISHMEA To operate a food establishme t irthe� TOWi �, P1SfRA^LE r �. RESTRICTIONS IF ANY: a r : -. SEATING: 0 ANNUAL °. SEASONAL: YESTEMPORARYk � x tw s R QF HEALTH RETAIL FOOD STORE: i$9 0 0b• y FOOD SERVICE ESTABLISHMENT , <rs - ' Yne 1Vliller, M.D., Chair erson } �r � � a P RESIDENTIAL KITCHEN FOR RETAIL SALE ° `� ' .a Paul : Canniff;D.M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST ° � It I fttchi Sawayanagi MOBILE FOOD UNIT: /n TOBACCO SALES: FROZEN DESSERT: 'tip,_ eGrllf�� I2EIl Thomas A. McKean, RS,CHO CATERER: Director of Public Health t Town of Barnstable ati1HE r ti Regulatory Services Barnstable tip. �r Thomas F. Geiler, Director /18-America City + BARNSTABLE, + 1619. ��a Public Health Division � r FDj"A� Thomas McKean, Director ., 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 5087790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE. NAME OF FOOD ESTABLISHMENT: OXW f Vt � ADDRESS OF FOOD ESTABLISHMENT: c�t j/ 0 MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (6 ?6) B s-�-- 6 S- S � NUMBER OF SEATS: INSIDE: OUTSIDE: _ TOTAL:_ TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL_ OPERATION: 22 TYPICAL HOURS OF OPERATION MON-FRI: ` /y: TO _\ DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF.SEASONAL: APPROXIMATE DATES OF OPERATION: /��/ 0 TO 'q l ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE _ ' RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) Q:\Healih\ApplicationForms\Foodappl.doc i ***REMXNDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING AND MEET ALL OF THE OUTSIDE DINING CRIT RIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING?'k- IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE D OR(S)? l CONTACT INFORMATION: FULL NAME OF APPLICANT Ls eve r) L V n db-� r SOLE OWNER: YES/ 1� 22 ADDRESS V r I G �� N- ► �'\ D PHONE # &7& - ^_S IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION J ' 1. k ,S FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1. - EXPIRATION DATE: / / 2. Vim/ EXPIRATION DATE: . 3. EXPIRATION DATE: 4. EXPIRATION DATE: / / SIGNATURE OF APPLICANT AND DATE QAHealth\lpplication Forms\Foodappl.doc PEr'afIT NO: OWN OF BARNSTABLE May 22, 2009 s 61 BOARD OF HEALTH PERMIT TO OPE A } �ABLISHMENT In accordance with ugel d ity of Chapter 94, Section 395A and Cha er on ferlf sue' t is hereby granted to: THOMAS ROBE 5 � '. D/ C a�� NERAL STORE .� Whose place of business is: IGVIL 11 85 , z. A PORT MA 02672 Type of business and any re rift : ' R I - ISHMEN To operate a food establishe t th TO LE c, RESTRICTIONS IF ANY: SEATING: 0 ANNUAL: h]R .«� t SEASONAL: YES TEMPORAR M s -- RETAIL FOOD STORE: .0 fir- d° - FOOD SERVICE ESTABLISHMENT: � ` ler, M.D.,Chairperson RESIDENTIAL KITCHEN FOR RETAIL SALE: 3 a J anniff, D.M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST: hi SaWayanagi MOBILE FOOD UNIT: TOBACCO SALES: $50.00 FROZEN DESSERT:CATERER: Thomas A. McKean, RS, CHO Director of Public Health ' r Town of Barnstable �d�. oFt"E'a,,. Regulatory Services „St 1 � Thomas F. Geiler, Director �/U"n­d.a Cl BARNSIABLE, q$A b Public He 1007 alth Division TEo rna�A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Officer 508-862-4644 Fax` 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: 02 NAME OF FOOD ESTABLISHMENT: CAS 6.v, i l e ADDRESS OF FOOD ESTABLISHMENT: 4U C?fi,41C`z,�/Q /9 toe P MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: 'PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: nMBFR OF EATS: INSIDE: OUTSIDE: TOTAL: — � d On T4-TAL�iUM ,jZ OF BATHROOMS: co ANNUAL OR S .+ SONAL OPERATION: g rc . TYPICA HOUI S OF OPERATION MON-FRI: TO '901 G DAYS CEOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) ,��� IF SEASONAL: APPROXIMATE DATES OF OPERATION: ,E/_'�12 TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT-. PLEASE CHECK ALL THAT APPLY OOD SERVICE ' RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST RES IDENTIAL TIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY_DESSERT MACHINES CATERING i OUTSIDE DINING (OVER) Q:1Hea1thWpphcation Forms\FoodappLdoc j - I ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT V O fM Q ) Q O1',�'"1 SOLE OWNER/NO ADDRESS 6PZ U C�cL164\1r I If �ac� , C Me rVl 1 I.e PHONE # IF APPLICANT IS A PARTNERSHIP FUL L NAME D HOME ADDRESS OF ALL PARTNERS: , IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. �. W CD, t ZE STATE OF INCORPORATION N (;; FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCfbDF)S RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE OODwAN9 CONTINENTAL BREAKFAST): LIST THE NAMES OF.YOUR FOOD SANITATION CERTIFIED-STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1. EXPIRATION DATE: 2. EXPIRATION DATE: / / 3. EXPIRATION DATE: / / 4. EXPIRATION DATE: / / SIGNATURE OF APPLICANT AND DATE QAHnith\Application Forms\Foodappl.doc NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS 378 $100.00 TOWN of BARNSTABLE Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit No. 378 ,JAta MU 1 T19 99 In accordance with Regulations promulgated under authority of Chapter 94,Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: CRAIC31TU E CENERAI STORE Whose place of business is 628 CRAIGVILLE BEACH RD. HYANNTSPaRT Type of business and any restrictions RETAIL FOOD ESTABLISHMENT To operate a food establishment in TOWN OF BARNSTABLE (City or Town) Permit Expires DECEMBER381, 19 92 Board of Health FORM 738 Re,1986 AGENT f NUMBER- FEE THE COMMONWEALTH OF MASSACHUSETTS Ad $10a.8A . . . .. .. . . .`IMM, . . of .. . . . �'aNSTAMM.. . . . . . . .. .. .. .. . Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit No. .. .84. . . . . .. .January. . . .. 19.91.. In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit ��is /hi�e 7r��epbyy�granted to: ��{y���t . . .. .. . . .. . . . . . . .. .. .. .. . . . . . . .. . . . . . . .. .. .. .. . . .a'ME..: -T ^•,••�rL� -Sq- M. . .. .. ... Whose place of business is . . . . . . .. . . . . . . . . .. .. .. . . .628. C`xa3cyi1le -DeaCh•Rd. -HyannispO Type of business and any restrictions . . . . . . . . . . .. . . EKE—VAIT,.FOM.0ST—A3._, SI . . . . . ... To operate a food establishment in . . .. . . . . . . . . . . . . .'a"C�IN O .RAMSTAM . . . . . . . .. .. .. . .. (City or Town) Permit Expires . . . .?-Nac am . 3,1,, . . . 19.9L . Copy GUSM.RFeST . .. .. .. . . . . . . . .. . . . . . . . . Board This Copy To Be Retained By Local Jf7S} '&x.�.. �i .r�.II,.. .. . . . .. . .. . of Board of Health. Health . . .. .. .. . . . . .. .. . . . . . . . . .. .. .. .. .. .. . . . FORM 738 HOBBS&WARREN,INC.-1986 Agent , NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS 51 $75.00 ... . . .. .. . . . .'1.'S?34i of ..I?A.K:'` :,3?.:F.. . . . . .. .. ... .. ... .. . Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit No. ..5.1. . .. ... . Ta* :,' .?..,. .. 19,89... In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: CRKIGVILLS GENERAL STORE Whose place of business is .. . . . . .. . . ... . . . .. .... 628 Craifr�ilje Beach Road,Hyannispoet .. .. . .. .. .. .. . .... ... .. .. . . ..... S RVICE E$TALISF:. : Type of business and any restrictions FOOD `T. . . .. .. .. .... .. ..... TOWN OF BARl7STABLE To operate a food establishment in . .. .. .. .. .. . ... .. ... (City or Town) Permit Expires .. .. . . . Grover C.M. Farfish,,, ,M.D. Chairman f Copy Anna Iae E hb;3uh Board This Copy To,Be Retained By Local ..j?Tr";n. . :Cr ockPY T. ... .. .. . . .. . Of (� Board of Health. Health J FORM 738 HO�BBS 8 WARREN,INC.-1986 ent NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS 327 $75.00 G� Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit No. ..327....... April 29, „ In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: %I .. .. ...... .. ..... .. ....... .. ... ... .. .. .. .. .. ..C,ra,:i.s*�71.1?n GE;i�rTr�.� .�� .... ........ Whose place of business is . ..... .. ..... .. ... .. ..Fir Type of business and any restrictions .. .. .. .. .. ..?'aQd. 5.e4m.t'u. .... ... .. To operate a food establishment in . . . ... . .. . ....:�vi'j.av 1, ;,,, ,,, ,, ,, ,, ,, ,,,,, (City or Town) Permit Expires . . ..Dece bte:r. W.,. ..19.E3a. Grover CM. c'' i i-Ai. ;1.13. CYO;;ir�.�tn Copy iinn Jane.E libapAh... ...... .. .. ..... Board This Copy To Be Retained By Local J=F?C:'. tI. Crocker. T. Of Board of Health. Health FORM 738 HOBBS&WARREN,INC.-1986 . .. .. ........ .. .. ...... .. .. Agent I NUMBER FEE 139 THE COMMONWEALTH OF MASSACHUSETTS $75.00 TOWN. .. .... .. . of .... .. BAP14STABLE.. .. .. ... ... .. .. .. ...... .. .. . Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit No. .. .. .... .. .. ....May ...pia...... .. .. .. 19. .. .. In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: Craigville General Store .. .. .. . . . .. ... .. .. .. .. .. ... . . ... .. .62€3' Cj algville'Y�e'adli'XdEjO..... .. .. .. .. .. . ... .. . Whose place of business is . .. . .. .. .. . ... . . .. .. .. .. ... .. ... .. .. .. .... .. .. .. .. .. .. ... . .. ... Food Service Establ4A.SIlmep Type of business and any restrictions . . . . . ... .. .. .. .. .. ... .. ... .. .. ... .... ... .. .. .. .. ... .. To operate a food establishment in . . Town of Barnstable (City or Town) Permit Expires .December 31, ,,, Robert L. Childs, Chairman �inil*Jran&''�s1lb�il�r� . ... .. .. .. .. . .. Board Copy Grov;Y FhYci:aii; .f.. ... . .. .. ... of This Copy To Be Retained By Local ..... .. .. . ... .. .. . ... .. .. ... .. ..... .. .. . Board of Health. Health " " " " " " " """ " " " """FORM 738 HOBBS&WARREN,INC.',1986 " ' I NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS of .. .. .".7 �J s ... .. ...... .. . Board of Health of� PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit No. .. ..38.... .. 7 rrt,. :r..4r . ..p.. : 19. .10. In accordance with Regulations promulgated under authority ;Of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: Whose place of business is .. . . .. .. .. .. .. .. .. 623 ��� ;•�:�•�l �t '_2. ? "„•�.3 '__ 3!i.Sp Type of business and any restrictions :r' ;�? ,-::�..r ;1:, To operate a food establishment in . . .. .. .. .. �� = . .€?F. !': . :? '.1?T.. .. .. .. .. .. ... .. ... (City or Town) Permit Expires al,. . .19. 110. ('! .•�,v o..• a..>• •_.F,••.•.*.•_'Sy••v T.'a Q' t . 'o CS.'a i.iit 1i► Copyn ct7l�. .r��.,� •,,n11. .. .... .. .. .. . �oar� This Copy To Be Retained By Local j ., ,. ,. . Of Board of Health. Health .. . .. . .. .. ... . . . .. .. . . .. .. .. . ....... .. . FORM 738 HOBBS&WARREN,INC.-1986 .� S� I BERMI ►NO: N OF BARNSTABLE 05/29/2007 ' I 61 BOARD OE-HEALTH PERMIT TO QPERATE,AFOQD k BLISHMENT � . In accordance with regulatxonspraTrt lgated unllei�authority of Chapter 94, Section 395A and Chapter 11l, "&fiiom 5 of the Gen is hereby granted to: THOMAS ROBER S € �5 /B/A C) VILE ENERAL STORE Whose place of business Is 62$CRAIGVILLE,;BI=ACFI �21 ;BbX 485 , W �l-1��ANNISPORT, MA 02672 u ' Type of business and any resdictlons: RET L F06JO E FABLISHMENT �. To operate a food establishment1ln the T4WNl, FI .Bt\R#STA 'Liz Ea 9 RESTRICTIONS IF ANY: SEATING:, 0 ANNUAL z r SEASONAL:. YESTEMPORARY �1=EsQARDOF HEALTH RETAIL FOOD STORE: ` 1II6 .r r FOOD SERVICE ESTABLISHMENT: xy rl �in `Miller,M.D.,Chairperson RESIDENTIAL KITCHEN FOR RETAIL SALE: , Paul J. Canniff, D.M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST. Unichi Sawayanagi MOBILE FOOD UNIT:,. � � �It �Ept��3 wQ/n TOBACCO SALES: ���� FROZEN DESSERT: Thomas A. McKean, IRS, CHO CATERER: Director of Public Health N i t-' I _s L i v' vi ""I uat""M oFt Re ulatory Services 24 � J Thomas F. Geiler,Director / 00 • 9B"MMAN. 'Public Health Division j°tED 39. Thomas McKean,Director J 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: NAME OF FOOD ESTABLISHMENT: 7/1 �10 6-�e,y AjX,41 S je ADDRESS OF FOOD ESTABLISHMENT: _' ;2 ,�� //� MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL:. TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: S'4''#.5 ox", +y TYPICAL HOURS OF OPERATION MON-FRI: TO DAYS CLOSED EXCLUDING HOLIDAYS (I.E.MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: S l 3 r l 07 TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING o D TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE C' ' RETAIL FOOD BED &BREAKFAST CONTINENTAL BREAKFAST ' coo RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER—+) Q:\Health\�kpplication Forms\Foodappl.doc ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED.FOR OUTSIDE DINING?- IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES /NO ADDRESS PHONE#C--) - IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): , LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 20049 EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION'CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1. EXPIRATION DATE: 2. EXPIRATION DATE: 3. EXPIRATION DATE: 1 / 4. EXPIRATION DATE: SIGNATURE OF APPLICANT AND DATE Q:\iealth\Application Porms\Foodappl.doc Town of Barnstable * . Iq Vq �FtHE 1py, Regulatory Services Barnstable ica City Thomas F. Geiler, DirectorAWAMef * BA"STABLE, • , 9�AT MASS. A � Public Health Division 2007 tx; FD 1A0� Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 pax: 508-790-630 y D APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: NAME OF FOOD ESTABLISHMENT: �0'_/�..-1�,{�E'i ;•yLy2-y9- r! 5'T K'-12 ADDRESS OF FOOD ESTABLISHMENT: (yz Ik- Xe-' -_h go'oep MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: TYPICAL HOURS OF OPERATION MON-FRI: �: _ TO DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: S/ 3/ / TO 'REMINDER' SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE RETAIL FOOD BED &BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN a MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) Q:\Health\Application Forms\Foodappl.doc ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING, AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT.STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES /NO ADDRESS PHONE # IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1. EXPIRATION DATE: / / 2. EXPIRATION DATE: / / 3. EXPIRATION DATE: / / 4. EXPIRATION DATE: / / SIGNATURE OF APPLICANT AND DATE Q:\Health\Application Forms\Foodappl.doc PERMIT NO: 0 TOWN OF BARNSTABLE • 05-24-2005 61 BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to: THOMAS ROBERTS D/B/A: CRAIGVILLE GENERAL STORE Whose place of business is: 628 CRAIGVILLE BEACH RD., BOX 445 , W. HYANNISPORT, MA 02672 Type of business and any restrictions: RETAIL FOOD ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY: SEATING: 0 ANNUAL: SEASONAL: YESTEMPORARY: F E E S BOARD OF HEALTH RETAIL FOOD STORE: $100.00 Wayne Miller, M.D.,Chairperson FOOD SERVICE ESTABLISHMENT: RESIDENTIAL KITCHEN FOR RETAIL SALE: Sumner Kaufman, M.S.P.H. RESIDENTIAL KITCHEN FOR BED+BREAKFAST Susan Rask, R.S. MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: December 31,2005 FROZEN DESSERT: Thomas A. McKean, RS, CHO CATERER: Director of Public Health L _ Town of Barnstable E.o " *ulat*ory Service * Thomas F. Geiler,Director • BARMASILNSTA LE, • / GJ�'— Gam. �. r s639• Public Health Division `WwH OF BARIqS TABLE �0 Thomas McKean,Director ?rIOS MAY 12 200 Main Street, Hyannis,MA 02601 AM It-' 41 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE.A FOOD ESTABLISHMENT DATE: / 2,1d NAME OF FOOD ESTABLISHMENT: �2 12171c r/!/lam Q glc��4Z_ _f ADDRESS OF FOOD ESTABLISHMENT: CE-v77 MAP AND PARCEL.OF FOOD ESTABLISHMENT: MAP: PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: TOTAL NUMBER OF-BATHROOMS: ANNUAL OR SEASONAL OPERATION: TYPICAL HOURS OF OPERATION MON-FRI: _ : /��r TO DAYS CLOSED EXCLUDING HOLIDAYS (I.E.MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: / 3 ONTO 'k'k*RENIINDEW" SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE =RETAIL,FOOD BED &BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN AiiA�T7 T, T.YIAT - . - TOBACCO SALES 4 FROZEN.DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER- +) , QAHealtlAkpplication FormsToodappl.doc *** *** • • � RENIINDER IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT 7z'jlr� s SOLE OWNER: YES/NO , ADDRESS Ito Nz, q/( . PHONE# IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY. 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD. SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1. EXPIRATION DATE: / 1 2. EXPIRATION DATE: 3. EXPIRATION DATE: 4. EXPIRATION DATE: / / SIGNATURE OF APPLICANT AND DATE QAHuldMpplication Forms\Foodappl.doc PERMIT NO: TOWN OF BARNSTABLE 61 BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to: THOMAS ROBERTS D/B/A: CRAIGVILLE GENERAL STORE Whose place of business is: 628 CRAIGVILLE BEACH RD., BOX 445 , W. HYANNISPORT, MA 02672 Type of business and any restrictions: RETAIL FOOD ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY: SEATING: 0 ANNUAL: SEASONAL: YES TEMPORARY: FEES BOARD OF HEALTH RETAIL FOOD STORE: $75.00 Wayne Miller, M.D.,Chairperson FOOD SERVICE ESTABLISHMENT: RESIDENTIAL KITCHEN FOR RETAIL SALE: Sumner Kaufman, M.S.P.H. RESIDENTIAL KITCHEN FOR BED+BREAKFAST Susan Rask, R.S. MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: December 31, 2004 FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK:CATERER: Director of Public Health �� III Town of Barnstable . Ft"E rati Regulatory Services o� Thomas F. Geiler,Director '* BARNSTABM * 9�A MASS. Public Health Division� 'FD N10� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: ' i NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS: INSIDE: _��OUTSIDE: TOTAL: �— TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL OPERATION: TYPICAL HOURS OF OPERATION MON-FRI: TO �NJ DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: TO / ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER--+)\ QAllealth\Application Formffoodappl.doc ` ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? �- IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT d _e SOLE OWNER: YES/NO ADDRESS ,� i2 J�Cd i.��/ ���: � ��� ;91-✓) /A-- PHONE# IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1. EXPIRATION DATE: / / 2. EXPIRATION DATE: / / 3. EXPIRATION DATE: / / 4. EXPIRATION DATE: / / VGNATURE OF fPPLICANT AND DATE QAHealdMpplication Forms\Foodappl.doc PERMIT NO TOWN OF BARNSTABLE 61 BOARD OF HEALTH PERMIT TO OPERATE A FOOD,ESTABLISHMENT /� Q In accordance with regulattons`pront ted under`authority of Chapter 94, Section 395A and Chapter 111,Sect►gn 5 of the Generat Laws,a permit is hereby granted to: THOMAS ROBERTS' DfBIA CRAIGVILLE GENERAL STORE s< Whose place of business Is 628;CRAIGUIFLLE BEAeH RP,.BOX 445 , 1tV HYANNISPORT, MA 02672 Type of business and any restrictions; 6&AIL FOOD ESTABLISHMENT To operate a food establishment Ifs tle TOWN OF Bi4RNSTAB!E RESTRICTIONS IF ANY L SEATING: 0 ANNUAL SEASONAL: YES TEMPORARY 3° 1=E E$ BOARD OF HEALTH RETAIL FOOD STORE: SuSan G. Rask, R.S.,Chairperson FOOD SERVICE ESTABLISHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE Ralph A. Murphy, M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST Sumner Kaufman, M.S.P.H. MOBILE FOOD UNIT: Permit expires TOBACCO SALES: December 31, 2003 FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK` Director of Public Health CATERER: r PERMIT NO TOWN OF BARNSTABLE 61 BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter ill,Section 5 of the General Laws,a permit is hereby granted to: THOMAS ROBERTS D/B/A: CRAIGVILLE GENERAL STORE Whose place of business is: 628 CRAIGVILLE BEACH RD., BOX 4 S , W. HYANNISPORT, MA 02672 Type of business and any restrictions: RETAIL FOOD ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY: SEATING: 0 ANNUAL: SEASONAL: YESTEMPORARY: FEES BOARD OF HEALTH RETAIL FOOD STORE: $75.00 FOOD SERVICE ESTABLISHMENT: Susan G. RaSk, R.S.,Chairperson RESIDENTIAL KITCHEN FOR RETAIL SALE: Ralph A. Murphy, M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAS-: Sumner Kaufman, M.S.P.H. MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: $14.00 December 31, 2000 � FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK'CATERER: Director of Public Health • 1 • Town of Barnstable • � Department of Health, Safety, and Environmental Services AW Public Health Division 16319- &� 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 509-775-3344 Director of Public Health SEATING ANNUAL SEASONAL ASSESSORS MAP AND PARCEL NO. DATE %/— APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT �� o.ti.a S ��o O�L/Z- S NAME OF FOOD ESTABLISHMENT (�2/2/+(g ii►- ADDRESS OF FOOD ESTABLISHMENT Gr ; ' C1144rc y,//Ie kv, 1{)'AN.v,5r-AT AM TELEPHONE NUMBER ZZL i 2 C TYPE OF ESTABLISHMENT: FOOD SERVICE RETAIL FOOD BED AND BREAKFAST CONT.BR. RES.KITCHEN MOBILE FOOD SOLE OWNER:/,YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: � - z�7Z 00f- IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# 7 2 FEES RETAIL FOOD STORE: $75.00 FOOD SERVICE ESTABLISHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE RESIDENTIAL KITCHEN FOR BED+BREAKFAST SEATING: 0 MOBILE FOOD UNIT: ANNUAL: TOBACCO SALES: $14.00 SEASONAL: YES CATERER: TEMPORARY: FROZEN DESSERT: MILK: TOWN OF':BARNSTABLE BOARD:OF HEALTH it PERMIT TO;OPRAtEA FOOD ESTABLISIMENT 3M1. ,I PERMIT NO: 61 In accordance,with regulations promulgatetl under authority of Chapter 94, Section 395A and C'fiapter 111`, Sec#Ion13 5 of the'General Laws, a permit is 3 S 1 hereby granted to" THOMAS ROBERTS D/B/A: CRAIGVILLE GENERAL; STORE Whose place of business Is 628 CRAIGVILLE BEACH, RD r Q0X 445 , W. HYANNISPORT, MA 02672 Type of business and any restrictions: RETAIL FOOD ESTABLISHMEiN.T , To operate a food establlshm�ent inAhe TOWN OF BARNSTABLE x Permit expires: December 311l�T11999, it ARD iH- BO OF HEALTH Susan G. Rask, R.S., Chairperson Ralph A. Murphy, M.D. RESTRICTIONS IF ANY: Sumner Kaufman, M.S.P.H. Thomas A. McKean, RS, CHO Director of Public Health FEES RETAIL FOOD STORE: $75.00 FOOD SERVICE ESTABLISHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE SEATING: 0 RESIDENTIAL KITCHEN FOR BED+BREAKFAST MOBILE FOOD UNIT: ANNUAL: TOBACCO SALES: $14.00 SEASONAL: YES CATERER: TEMPORARY: FROZEN DESSERT: MILK: p, TQWN QF BARNSTABLEi' B0 1R0 OF HEAE_TR,-N, _ PERMITTOOPERATE A FOOD ESTABLISHMENT PERMIT NO: 61 r MARCH 1, 1998 In accordance;+. th regulations prom's; enn qA d under author ty of Chapter 94, Section 395A andr'Chapter 11t Sector of the General Laws, a permit is hereby granted to: THOMAS ROBERTS 1 Y ' D/B/A: CRAIGVILLE GENERAL`STORE'? " ` s " �` Whose place of business is 628,CRAIGV[LL—BEACkL RD., BOX W..HYANNISPORT, MA 02672 v 7' Type of business and anrrestf'rc ions: RETAIL F40D..ESTABLISHMENT,¢, Tooperate a food establishrnent�in they �TONN OF BRNSTABLB Permit expires: December 31=,,'�99,�8 A' t@'v is a . - BOARD OF HEALTH Susan G. Rask, R.S., Chairperson Ralph A. Murphy, M.D. RESTRICTIONS IF ANY: Sumner Kaufman, M.S.P. Thomas A. McKean, IRS, CHO Director of Public Health FEES RETAIL FOOD STORE: $75.00 FOOD SERVICE ESTABLISHMENT �. RESIDENTIAL KITCHEN FOR RETAIL SALE SEATING: 0 RESIDENTIAL KITCHEN FOR BED+BREAKFAST MOBILE FOOD UNIT: ANNUAL: TOBACCO SALES: $14.00 SEASONAL: YES CATERER: TEMPORARY: FROZEN DESSERT: MILK: WwQ EX AR ,B PERM T4 PI _ TEA FOOD-EW ABL'ISHMENT PERMIT NO: 61 x JUN' 2 0- 199T In accordance `'t regula, gns prom Igatedunder authQ;rlty$of Chapter 94, Section 395A and Chapter co :a► a General Laws;a permit is gi r hereby grante to: i ' �' ,a THOMAS ROBERTS DIB/A: BLP CRAIGVILLE Gla1 ERAL O ' Whose place of businesais 8 CRAIGV E _' RD., BOX . HYANNISPORT, MA 02672 �x 4 F ,Type of business and an res s: RE FQESTABT { Eli � cr • 3° r' `' � �,� � .. r - T operate a food establish a O & R. B Pi itex .es ,, December 9T AA . r' ,.," ...' a.:f v...': w. r«,...-- •..Tuuf.p!oq;iv_.••:. r.r..r,..,•. ,�. .. - , ,.._ lqe - BOARD OF HEALTH Susan G'.,Rask,R.S.,Chairperson , Brian R.Grady.R.S. .r,ac+�.. ...,.r..,.'�-i .'�. ....yrt..,:.aa.",r��Mr>i.:r..a..�.„-.,�.�.,._Za_•.�+z„�--wy...(r.;.,i--Y`W.•!S.�,l b^'.,"Ci.:v..k.r`:..,+..•r,.,>,+.L>.c..y*,..:4.'.'k�...$.t.2a.:n.l<-�}kh„x.:;.,s4.M,-(.,a.e...•,7}�;^.'�Ja.i,F,,o}'.-^1f-.rr._:y.'.••-.,x�'"�r S...�, ,�-"'`+1`'`S'y�,".'rfR`•�.t'+..h'3+sr,y?-'+�:M1Y'a'•,?�.+:.-.M,y`�75y,P �.^ 'r ..-r,T�v.y:r:^.<l^�rY*-,'.._�...-.,a.z.t;,.�1.'#'4' s"'2';i..:s1..."� ♦.....r=-.5�.T..'^n>;¢:'.yiy K_a F.... M.,D'' ` �•1�`� k -4t A:'Murphy,'RESTRICTIONS IF ANY Ralph �t sti, ri.fs .1» M:..<. ,i. .- -:s i.34 •-nv„'k� ^:/•:," ,..-. r,y.•A'�'. -••rk•",..,!,,,,sk c. <.-: �'• -.�,+. 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FEES RETAIL FOOD STORE: $60.00 FOOD SERVICE ESTABLISHMENT: RESIDENTIAL KITCHEN FOR RETAIL SALE: SEATING: 0 RESIDENTIAL KITCHEN FOR BED t BREAKFAST: MOBILE FOOD UNIT: ANNUAL: Yes TEMPORARY FOOD ESTABLISHMENT: SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: MILK: TOWN OF BARNSTABLE BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NO: 61 JANUARY 1, 1996 In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111, Section 5 of the General Laws, a permit is hereby granted to: TOM ROBERTS D/B/A: CRAIGVILLE GENERAL STORE Whose place of business is: 628 CRAIGVILLE BEACH RD. , HYANNISPORT, MA 02647 Type of business and any restrictions: RETAIL FOOD ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE Permit expires: December 31, 1996 . BOARD OF HEALTH Susan G. Rask, R.S., Chairperson Brian R. Grady, R.S. RESTRICTIONS IF ANY: Ralph A. Murphy, M.D. Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Department of Health, Safety, and Environmental Services MASS. Public Health Division 1639. ` 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health November 13, 1995 CRAIGVILLE GENERAL STORE 628 CRAIGVILLE BEACH RD. HYANNISPORT, MA 02647 Dear Owner/Manager: Your food permit(s) will be invalid after December 31, 1995. ESTABLISHMENTS FEE Number of Seats: 0 FOOD RETAIL 60.00 MILK FROZEN DESSERT TOTAL DUE $60.00 Food establishment inspections are ongoing by a Health Inspector; therefore it is not necessary to make an appointment with the Health Department. However, if your establishment is not open during normal working hours (8:15 -4:45 p.m.),please call 790-6265 to schedule an inspection with Christina Kuchinski or Jerry Dunning. Enclosed is a food permit application form. Please complete the form and mail it along with the required payment on or before December 15, 1995 to the Town of Barnstable, addressed to the Public Health Division, P.O. Box 534, Hyannis, MA 02601. Upon satisfactory compliance and receipt of your payment,you will be sent,via mail,the food permit(s)for calendar year 1996. Failure to renew permit on or before January 1, 1996 will result in an additional fee of $10.00 late charge. Sincerely yours, Thomas McKean Director of Public Health Am Mew NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS 41 $100.00 TOWN of�BcxiRNSTAB a Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit No. 41 June 2, 19 95 In accordance with Regulations promulgated under authority of Chapter 94,Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: Tom Robertr, d./h/a C'raigvillP (xgnPr3l Sort- Whose place of business is 629 C:raigville.Reach Road, HTannis=nrt, eta Type of business and any restrictions Retail Food Establishment To operate a food establishment in Town of Rarnstahle (City or Town) Permit Expires 19--q,5_ Susan G. Rask, R.S. Copy Joseph C Snow, M_n_ Board This Copy To Be Retained By Local Rria� R (rady, R S of Board of Health Health FORM 738 Re,1986 Agent SEATING: NONE FEE RETAIL: $100.00 FOOD: MILK: TOWN OF BARNSTABLE BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NO. 62 JANUARY 1, 1994 In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: TOM ROBERTS D/B/A CRAIGVILLE GENERAL STORE Whose place of business is at 628 CRAIGVILLE BEACH RD. , HYANNISPORT, MA Type of business and any restrictions RETAIL FOOD ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE Permit Expires DECEMBER 31, 1994 BOARD OF HEALTH Brian R. Grady, RS, Chairman Susan G. Rask, RS Joseph C. Snow, M.D. Thomas A. McKean Director of Public Health a ,i The Town of Barnstab e Health Department t "a""'� ' 367 Main Street, Hyannis, MA 02601 039 F Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health November 1st, 1993 CRAIGVILLE GENERAL STORE 628 CRAIGVILLE BEACH RD. HYANNISPORT, MA 02647 Dear Owner/Manager: Your food permit(s) will be invalid after December 31, 1993. Therefore, we ask that you remit the following amount prior to December 15, 1993: ESTABLISHMENT FEE Number of Seats: NONE Retail 100.00 TOTAL DUE $100.00 After your establishment is inspected with satisfactory compliance and after receipt of your payment in full, you will be sent, via mail, the food permit(s) . If there has been any change in owner's name, address, telephone number or FID number, please send a representative into the Health Department Office to update and to sign an application form. Thank you. Sincerely yours, Thomas A. McKean, Director of Public Health r f SEATING: NONE FEE RETAIL: $100.00 FOOD.- MILK: TOWN OF BARNSTABLE BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NO. 71 JANUARY 1, 1993 In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: TOM ROBERTS D/B/A CRAIGVILLE GENERAL STORE Whose place of business is at :628 CRAIGVILLE BEACH RD. , HYANNISPORT, MA Type of business and any restrictions RETAIL FOOD ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE Permit Expires DECEMBER 31, 1993 BOARD OF HEALTH Susan G. Rask, Chairman Joseph C. Snow, M.D. Brian R. Grady Thomas A. McKean Director of Public Health 1NE o� >o the Town of Barnstabit p� ♦� f Health Department 367 Main Street, Hyannis, MA 02601 rua ab t67 q. ` Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health October 26th, 1992 CRAIGVILLE GENERAL STORE 628 CRAIGVILLE BEACH RD. HYANNISPORT, MA 02647 Dear Owner/Manager: Your retail food permit will be invalid after December 31, 1992. Therefore we ask that you remit the following amount prior to December 15, 1992: ESTABLISHMENT FEE Number of Seats: NONE Retail 100.00 TOTAL DUE 100.00 You will be sent, via mail, the retail/food permit(s) upon receipt of your check payable to the Town of Barnstable. If there has been any change in owner name, address, etc. , please send a representative in to update an application for permit to operate a retail/food establishment. Thank you. Sincerely yours, C_ Thomas A. McKean, Director of Public Health � 111 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppY1LatI01Y for Disposal *pstPIU COUBtCULtIDtt J)Cr1Ult Application for a Permit to Construct( ) Repair/Upgrade( ) Abandon( ) []Complete System ❑Individual Components Location Address or Lot No. (;;(8 C"&,q✓i 1 0,_ Owner's Name,Address,and Tel.No. . Assessor's Map/Parcel 2, 0 2 CMYL�) Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. g1�S soB-fGO-7/ •y �Nr e�s�' (,vo/ S Type of Building: Dwelling No.of Bedrooms 7..' Lot Size ///y0 sq.ft. Garbage Grinder( ) Other Type of Building J No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ;L$3 p�� gpd Design flow provided s q j 4 gpd Plan Date /ry.G bo Number of sheets Revision Date Title Size of Septic Tank 1Slo 2 COn110 Type of S.A.S. 6-00 GCd1l0,J fhl rlFS Description of Soil S i?t p 9 cvJ Nature of Repairs or Alterations(Answer when applicable) 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 Certificate of Compliance has been issued by this Boardj'ait i e rip Date Application Approved by Date162 Application Disapproved by Date for the following reasons s Permit No. Date Issued L'S/A114 a.. ... `,-.....w,.w„-..,,�..,.,,_ `... -y.�_„".4,r�,:.^....r....?d�nr�ji..:ns�^"'y�„"'..I.rl�c--�a4..�e.�r��n,. ....m-_... .., „ _ � _.�r-+„e.-+rv^ api�'°+�w**•�:r..:.�t,:r.-.�.. .fir•.,.-.,.`-,i a f No. .......... .' Fee h�t� computer:Entered in THE COMMONWEALTH OF MASSACHUSETTS . Yes PUBLIC HEALTH DIVISION =TOWN'OFi BARNSTABLE, MASSACHUSETTS r�rdJ�� �� cation for Moped �p's"S tem Construction 3peflnit t Application for a Permit to Construct( ) Repair/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components + Location Address or Lot No. Owner's Name,Address,and Tel.No.S teeX N pow Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address, ,and Tel.No. N tNr-'P/N )p Type of Building: Dwelling No.of Bedrooms Lot Size //,/to sq.ft. Garbage Grinder( ) Other Type of Building dr,00,k No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �,F? GL� gpd Design flow provided 2 q) gpd Plan Date 5/2,-/Z n Number of sheets Revision Date Title Size of Septic Tank 15M 2 <On1Q Type of S.A.S. 5-00 Description of Soil S PG Nature of Repairs or Alterations(Answer when applicable) tro-,Fr} r-j ew SF'U4 t C 6 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 Certificate of Compliance has been issued by this Board PH Ith. igne G'C/, Date Application Approved by / { �' Y �� �� Date Application Disapproved by t. v Date / for the following reasons Permit No. C� Date Issued ! w THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS eeftificate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(t/ ) + Upgraded( ) Abandoned( )byajA n i, -U-1 N at T 2 (t r c t,,�l r �.r F. has been const ��aied ce J with the provisions of Title;5 and the for Disposal System Construction Permit No. InstallerT �&s A I�tp�JIJ ��C Designer nt i ejr r 0 rQ r wo IC #bedrooms Approved design flow gpd The issuance oftrhis permit shall not be construed as a guarantee that the system will fu�nc'on�as esigned. Date 1 n �l t) Inspector lr,l A ,.• No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS �18�108aY �pStell��OYC�tCUttioYC �eflllit Permission is hereby granted to Construct( ) Repair I Upgrade( ) Abandon( ) System located at(, Z 8 (i u,t✓�I�Y GC'G(h id and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must a completed within three years of the date of this permit. Date 'a Approved by , 06/10/2010 07:13 5084775313 ENGINEERING WORKS PAGE 01 'down of Barnstable Regulatory Services Thomas F. Geller,]Director i Public Health Division Thomas McKean,Director Zoo Main street, Hynnk,MA 02601 Fax: 508-790-b304 Office: 508-862-4644 Date: t 6 Sewage Permit# Assessor's Map/Parcel 2 0 i_ns e &Designer CerdACI ML010 Designer: t�„Lq= k C • Installer: Address: JZ- W. Cre .c S-C-c\ul CC6, Address: On .N2;,Cb 1Ai,& lac_ was issued a permit to install a (daft) ins ler) 4 -Abased on a design drawn by septic system at (0 2� ss) f 3: M C.E 1^tA T^' f dated �Z_C_ es gner .� I certify that the septic system referenced above was installed substantially sccordin to e desi which may include minor approved changes such as lateral r81�d the��$ di �' ut if required) was inspected distribution box and/or septic tank. Stnpo ( �! ) were found satisfactory. 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 Regg l inspecte� and the soils ations. Plan revision Or certified as-built by designer to follow. Stripout(if required) tsigner'SS nd satisfactory. OF M4S g PETER T. ignature) M CIVIL EE H rgnature) (A D r6 TAB Emil MUL Mal IM MUM CAM ME RE y;b�eo f0rM,4=iyaw=ruf%*6on fmm.dw l Town of Barnstable P# Department of Regulatory Services ae A Public Health Division Date Sa3 I a t639.h 200 Main Street,Hyannis MA 02601 Date Scheduled . t7 Time Fee L Pd. ( 6rj cW Soil Suitability Assessment for Sewage Disposal Performed By: in j Witnessed By: tll/ r LOCATION& GENERAL INFORMATION ) Location Address �/� Q G� Owner's Name�be,.H T M� e 1- �i r ✓�tr"V Ile Address 3Z t v qv,5 c4vvt Assessor's Map/Pa=l: f? —(�2 Engineer's Name t -_rl NEW CONSTRUCTION REPAIR K Telephone# Cj — "7— t'O. Land Use Las jz&V-ra. 1 f�US`�Sll opes(%) Surface Stones �J Distances from: Open Water Body �S� ft Possible Wet Area I ft Drinking Water Well i-3 d ft Drainage Way 7;> C 5U ft Property Line 20 + ft .Other'` ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) F �oD: l U orm,V,5 Parent material(geologic) 'jt V it ~ Depth to Bedrock, Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater i 3)� ` 6�Vu- 6-a J(&_ DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: 1n. Depth to soil mottles: in. . Depth to weeping from side of obs.hole: in.' Groundwater Adjustment ft. Index.Well# Reading Date: Index Well leveler Adj.factor.....m, Adj.Groundwater Level PERCOLATION TEST bate, '>ane.��. Observation Hole# Time at 9" Depth of Pent Ak C _j Time at 6" Start Pre-soak Time® G M i� Time(V-6") � n Q End Pre-soak Rate MinJlnch. 2 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YM) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- . **If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable Conself vation Division at least one(1) week prior to beginning. Q:\SEPTICIPERCFORM.DOC J DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color_ Soil Other Surface(in:) (USDA) (Munsell) Mottling (Structure;Stones;Boulders: i vl - 2-� A SL 1012`�)Z y 00_t 3 Z M—c- So,� 6�y DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil color Soil •_ Other Surface(in.) (USDA) (idiunsel1) Mottling (Structure,Stones,.Boulders. o sistency.%GrayclY 0 -3� Ft LL A s' >t 3-'L c. M-c. Same( Z,5-1 (1 N DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consiste e I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. i Flood Insurance.Rate Map: Above 5Ot2 year flood boundary No— Yes Within 500 year boundary No Yes within iob year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughoutah0. area ro osed for soil absorption system? � 5 -- .P . p If not,what is the depth of naturally occurring pervious material? Certifllcation el I certify that on 1� r4 (date)I have passed the soil evaluator examination approved by the Department of,Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 310 CMR 15.017. Si nature Date 6 g Q:\.SEpTlOPERCFORKDOC 'rJ DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in,) (USDA) (Munselg Mottling (Stnte ure;Stones;Boulders. vI A fau—13Z M—t SA,,,,t 2-sy b( DEEP OBSERVATION HOLE LOG Hole# •z_:_ Depth from Soil Horizon Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,BouldersConsistency.%Gravel) F,LL . . fib.=yr° A . Si 10�►'Z-Y�Z Ito -5r S"$713 Z L M—C, S Grta (914 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Strueture,.Stones.Boulders. i Flood Ingurance:Rate Mats, Above 500:year tlood'boundary .No_ Yes Within 500 year boundary No Yes within 100 year flood boundary No—'�L Yes " Death of NaturaAv Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughot}t the area.proposed.for_the soil absorption system? If not,what is the depth of naturally occurring pervious matortal? ....... Certification T f that on i� l�� (date)I have passed the.soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 510 CMR 15.017. Si gnature Date /i6 Q.\$EvnCI PBRCPORM.DOC "' � F is • 97 52 100,47 -- 100 --EXISTING CONTOUR N s� k�s 90. 9 1 x 100.98 EXISTING SPOT GRADE ® o 100,00 W EXISTING WATER SERVICE LAKE EUZABETH == LOCUS 4c;. 9 .77 100.41 G EXISTING GAS SERVICE S 89 32 10 E edge of pavemen 100,90 -- -� 63 91' U UNDERGROUND WIRES �e ape o I ? H.K-OVERHEAD WIRES C1 a o �`"°, o� w 100.78 TEST PIT BENCHMARK v 99.69 �. i LEGEND Cra+gwlle °O oo, 9L e P �� CRAIGALLE BEACH a x 97.4 2 LOCUS MAP • 99,64 Paved Parking t NOT TO SCALE Q) X. 98 �Epo/ x i � 99.55 Poo- 98.7t , / ed or 9 9.6 7 �\ 100,40 GENERAL NOTES: / r0 L___ - ovement 100.04 /.h�h .100.76 _ 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 100,25 x 100,41 \�1 2x x 100, 5 10 ,26 BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 98,47 � St g' OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE Storage 100.41 w LOCAL RULES AND REGULATIONS. PROPOSED SEPTIC TANK 0 Shed x ` � 10 ,40 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR LO c TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE EXISTING CESSPOOL (approx.) ,� 21' 1;400,88 ' ;r 100,57 DESIGN ENGINEER. CONTRACTOR SHALL LOCATE, PUMP, r�� _ o o I 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FILL WITH SAND AND ABANDON i 1' D O TINGEX/S z 4 c) FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN OR REMOVE, SEE NOTE 11. / 1--10, ENGINEER BEFORE CONSTRUCTION CONTINUES. i .66 _Q BUILDING (#628) 100,96 o 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. v ! P. 101,02 1st Floor-Retail Store 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 2st Floor-2 BR Apt. -. THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 1O0✓,� A �N 0 41,04 �' C (Crawl Space) o Y HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. �w ✓ / N t {::.1. pav ment vim, 0 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. VENT of i� ',��- 0 101,43 a 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 10 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS x 00,51 e 9e_ _� I AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE -+!� COnc. 1b DIRECTED BY THE APPROVING AUTHORITIES. 7i 100.90 ��-11.2--1 I 101.49` a/� 1 101.14 00,88 0 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 101,7 101.03 .�^ C� 3 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 3 CONSTRUCTION. 10 _ Paved Parking 101.30 r 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS I �� OF Myss IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 101,32' REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). • SS2�S�" APN 246-028 a o��P PETER T. �yGs 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE Benchmark Set �.�o1�?,y 11,190fS.F. stcN 101.33 g McENTEE INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. 101,66 N 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND Orange Paint/Conc. Pad F CIVIL EL.=101.24 (Assumed) 101,94 � 3 0. 35109 IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 51.50 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC sidewalk 101.57 o fGl$ E� �� SYSTEM COMPONENTS WHICH MAY EXIST ON THE PROPERTY. 9r 101, N 88'48'OS' E 101',58 sidewalk 101,27 o��f 101,63 0 en'trance apron 101`30 101.43c 101.59 edge of ovement PROPOSED SEPTIC SYSTEM UPGRADE PLAN urb y 101,35 628 CRAIGVILLE BEACH ROAD, CENTERVILLE, MA Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 FEMA DATA CRAIGVILLE EACH ROAD OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. FIRM PANEL 250001 0008, D \ LUNDBERG, 'STEVEN C & JAN g.En ineering Works 1 =20' P.T.M. 150-10 M ARLENE ROBERTS REVISED JULY 2, 1992 32 BRIGHAM ROAD 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. ZONE C' BERLIN, MA 01505 (508) 477-5313 5/26/10 P.T.M. 1 Of 2 f} NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:97.4 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. (3) 5" DIA.OUTLETS INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL H-20 RISER, FRAME & OVER ONE CHAMBER I 15.5" _I �E 16 �2" T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE AND SET TO 3' OF F.G. TO SERVET(C )AO TION PORT FE EXISTING 100.9t 101.Ot 101.0 (MAX.) TALL VENT AL RECOMMENDED) > 12" 15.5" `- L = 12' L = 7' L =04' 2^ LAYER OF WASH TO 1/2" 6' ® S=1% (MIN.) ® S=1% (MIN.) ® S-1% (MIN.) .. 4"SCH40 PVC fi 4"SCH40 PVC 4"SCH40 PVC (OR APPROVED FlLTER FABRIC) P 10"1 6• mia Me 2" 14" 14' eaeaaaB H-10 LOADING INV.=97.45 48" LIQ. LEVEL(MIN.) INV.=97.20 GAS GAS INV.=97.1pROPOSED D-BOX rEFF� S.2' 3' D-BOX TIVE = 11.2' INV.=96.90 _50 - - -- G20 RATEO N.T.S. ' PROPOSED SEPTIC TANK (1500 GALLON-MINIMUM) _ d CHAMBERS COMPARTMENT NO. 1 - 1000 GALLON MINIMUM STORAGE SURROUNDED WITH STONE AS SHOWN COMPARTMENT NO. 2 - 500 GALLON MINIMUM STORAGE PROVIDE NEW SEWER OUTLET SET TOP CONC. ELEV.=98. AT, OR ABOVE, INV.=97.60 BREAKOUT ELEV.=97.4 mmmmmij INV. ELEV.=96.90 a®Ba NEIaaaaa aaaBa aaaa aaaaB NOTES: 1) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND BOTTOM ELEV.=94.90 ® TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX 3' 2 X 8.5'-17.0' 3' ~ 37" INCH CRUSHED STONE BASE, AS SPECIFIED IN 4' MIN. OF NATURALLY --i w ® 310 CMR 15.221(2). OCCURING PERVIOUS MATERIAL EFFECTIVE LENGTH = 23.0' N > ®LTE3 2) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' (MIN.) ABOVE HIGH G.W. Z 3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE LEACHING SYSTEM SECTION AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. BOTTOM OF TP, EL.=89.9 4) MAXIMUM COVER OVER SEPTIC TANK, D-BOX & S.A.S. EST. DEPTH TO G.W.=14' BELOW GRADE 102" SHALL BE 36". SEPTIC SYSTEM PROFILE (BARNSTABLE G.I.S. DATA) N.T.S. 4" KNOCKOUT DESIGN CRITERIA SOIL LOG 20" DIA. COVER MULTIPLE USE: DATE: MAY 14, 2010 (REF. P#12,927) 4" KNOCKOUT 4" KNOCKOUT 62" RETAIL SPACE (1st Floor) = 1250 SF SOIL EVALUATOR: PETER McENTEE PE, (SE#1542) SEWAGE FLOW = 1250 SF x 50 GPD/1000 SF = 62.5 GPD Storage WITNESS: DAVID STANTON R.S. 0 TWO BEDROOM APARTMENT (2nd Floor): 220 GPD Shed HEALTH AGENT G COMBINED FLOW = 62.5 GPD + 220 GPD = 282.5 GPD 4" KNOCKOUT SOIL TEXTURAL CLASS: CLASS I ,� Elev. TP- 1 Depth Elev. TP-2 Depth DESIGN PERCOLATION RATE: <2 MIN/IN `L1' ,��' G 100.9 0" 101.0 0" EXISTING FILL FILL DAILY FLOW: 283 G.P.D. -- BUILDINGS DESIGN FLOW: 283 G.P.D. - 97.4 A 42" 98.0 A 36" 500 GALLON CAPACITY, H-20 LOADING GARBAGE GRINDER: NO v? SANDY LOAM SANDY LOAM i LEACHING AREA REQUIRED: (283) = 382.4 S.F. N N R• 96.9 B1OYR 4/2 48„ 97 2 610YR 4/2 46„ CHAMBERS .74 ij: PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY o LOAMY SAND LOAMY SAND 46�58 N.T.S. " PROPOSED DISTRIBUTION BOX OMPIN LETE 3T OUTOLETS00(H-10) _ a -��--20.0' 95 9 ClC1 10YR 5/8 60„ g5.2 10YR 5/8 58 USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 11 2� PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES M-C SAND M-C SAND 628 CRAIGVILLE BEACH ROAD, CENTERVILLE, MA 31.2 2.5Y 6/4 2.5Y 6/4 SIDEWALL AREA: 2(11.2' + 23.0') X 2 = 136.8 S.F. ` Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 BOTTOM AREA: 11.2' x 23.0' = 257.6 S.F. , Engineering by: SCALE DRAWN JOB. N0. TOTAL AREA:..............................................................394.4 S.F. 89.9 I 132" 90.0 132" Engineering Works NTS P.T.M. 150-10 DESIGN FLOW PROVIDED: 0.74(394.4) = 291.9 G.P.D. S.A.S. LAYOUT NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. PERG RATE: <2 MIN./IN. ("B" HORIZON) (508) 477-5313 5/26/10 P.T.M. 2 Of 2 •