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HomeMy WebLinkAboutDUNKIN DONUTS - FOOD DUNKIN DONUTS 3821 .Falmouth Rd. ,1 Marston Mills, MA �tKEt Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. DAmNsrAam F.P.(Thomas)Lee, v � 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. a Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 77 Issue Date: 01/01/2022 DBA: DUNKIN DONUTS # 77 OWNER: CAPE COD ENTERPRISES, LLC Location of Establishment: 3821 FALMOUTH ROAD-#11 MARSTONS MILLS„ MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 18 OutdoorSeating: 0 Total Seating: 18 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE- ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING. PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: I • Initials: t�t Office Use Only. of oiy Town of Barnstable .For O "' Date Paid Amt Pd$ BARNSrABLL Inspectional Services Public Health Division check# Q /°� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 12/20/21 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Cape Cod Enterprises, LLC DBA Dunkin' ADDRESS OF FOOD ESTABLISHMENT: 3821 Falmouth Road, Marstons Mills MA 02648 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): c/o Couto Management Group, 169 Main St,Stoneham,MA 02180 E-MAIL ADDRESS: office@coutomanagement.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O8 ) 428 - 1314 (x TOTAL NUMBER OF BATHROOMS: 2 WELL WATER:YES_NOV ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V SEASONAL: DATES OF OPERATION:!!/_ TO NUMBER OF SEATS: INSIDE: 18 OUTSIDE: N/A TOTAL: _ 18 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE _RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) _BED&BREAKFAST _CONTINENTAL BREAKFAST _COTTAGE FOOD INDUSTRY(formerly residential kitchen) _MOBILE FOOD _FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) _CATERING•.. (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV,FOR INSPECTION PRIOR TO PERMIT BEING ISSUED .PLEASE CALL 508-862-4644 QAApplication FormsTOODAPP 2020.doc i OWNER INFORMATION: FULL NAME OF APPLICANT Salvi Couto SOLE OWNER: YES NO OWNER PHONE# 781-279-0290 ADDRESS 169 Main St Stoneham Ma 02180 CORPORATE OWNER: Cape Cod Enterprises, LLC CORPORATE ADDRESS: 169 Main St Stoneham Ma 02180 i PERSON IN CHARGE OF DAILY OPERATIONS: Simone Scatambuli List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES" The Health Div.will NOT use past years' records.You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified:Food Managers Expiration Date Allergen Awareness Expiration Date 1. Simone Scatambuli 11 / 20 f2023 1. Simone Scatambuli 3/ 7 /2024 2. Jodi Howard 05/ 17 /2024 12/ 20 /21 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div,at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. QA1Application Forms\FOODAPP REV3-2019.doc I Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BAR'wrkom : Paul J.Canniff,D.M.D. 9 � 200 Main Street, Hyannis, MA 02601 lF.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 77 Issue Date: 01/01/2021 DBA: DUNKIN DONUTS # 77 OWNER: CAPE COD ENTERPRISES, LLC Location of Establishment: 3821 FALMOUTH ROAD MARSTONS MILLS„ MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 18 OutdoorSeating: 0 Total Seating: 18 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Qh FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: I i a,1 For Office Use Only: Initials: Town of Barnstable Date Paid l Amt PdPd$ .,, M8LE,: Inspectional Services s KAS& n 163j. Check# I 1 ����• Public Health Division Thomas McKean$ Director 3 200 Main Street,Hyannis,MA 02601, Office: 508-862-4644 Fax: 508-790-6304 t APPLICATION FOR PERMIT TO OPERATE.A FOOD ESTABLISHMENT DATE 11/16/20 NEW OWNERSHIP RENEWAL ►j NAME OF FOOD ESTABLISHMENT Cape Cod Enterprises, LLC DBA Dunkin' j ADDRESS OF FOOD ESTABLISHMENT: 3821 Falmouth Road, Marstons Mills MA 02648 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): c/o Couto Management Group,169 Main St,Stoneham,MA 02180 } E-MAIL.ADDRESS: office@coutomanagement.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O8 ) 428 - 1314 I TOTAL NUMBER OF.BATHRO.OMS: 2 WELL WATER:YES—NOV ..4 (ANNUAL.WATER ANALYSIS REQUIRED) ANNUAL: V SEASONAL: DATES OF OPERATION: / /_ TO I NUMBER OF SEATS: INSIDE: 18 OUTSIDE: N/A TOTAL: 18 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. i ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED:FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? { TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE _RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY.(formerly residential kitchen) _ _MOBILE.FOOD I _FROZEN'DAIRY DESSERT MACHINES (MONTHLY LAB ANALYSIS REQUIRED) i 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:1Apphcation Forms\FOODAPP 2020.doc. i 3 s } OWNER INFORMATION: FULL NAME OF APPLICANT Salvi Couto i SOLE OWNER: YES NO OWNER PHONE# 781-279-0290 .ADDRESS 169 Main St, Stoneham, Ma 02180 CORPORATE OWNER: Cape Cod Enterprises, LLC CORPORATE ADDRESS: 169 Main St Stoneham Ma 02180 PERSON IN CHARGE OF DAILY OPERATIONS: Simone Scatambuli I I List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES" The Health Div. will NOT use past years' records.You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date, Allergen Awareness Expiration Date 1 I 3 1, Simone Scatambuli 11 / 20 t2023 1. Simone Scatambuli 3 / 7 /2024 i 2, Kristine Fusco 12/ 6 /2023 i 11/ 16 /20 SIGNATURE OF APPLICANT DATE **`*FOOD'POLICY INFORMATION*." SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance: FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. 0 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 httn:/hvww:townofbarnstabie.us/healthdivision/applications.asp', OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits Nn'annually from January 1st to Dec.3151 each calendar year, IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES.BY DEC lst. s , t 3 9 .ti Q 1App icatioii,Forms\Pb6DAPP REVS-2619Aoc ! BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. t BARNsrAuLK 2 Paul J.Canniff,D.M.D. nay F.P. Thomas Lee Alternate 1s� . 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 77 Issue Date: 12/10/2019 DBA: DUNKIN DONUTS # 77 OWNER: CAPE COD ENTERPRISES, LLC Location of Establishment: 3821 FALMOUTH ROAD MARSTONS MILLS, MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 18 OutdoorSeating: 0 Total Seating: 18 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G?� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: THE rok� For Office Use Only: Initials: a Town of Barnstable Inspectional Services r7r7 A�EDrhA�A Public Health Division Thomas McKean,Director 2-0 200 Main Stteet,Hyannis;MA 02601 =� Office: 508-862-4644 Fax: -508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT -DATE 11/14/19 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Cape Cod Enterprises, LLC DBA Dunkin' Donuts ADDRESS OF FOOD ESTABLISHMENT: 3821 Falmouth Road, Marstons Mills, MA 02648 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): c/o Couto Management Group, 169 Main St., Stoneham, MA 02180 E-MAIL ADDRESS: office@coutomanagement.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( 508 ) 428 - 1314 TOTAL NUMBER OF BATHROOMS: 2 WELL WATER:YES NO V ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: 18 OUTSIDE: N/A TOTAL: 18 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES...(MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) X** SEASONAL,MOBILE&NEW FOOD ONLY*** REOUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:\Application FormsTOODAPPREV2018,doc r t PLEASE CALL 508-8624644 OWNER INFORMATION: FULL NAME OF APPLICANT Salvi Couto SOLE OWNER: YES NO OWNER PHONE# 781-279-0290 ADDRESS 169 Main Street, Stoneham, MA 02180 CORPORATE OWNER:Cape Cod Enterprises,LLC FEDERAL ID NO. CORPORATE.ADDRESS: 169 Main Street, Stoneham, MA 02180 PERSON IN CHARGE OF DAILY OPERATIONS: Simone Scatambuli List(2) Certified Food Protection Managers AND at least(1)Allergen,Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. *ATTACH COPIES OF CERTIFICATES** The'Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date .1.-Simone Scatambuli 11/ 20 /2023 1. Simone Scatambuli 3/ 7 /2024 2. Kristine Fusco 12/ 6 /2023 217 ``~ - 11 / 14 /2019 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.fownofbarnstable:us/healthdivision/apalications.asn. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food.product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:\Application FonnsTOODAPPREV2018Am A A'rr? T Town of Barnstable BOARD OF HEALTH iY Paul J Canniff,D.M.D. + ' Board of Health Donald A.Gaudagnoli,M.D. un%urr.ABLr- John T. Norman {, as 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 77 Issue Date: 12/20/18 DBA: DUNKIN DONUTS # 77 OWNER: CAPE COD ENTERPRISES, LLC Location of Establishment: 3821 FALMOUTH ROAD MARSTONS MILLS MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: Indool-Seating: 18 OutdoorSeating: 0 Total Seating: 18 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - - ----- - - - MOBILE-FOOD: MOBILE-ICE CREAM:/, FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FF OR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COM MON VICTUALER LICENSE Restrictions: �pFIKE Teti For Office[l Initials: y( o� Town of Barnstable Date Paid ` Amt Pd BAMszABLE, Inspectional Services �l v� 16 Public Health Division Check# Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT .DATE 11/17/18 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Cape Cod Enterprises, LLC DBA Dunkin' Donuts ADDRESS OF FOOD ESTABLISHMENT: 3821 Falmouth Road, Marstons Mills, MA 02648 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): c/o Couto Management Group, 169 Main St., Stoneham, MA 02180 E-MAIL ADDRESS: office@coutomanagement.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O8 ) 428 - 1314 TOTAL NUMBER OF BATHROOMS: 2 WELL WATER:YES NO V ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V SEASONAL: DATES OF OPERATION: 1 / TO NUMBER OF SEATS: INSIDE: 18 OUTSIDE: N/A TOTAL: 18 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING.MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES...(MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE&NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q\Application FonnsTOODAPPREV2018.doc I PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT Sa'vi Couto SOLE OWNER: YES GD OWNER PHONE# 781-279-0290 ADDRESS 169 Main Street, Stoneham, MA 02180 CORPORATE OWNER:Cape Cod Enterprises,LLC FEDERAL ID NO. : 81-0559006 CORPORATE ADDRESS: 169 Main Street, Stoneham, MA 02180 PERSON IN CHARGE OF DAILY OPERATIONS: Simone Scatambuli List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div.will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1.Allison Fay 4 /28 /2023 1. Allison Fay 7 / 3 /2023 2,Amanda Occipinti 11 / 12 /2019 11 / 17 /2018 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION"* SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOHING: Outdoor cocking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January Ist to Dec.31s1 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q\Application Forms1F00DAPPREV2018.doc �p IME r, TOWN OF BARNSTABLE y HEATH INSPECTOR'S Establishment Name: - Date: _ Page:._ ,of W PUBLIC OFFICE HOURS BAR E.O' 2 0 MAN STREET - - - - 3: 0-s:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. MARS. g. MON.-FRI. �A +679• �0 HYANNIS, MA 02601 - .- - soa-es2-asaa No Reference R-.Red Item, PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT Name Date Tyne of type of Inspection _ R ' Address�j `� Risk pod Se- ' Re-inspectio Level Real Previous nspection 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 Cob In: Other Inspector Out: fA Each violation checked re uires 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 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 8 red items) ' Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or ❑ within 90 days as determined b the Board of Health. Overall Rating �_ 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. ElEmbar o g ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations re 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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 da s of recei t of this order. violation,4 to 8 non-critic! violations=C. 29.Special Requirements (590.009) y p 30.Other DATE TE OF RE-INSPECTION:RE-INSPECTION: Inspector's Signat e P int: 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 Signa a Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N j,�._,-,_.�.�.�.--..�ti-.Y� ..��y_, ..* _ -rA ;+:s"•-•...;-..-�-•-.._�'.-.,--.;�f..c-.r•-1-a�:'v-.r..'�ry+...--^... .--4...�--h..w..+��--.1,.,._ �.-�«..-.r.. ��K,s, -u.--s..�. r--..-4-......�... --..._ .r..-. .-�..,-..- �..-,. .-.+.- � -, .�.,..r--�-:.,r...._-.... _- ror.�.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 11 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 Other* Identi mg g Information-Original Containers* 2 590.003(C) _� Responsibility of the Person-in-Charge to 7-102.1 I 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 7-20111 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 1] 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(1)) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ) Disposition ofAdulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( P 4-$01.111 Manual Warewashing-Hot Water 7.206.12 Roden[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 3-202.16 Ice Made From Potable Drinking Water* CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 3-401.11A(1)(2) Eggs-155gg °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 Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef°""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* 3-401.1](A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A - D Violations of Section 590.009 A - D in cater - Sources*Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) ( ) ( ) * Ratites-165°F 15 sec* in mobile food,tern or and residential Sources 10 Proper,Adequate Handwashing g' p � Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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 3-202.15 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 01 3-1 .11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Heim Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* 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 Cabello of Ingredients* Supplied with Soap and hand Drying Devices (n 9 g 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item,in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oFIK .E TOWN OF BARNSTASLE ., HEATH INSPECTORS Establishment Name: Date: Page:. of _ 1 -'OFFICE'HOURS P ° PUBLIC HEALTH DIVISION a oo s:301A.M. BARNSTABLE. • 200 MAIN STREET 3.30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified n639- �* MON.-FRI. ,b3s. �0 HYANNIS,MA 02601 sos-N.-asaa No Reference R-Red Item PLEASE PRINT CLEARLY ..FOOD ESTABLISHMENT INSPECTION REPORT, Name �( vT"� Date Tyge o Tyue of Inspection �y / Routine Address Risk Re-inspection Level Retail Previous Inspection l� Tv Telephone MobResidential Kitchen Date- Pre-operation ` peration Owner HACCP. Y/N Temporary.. / ffGeneral.Complai f2oe Caterer ` Person in Charge(PIC) Time Bed&Breakfast In: Inspector JCe..i�n i 2c. Each violation checked r uiresan 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 imaiinent.health.hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by.the Board of Health. . Allergen Awareness 590.009(G) ❑ T 1,91aud,i FOOD PROTECTION.MANAGEMENT ❑ 12.Prevention of Contamination from Hands / ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities Mil lee r.' 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 l �'1 ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ l"i.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) V 4 ❑ 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 Li / Violations Related to Good Retail Violations Related to Good Practices(Blue Items) Total Number of Critical Violations c� �.r► (� 2 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. F] Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order forOfficial 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 no violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health: Failure to correct violations re ardiess of the number of critical,results in an F. B=One critical violation and.less than 4.non-critical violations 9 _. • 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 6von-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=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 9raon-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of violations observed,7 to 8,non-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 8 critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector' nature Pr ?(/� 31.Dumpster screened from public view G� U Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N l�lnature Print: Self Service Wait Service Provided Grease Trap Size.. Variance Letter Posted Y N Dumpster Screen? Y N i .._,,.:..�.�� r:,-�.. . .r - ,. .��,_...,,� :'- -' a �. �, - � - -.' ,,,- .. ,�.. -v.-.`i v...... -_,^•��..�='A3L.'`.vim-va ��: - _. -n.. •.. ,. . a _.. � _ y. _ _... -_. �r.�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 L14 Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* - "*' 19 PHF Hot and Cold Holding 4. 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Rawingredfents 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41•F/45•F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other-*, g3-501.16(A) Hot PHFs Maintained At or Above.140-•F*. 7-101.11 Common Name-Working Containers* 3-501.16 A Roasts Held At or Above 130•F* Require Reporting by Food Employees and Contamination from the Environment ( ) 7-201.11 Separation-Storage* • Applicants*' 3-302.H(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* 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 Rrated orce,of Food 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Oisposition•ofAdultereted or Contaminated - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Souicei F 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 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 Pe 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* TWEITEMPERATURE 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 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 Equipment* ( ) ) Pathogens*590.006(A) Bottled Drinking Water* 3-401.11 A(2 Comminuted Fish,Meats&Game g * Effective mrzoot 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 SP,ECIAL'REQUIREMENT,S 1, i.=C?_" _ 4-703.11 Methods*f Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical Ratites-165'17 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* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145•17 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165•F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) 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 foodbome * 12 Prevention of Contamination from Hands 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated illness interventions and risk factors listed above,can be found in the 590.004(E) Preventing Contamination from Employees* ,18, Proper Cooling of PHFs following sections o the Food Code and 105 CMR 590.000 8 Tags/Records:Shellstock f4 $ f 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140•17 to 70•17 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70`F to 41•F/45°F Hem Good Retail Practices FC 590.000 Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* 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 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. Rentokil Proof of Service 047 BOSTON PEST,A RENTOKIL COMPANY,CINCINNATI,OH,45274-0608,800-649-7228,781-331-8321 Servicing Branch 4047 Contract Number 015883465 Customer COUTO MANAGEMENT GROUP Premise Number 10 353341-3821 FALMOUTH RD,DUNKIN MARSTONS MILLS Visit Type SERVICE MAINTENANCE 3821 FALMOUTH RD Visit Date 04/27/2022 DUNKIN MARSTONS MILLS MA 02648-5701 Licenses Certifications 00-44647 Order Number Status Service Date 'Report Des ipbon 6243258 Completed 04/27/2022 PEST CONTROL MAINTENANCE Device Summary Device type 4Vitti'activity Vtlithout acimty UnServiceable. ` Total inspected Inspection Point 0 5 0 5 Insect Light Trap 0 1 0 1 Materials Used Materials Used epa'' Lot# Dilution%, Concentrate,._Quantity Una_ ,,Me . Target' ILT Glueboard na 0.000000 0.000000 1.0 each Pavement ants Device: ILT 001 Hardware: Hand Materials Used epa Lot# Dilution% Concentrate.'Quantity;_� :Unit Meths Target" Rodent/Insect na 0.000000 0.000000 2.0 each Occasional Glueboard invader Device: Storage Hardware: Hand Comment: Replaced monitor Recommendations Date Location Recommendation:Type/details Recornmendation'Image b 04/27/2022 Building: 3821 Falmouth Rd Status:NEW Floor: Main Type: Sanitation Reference: Zone: Basement Responsibility: 56 Location Area: Internal Debris collecting interior. Please remove debris to prevent Location: Basement unsanitary conditions and attraction by pests. 04/27/2022 Building: 3821 Falmouth Rd Status:NEW Floor: Main Type: Sanitation Reference: Zone: FRONT COUNTER Responsibility: 55 Location Area: Internal An accumulation of food product from damaged goods Location: Front counter noted. Please remove food product to prevent attraction by pests. noted under front line sandwich station and coffee prep Rentokil Proof of Service Detailed Inspection Results Site 3821 Falmouth Rd,Main,Storage Device Time. Pest Type" Quantity.. Infestation Levd - ILT 001 11:42 AM No Activity Found Storage 11:44 AM No Activity Found Site 3821 Falmouth Rd,Main, Dine In 'Device ,- Time Pest Type . - Quantity ' infesra'tlon°Lauds . Dine In 11:45 AM No Activity Found Site 3821 Falmouth Rd,Main, FRONT COUNTER Device- Time Pest Type Quantity_. _ Infestation_Levef , Front counter 11:45 AM No Activity Found Site 3821 Falmouth Rd, Main,Basement Device Time Pest Type Quantity Infestation Level Basement 11:48 AM No Activity Found Site 3821 Falmouth Rd, Main, Restroom Device Time Pest Type Quantity Infestation Levd Restroom 11:52 AM No Activity Found Bellaire, Dianna From: Soto, Kathryn Sent: Wednesday,June 1, 2022 6:28 PM To: Bellaire, Dianna Subject: RE:Anchor In Yeah I lost my sheet with that and their pool inspection. I know I have it somewhere, I will look for it tomorrow From: Bellaire, Dianna Sent: Wednesday, June 1, 2022 5:35 PM To: Soto, Kathryn Cc: Bellaire, Dianna Subject: Anchor In I didn't see an inspection, are you good with them? This is for food. 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 1he.information contained in this electronic trsmsmission("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 pri-6leged.and confidential work-product or a privileged and confidential communication.'I'lie Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only.The Information may not be disclosed,�i7tliout 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. 1 1 00HE ro� TOWN OF BARNSTA$:LE. �: NEALTH wsPECTOR's Establishment Name: Date: Page: Of, ' 64icE°HOURS PUBLIC HEALTH DIVISION 60o saoa.nn. BARNSTABLE. ` 200 MAIN STREET 3.30 4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date Verified M"SS HYANNIS,MA 02601 Mors.-FRI. No Reference;c R.-;Red Item ,.: PLEASE PRINT CLEARLY .,- �p 6}9•see _ .. .. -.. .' . . • -.�;'.�: 508-862-4644 .. ° .'. FOOD ESTABLISHMENT,INSPECTION REPORT Name tl/1�MU�t Date Tyneof. . ly3Te-o'Inspection Address. Z Risk.. s Re nlspection59 - / ,1 Level Retail Previous Inspection Telephone - Residential Kitchen Date; . . Mobile. Pre-operation Owner HACCP Y/N Temporary. Suspect Illness Caterer General Complaint �,/ q,, Person in Charge(PIC) % � �%�JG(JC/J'1 Time. Bed&Breakfast HACCP : . ` In: Other Inspector �j Out. 41 gI y Each violation checked requi s an'explanation on the narrative pages)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) ❑ �fl.>✓1 - Action as determined by the Board of.Health. Allergen Awareness 590.009(G) ❑ /. ` FOOD PROTECTION MANAGEMENT, ❑ 12.Prevention of Contamination from Hands S' ❑ 1:'PIC Assigned/Knowledgeable 1.Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 'I vu" ' ' ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or.Color Additives I G '/ , ❑ 3.Personnel With Infectious Restricted/Excluded ❑ 15. Toxic Chemicals w� L �( 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. cC ❑ 7.Conformance with Appro4ed_Procedures/HACCP Plans ❑ 19.Hot and Cold Holding J 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 HS ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY py ;CJ. - ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations '1� � G✓ - ;/� �dt� ' 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. El 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 Hof 105 CMR 590.000/Federal Food Code. F[:] Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC72)(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'ormore 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. 13=One critical violation and less than 4 non-critical violations 9 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,4to 6 non-critical.violations=B. 26.Water;Plumbing and Waste` (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (F,C-6)(590:007) aggrieved by this order,you have a_;right to a hearing. Your request must C=2 critical violations and water,sewage back-up,infestation of rodents or insects,'or lack of.less than 9 non-critical. If no critical )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 g violation,4P 8 n-cr ical'violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's i ature Pri t: - 31.Dump er 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' ature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted, Y N Dumpster Screen? Y N _ .� � �- - ..� �-•-.. _ �. --•-._. �. _ . _ -� _ .� �.-ti-s .- -._---�-.,.,,+,,��--;-�. ------��-�-._ .-. .-- -.._ -..�--�. .��..__._ � �....s,.•`.-...a - , . -•` _ _ __.`. 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 1 Person-in-Charge Duties Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding . 2-103.1 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 590.004(F) 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* ....:.:. ..... . . * 3-501.16(A) Hot PHFs Maintained At or Above 140°F*. Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers 3-501.16(A) Roasts Held At or Above 130`F* Applicants* 7-201.1.1 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* * p° ty3-302.15 Washing Emits 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* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* 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 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 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 m 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 3-101.11 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* sty"';"vtiaooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121'min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs ^ y._ SPECIAL REQUIREMENTS + •:+`^Y ' 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* 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 r2-301E.14 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* Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 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* 11Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 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 * 3-301.12 Preventing Contamination When Tasting* 3-403.11 * (Blue Items 23-30) 3-202.15 Package Integrity (C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and.Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 t3 Proper Cooling of PHFs .. following sections of the Food Code and 105 CMR 590.000 - 3-202.18 Shellstock Identification* L13 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 * 5-204.1Q. 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 3402.12 Records,Creationand.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 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 1 Hand Drying Provision 129. 1 Special Requirements .009 3-502A l Specialized Processing Methods* 30. 1.0ther 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. pp THE rp�,- ,TOWN OF BARNSTABLE..`.,, �-•: ..oFFlce HouRSRs Establishment Name: - Date: Page;. of,'..�� 1• HEALTH INSP.E PUBLIC HEALTH DIVISION': BARNS•rABLE. • 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. FOOD ESTABLISHMENT NSPECTI No Reference; R.-Red Item PLEASE PRINT CLEARLY EED MAC 508 862-4644 ON REPORT Name Dat 7 lype O sec io O s outine Address Risk = lServick ion Level Retail. Previous Inspection Telephone i Residential Kitchen e' i Mobile a-oeC ration _ Da Pr tion Suspect Illness Owner HACCP Y/N Temporary'. P - Caterer General Complaint Person imCharge(PIC) Time Bed&Breakfast . , HACCP Other In: LAI O er _ "Inspector Out:. t Each violation checked requires an explanation,on the narrative page(s)and a citation of specific provisions)violated. Violations Related to Foodborne Illness Interventions and Risk Factors Red Items ( 590.009(E)Anti-Choking- ❑ Violations marked may pose an imminent health hazard-and require immediate corrective Tobacco 590.009(F) ❑ Y( Fe. 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'tiy Food Employees and PIC ❑ 14.Approved Food or ColorAdditives .- ❑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 . ❑ 6.Receiving/Condition ❑ 17.Reheating _. . 31js ❑ 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 _ C - ` ❑ a.,Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and,Sanitizing ❑ 21 Food a,nd Food Preparation for.HSP, 1 . ❑ 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 3`l� - /C� Critical(C)violations marked must be corrected immediately. (blue&red items Corrective.Action Required: No 1.❑ Yes ? _Q- 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 forCorrection: 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.. B=One critical violation and less than 4 non-critical violations 9 . 25.Equipment and Utensils (FC-4)(590:005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. "" 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation offood establishment operations. If Seriously Critical Violation=F is scored automatically if: no'hot 27.Physical Facility (FC•6)(590.007) aggrieved by this order,you have 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. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease.TrapSize 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* 6 Cross-contamination 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(]) 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*. . 7-102.11 Common Name-Working Containers* 3-501.16(A) HotPHFs 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* 20 Time as a Public Health Control 590.003O 3-302.11(A) Food Protection Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use*P ty3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(I1) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.11. Sanitizers,Criteria-Chemicals* 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* 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* 3-401.1 I A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-]Ol.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* Eff cnw rnnooi 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* ui ment* 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* I Eggs* 1 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs _ (SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009 A D Chemical ( )-( ) Violations of Section 590.009(A)-(D)in ca[er- 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* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g, 1= g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3-403.11(C) Commercially Processed RTE Food-140°F 3-101.11 Food Safe and Unadulterated 12 Prevention of Contamination from Hands (E) g Unsliced Portions of Beef Roasts Critical and non-critical violations,which do not relate to ndthe n the me * 3-403.11 Remaining * 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 140'17 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.a:. .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 1 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °p THE T TOWN OF BARNSTABLE - HEALTH INSPECTOR'S Establishment Name: tG (_,t 0&4 LAI Date: Page:�_of ' l OFFICE HOURS eAR�srAB�E° PUBLIC 0 MAIN STREET - 3:30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. e3. `0l HYANNIS,MA 02601 M-8 -46FRI4 No Reference R-•Red Item PLEASE PRINT CLEARLY 50862 644 FOOD ESTABLISHMENT INSP CTION REPORT Name Date (3 2 -Type o Type of Inspection ✓t.� \S V�b I G t s u�c�G fi> AddressZ �!j Risk Food Service Re-inspector I � a Level Re Previous Inspection I/sk) Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) S Yet , Time Bed&Breakfast HACO herCP u Inspector Out: 3 Each violation checked re uires an explanation on the narrative page(s)and a citation of specific provision(s)violated. �Q��i'� Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ LLzqS j^ l I Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ J C11 64L O� Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands P VV 1 b �, --M ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities Y l EMPLOYEE HEALTH PROTECTION FROM CHEMICALS L4 Id 7 ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals t a 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 HS ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORYLb ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories yc l/ Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items 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) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 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 i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 g violation,4 to 8npn-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's . ature Print:r 31.Dumpster screened from public view I p y Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sig at Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N -. � .+-� .+--�"-..-.,,r.�-�". � ��. ti .r ,: �.....,-r--.�.--.... ,.--�-....-._ � �_,. .,�-.._ ..--"_-`..V. •--- -�-'^ r. . ..�,,.. « .°- - _.. ..-,<. ..- .nv -- -.-e.�-.-.�-4.--.. "...- -.. -,rse•...-.-- ._ ..-. �. .. xsr .. f -,- .-�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 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * - 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 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 ontro 7-201.11 Se ara[ion-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 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 Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served y Pe 7-206.13 Tracking Powders,Pest Control and 3-201-.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Pasted 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) Comminutcd Fish,Mcats&Gamc Pathogens* e//&ro rennet 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-Ho[Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* 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. * 2-301.14 When to Wash* 3-401.11 A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )�) 11 Good Hygienic Practices d practices should,be debited under#29-Special 3-201.17 Game Animals* 17 Reheating for Hot Holding 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 3-301.12 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 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) 1= illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A Coolie Cooked 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[0 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* Temperature 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 HACCP Plans 6-301.12 Hand Drying Provision 28. Poisonous u Toxic Materials FC-7 .009 rY g ti 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doo *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. o-AHE roN TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: (')Z�A L/f___> Date: 1(P 2 Page: Of '. 2- OFFICE HOURS ' PUBLIC HEALTH DIVISION 8:0029:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 9•. o� MON.-FRI..6 No Reference R Red Item PLEASE PRINT CLEARLY �A i67 a HYANNIS,MA 02601 - 508-862-4644 reoM"+ FOOD ESTABLISHMENT INSPECTION REPORT ' Name 07� Date , T e o of s action > I� Re-in l(�C Address '3 g'z I Risk ood Serv' Re-inspection r �r-l Level Retail Previous Inspection �' J( � Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) j� /� Time Bed 8 Breakfast HACCP j/nt L I uWjJV In: u: d f Other ` Inspector SU 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) ❑ OL Y� Action as determined by the Board of Health. Allergen Awareness 590.009(G) ✓IAS FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ✓ ❑ 1.PIC Assigned/Knowledgeable/Duties [-rS-Handwash Facilities f� 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 Foo s) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating cb ° r ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling � ( ✓ / ❑ 7.Conformance with Approved Procedures/HACCP Plans 19.Hot and Cold Holding SO C{ II ,,,",,,, a PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control If e Separation8. /Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP f _ Dd ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories T(�M Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ 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 Embar o 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) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to Snon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 g violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspect p4aiure Prin 31.Dumpster screened from public view 0\3 Permit Posted? Ll< IkN- Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N v- ...,-. , .- R. + � __..,.. _�� i .. .- i. -'�....- a ......--�._ .` .. _ •• ----' - -_ ._. ...-. ., .-.� .. _. -_ _� ..✓_'.,,..... w .:..y�r-.. - �.....,.,�.-�-�r.,..-.r}- .. ...-....,.-. r�.-v. -� >.+�- -+.0.�- .T.�J.-...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.) a 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 Additives5 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.* * PHF Hot and Cold Holding- Contamination 2-103.11 Person-in-Charge Duties - -- - - - 3-302.14 Protection from Uhapproved Additives Contamination from Raw Ingredients F15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F - -590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* " 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 - - - 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Se azation-Storage* Applicants* 3-302.11(A) Food Protection* P20 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)- 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q - - Reporting-by Person-in-Charge*- - --- - - - `Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Watei 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 ( ) P 4-501.111 Manual Wazewashin 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) I 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 Tee Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11 A Cl Utensild Food Ctt Surfaces of * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from.an Approved.System*.. .. _ ( ) ean s an onac 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* of ai°r 1°/2001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish-From an Approved Source _ - _ - 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish*" - - 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and a ide in cater- * - - - Ratites-165°F 15 sec* in mobile food,tem or and residential Sources 10 Proper,Adequate Handwashing g' P Game and Wlid Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* - 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3403.11(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) 3-202.15 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 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* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 13-502.11 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. °giNE rpk, TOWN OF BARNSTABLE _.. HEALTH INSPECTOR'S Establishment Name: R44k� �� Date: Page: ZZ of. OFFICE HOURS PUBLIC HEALTH DIVISION - a00,9:30A.M. • BARNSTABLE. ' 200 MAIN STREET 330-4:30P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified Mbs. m� HYANNIS,MA 02601 50e-862 aRsaa No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT Name �1 Date I� �) Type of section p l l O Routine Address g'L YLfm Risk ood Se Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: ; )mot Mobile Pre-operation �✓1 Owner HACCP YIN Temporary Suspect Illness ` v Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other / Inspector ? Out: 1S CL '. l t r Cmrs 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) ❑ 1 Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ �( 1--@l 1 )T 1 Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ Qom^ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands Cb ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities r , EMPLOYEE HEALTH PROTECTION FROM CHEMICALS �- , U'� /t_e I v�C�I IC '1 ❑ 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) r w� ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating - ! "p ❑ 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 IiP �G ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY �C 0 ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embar o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 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) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 6n violations 26.Water,Plumbing and Waste, (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 g = 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations C. 30.Other DATE OF RE-INSPECTION: Inspector's nat 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 PIC's n`atur Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted . Y N Dumpster Screen? Y N 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 15 590.004(F)Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°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 - - - 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) i 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* 3-304.11 Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use* 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* 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 Disposition of Adulterated or Contaminated g ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Warewashin 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. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11 A Clean Utensils and Food Contact Surfaces of * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved,System*. ( ) - Eggs-Immediate Service 145°F 15 sec Not Otherwise Processed to Eliminate Equipment* ( )O Pathogens 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game * E ecr;ve ronoor 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* - P 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under - Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#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 3403.11E Remainin Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated ( ) g Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-203.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite 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 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. 9/h oFtHe roK TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: I; Date: Page: of OFFICE HOURS PV a,,- V - dP �' PUBLIC HEALTH DIVISION � 8:00-9:30A.M. BARNSTABLE, • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MAS& �/6}9• .0� HYANNIS,MA 02601 MON.-FRI. No Reference -R-.Red Item. PLEASE PRINT CLEARLY p _ Argo�� , FOOD ESTABLISHMENT INSPE T1 N REPORT 508�862-4644 NameYA111412�51 Date vne of I s ec io n � t n O outi Address f ood Se ce Re-inspectiopl el � Previous,_Irse _ Telephone Residential Kitchen Date: Mobile Pre-operatio q Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint t� Person in Charge(PIC) , Time Bed&Breakfast HACCP A Q Other i 21-5 i Inspector r Each violation checked requires an explanation on the narrativ4sk page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and 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 77/ 2.Reporting of Diseases b Food Employees and PIC 14.Approved Food or Color Additives ❑ P . � 9 Y ❑ PP � ❑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 1 r' ❑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) O ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY l v ❑ 11 I Good Hygienic Practices ❑22.Posting of Consumer Advisories 1-�t -DB 06 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations 7 l Critical(C)violations marked must be corrected immediately. (blue&red items) I b �sl�q 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,t e it ms Qv 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 6=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. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F n scored automatically o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. . f 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 no'-criticl violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8nonvcritic '�olatio s=C. 30.Other DATE OF RE-INSPECTION: I s to s ignatur // a rint: 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' ature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding e 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH_ 3-302.11 A 2 Raw Animal Foods Se arated from Each * 590.004(F) ( )O P 7-101.11 Identifying Information-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 7- Require Reporting by Food Employees and Contamination from the Environment 7-202.11 01.11 Separation-Storage*Common Name-Working Containers 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 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 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed 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 F9 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 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 I Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 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- mme is 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 * s ecrme ionom 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 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. 3-2 2.1 C Wild Mushrooms 2-301.14 When to Wash* * Other 590.009 violations relating to good retail ( ) : 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec practices should be debited under 929-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. $ 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 Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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 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* 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* Supplied with Soap and hand Drying Devices Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials 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.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. pp THE r - TOWN OF BARNSTABLE. HEALTH INSPECTORS Establishment Name y( Ali DoAl Date: _ 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 MASS. �r. MON.-FRI. ,639• �• HYANNIS,MA 02601 soa-as2 asaa No Reference R Red Item PLEASE PRINT CLEARLY, A°p�a FOOD STABLISHMENT INSP T O REPORT Name - Date e o Ins ctio p s outine J Address Risk Fo' Serva 'f3e-i spection p Level Retail PrevioVatiln ec�tt n Telephone esidential Kitchen Date:Mobile Pre-op � Owner HACCP Y/N Temporary Suspect Illness - Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other a Inspector _ 0 Each violation checked requires an explanation on the narrative ge(s)and a citation of specific provision(s)violated. Violations Related to Foodborne.11lness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective. Tobacco 590.009(F) ❑ , Action as determined by the Board of Health. . Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands f ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food.Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) - ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures _ ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ' ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control Ir ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) J ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP D❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY D� G ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories J . ^ Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) ' Corrective Action Required: ❑ o ❑ 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 ite checked indicate violations of 105 CMR 590.000/Federal Food Code. Embargo❑ g ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number.of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 B=One critical violation and less than Orion-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 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 nor}critica violations. If 1 critical refrigeration: 29.Special Requirements 9) PY within 10 days of receipt of this order. v ion,4 to 8 non-critical vi ation -C. (590100 30.Other DATE OF RE-INSPECTION: I ector Sign ture Print - v 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 PI 's ignature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y 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 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 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* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P 8 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 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 17.206.12 1 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens* 1/ 590.006(A) Bottled Drinking Water* --- 3-401.11 A 2 Comminuted Fish,Meats&Game g * e ecnvc innoot 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 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* n42 When to Wash* 3-40L11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* Good Hygienic Practices 97 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* Discharges From the Eyes,Nose and Mouth* 3-403.11(13) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * Preventing Contamination When Tasting* 3-403.11 C Commerciall 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 * Prevention of Contamination from Hands 3-403.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated �) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Lu Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140'F to 70°F 3-202.18 Shellstock Identification ( ) hem Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 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. PKIA °FTOW ro _ _ TOWN OF BARNSTABLE HEALTH INSPEcroR's Establishment Name: / r ate: 4RECTION ge: 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 CO Date Verified MA55. HYANNIS,MA 0260 _ M-8 -FRI. No Reference R-Red Item - PLEASE PRINT CLEARLY �p esv.s�0 508-862-4644 rFDN1P� FOOD E T B ISHMENT lNSq CT ON REPORT Name Dat a of Type of Ins ection 100 bis Routine i Address Risk Food Service Re-inspection - Leve 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 Inspectorri Out: Each violation checked requires an ex anation on the narrative page(s)and.a citation of specific provision(s)violated. Violations Related to Food borne 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 Asa Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required:. ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo Emergency Closure ❑ Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) Constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4von-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critic violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's g;aj 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 PI 's gna ure 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 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* Other* 83-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage Applicants* 3-302.11(A) Food Protection* 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 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food 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* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef aicN 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3 401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and-Wildut Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004 C Wild Mushrooms* 2-301.14 When to Wash* * Other 590.009 violations relating to good retail ( ) 3 401.11(A)(1)(b) All Other for H-1 olds 15 sec practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. $ 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* 2401.12 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 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* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70'F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite 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 29. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* i 8-103.12 Conformance with Approved Procedures* i S:590Forrnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. t. °F. row TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Page: of �'f q OFFICE HOURS BARN E.O` PUBS 0 MAN STREET EEVT 3:30-4:30 P P.M. DIVISION - : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mnss. g MON.-FRI. A ,639.��m HYANNIS, MA 02601 No Reference R,-Red Item PLEASE PRINT CLEARLY sos-as2-seas • . 'FON1�` FOOD ESTABLISHMENT INSPECTION REPORT Name Date ry T e o �e of Inspection ,�n p g Routi s [y Address Risk F od Se nspecti Level a al us Inspection Telephone Residential Kitchen Date: Mobile Pre-operation _ Owner HACCP YIN Temporary Suspect Illness - Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP led In: Other Inspector Out: '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 TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved.Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: El No Yes Non-critical(N)violations must be corrected immediately or within 90 Overall Rating days as determined by the Board of Health. ��I a2�1 1 g ❑ 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. 26.Water,Plumbing and Waste (FC-5)(590,006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically if: la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i cal violations. ritical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,•4 to 8npn-critical violations=C. • 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: Ifl 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' ature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N A t 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 k and RTE Foods.* Unapproved - 19 PHF Hot and Cold Holding _ _ _ Cooked _ - * - 2 103.11 Person in Charge Duties 3 302.14 Protection from Additives g 1 B 1 PHFs Maintained At or Below 41`F 4 -F Contamination from Raw Ingredients - 3 501. 6( ) Cod s / 5 15 Poisonous or Toxic Substances 590.004(F) - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140'F 2 590.003(C) Responsibility of the Person--in=Charge to - 7-102.11 Common Name-Working Containers* Require Reporting b Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* P g Y3-302.11(A) Food Protection 7-201.11 Separation-Storage*Applicants* * P g 20 Time as a Public Health Control A Food Employee r An 7-202.11 Restriction-Presence and Use* * 590.003 Responsibility of o o ee o 3-501.19 Time as a Public Health Control _ (� P tY P_ Y _ _ _ 3-302.15 Washing Fruits and Vegetables * Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food,Contact with Equipment and Utensils ( ) q * 590.003(G) --Reporting by Person in Charge* - - - 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions � g ( ) Disposition of Adulterated or Contaminated _ 7.204.14 in Agents,Criteria* 21 3-801.11 A Unpasteurized Pre-Packaged Juices and - Food Drying g ( ) P g FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* - 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* -- Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food 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* Eff°"9e Inrzoot 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 r f ces Sanitization of Utensils and Food 3-40 L11(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 cater- Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165'F 15 sec*3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 * (Blue Items 23-30) 3-202.15 Package Integrity (C) Commercially Processed RTE Food-140'F Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11 g 3-101.11 Food Safe and Unadulterated (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 * 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 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 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. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen.Packaging Criteria*. 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1909 Food Code or 105 CMR 590.000. `°F�He row TOWN OF BARNSTABLE . HEALTH INSPECTOR's Establishment Name: Date: Page: of OFFICE HOURS BAR E PUBLIC 0 MAN STREET EEVT 3 DIVISION. :3 4 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MAss. �.. MON.-FRI. �A ,aw• HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY ,FOM�,e FOOD ESTABLISHMENT INSPECTION REPORT o�G Name Date l/� Tvpe of Type of Inspection ` Routine Address Risk Food Service Prelnspectionection Level Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PI l Tiryt Bed&Breakfast HACCP 1 Other Inspector Out: 0. 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) ❑ l 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 SUSCEPTI E POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HS ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 4 11.Good Hygienic Practices E]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) I� Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating (f within 90 days as determined by the Board of Health. b ❑ 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ 9 Y ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an'order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations re 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 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) P Y within 10 days of receipt of this order- violation,4 to 8 non-critical violations=C. . 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view r Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N If #Seats Observed Frozen Dessert Machines: Outside Dining Y N P. 's Si e - Print: y 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 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 _,- Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH � 3-302.11(A)(2) Raw Animal Foods Separated from Each 7+101.11 Identifying Information-Original Containers* � ' Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to - - 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* - 3-302.11(A) Food Protection* p g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 3-304.11 Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use* - 590.00411 Requirements 590.003(G) Reporting-by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) - Variance Contamination from the Consumer 3 590.003(D) 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 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 ' Fluid Milk and Milk Products* 4-501.112 Mechanical 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.I IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of 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* E//cti-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3 401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* * 10 Ratites-165°F 15 sec* in mobile food,temporary and residential Sources Proper,Adequate Handwashing g' p Game and Wild Mushrooms Approved B 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority y 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 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 * 3-301.12 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 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked PHFs from 140*17 to 70°17 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 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. 4*8 °FINE r°,r TOWN OF BARNSTABLE. HEALTH INSPECTOR'S Establishment Name: Date: age: of d 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 p Ma3v.ae� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY • 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Nart7eDCAAG t%� �L Dat 'Q e o Ise 'on 011erationts) tine Address Risk o e- ection N_ ° Level Re ai Previous Inspection •v` Telephone 4 Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP �' n r A ;' In: Other Inspector\M Out: C Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. _ l 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) ❑ l`.v 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 1 EMPLOYEE HEALTH PROTECTION FROM CHEMICALS yo- ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals r� FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Food4o � ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ( �+✓ F­] 5.Receiving/Condition ❑ 17.Reheating �`C! ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ .Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans 19.Hot and Cold Holding bL PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBL POPULATI NS(HSP) 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HIS {, L ❑ 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 Violations44, Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: Yes Non-critical(N)violations must be corrected immediately or Overall Rating /(� within 90 days as determined by the Board of Health. �� (o ❑ Voluntary Compliance ❑ Employee Restriction Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based n an in pection today,the items Embar o 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) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than 4 non-critical violations 9 if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials' (FC-7 590.008 9 violation,4 to 8non-critiCal violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. Inspector's Si gnat re Print: 31.Other DATE OF RE-INSPECTION: }f � 31.Dumpst 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 re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N C. Qi'w� 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 6' 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) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* -2 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* P g 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* Restriction-Presence and Use*7-202.11 20 Time as a Public Health Control 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 * ( ) 4 590,003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B.)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources - 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501:111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Tem erasures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* - 4-501.112 Mechanical Warewashing-Hot Water I Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 . Shell Eggs* ._ - Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - ' Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* _ * gg Not Otherwise Processed to Eliminate R(]npment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E//'i"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 approved Source _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A D Violations of Section 590.009 A 3-201.15 Molluscan Shellfish from NSSP Listed .Chemical* ( )-( ) ( )-(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* 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. $ Reeeiving/Condition -, � g. g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* - i`. 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 foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Harids 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 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand m Provision Drying 29. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Forrnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Fiaer TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: l� Page: _of �1. OFFICE HOURS ' PUBLIC HEALTH DIVISION 8:00-9:30 A.M. NSrABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified pBMy39,n�0� HYANNIS,MA 02601 _ MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY rF MPS 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Date,U LO Ao yne of T Ins ec io outi Address Risk od Servi -Fie-inspection Level ai Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation 1 Owner HACCP Y/N Temporary Suspect Illness ,f h ( (� f G ( V l Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCPILA &44 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) ❑ �IL 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 t EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 120 1 ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives _ ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals _ IL u FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Fo ds) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating - ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling � f ❑ 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 POPULATIO S(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ` 1 ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY l ❑ 11.Good Hygienic Practices ❑ 22.Posting-of Consumer Advisories ' Ala:A Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) r Corrective Action Required: Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Emplo ictio x I e-ins ti c Q-Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo F] 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. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically if:tion of rodents or insects,or lack of no hot 27.Physical Facility (FC76)(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 )( ) be in writin 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. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view -y\ -r ii _ �j j Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N ' r ` v - 1 #Seats Observed Frozen Dessert Machines: Outside Dining Y. N PIC' Signafa a Print: o Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N ""�-C•''-(•°Q�" ,'� Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * * 3-501.15 Cooling Methods for PHFs �r 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives 2-103.11 Person-in-Charge Duties - - Cooked and-RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding, Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F 590.004(F)- - * - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590: Other*003(C) Responsibility-of the Person-in-Charge to - - - 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-Stora 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 * 590.004 11 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 ) Variance Requirements 590.003(G) Reporting by Person in Charge* - -- 7-203.11 Toxic Containers-Prohibitions* ( Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition of or Contaminated - - - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P - - - - 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved.System _ * gg Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg cr;°e rnnoor 4-602.11 _ Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 3-10 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* - Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* I g g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g, P mrY 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 2-301.1 f 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* _ 2-301.1-2 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C)_ Wild_Mushrooms* _ _ _ _ _ 3-401.11(A)(1)(b) All Other 145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 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 * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* (Blue Items 23-30) 3-102.11 Package Integrity _ ( ) Y Critical and non-critical violations,which do not relate to the foodbome 12 Prevention of Contamination from Hands - 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* - ' - ( ) g illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 1.003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 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.' F. .o TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date:` C7 �01 Page of .� k$ OFFICE HOURS BARE PUBLIC 200 MAN STREET 3:30-4:30 P.M.DIVISION : 0- :30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified r � "'Ass. •� HYANNIS,MA 02601 MON.-FRI 508-862-464.4 No Reference R-Red Item, PLEASE PRINT CLEARLY A +639•n� FOOD ESTABLISHMENT INSPECTION REPORT EPORT NaiVe Date 10 l� impe o e of 1 s ection O tio a outine Address s ( Risk ood Servi ection Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness5 / Caterer General Complaint / Person in Charge(PIC) Time Bed&Breakfast HACCP ( In: Other y Inspector Out: ,; Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS. ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No F[:] 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 n_o 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 8=One critical violation-and less than non-critical violations 9 if no critical violations observed,4 too 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 9 violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view- 4 � Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's Signa a Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N . Dumpster Screen? Y N 'i' ""`� ��" p� d� 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 Crosi-contamination 14 Food or Color Additives - Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15 CoolingMethods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties - - 3-302.14 i Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F *- EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* - - 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Se azation-Storage*Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q -590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and 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 F9 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 Wazewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Contact Utensils and Food Contt 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 Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effe ctiw 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 Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#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) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands _ 3-403.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated �) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashin 9 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 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* is 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. `ap THE r TOWN OF BARNSTABLE. HEALTH INSPECTOR,s Establishment Name: Date: Page:. of 'l 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 MASS-67 `0$ HYANNIS,MA 02601 sos-sz 4644 No Reference R-Red Item PLEASE PRINT CLEARLY p'EDMP+A FOOD ESTABLISHMENT INSPE TIO REPORT Name ` p Date L Type of Type of Insection O e Routine f Address Risk od Servi Re-inspection Level etai Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspe " _1 Caterer eral Person in Charge(PIC) i Time �� Bed&Breakfast C �. In: Other Inspector Out: C r �- Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ '®^ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ �� �V ` 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 Ap ❑ 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 CW ❑ 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 (Jlinspec !� Violations Related to Good Retail Practices Blue Items) Total Number of Critical Violations (?(1c. .•- Critical(C)violations marked must be corrected immediately. (blue&red items) v` ) �'' Corrective Action Required: N � Non-critical(N)violations must be corrected immediately or Overall Rating ,�` ls�-• within 90 days as determined by the Board of Health. \ �� ❑ Voluntary Compliance ❑ Employee Restriction/ clusion ❑ Re-inspection Scheduled ❑ E cy Sus ension C N �` Official Order for Correction:Based on an Ion today,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 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. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: actor' ature 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 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 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 590.004(F) * -- EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-201.11 Separation-Storage* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* _ Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An f 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge*- Contamination from the Consumer 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 7-203.11 Toxic Containers-Prohibitions* ( ) q - 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and water From Regulated Sources 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 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-Hat Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* _ - Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service.145'F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 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* Effe cti-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* :2f-301.11-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 3-401.11(C)(3) Whole-muscle,Intsec*act Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By Clean Condition-Hands and Arms*Regulatory Authority3-401.12 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. h*W 2-301.14 When to as * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* _ 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 77 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 PH_F'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) 3-102.11 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* 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 590.000 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 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* 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 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* .'S:590Forrnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °FI H�E r°,r OWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of 4 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00=9:30A.M. BARNSTABLE. ` 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified � MASS HYANNIS,MA 02601 MON08 '-62-4 FRI'644 No Reference R-Red Item PLEASE PRINT CLEARLY A +a79•p.0 5 -8 ' M FOOD EST LISHMENT INSPECTION REPORT Name ` Da a of Type of Inspection g Rout' Address Risk o rvic e-inspectio Level nspection Telephone esl ential Kitchen Date: Mobile Pre-operation ��� Owner HACCP YIN Temporary Sus lass Caterer raI Com - Person in Charge(PIC) Ti � Bed&Breakfast H In: � Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous F d ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating t n ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling �1"f ❑ 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(li ❑ 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 8+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 . F] 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 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 9 violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspe/ctto�r'ss Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si lure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N �/ ebzccc, L- Kates 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 Crosi-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 frtern Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F EMPLOYEE HEALTH 3- __ 15 Poisonous o r Tozic Substances * - 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 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* * 7-20].11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* _ ... 590.004 11 Variance 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 Rated or 7-204.12 Chemicals for Washing of Food* Produce,Criteria* HSP HIGHLY SUSCEPTIBLE POPULATIONS 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a 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 Warewashin Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* � g- g 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 ContactEggs Utensils and Food 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* Eg crave 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* 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* 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 3-001.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 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 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite 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 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. oF1He r TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: Date:, /AM Page: of d to OFFICE HOURS UBLIC HEALTH DIVISION - 8:00-9:30 A.M. BARN LE. • 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. 16�9• a '/fAj HYANNIS,MA 02601 soe-862-asaa No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT Name Da a of Type of InsDectiori e s Rout' Address Risk P Service a-ins e n Leve a pection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) J 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 l ❑ 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 ❑ 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 1 ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 6=One critical violation and less than 4non-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and le violations non n non-critical. If If critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If i critical refrigeration. within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Ins ector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N 17 #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI s ' nature P nt: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N {� -�.� Dumpster Screen? Y N ✓✓✓ v K i <,' rr Y�+ ,` -`^ .- r _. -.y,,,.�:ftiF✓ -w.:Fy...-��t•`Y . .� - t .. .. _. _ _ 7 t IJ , Y 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 1 q 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_A[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* 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 tY g 7-102.11 Common Name-Working Containers * Require Reporting b Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 9 P g Y Applicants 3-302.11(A) Food Protection* 20 7-201.11 Separation-Storage*7-202.11 Restriction-Presence and Use Time as a Public Health Control * 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 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 ofAdulterated 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* 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* * 3-801.11(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) I 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. 18 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 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 g * E ecrive]/Irzoo] 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* ( try,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Shellfish* 3-401.11 )O P A 3 oul 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* �,. Ratites-165°F 15 sec* Sources* _ �E ing,mobile food,temporary and residential 1 o 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* I ' 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. 2-401.11 Eating,Drinking or Using Tobacco* 3.403.11 A& PHFs 165°F 15 sec* $ Receiving/Condition ., ( ) (D) 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-43.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3s103.11(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-Q3.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated B) g 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 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification g Item Good Retail Practices FC 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. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 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. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `gp THE Tp� TOWN OF BARNSTABLE .HEALTH INSPECTOR'S Establishment Name: - - Date: Page: of q OFFICE HOURS p ° PUBLIC HEALTH DIVISION 8:00-9,30 A.M. BARNS'1'ABLE. • 200 MAIN STREET 3:30-430 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MONMASS.� HYANNIS,MA 02601 8-8 -FRI.62-4644 508-8 No Reference R-Red Item PLEASE PRINT CLEARLY p +639•pie 'FDN1A` FOOD ESTABLISHMENT INSPECTION REPORT G Name Da De of Type of Inspection i Address i Risk 1 god Servi Re-inspecio ectionLevel Re-raw LV Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary S (/l Caterer General Com I ' , Person in Charge(PIC (�, ime Bed&Breakfast 1­1other iM Ar 1n: Inspector Out: had Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. 10 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 A on ❑ 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 ///III ❑ 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) J Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4(590.005 6=One critical violation and less than 4pon-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 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. w 29.Special Requirements (590.009) Y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view . 4 VIQ� Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y - N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 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 ' S90.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* Y g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* r 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage Applicants* ` 3-302.11(A) Food Protection* 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 7-203.11 Toxic Containers-Prohibitions* 590.003(G) . Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions*590.003(E) Removal of Exclusions and 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reted of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Restrictions Disposition of or or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hat Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 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 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 * Effl e6ve//t/zom 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 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 * 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 practices should be debited under J/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 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* 1 g - Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 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[0 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 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 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. i °p iME r TOWN OF BARNSTABLE . HEALTH INSPECTOR,s Establishment Name: Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARN STABLE. • 200 MAIN STREET 3:3o-a:3oP.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 0� HYANNIS,MA 02601 M - 6 soa-8 s24 No Reference R-Red Item - - PLEASE PRINT CLEARLY �saa 'FD MA+ FOOD ESTABLISHMENT INSPECTION REPORT Name 1 DateLo �eratios ection .- utine Address Risk F - spection Level Previous Inspection Telephone fa Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed 8 Breakfast HACCP �- AA In: Other �Inspector Vy� f V V /I 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) ❑ owe Td-1 It- 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 1U ❑ 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 si)/m u 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 ❑ 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 6=One critical violation and less than 4non-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Mated s (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) y P 30.Other C Inspector's Signature Print: 31.Du ster r f iewON 11 Permit Posted? N Grease Trap Previous Pu Ting Date Grease Rendered Y N #Seats Obse� Frozen'Dessert Machines: Outside Dining Y N P C Signature Print: Self Service Wait Service Provided Grease Trap Size -Variance Letter Posted Y N Dumpster Screen? Y N Violation 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 LL4 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 F 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* 7-102.11 Common Name-Working Containers* 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-201.11 Separation-Storage* 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-202.11 Restriction-Presence Applicants* 3-302.11(A) Food Protection* and Use* 20 Time as a Public Health Control 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 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer ' 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Tem eratures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* I Sanitization Temperatures* 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 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 Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved S stem* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* g 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 eceve 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* P 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially 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 foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite 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 Specialized Processing Methods* - 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oFtHe r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page_ of P` c OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. 7'ABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified BARNS MON.-FRI MASS . �p i639,6 m� HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item. PLEASE PRINT CLEARLY 'FDN1 FOOD ESTABLISHMENT INSP CTION REPORT Name Date L� e o c i Routine I Address ` C Risk ood Service ion 15 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 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 A. EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 11 ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives A- ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Fo ❑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) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(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 toda , e Items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.E Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 q )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. violation,4 to 8non-critical violations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. = 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: VVNP31.Dumpster screened from public view ermit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N 4. V ' v � #Seats Observed Frozen Dessert Machines: Outside Dining Y N PC' Signature Print: Self Service Wait Service Provided ' Grease Trap Size Variance Letter Posted Y N ; Dumpster Screen? Y N J 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.) t 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 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 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* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and 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 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS * 4-501.114 Chemical Sanitization-Temp., H. CONSUMER ADVISORY 3-202.14 Eggs and Milk Products,Pasteurized P•.P 16 Proper Cooking Temperatures for PHFs 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Bg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef ctiw 11112001 4-602.11 Clearling 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* 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 cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential Ill Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11 A 1 All Other PHFs-145°F 15 sec* Other 5,90.009 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. $ Receiving/Condition g� g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * Blue Items 23.30) 3-202.11 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbore 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°17 item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures 1 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 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. ' aTHE T TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of �o OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. STABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ` Date Verified BARN STABLE. HYANNIS, MA STREET MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �A ,e3v a.0 508-862-46" 'F0N1� FOOD ESTABLISHMENT INSP CT ON REPORT Name Dat Tvoe of iyl2e of Inspection •on Routine Address Risk ood Servi s ection _ Level e u ection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Cefj In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands / ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foo ) o� ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating LJ `1 ❑ 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 nar �- -Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: 7 Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Emplo ee Restriction/Exclusion ❑ Re-inspection Sched a ency 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. I 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. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation ttion of rodents or insects,or lack of 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 non-critical. . It critical water,sewage back-up,infestation 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. f 1 critical refrigeration. violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view4A-,)) ��5 / Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed "`Frozen Dessert Machines: Outside Dining Y N P C Signature Print- Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N J) VAN Dumpster Screen? YN 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.) Ir. 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 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 Each I 7-101.11 Identifying Information-Original Containers* 590.004(F) Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person- Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* * 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing FruitsUse 7-202.11 Restriction-Presence and 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* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Foam* 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 1 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11 A Cl Utensild Food Ctt Surfaces of *. Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* ) ean s an onac 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* Effective 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 155 Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-1 1 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- * Ratites-165°F 15 sec* in mobile food,tern or and residential Sources 10 Proper,Adequate Handwashing g' P Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 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 Requirements. radicsshould be debited under#29-Special $ 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 foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the - 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 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. i i No-f-ILY43 FEB THE COMMONWEALTH OF MASSACHUSETTS m O\v BOAR® OF HEALTH TOWN F TO O BARN TAB S LE Appliratiun for Diri.puittl Wur1w Tunutrnrtiun Frrmit Application is hereby made for a Permit to Construct ( ) or Repair (1,,j""an Individual Sewage Disposal System at: -.......- ----------------------------------------------------------------•--...._..__..._...........•. �y Locati \dd y- ,Q or Lot No. ........... _7 Pv�r Mi!1C.�_L�??!'s� �-UY4Oi.� [seer A dress -------------------- �. f •-- ---- •--••------•-----•---- -_....t •-•-•••-•--••--••----•--•-------.......•--•- Installer Address Type of Building Size Lot............................Sq. feet ,.., Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ....................._...... No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures _________________________________ W Design Flow............................................gallons per person per day. Total daily flow................................._........._gallons. R; Septic Tank—Liquid capacity------------gallons Length________________ Width................ Diameter................ Depth................ Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ ,.� Test Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit__.______-__________ Depth to ground water........................ P4 ••--•-•---- -- -------- 0 Description of Soil-••••-••-•-•-•-•-•-•Ste. ----------••------••-•••---••-------------- --------------------------•--•-•---- -----------------•-•-••----_----- U -------------- •................. -------------------------------------------------------------- -------------------------------------- -_...... _------------------------ W - --------------------------------------------------------------------------------------------- -- v= VNature of Repairs or Alterations—Answer when applicable----^.-5_ -•---------•---------------------------•-----------•----•--•-------•-•--•-----------•-•-•--...--------------------------.-.•-----------------------------------------------.........._..___--------_.._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has n tiued by the board of hea h. Signed ......................... ................. .- ...... .3 3 ................ .. ....................... Date Application Approved By ........ .. ...... Dat�...ae.:..4.-� Application Disapproved for the following reasons: .................................................................. . ..................................................... ...... ............... ........................................ . •.............. .... .......................... ...........................--- ---............... . -- -- -- ------------.--- ............. Da[e Permit No. ........ 8---..��................... Issued ....................D.. . .......... ....................... are �..r.-..-.. .-...✓'......-e^'�.:.�.�"`r-��.--, -...• `. ��„--..^—..�+.. �..r.r � -. �y-tiy..ti_ -��.n-�._..._...wr+..r�1''^^^""'vv�n.�r��-.., No..-'34A3 y�c r Fps..... ............ THE COMMONWEALTH OF MASSACHUSETTS ® �`v BOARD OF HEALTH TOWN OF BARNSTABLE \V Apphration for Diriiluual World, Tuastrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (Z,,j'*"an Individual Sewage Disposal System at: .............. ........T�T2F-•--ly�� 4�� ��... .._...... Locatioe[� Address or Lot No. '-��y u L 7 / /O��rf _ /fl.H!7C!y 1�?✓�2 -----`-"y'B-�." •.............................. o-ner A dress a �?1?Y►... _��._r ��r. --•-•---•--•--_...._ /rvcv4h "f.S .. t�t..S.trH s /�,11 --••••• ....•.......--••-•........ Installer Address UType of Building Size Lot............................Sq. feet [.. Dwelling— No. of Bedrooms-----------------------------------_--------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a4Other fixtures ---------------------------------------------------------------•-•---...-------•------- ---••----•-•-•-----••-•-•--•-•---•-•......••.....--•......... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter........:....... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0+ ........•--------------- D Description of Soil.....................,_. . V ..........••••••-••••....•••---•••••-•••-•--•-•-••--•......•--•------ - -----••---••--••-----••-•--- ------•-•.............•-......---••-•-.......-----•.....--•..............--•--•-•_..... W U Nature of Repairs or Al£erations—Answer when applicable._.__..f'h.5_4-_..........�n"8......__. .�................................... •...........................•-------•-----------•-•--------•-----------•----•-••----•--------..............----------------------------•-------------------..._...................................--•-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until-a Certificate of Compliance has b- n is.ued by the board of health. Signed .......................\ . ................e�...... ---- -----a......J7... ....3 Da[e 1 Application Approved BY -�T X�1. ------- ----..9...-3-7._,7.. t ..._-- ----.....----------------.—.......................-----......... Date Application Disapproved for the following rea.ronr: ........................ .. ........................................................................................................ ........................ ......... .............................. . . ... ...... ............... . . ---`-.. .... -- -- ....-- ......... ...................I.................... Dace Permit No. ......... ...-... Issued :. Dale ————+ —`THE COMMONWEALTH OFMASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (11'.elr#tfirate of %('LlIImylianre THIS IS TO CERTIFY, That the Individual r,ewage Disposal System constructed ( ) or Repaired ( (�) by :o h !�,44 l` ,�" InsrJlcr at ................ - ------.----- ...... ` �-x-t- ... - ----.....--------........ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......CF3..-,..�-f dated ......._.......................... _.. THE ISSUANCE OFJHIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE, SYSTEM WILL FUNCTION SATISFACTORY. r�- 1 DATE .....................��. �T----- Ic ..: _........ ...... .. ... Inspector _. . ---------.... - ................... ....�_ ,_ . -- ---- ------------r- /_ --------- _'t- -_-------•--�--_--_,---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No._/.� p -.7 Li0 3_. TOWN OF BARNSTABLE FEE.:�l')........ Uioliuiittl Work.5 Tomitr iun rrmit r Permission is hereby granted---------- .--------------------------------•--------------•-•-----•-•---------••---__...-------- to Construct ) or Repair (X" an Itt Flividual Sewage Disposal System ��, j atNo....-------- E+ .......... r•- 'l �- z - ................ Street as shown on the application for Disposal Works Construction Permit Noo....-3��--��. . Dated...9__'_.��..-'. .............. ---------- ----------------------------•----••------•-- p Board of Health DATE................. �-��------- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS , .f:). w ",..... .-.. "*t'��...wm". �.... ` , w�.rw�r _.:r.a•r an4',ieY.rw» .,.�.ro.. i.. ..aw- a...a. :W.. �� Y +n+rv,.:�. N.r�. {! y "'� � r `�. `i as .\\ } t` _ �'- t £ i •J { - � ' '` r' , 1 � l 1 oA,. 1• 1 ,1 � 1 � � 1 - Aff a .. , '` � A _ ,.y: k++ ra" A \ ,� _ _, � - ''9,•.a is ' � -,e •'1. _. .- .,. _ �..""a. ,,. r5w,m...+ .s*? -,.++•,. ,. At - lee #77- f - i .� e IL L4 Is-, Fps.. No....No....&K -XuA THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...............................................___.................................... Appliration for Dhipoiial Works Towitrurtion runfit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: - 0--�, �Dc"-4m �k 4,0� 1k,tf ,:Rya- ) 12f 9 1 '14 .V 4.V A ......... ...................................................... ............. ...... ..... .......3...................................................... 4es,-,,j,4 Location-Address or Lot No. .............. . ....................................... ..... ................................. Owner Addl'ess — 1q.6.1...... ........01� 'S............................................ ......yens� __SL...122jerp.o., S..................... Installer Address U Type of Building Size Lot............................Sq.:f&t Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) Otherfixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. P4 Septic Tank—Liquid capacity....r.......gallons Length................ Width................ Diameter.....--...--.... Depth................ Disposal Trench—No. .................... Width.................... Total Length..--................ Total leaching area..........---------sq. f t. Seepage Pit No..................... Diameter.------............. Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box ( ) . Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ,.-I Test Pit No. I................minutes per inch Depth of Test Pit.............------. Depth to ground water--..-------.-----------_ 0-� �rq Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water.-.--.-----------.-..._ tZ ............................................................................................................................................................. 0 Description of Soil........................................................................................................................................................................ x U ........................................................................................................................................................................................ .............. .......................... .................................................................................................................... ...................................................... U Nature of Repairs or Alterations—Answer when applicable....... ­&P.C.Q.r-------tznr.... ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL IL THE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..,Xr� rlg...... ....................... "Ig Date Application Approved By--------------- ---------------------- ............ ......8.1r Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo.......ce,PL -_.q.,3 k..................... IssuedL....................................................... Date o. No. 5..:.. �... Fss..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....--• ........ ............OF.........................----•---...... Appliraation for Eliipuiial Vorkfi Totes ruffian .erntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: n .Z � �C� � � L.� ICJ i� f,r'J r �%�� .�/ /e�+'P�_�' •"" � -f Location-Address or Lot No. 1 - 4,4 ..merit/ ._...- ' . ........ ...Owner ...__._.-------------------------- . '..._.....Address -- Installer Address Q Type of Building Size Lot___.--_._•-•--------------_Sq. feet V Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) ~ .............. No. of ersons_.•.._-_____-__-_-__-__----_ Showers — Cafeteria p`•'., Other—Type of Building .............. p ( ) ( ) Pa Other fixtures .............••-••------•---•--• . w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.--_____.-_---_-_-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_--_-.-.---__-_____-_... Ga., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 --•-'-•--'......................••'••...'-'-•'............'•'-'--'--......----"'--------'-'••--••--'-•-•'-'-•-'--•.._.......--•'-•......•••••---------'----- 0 Description of Soil.......................................................................................................................................................................x w UNature of Repairs or Alterations—Answer when applicable______._ _.:��_/_.__.rr. --___:�! .... A�l ---------•-•---•-------•-------------•--------•--'•------------•--------------------"-'.............._.....•'---••'••'•-•-'----•--••-"••--•--•--•--•'-••-------•••--•---••-------•-•--"-..........._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i T: y g g p y 5 of'the State Sanitary Code— The undersigned further reel not to lace the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.---f=---=-------------•-'-•.......---•--- -- --------;�-------1-----...:: Date Application Approved BY....... .. ........... Date Application Disapproved for the following reasons:-------•-----------'----------•---------'---------'-------------'-----'------••.•-•---•----''-•-...__...•....... ..........."'-'•-"•--'-----'-'--_._....-•'-'-...•'--•-•"'...•-'•'.........-•"-----_......•'-'---"'-----•'-_.........'•-----'-'----'-"•--"-"--•--------•--•--•-"'--....-----'-••-"•-••'-'-'--- Date Permit No.......K_..Y�a k--------------------- issue(L....................................................... Dste i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ?' .........OF.............. c - ti -ya✓ ..................................... %rrtifirttte aaf Tiamptianrr THIS IS T9 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (k by....................... mo.. +................. ..................................... -----'-•......................'-'--------------.................------...........•--'-..."-'----•.•'- _ Installer has been installed in accordance with the provisions of TIT E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..........F_Tly._....` ..'��d__ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................'---.......----•----........._.........-"'-•-'-------. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f' , ��` � ............ .l9`�.UGfd__........OF.......... r�............................._.. FEE....��........r.w No."' -- Disposa ork� n nr#ivit autif Permission is hereby granted ------i `'-�e.F'=".....................................-------'......--------------•........------............--'•--•--....... to Construct ( ) or Repair ()e arj, Individual Sewage Disposal System _ at No---------------`— ----�'-./------------ ''�' �� �-rf -- �- � '�7�L.c ')......... Streets^/P as shown on the application for Disposal Works Construction Permit No_________________.__ Dated.......................................... DATE-- + V' Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOWN OF BARNSTABLE LOCATION;' ;' ':' �,� �,., 1.., r SEWAGE #_SSA- y /1n , 111r114 VILLAGE 4-2 -y,<F f2 ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY ��'`"---v SC rk LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER � DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� 7 - Iii GALLO CONSTRUCTION COMPANY, INC. 9 P.O. Box 443 • 845 Sandwich Rd. Sagamore, MA 02561 v (508) 888-0346 <<' tS � May 19, 1997 �,f frvp) --��� S.K.J.G. Co., Inc. �7 Lf0 GPD Attention: Steve McCarthy co-r 254 Shore Road Unit F Bourne, MA 02532 Dear Steve: Today, I was able to look over the engineered plans for the sewer disposal system at 3821 Falmouth Road (Bldg. #4), Marstons Mills. The Town of Barnstable has no asbuilt for the original system, but has siteplan showing the septic design and general location. Also found is an asbuilt for the grease trap for the same address. Based on the above information, I would conclude that you have adequate system.for the expansion of the Dunkin Donuts at the same address. Here's the breakdown: Original Septic System for Building.#4 H-20 - 1,500 Gallon Septic Tank 11-20 - 3 Hole Distribution Box H-20 - 1,000 Gallo Leaching Pit Additional Iipuade for Building#4 1,000 Gallon Grease Trap --------------------------------------------------------------- Building size: 2,630 Square Feet Conversion frorn office space to 37 seats for fast food restaurant: 37 Seats @ 20 Gallons,Seat= 740 GPD Double Daily Flow (740 x 2) = 1,480 Gallons (Septic tank) Grease Trap 37 Seats @ 15 Gallons/Seat= 555 GPD If you have any questions regarding this matter, please do not hesitate to call us. Cordially, yn MacLean ` Title V Inspector I ✓J � J€V� No. 2ol J5 199 Fee J© THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLatlon for Disposal *pstem Construction Permit Application for a Permit to Construct(Repair( ) Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No.'39 %I "Falco_�2 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel '51—Li f3Of71 Sk-_c^ Installer's Name,Address,and Tel.No. 1 Designer's Name,Address,and Tel.No. fir Ao lo- Type of Building: C-0MM42C i A-C CF-01 7 F*01) 2es �r Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) >1 JE5 gpd Design flow provided gpd r Plan Date Number of sheets Revision Date Title Size of Septic Tank 1590JI000 Type of S.A.S. Ll--&00 C.1. mbg,1T Description of Soil Wf1 WM Am co,rs. 54 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 t of to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date A Application Approved by Date Application Disapproved by Date for the following reasons Permit No. an�s — 19( Date Issued MIA i I� l��s�c yr 2n�` _UQ No. /.�GOI}� �99 Fee �Q ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer-, g PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS �Yes 4 Application for 1k5pos &*pstem Construction 3permit Application for a Permit to C struct( epair( ) Upgrade O Abandon( ) ❑Complete System ' ❑Individual Components Location Address or Lot No."3$1 i Owner's Name,Address,and Tel.No. Assessor's Map/Parcel rj - 'Ll 19orn Stn A Installer's Name,Address,and Tel.No. 5bV--- 7"7 ` - Designer's Name,Address,and Tel.No. Type of Building: COMrA5 rZC/n-ir CF fM 7 J/) 12es ,rrc..r �..+� Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) W Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 5 gpd Design flow provided 41 /S, -7 gpd Plan -Date_6p hA /,G Number of sheets 1 Revision Date Title Size of Septic Tank I1;001ttw Type of S.A.S; '`1 _&07 60(a,.t Description of Soil Mgr (JAA 5AJ r Nature of Repairs or Alterations(Answer when applicable) Date last inspected: I 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 Cod of to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. a Signed Date Application Approved by Date (U Application Disapproved by Date for the following reasons Permit No. 2 01 rj - 19 Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(-�`Repaired( ) Upgraded( ) Abandoned( )by h� &)r' 104 l t 4y --,- W CCU rJ S;Z-. at ,1311 C%a n.,7utln 06 M•M-(S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoZ/sj 199 dated 61 25�� Installer �� Le -. o Ir Designer L- eC/ #bedrooms i is.Se 1_ ;;s,,'A R,-_,aa,w .L- Approved design flow gpd The issuance of this permit phall not be construed as a guarantee that the system -fanr� n as •esigne . Date �/ `�`� - Inspector - _ . I No. 2 D!• -) _' S q Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Vermit Permission is hereby granted to Construct( t2_- Repair( ) Upgrade( ) Abandon( ) System located at 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 be completed within three years of the date of this permit. Date G�z.S` �s' Approved bye " I JUL-30-2015 2 .'02 From: To:15087906304 Pa9e:1,11 07/36/2015 09:55 5082730367 44139 P. 001/001 Town of Barnstable Regulatory Services Thomas F.Geller,Director B" Public Health Division i63¢ Thomas McKean,Director 2,00 Main Street, Hyannis,MA 02601 office: 508-862-4644 Fix: 508-790-6304 Date: 22-1 Sewage permit#a—AIE-14 Assessor's Map/Parcel 151 A, Instift-tr&Designer Certification F rm Designer. TC Installer: 60c kO l8 kki C003�(Uou' ajj Address: 2$Sy Gcanbp ry Wi hW6V Address: UX 70 y EAS{ ticJatt ham }tA D2�3$ }bars 5 V M S r R k G 16 Y 8 r On 4 t Ar khtt issued a permit to itl Wl a (date) (installer) septic system at 3 6 21 fafom th M, Ft"zw*z. D'-,�se d on a design drawn by (address) SC � trlee.c ink , Z11 G, dated fo-2-1 1 Mu,2: (designer) V I certify that the septic system referenced above was installed substantlauy according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. 1 certify that the septic system referenced above was installed with major changes (i.e, greater than 1 D' lateral relocation of the SAS or any vertical relocation of any component of the septic s t in accordance with Stag&Local Regulations. Plan revision or certified uilt b esigner to follow. Stripout(if required was inspected and the soils wer and saris etory. T�I.'S.,QF _. CH � (Installer'sSignature) W G signer's :gnafBARNST ZLTH p ere) PLEASE RETURNTAB UBLIC DIVISIQN. CERTIFICATE F COMPLIANCE WILL NU ISSUED UNTnIL BOTH S )F'O AND AS. BUILT CARD ARE RFCEIVFJD BY THE BARNS ABLE P C A T11 DIVISION. JHANK YOU. gAolrice(bmMdasigz=r4c%Uan rerm.doc Doc:,.-1 :272 s 2SO 06=-24-2015 2 a 01 BARNSTABLE LAND COURT REGISTRY Cl - ifeocta F' ra.,V �•, yes` cJtat&.%&eael; ✓Jo-&gw, ✓0G�CfLG/&a 091S y r ,a* William Francis Galvin Secretary of the Commonwealth June 18,2015 TO WHOM IT MAY CONCERN: I hereby certify that a certificate of organization of a Limited Liability Company was filed in this office by WINDMILL SQUARE,LLC in accordance with the provisions of Massachusetts General Laws Chapter 156C on December 23, 2008. I further certify that said Limited Liability Company has filed all annual reports due and paid all fees with respect to such reports;that said Limited Liability Company has not filed a certificate of cancellation or withdrawal; and that said Limited Liability Company is in good standing with this office. I also certify that the names of all managers listed in the most recent filing are: HOLLY MANAGEMENT AND SUPPLY CORPORATION I further certify,the names of all persons authorized to execute documents filed with this office and listed in the most recent filing are: HOLLY MANAGEMENT AND SUPPLY CORPORATION, STUART A BORNSTEIN The names of all persons authorized to act with respect to real property listed in the most recent filing are: STUART A. BORNSTEIN In testimony of which, I have hereunto affixed the Great Seal of the Commonwealth on the date first above written. Secretary of the Commonwealth Processed By:tpg "ate � L cci N REGISTRY O!DEEDS BARNSTABLE REGISTRY OF DEEDS <sR COPY,ATTEST John F, Meade, Register JOHN F.MEAD!,REGISTER LAND COURT,B Dor:1 r 272 s 261 06-24-201 S 2:Q 1 xi9tT�d will will be be The Lend herein de shown on our approved pph to follow as BARNSTABLE LAND COURT REGISTRY R t�e�r To JUN 2 12015 Plan Lot . 1EXAMINEo AS DESCRIPTION ONLY) .DEED RESTRICTION T.C. PONTBRWND WIN* ( 76) WHEREAS,WINDMILL SQUARE, LLC,a Massachusetts limited liability company (successor-in-interest by merger with Windmill Square Limited Partnership),having an address of 297 North Street,Hyannis, Massachusetts, is the owner of Windmill Square,3821 Falmouth i Road(Route 28), in Marston Mills, MA and being shown as Lot 1 and Remaining Land on Land Court Plan 15069-B;and WHEREAS,the Town of Barnstable Board of Health,as a pre-condition to granting a subsurface sanitary sewage disposal works construction permit for a septic system in compliance with 310 CMR 15.200,State Environmental Code,Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage,is requiring that the grant of a restriction limiting the combined wastewater discharge flow on Lot 1 and Remaining Land on Land Court Plan 15069-B to 2,645 gallons per day be put on record with the Barnstable County Registry of Deeds,Land Registration District, by recording this restriction;and WHEREAS,WINDMILL SQUARE,LLC, as the owner of said lots has agreed with the Town of Barnstable Board of Health to grant this restriction limiting the maximum wastewater discharge of Lot 1 to 415 gallons per day and the maximum wastewater discharge for Remaining Land be restricted to 2,230 gallons per day for a total of 2,645 gallons per day as a pre-condition to obtaining a disposal works construction permit for the property in compliance with 310 CMR 15.00 State Environmental Code,Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. NOW,,THEREFORE,WINDMILL SQUARE,LLC does hereby place the following restrictions on the above-referenced land in accordance with its agreement with the Town of Barnstable Board of Health. 1. The maximum wastewater discharge for Lot 1 on Land Court Plan 15069-B is restricted to 415 gallons pet day. 2. The maximum wastewater discharge for Remaining Land on Land Court Plan 15069-B is restricted to 2,230 gallons per day. 3. Except for an anticipated subdivision to assign a lot number to the land shown as Remaining Land on Land Court Plan 15069-B,no further subdivision or re-subdivision of the land shall be made by WINDMILL SQUARE,LLC,its successors or assigns,without the express written approval of the Board of Health recorded in said registry district. 20140272 restriction i WINDMILL SQUARE,LLC,further agrees that this restriction shall be a permanent deed restriction affecting Lot 1 and Remaining Land as shown on Land Court Plan 15069- B and shall.run with the land and be binding upon all successors in title and have independent legal significance;provided,however,that if it is determined that this restriction is not permanent and limited to a term of thirty(30)years,the Town may unilaterally re-record this restriction to extend the protections provided herein for an additional twenty(20)years;and provided further that such re-recording shall occur prior to the expiration of thirty(30)yearns from the date of the recording of this document The parties intend,and agree,that the foregoing restrictions be and are imposed for the benefit of the-parties and the Board of Health and are enforceable by the parties and the Board of Health and cannot be amended or released without the prior written consent of the Town of Bamstable Board of Health.. For Title of WINDMILL SQUARE,LLC,see Deed filed with the Barnstable Registry District of the Land Court as Document No. 643,048,Certificate of Title No. 137678. Property Address: Windmill Square Plaza,Route 28,Marstons Mills,MA Executed as a sealed instrument this d4j day of \ n )2015. WINDMILL S ARE, LLC By: = tuai . Bornstein,General Manager COMMONWEALTH OF MASSACHUSETTS Barnstable,ss. On this day of �.�+.�- ,2015, before me,the undersigned notary public, personally appeared Stuart A. Bornstein, and proved to me through satisfactory evidence of identification,which was a MA driver's license,to be the person whose name is signed on the preceding or attached document, and acknowledged to me that it was his free act and deed and that he signed it for its stated purpose,as the General pager of Win it Square,LLC. PubIic:�Toh,,, Al, y commission expires: - 20140272 restrictionREGISTRY OF DES _ A�bIf�YA�L�6`�GliV'P'6' � .J . �`"`` � .i., • .••'.:::;r:': A TRUE COPY,AT EST BARNSTABLE REGISTRY OF DEEDS >` John F. Meade, Register JOHN F.MEADE,REGISTER � ro� •'-,�`+`,Via, :�3 0�15/201S24 5082730387 94051 P. 002/011 LETTER OF TRANSMITTAL xC Engineering Inc. Civil&Environmental Services 2854 Cranberry Highway Telephone: 508-273.0371 E.WartbaA MA 02538 Facsimile; 508-273-0367 TO: Salvi Couto DATE: 01109115 30B NO, 5I2-B Couto Management Group,LLC RE: Septic plan V.1 &Site Plan .2 169 Main Street 3.821 Falmouth Road Stoneham,MA 02190 Marstoas Mills.MA WE ARE SENDING YOU: X Enclose �Under separate cover via X the following: Rcpmt _Prints —Brochures _Shop Drawings Specifications Copy of Letter _Change order Forms As Le queste see attached ten(10)Seot'c PT 1�lsig[Led and st=W)that were approved by the Board of Health on 12-9-14 a BaH checklist.a Soil S itabilk Foam and six(6)Site Plans[signed and s=Rgd) for your use. TBESE ARE TRANSM rMD as checked below: For Approval Resubmit Copies for Approval K For Your Use' Approve as Noted Copies for Distribution —As Requested Returned Approved as Submitted Returned For Review and Comment For Your Wormatiaa REMARKS Should you have any questions,please fael free to contact our ofFice. Thanks, COPY TO; File SIGNED: Michael Pirfient6l, E=.I.T. 4� 0 Ci Ic CEIIHT C e I CEILING uIO . I� 1' 4 HEIGNi ® I ♦♦ 1x'-4 STORAGE N V m� HE ENT PREP _® Q W$J� _ y OFFICE Yy nl s 1 �CE.U. AREAJ; N"g'.� I I HE GHT tl a 7.-5. E9 x W = -. I I i 3=x ..11 PREP AREA I a - • ElFunaip1 � o I TpllE� a N xNlYf ______ __ ___ _ CE GNT I� -_�+ HEIGHT .® •®••®• ❑ 3/I \ T ' I FREEZER CEILING I 1^' ; I� �~ a s EIGHT COOLER 7'-5- I moNn • C9. dxn' SERVICE AREA D DRIVE �o .o9a':iloN CEILING I I THRU EIGHT I CEIIINO I e'-9- E HT CEILING O p g I N HEIGHT ,ACCE51®LE I 7•I11• T 5 tneslxooil I II i. II O CD om I e$■ F N i "'-Ir-- —ll a :1lCEG5I0LE l yi F 1 I i H ncN.rmuE REST0.00 ----- ------- E I SALES AREA CEILING �E aw°r Its iL41s) EIGHT ``�1 ll%/ PO�B 8-g fRAN91i rbR - iM � illE ION IttP.I ------- --- ------- „TO MATCH PV I I I ; CEILING EX STINO V' 1 y a CEILING HEIGHT O HEIGHT I a I =J Y a. CEILING I HEIGHT I ) S o EIGHT 1 T'-S. 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Q�� 11 �� ,au :i:: • �j i� o ncl ncl o ucl lla ucr ucl ncl ncl ■ ru, nG, p I, I I nu nll I%11171UI=lilllli■ll�llrlilUl�,RA „G, I■\„I V ■� I`:,I - 11 t I+ Old lll'J lti/rl G„rG,RI rll• RA BIN ■ ,■c, ■� �i i II° �!J 1�1=1 1= III; _�:� ICI I—I �i i�fl 1,11�■t�l� � I �� � • c3'� LAND COURT,BOSTON.The Land Doc e 1 9 272,261 06-24--201 S 2=01 _- herein deacrlbud will be shown on our approved ppn to follow as BARNSTABLE LAND COURT REGISTRY Rr�a�r To JUN 212015 Plan ��S�D(o9 Lot 'EXAMINED AS DESCRIPTION ONLY) DEED RESTRICTION T.C. PONTBRIAND . A&M100 CHIEF ENGINEER(7-J6) WHEREAS,WINDMILL SQUARE,LLC,a Massachusetts limited liability company (successor-in-interest by merger with Windmill Square Limited Partnership),having an address of 297 North Street,Hyannis,Massachusetts,is the owner of Windmill Square,3821 Falmouth Road(Route 28), in Marston Mills,MA and being shown as Lot 1 and Remaining Land on Land Court Plan 15069-B;and WHEREAS,the Town of Barnstable Board of Health,as a pre-condition to granting a subsurface sanitary sewage disposal works construction permit for a septic system in compliance with 310 CMR 1S.200,State Environmental Code,Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage,is requiring that the grant of a restriction limiting the combined wastewater discharge flow on Lot 1 and Remaining Land on Land Court Plan 15069-B to 2,645 gallons per day be put on record with the Barnstable County Registry of Deeds,Land Registration District, by recording this restriction;and WHEREAS,WINDMILL SQUARE,LLC,as the owner of said lots has agreed with the Town of Barnstable Board of Health to grant this restriction limiting the maximum wastewater discharge of Lot 1 to 415 gallons per day and the maximum wastewater discharge for Remaining Land be restricted to 2,230 gallons per day for a total of 2,645 gallons per day as a pre-condition to obtaining a disposal works construction permit for the property in compliance with 310 CMR 15.00 State Environmental Code,Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. NOW,THEREFORE,WINDMILL SQUARE,LLC does hereby place the following restrictions on the above-referenced land in accordance with its agreement with the Town of Barnstable Board of Health. 1. The maximum wastewater discharge for Lot 1 on Land Court Plan 15069-B is restricted to 415 gallons per day. 2. The maximum wastewater discharge for Remaining Land on Land Court Plan 15069-B is restricted to 2,230 gallons per day. 3. Except for an anticipated subdivision to assign a lot number to the land shown as Remaining Land on Land Court Plan 15069-B,no further subdivision or re-subdivision of the land shall be made by WINDMILL SQUARE,LLC,its successors or assigns,without the express written approval of the Board of Health recorded in said registry district. 20140272 restriction i WINDMILL SQUARE,LLC,further agrees that this restriction shall be a permanent deed restriction affecting Lot 1 and Remaining Land as shown on Land Court Plan 15069- B and shall.run with the land and be binding upon all successors in title and have independent legal significance;provided,however,that if it is determined that this restriction is not permanent and limited to a term of thirty(30)years,the Town may unilaterally re-record this restriction to extend the protections provided herein for an additional twenty(20) years;and provided further that such re-recording shall occur prior to the expiration of thirty(30)yearns from the date of the recording of this document. The parties intend,and agree,that the foregoing restrictions be and are imposed for the benefit of the-parties and the Board of Health and are enforceable by the parties and the Board of Health and cannot be amended or released without the prior written consent of the Town of Barnstable Board of Health.. For Title of WINDMILL SQUARE,LLC, see Deed filed with the Barnstable Registry District of the Land Court as Document No. 643,048,Certificate of Title No. 137678. Property Address: Windmill Square Plaza,Route 28,Marstons Mills,MA Executed as a sealed instrument this day of n ,2015. WINDMILLS ARE,LLC By: tuar A. Bornstein,General Manager COMMONWEALTH OF MASSACHUSETTS Barnstable,ss. On this day of ���- ,2015,before me,the undersigned notary public, personally appeared Stuart A. Bornstein,and proved to me through satisfactory evidence of identification,which was a MA driver's license,to be the person whose name is signed on the preceding or attached document, and acknowledged to me that it was his free act and deed and that he signed it for its stated purpose,as the General ager of Win it Square,LLC. ry y commission expires: 20140272 restriction_ '``'y 4V• �`~ ' [3i�Pel�1't'8�L �i�1.13VY'd �' . .1 t•"', . ,^� c•:'x'.;='? TRY OF DEEDS ATRU COPY,ATTEST BARNSTABLE REGISTRY OF DEEDS John F. Meade' Register JOHN F.MEADE,REGISTER LAND COURT,B The Land Dar.-herein deseribtsd will Dar.-_1 9 272 s 261 tpE►-24-2O11 S 2:4I will be be Shown on our approved plan to follow as BARNSTABLE LAND COURT REGISTRY Rrferrevr ro JUN 2 12015 9 Plan i� at rEXAMINED AS DESCRIPTION N ONLY) DEED RESTRICTION � T.C. PONTBFMANp A6i MOCHIEF ENGINEER(776) WHEREAS,WINDMILL SQUARE, LLC,a Massachusetts limited liability company (successor-in-interest by merger with Windmill Square Limited Partnership),having an address of 297 North Street,Hyannis, Massachusetts, is the owner of Windmill Square,3821 Falmouth Road(Route 28), in Marstons Mills, MA and being shown as Lot 1 and Remaining Land on Land Court Plan 15069-B;and WHEREAS,the Town of Barnstable Board of Health,as a pre-condition to granting a subsurface sanitary sewage disposal works construction permit for a septic system in compliance with 310 CMR 15.200,State Environmental Code,Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage,is requiring that the grant of a restriction limiting the combined wastewater discharge flow on Lot 1 and Remaining Land on Land Court Plan 15069-B to 2,645 gallons per day be put on record with the Barnstable County Registry of Deeds,Land Registration District, by recording this restriction;and WHEREAS,WINDMILL SQUARE, LLC,as the owner of said lots has agreed with the Town of Barnstable Board of Health to grant this restriction limiting the maximum wastewater discharge of Lot 1 to 415 gallons per day and the maximum wastewater discharge for Remaining Land be restricted to 2,230 gallons per day for a total of 2,645 gallons per day as a pre-condition to obtaining a disposal works construction permit for the property in compliance with 310 CMR 15.00 State Environmental Code,Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. NOW,THEREFORE,WINDMILL SQUARE, LLC does hereby place the following restrictions on the above-referenced land in accordance with its agreement with the Town of Barnstable Board of Health. 1. The maximum wastewater discharge for Lot 1 on Land Court Plan 15069-B is restricted to 415 gallons per day. 2. The maximum wastewater discharge for Remaining Land on Land Court Plan 15069-B is restricted to 2,230 gallons per day. 3. Except for an anticipated subdivision to assign a lot number to the land shown as Remaining Land on Land Court Plan 15069-B,no further subdivision or re-subdivision of the land shall be made by WINDMILL SQUARE,LLC,its successors or assigns,without the express written approval of the Board of Health recorded in said registry district. 20140272 restriction i WE*4DMILL SQUARE,LLC,further agrees that this restriction shall be a permanent deed restriction affecting Lot 1 and Remaining Land as shown on Land Court Plan 15069- B and shall.run with the land and be binding upon all successors in title and have independent legal significance;provided,however,that if it is determined that this restriction is not permanent and limited to a term of thirty(30)years,the Town may unilaterally re-record this restriction to extend the protections provided herein for an additional twenty(20)years;and provided further that such re-recording shall occur prior to the expiration of thirty(30)yearns from the date of the recording of this document, The parties intend,and agree,that the foregoing restrictions be and are imposed for the benefit of the--parties and the Board of Health and are enforceable by the parties and the Board of Health and cannot be amended or released without the prior written consent of the Town of Barnstable Board of Health.. For Title of WINDMILL SQUARE,LLC,see Deed filed with the Barnstable Registry District of the Land Court as Document No. 643,048, Certificate of Title No. 137678. Property Address: Windmill Square Plaza,Route 28,Marstons Mills,MA Executed as a sealed instrument this dq day of V---nt,A,'q— ,2015. WINDMILL S ARE,LLC By: tuar A. Bornstein,General Manager COMMONWEALTH OF MASSACHUSETTS Barnstable,ss. On this-CZ!!�day of_ :A A - ,2015,before me,the undersigned notary public, personally appeared Stuart A.Bornstein,and proved to me through satisfactory evidence of identification,which was a MA driver's license,to be the person whose name is signed on the preceding or attached document, and acknowledged to me that it was his free act and deed and that he signed it for its stated purpose,as the General alter of Win it Square,LLC. y Public:C9h,,, Al, (;y commission expires: r 20140272 restriction BARNLta1�REGISTRY LMEEDS A TRUE COPY,ATTEST BARNSTABLE REGISTRY OF DEEDS John F. Meade, Register � � - ,- JOHN F.MEADE,REGISTER ',uMlb4 0;Mpd>l to(1)aua ;tig aQ> KI txupae ta�ft0�al4 gg OII;eag}sn�u a0,f'pttu�aes jo AOt [lid►[mur ma aq 03 gl m aoB>av=d A,** "md-oa vH O,L'► a um ljupi iO o °MIC+Atm+N%mod vini'llo --Py WA)PVNNS'#fmlL1MPWV ~'WMMiff data 'snenr�oeyAut9mro�dNs 7 z 7 v�otr1 qug —5�'4 ""'6v:►I +ao� ="^`Wfr«m oml L wv5�j;1 war M-11 0 OutLL VmmA MW p DIM +_romp �" !! 01 xl•r!b a I=NdLLVPIOOUd Imo[ysfMpu p.;Y�`a V fpv tWW tloM t "_Mm end — N ifa6A.x�q - -Jin a OnE__ l aN1m �0> M o7 R1AeQ •Wo eq P14"m 1 &-- �4'I PtlC�VY VIA 19OIR,•ZVNOBV�S 2I a�tOLLvbmmn ' � q�9-�1 L ,■gen�onmp$gIH tnno►as D "vim=480*m "`�laF#a1+�feM s�v�exP�Dw p r �, �oardog of yJdvq � �,� t�l�to�1 P rnuy i.= 9.2 , I veld av?VW"'79S JMP0 aun +dbM�i,wd _ iL—�IIvM•mInMB �—m+MteAt�t4E�.1 ->a�`""�+91v1�'I�d �3EQ �.."• �8 ftb)�d� n�„�.7,ns � •�ftP'�. NOU;)ftUW=AMN �c+r4aeY�art F'o-o"a oo/ r S nM'�f ,�S SON L bL' �vDv -.W" ' e!'���'�1?S'r31'vQNtr�'1.unHr,r�anp C'��°�Z}, �ea�ppynepm� KOLLVMOAM W V KOLLV3(n Ao klWOS.Iof;uqwssaysv ns nos d egla araQt7 - i'`opm v� ins�rovuos , ffl LLOIEOO d l�Ob# L9EOEZZ809 bZ:80 9LOZ/93/80 06/25I2015 68 U730367 #4051 P. 0041011 tusaw !t3`frs1b g r32 G -CS 2: Y`/v DM OBSERVATION WEL'I LOG Bole# rho (tie-? Sop HA= Sop Taman soil solar sop OTW MOM (14MU4) atotetn tsh+EwM ste M v4Q ta. D=P0BMVAn0NH0LELOG Hale# Depth tom' so lter W &M TC" gem Color Soft Ode ' 91u1Sam Qn.} tUgT)Aa (aa�tti Adatahtg {8suetme,smna,!)aatdeal. DFMP OBSERVATXON ROLL,LOG Hale# Qepth flak w Aadma Sap Tcan rdI Color Sate other 8srmee¢a) (UPDA) ltdt+peeStl Motgteg tpa MM So";Sc I&L a Yttaod IL"Ma Ball Mew AhovsSOoyesr}Itla4boettd4ty Ne— •Ya:� � - • Wtmfi 50e you bomAly No!f Yee VAO&too*fowl bm t lwy Nam Yer� Nat of Neturgly g2wft Pervious Motertai Ueta at least tour feat ttateallY occtastng porvlatm Mitts iat exlat is ett Areas obscrvod thmshout the • atrapioposadfartl►e•eoilt�aotpttbn:+yatnm? Y?�— . If not,what to the depth of twa y oxudn Pervious materialf 0 I 16-y7-41(lope)I bave p om the gait ovduoc ctutolmdon approved by pie I)paruurut of RvtmMcntsl Protodou MW that to&m saf ysis was pwftmW by ttw cOAdstettt whh the regtdred bab big,exportiaa d dmliw in Ila M.15.017. - SignaCut: gvana+ottsH.raoc f; 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3821 Falmouth Road (Route 28) -Unit 11 - Former Bank Property Address Windmill Square Limited Partnership Owner Owner's Name information is required for every Marstons Mills MA 02648 October 2, 2014 page. City/Town 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:When filling out forms A. General Information on the computer, use only the tab key to move your 1. Inspector: �pHN L. `�� cursor-do not John L. Churchill Jr., PE, PLS, CSE � CHU HILL JR. co 01- use the return Name of Inspector 1 key. JC Engineering, Inc. \ NO 4 rm Company Name S _ �v 2854 Cranberry Highway - -! Company Address �7 �fBn East Wareham MA 02538 City/Town State Zip Code 508-273-0377 PE#41807 SI 48 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority October 3, 2014 Inspector's Signature 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•3/13 Title JOfficial cti Form:Subsurface Sewage Disposal System-Page 1 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 3821 Falmouth Road (Route 28) - Unit 11 - Former Bank Property Address Windmill Square Limited Partnership Owner Owner's Name information is required for every Marstons Mills MA 02648 October 2, 2014 page. City/Town 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: ® I 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: B) 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. j `A matal 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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3821 Falmouth Road (Route 28) - Unit 11 - Former Bank Property Address Windmill Square Limited Partnership Owner Owner's Name information is required for every Marstons Mills MA 02648 October 2, 2014 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 3821 Falmouth Road (Route 28) - Unit 11 -Former Bank Property Address Windmill Square Limited Partnership Owner Owner's Name information is required for every Marstons Mills MA 02648 October 2, 2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) - 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: i D) System Failure Criteria Applicable to All Systems: You must indicate "Yes or"No" to each of the following for all inspections: Yes No ❑ 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® 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 Y day flow t5ins•3/13 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 3821 Falmouth Road (Route 28) - Unit 11 - Former Bank Property Address Windmill Square Limited Partnership Owner Owner's Name information is required for every Marstons Mills MA 02648 October 2, 2014 page. City/Town State Zip Code Date of Inspection B. Certification (cost.) 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 Tess 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 than 5 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. I 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 Forth: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 3821 Falmouth Road (Route 28) -Unit 11 -Former Bank Property Address Windmill Square Limited Partnership Owner Owner's Name information is required for every Marstons Mills MA 02648 October 2, 2014 page. CityrFown 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? ❑ ® 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. ® El approximation 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): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 3821 Falmouth Road (Route 28)-Unit 11 - Former Bank Property Address Windmill Square Limited Partnership Owner Owner's Name information is required for every Marstons Mills MA 02648 October 2, 2014 page. City/Town State Zip Code Date of Inspection D. System Information Description: t Number of current residents: 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 Seasonaluse? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Former Bank Design flow(based on 310 CMR 15.203): 450 GPD Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): (6,000 S.F./1,000 S.F.) x 75 GPD 450 GPD 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: 2012: 66 GPD, 2013: 107 GPD t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3821 Falmouth Road (Route 28) - Unit 11 - Former Bank Property Address Windmill Square Limited Partnership Owner Owner's Name information is required for every Marstons Mills MA 02648 October 2, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Unknown Date Other(describe below): General Information Pumping Records: Source of information: Owner 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) ❑ 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): One (1) 1,500 gallon septic tank to one (1)6-ft diameter leaching pit. t5ins-3113 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System-Page 8 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3821 Falmouth Road (Route 28)-Unit 11 -Former Bank Property Address Windmill Square Limited Partnership Owner Owner's Name information is required for every Marstons Mills MA 02648 October 2, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Unknown 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: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: Approx. 12" p g 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: Approx. 10'x 6.25' (1,500 gal.) 6 Sludge depth: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of`Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3821 Falmouth Road (Route 28) - Unit 11 - Former Bank Property Address Windmill Square Limited Partnership Owner Owners Name information is required for every Marstons Mills MA 02648 October 2, 2014 page. City/Town 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 24" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? In field Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.) Pumping should be-conducted every 2 years; inlet tee appeared to be in good condition; tee on outlet pipe not measured due to being below pavement. (sludge, scum and tee measurements taken at inlet);top of liquid in tank appeared to be below invert of inlet comparable to indicate a fully functional outlet/septic tank; no evidence of leakage was detected. Top of tank was measured to be approximately 12 inches below grade; recommend installation of outlet riser to be brought to grade. Inlet riser currently at grade. 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 Commonwealth of Massachusetts v Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3821 Falmouth Road (Route 28) - Unit 11 - Former Bank Property Address Windmill Square Limited Partnership Owner Owner's Name information is required for every Marstons Mills MA 02648 October 2, 2014 page. City/Town 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 r Commonwealth of Massachusetts Title 5 official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3821 Falmouth Road (Route 28) - Unit 11 - Former Bank Property Address Windmill Square Limited Partnership Owner Owner's Name information is required for every Marstons Mills MA 02648 October 2, 2014 page. City/Town 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 N/A 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.): No D-box 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: One 6' dia. leaching pit t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3821 Falmouth Road (Route 28)- Unit 11 -Former Bank Property Address Windmill Square Limited Partnership Owner Owner's Name information is required foc every Marstons Mills MA 02648 October 2, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: One (1) 6'dia. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: 9 ❑ innovative/alternative system I Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No signs of hydraulic failure. Bottom of leaching pit appeared to be dry (i.e. no standing liquid). 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 _ 1 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3821 Falmouth Road (Route 28)-,Unit 11 -Former Bank Property Address Windmill Square Limited Partnership Owner Owner's Name information is required for every Marstons Mills MA 02648 October 2, 2014 page. City/Town 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 Ia 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 3821 Falmouth Road (Route 28) - Unit 11 - Former Bank Property Address. Windmill Square Limited Partnership Owner Owner's Name information is required for every Marstons Mills MA 02648 October 2, 2014 page. City/Town 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 [� S{ i' r i D-Lr-AC-H1rJG I 1 C f'' i:vi K.. �Q�_L [3 i C- .1 1 PL IC. 2-I$ (Sins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 3821 Falmouth Road (Route 28) - Unit 11 -Former Bank Property Address Windmill Square Limited Partnership Owner Owner's Name information is Marstons Mills MA 02648 October 2, 2014 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells > 5 feet below bottom of leaching pit Estimated depth to high ground water: 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: October 2, 2014 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board bf Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Compared site elevation with surrounding water bodies elevations. You must describe how you established the high groundwater elevation: The property elevation is approximately at 71' M.S.L. and the groundwater elevation is<59' M.S.L. based on the test pit data observed on September 14, 2014 and referenced on "Proposed Site Plan Prepared for: Couto Management Group, LLC, Located at: 3821 Falmouth Road, Marstons Mills, MA 02648, Prepared by: JC Engineering, Inc. 2854 Cranberry Highway, East Wareham, MA 02538." Dated October 2, 2013. 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 - h Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3821 Falmouth Road (Route 28)-Unit 11 - Former Bank Property Address Windmill Square Limited Partnership Owner Owner's Name information is. required for every Marstons Mills MA 02648 October 2, 2014 page. City/Town 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 I No.-V Fee- - - BOARD OF HEALTH m� TOWN OF BARNSTABLE Application-*rlell Congtruct ion Permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (X)an individual Well at: Location — Address Assessors Map and Parcel Oli.q M L° ( E A,� (tr/tv ✓ a1 l LL S _Cl�l✓� ----------- ------------ -------- --------------------------------------------------------j------ --------------------------------------------------- - - ---- Owner Addres$ — iG.Pr�c o . �}Tt.�-r�►T-_c, taJ �L �Re.c c luu�— ze, 7� 3 S-' RA Md4 Installer Driller Address Type of Building Dwelling--------------------------------------------------------------- Other - Type of Building-`r-�'l q'`iT[�VV---Lr��s� No. of Persons------------------------------------------ -- 0 l� Type of Well ------------------- Capacity-- �� -`-------------------- -— — Purpose of Well------- EN------------ - Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed - - ------ T date Application Approved By--__�`1 V -- -- • --------------- date Application Disapproved for the following reasons:----------------------------------------------------------------------------------------- -------------- date Permit No. Issued ---- -- - - ----------------------- date yy t a �... 'w+ .•yam•s� .r�•.:�,.l-r++�TL tKiKYf1M`s�e'�'^PY7►1.x+hM"yS'"\y' '� .^.:�;�„'�').r�✓-e.,n._:.:;:`A`=h+,..r"�;M..Y"'.,yer�^�v'�T':�yw"wo.e'..AY.A",:f•.'ww��t'"laq'."fit ryrt} ♦.-. 1N 62___� _ .,:, Fee- --- -�------._...-- No.= -- - BOARD OF HEALTH TOWN OF BARNSTABLE Application or'Vell Cow6tructionVermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ()e)an individual Well at: ► e n/ Location — Address Assessors Map and Parcel Owner Addres il 4r4ty T L C, wt I-L 400 c,cr� X tc , 7q 3 �c�P►� M.4 0 . ------------------------- - ------- ------- '- --------- - - r - - Installer Address Type of Building F t Dwelling------------------------------------------------------------------ Other - Type of Building-+rr19i4TtaVV--_--- No. of Persons--------------------------- &L --------------J----- • - Type:_of Well- - ---n� = -- --- - - p Ca acity- d ��-ril- Purpose of Well — R 1.14 r--i�N - ------ --- - - - ---- Agreement: The undersigned agrees.to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed----_--- - -- -- ------ - - date Application Approved By—_-_�\ V --- -- -— —�� - T date Application Disapproved for the following reasons:---------------------—-------------------------- ------- - -- --- ----------------------- -- ----------------------------------------------------------------------------—---- - p date Permit No. -- � S� —-- ----------- Issued ---- �3da� �----------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE �ertif irate ®f �Com�iiance THIS IS TO CERTIFY, That the Individual Well Constructed (vT, Altered ( ), or Repaired ( ) by---------- --------------------------------------------------------------------------------------------------------------------------------------- Installer � f at-------- � � - - —- — — .�=�''=`' �l� t-(I- - - --------------------- has been installed in accordance with the provisions of the Town of Barnstable Board'of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -1- --= - Dated - -�16. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- ---- —---- — - ---- — -- Inspector----------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Ivell Con5tructionj3ermit ,. . No. )- -- Permission is hereby granted--- — - ---------------------—--------------------------------------- to Construct , Alter ( ), or Repair ( ) an Individual Well at: No. - ---- —V- - --r---------------------------------------------------------------------------------------------------------- Street as shown on the application for a Well Construction Permit CDP No. - — — ---------------------------------- Dated------------ ------ ---0-- u -----------------------—- - -------------- ------ ------- DATE . .......-- oard of Health ---�_�—�-!_�2------ ----- i BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO C RTIFY, That the Individual Well Constructed (,k�, Altered ( ), or Repaired ( ) bY----------- --------------------------------------------------------------------------------- -------------------------------------------- Installer Y----------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Bol f Health Private Well Protection Regulation as described in the application for Well Construction Permit No. 1 --= Dated �Ic THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- ---—------- - -- —- Inspector-----------------------------------------——- ----------- ,x. OWN CLERK Noy ................ ....... u,1RhlST�+BLE. MASS. Facs........................... 'U���i THE COMMONWEALTH OF MASSACHUSETTS AUG z1 ,� E J6dl OF HEALTH 3� v� Town Barnstable :D OF.................................... ................................................... 0 Appli.ratiun for 11hip a imi lark .. Tonstrnrtinn ramit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: ..... te . 28 & Putnam Ave ..,...Marston Mills.,..Ma.-...........•......•........._... ........... .. ...... .. .... Locati n•Address Cotuit Wax.Trust 404 Main ST:;tNCe.nterville , Ma. ...................... ...........................•-................... .........•-••--....................................................... ... W J.P . Morin Owner 75 Salt RoC(kdrY 3 Barnstable Ma ......................................................... ........._............-••.............. ............................................ Installer Address d Type of Building Bldg #11 Size Lot............................Sq. feet Dwelling—No. of Bedrooms_.........................................Expansion Attic ( ) Garbage Grinder ( ) .._... Showers 1 — Cafeteria p.I Other—Type of Building .A!N.(:a.11tlo... No. of persons.........J..._._...... ( ) ( ) Q' Other fixtures :..................................................................................................................................................... d WDesign Flow...........5,5............................gallons per person per day. Total daily flow.............0 .......................Vlons. 1:4 Septic Tank—Liquid capacity..lQQQ�allons Length.............. Width......4........ Diameter................ Depth.. _........ W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.............._.....sq. ft. xSeepage Pit No.....1............. Diameter.10 i.5....... Depth below inlet..A!��........ Total leaching area...416-._4 BtX I z Other Distribution box ( X) Dosing tank ( ) G0-4 Percolation Test Results Performed b Ow & ..* .11e•r P_..E........................ Date.... 1 Test Pit No. I.........?....minutes per inch Depth of Test Pit.......1.3�..... Depth to ground water.....None,••-_.. tz, Test Pit No. 2...minutes per inch Depth of Test Pit.......i.32".. Depth to ground water..... one w ...............................................•.......................1 ........... ...................................._..MoTyfs........ O Description of Soil.................... ............ x 5ee attached plan W ... ............................................................................................................................................. ..................................................... UNature of Repairs or Alterations—Answer when applicable............................................................................................... ............................•-............................----...................................----...........................--•--..................................--.._............................ r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with j the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue boar f health. i Signed........ . - •............ Date j ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:..........................................................................................:. at ............_ i .............................................................................................................................................................................................. Date Permit No............... .. Issued_................. j ................................. -Date...---...................---... ... .,.. .. ..,.._....,.....,., �... ..,...,.-..•aoe••v•e•••••e•eoe••oa••••.•eewvvvo•vov•vv veo••eo•oo v. ........... THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF .HEALTH ..........................................OF..................................................................................... Qlatif ira#r of (gam-pfiana THIS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by. .............. .......................--•..........in9cz.iu_......... ...........-•--•----.....................-•---.................................. at...... .. � 1�............................. .............•--..........._.._..............._..................................... ..........................-----_.... has been installed in accordance with the provisions of TITLE 5 of .The State Sanitary Code as described in the application for Disposal Works Construction Permit ................ dated....... ................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................................•-•---••••......---••-•--.......... Inspector.................................................................................... ........• .........e............e.............................••.. . .......•.........__... THE COMMONWEALTH OF MASSACHUSETTS j BOARD OF HEALTH .........................................OF..................................................................................... FEE........................ ! Permissionis hereby, granted......................................................------••-------...................:..---.....:..................................-•...... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No......................................................................................................................... ._.....------•.......... ............................... ... ......... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... .....................Boar.•���.�� � t� Board of Hearth DATE.............................................- .... :.......... ............... FORM 1255 A. M. SULIUN. INC., BOSTON ��•�. - i COTUIT LANDING SHOPPING CENTER, MARTONS MILLS PROPOSED HARDWARE STORE ADDITION SANITARY .SEWER DESIGN October 20, 1993 The following information is taken from calculations done prior to original construction by Bradford Savitz & Assoc . i Original design Septic tank Leaching area design requirement* 6728 gpd 4485 gpd design capacity 7000 gpd 5082 gpd --------------------------------- excess capacity 272 gpd- 525 gpd ADDITION 4980sq. ft. @ 50 gpd/1000sq. ft . = 250 gpd Retail store *The actual water usage of this system taken from the water bills covering the period from 7/92 to 6/93 is only 2395 gpd. ( see attached bills ) t The existing system has the excess capacity available for the addition. i i i i i ,P Y, I I fi c1�n�Pn+ c.(Pon Can�ma�,cT'1 � . .. •■.■v16-a vas \ILV NOT TO SCALE IAL LEAN TEST P11 PER -_ EDGE OF PAVEMENT(TYP) Yr C NO. 14 4 INSPECTOR: Donna, r i• f t{ x-y 1SR 5 x` J•iiT 'y r°'+1 ' ."f Y Y 'riw Y '1/t y� Y i)f 5 EVALUATOR: Michael' a � ✓�_: '� 'yz t `a�9 at j.,,. , �hi�Y4 cr` • � � h4.3 C.S.E.APPROVAL DA7 DATE: Septeml TEST PIT#: ELEV TOP ELEV WATER= TP 4 -72 PERC RATE01 rc N rti 72x0 �` DEPTH OF PERC= TP 3 0 ^• TEXTURAL CLASS: 72xO' �/ Q� Ss tR tT? 2 as Y?EG 4 t5 spa z f F LOCUS i F h �� L { } s r r�� •, b��t � y ���E.�F+ Y�'a �� a� e��` F �t �y�R�'� k,'�r � 1�Vt: " � I xQ J 's 7 n H h 5 s 5Fh y Fill r r , -PR.4" PVC r VENT PIPE 24 B Loamy Si 1 OYr 5/1 48" PR.4" PVC :8)\ INSPECTION Perc PORT 66" LOCUS PLAN 7 SCALE: 1"= 1000' Med.to Coarse EX. LEACH. CBN TO DESIGN DATA C 2.5Y 6A / BE.REMOVED& REPLACED w/NEW PREVIOUSLY APPROVED DESIGN FLOW: NON-LEACHING `o L.C. LOT 1 (PER AS-BUILT PLAN DATED 7-19-05)= 291 GPD CBN AS SHOWN L.C. LOT 2(PER AS-BUILT PLAN DATED 7-19-05)= 2,354 GPD I TOTAL FOR BOTH LOTS= 2,645 GPD 156" NEW REALLOCATION OF DESIGN FLOWS:/ No Mottling, standing or W Benchmark L.C. LOT 1 (NEW DUNKIN DONUTS)= 415 GPD- Top of SB/DH L.C. LOT 2 (REMAINING EXISTING BUILDINGS)= 2,230 GPD PROPOSED Elev. =71.00' TOTAL FOR BOTH LOTS= 2,645 GPD TEST PIT ENCLOSED Approx. U.S.G.S. DUMPSTER ON *DEED RESTRICTION TO BE FILED PERC NO. 144E CONCRETE PAD PROPOSED USE (LAND COURT#'I): INSPECTOR: Donna M CBN � '�EACHING) / / TYPE OF ESTABLISHMENT= RESTAURANT(FAST`FOOD)& EVALUATOR: Michael Pi ' 200 S.F. OFFICE SPACE ON 2nd FLOOR C.S.E.APPROVAL DATE ")=66.70' / / NUMBER OF SEATS 15 DATE: Septembe P DESIGN FLOW = 20,GPD PER SEAT TEST PIT#: 2 TOTAL DESIGN FLOW =, (20'GPD x 15 SEATS)= 300 GPD T / &QP�� DESIGN FLOW = 75 GPD' PER 1,000 S.F.OF OFFICE SPACE ELEV TOP= TOTAL DESIGN FLOW = (200 S.F.11000 S.F.)x 75 GPD= 15 GPD ELEV WATER= <! GRAND TOTAL DESIGN FLOW = 315 GPD PERC RATE _ -- GREASE TRAP SIZING: USE PROPOSED 1,000 GALLON H-20 GREASE TRAP TANK DEPTH OF PERC= DESIGN FLOW NOTE: 15 GPD PER SEAT= 15 x 15=225 GPD(REQUIRED) TEXTURAL CLASS: IN ORDER TO ALLOCATE A TOTAL OF 415 GPD ON USE 1,000 GAL. TANK(PROPOSED) L.C. LOT#1,A TOTAL OF 124 GPD IS PROPOSED TO BE REMOVED FROM L.C. LOT#2 TO MAKE UP SEPTIC TANK SIZING: THE DIFFERENCE BETWEEN THE PREVIOUSLY oil APPROVED DESIGN FLOW OF 291 GPD FOR THE USE PROPOSED 1,500/1,000 GAL. 2-COMPART. H-20 SEPTIC TANK VACANT BANK ON L''C. LOT#1 AND THE TOTAL Fill FLOW OF 415 GPD PROPOSED FOR L.C. LOT#1 COMPARTMENT.1: (i.e.415-291 = 124). L.C. LOT#1 IS TO BE DEED DESIGN FLOW x 200%=315 x 2= 630 GAL/DAY(REQUIRED) 24" RESTRICTED TO--415 GPD AND L.C. LOT#2 IS TO DESIGN CAPACITY = 1,500 GAUDAY(PROPOSED) BE DEED RESTRICTED.TO 2,230 GPD (i.e. 2,645- COMPARTMENT 2: B Loamy San 415=2,080). BOTH LOTS ARE LOCATED WITHIN DESIGN FLOW x 100% 315 x 1 = 315 GAUDAY(REQUIRED) 10Yr 5/6 THE ESTUARINE WATERSHEDS. DESIGN CAPACITY = 1,000 GAUDAY(PROPOSED) 48" SWING-TIES LEACHING FACILITY SIZING: INSTALL 3 - 500 GALLON H-20 LEACHING CHAMBERS DESCRIPTION BC-1 BC-2 BC-3 WITH AGGREGATE GREASE TRAP COVER IN (1) 23.0' 34.9' -- SIDEWALL CAPACITY C Med. to Coarse; GREASE TRAP COVER OUT(2) 27.0' 37.7' -- (LENGTH +WIDTH)(2 SIDES)(2'HIGH)(0.74 GPD/SF)=GPD 2.5Y 6/6 (32.5'+ 11.83')(2)(2')(0.74 GAUSQ.FT.) = 131.2 GPD SEPTIC TANK COVER IN (3) 29.7' 29.1' -- BOTTOM CAPACITY SEPTIC TANK COVER OUT(4) 37.8' 22.0' -- (LENGTH x WIDTH)(0.74 GPD/SF)=GPD CORNER OF STONE (5) -- 42.4' 21.1' (32.5'x 11.83')(0.74 GAUSQ.FT.) = 284.5 GPD 156" CORNER OF STONE (6) -- 53.0 22.4 TOTALS: No Mottling, Standing or W TOTAL NUMBER OF CHAMBERS: 3 CORNER OF STONE(7) -- 72.3' 53.9' TOTAL LEACHING AREA: 561.8 SQ.FT. TOTAL LEACHING CAPACITY: 415.7 GAUDAY(PRIMARY SAS) CORNER OF STONE(8) -- 64.9' 53.4' TOTAL LEACHING CAPACITY: 415.7 GAUDAY(RESERVE AREA) 1 IL op � • i 00 "Af 4OW - .00 ~ � / / •�\ it "ten-', ' ��r���c • • N / / `'l" � ' �� ' F 40 df do r' A i / < A • it _.. c '� _ ► 1 C LC 1% ` f � OP' � �+ _ -- _ •. _ • V (/ 4 - - ` / / • /if or lot ;lop C__ \ lit- \ r 11 ./ �• t / LPL TqN�/F/ �E � rt - � / 3 ,�� •+ /r��o�, � �a � �"` ~ �11 \/ Uu Isle ' / ```• �� '` / // {gyp F?�' / , .31 + ' _ -a. o /, ''►L. ' N \/ 4617 - ` x� i c 1 '�. 'e S_o• kv 01 .- �► _ I 1 i _ r i ak - 4 • • rvf.0 7 4 ..-... • IWO,*JO J �' � I '�� �� '� �� � nil � � / + • � � � 1` �i � � \ � - � � , ,�it � � - -- - - - -- — - f \ e4iwt S ' ^ I - , I I I A te g �. � i `-,,�"- I � "„/ � ' I C I i ,!1 I �� � I Il hV I,�b I ► � I 1 ��, \ f� .�.J!_, � •... de 1,0 F/ 06, ,7 1.00 Id Of Ift LN IAI 7. 32 MAft4WAM Edda -qfttb - - Ile Odom PAP 0 .�► i r� i • f f p"a ► , Idop • r... ' , awmamilaw-"map -ago _ �. l :� �? G ' 37 2`� sic :•_ +�... . - is e2Li , FOOD SERVICE EQUIPMENT SCHEDULE ME CHANIC AL SF. 'JI., _:,.•„ - I„N DESCRIPTION MANUFACTURE MODEL WATER WASTE ELE T I,A'• IGAL !xH NJLF- REMAAKS CW NwDIR INDVOt_TPNSCORDJD HP KW SI 'DTU CfM , I ti MIXER-80OT NOBART M-002 ZGB 3 • 2 2 11 FRIALATOR PITCO P-'�4 Yt 12cid 404 Zr4 FRIALATOROPTIONAL 3 11 SHORTENING FILTER HUNTER E05C-165 120+ 1_ • NF 1 SCREEN CARRIER EASTERN 004407 r - 197 6 4 &'.REEN RACKS EASTERN AA-+.1-20-2•S4 -;- I 7 - T t PROOFER9 ASTERN ♦4305 Il i'<i' 2 I • 197 20A 8 1 CONVECTION OVEN BLODGET OFG-100.3 �- t227 1 • 55K 9,b xn•o CooIFR 1 • •♦ .;u•..�DO.1 1 :a Ft.N C70 E a NOR-LAa DOKOOF/C G12( +-- 1 11 1 DONUT MACMINE BELSNAW TYPE's. T _ - - _ 12 1 SOUP UNIT_STAND EASTERN 00-9876 OPT,ONAL �E� �T . G�QA�,�j� t✓1 U 1 NOT PLATE 2 BRNR WELLS N-u5 -': 20t I 1.5 597 OPTIONAL �I _ I r- Y ��r-' 4 1 CUTTING TABLE CUSTOM 7'•4' - -1 I _�I (�i �UW I �G rT"�� �✓ r-+✓Mc�IE' ��cM v — � 70 MO 15 1 FINISHING TABLE CUSTOM8'.3' �___ /- � r~ .�' G.'I I� p �`-;,�fRSTT�*�ti,•.,,_ .,-r. r 17 t FINISNPRODUCT RACK. EASTERN wr-G6-1F5 �� 197 'i IB 1 GLAZER LL TERN -} _ • t3 19A 7 FITTER UNIT, EDI4ARD - _ - 1 CLILAR PLASTIC ��i�'„y' s ------.--- - - - ----+ I '•�' �- `� „ }*,r.� � 1 �: 19 1 PGwER BASE EOMARD _- _ � 10 _ t-T - - - - -- - I 21 1 SPICE CART EASTERUBBE:N -DD 431e0 -- --_- I I�6 -- t G 22 1 INGREDIENT BINS RUBBER MAID 3627 '-� � � 23 1 SUGARING BINS NOPMANDIE •00 ---�- t__ - - - - ---- - - •�= 24 1 FLOOR SCALE Dt1EC Tp 4570 �- i �~-- _ r-' I �d'G ' `_ '>wa'�„y-•,y. ,. h,� -- - �- '- --- rJ-` i--••FX T I I�I �►l_{Gj �r G�..{!.`V-� wr TCI�I Lam. r9 -" • 30 1 X+GERCOUNTERLx,MVASMER NOBART WM•5'H rl.' I/e' • I/q 7.2 OPTIONAL 31 f ICE FLAKER SC.OT�MAN A c t A'' ' • '4 W LEGS 32 --�--- - I ' 33 2 k4iCRC-V,\,E OVEN 15,aRG-+R�3-`T _ 1 11 • .73 I I �eW lµ�.((J + � M rGM r34 I COFFEE.MAKER,- ;RINGER BUNN OT_35 /2, 4.7 51 FOR DE-CAF I � w r- 35 ? COFFEE.Mni tR•2 BRNR BUNN OL-35 �' _ _ • 3.8 �A I ---- - L -- 36 CCFFEEG?INUER 6R1N01- TER CC•G • 12O I • 9 360 DAFACEPLATE _ ✓�'I+��(f'• 37 1 140T WATER DISPEN,ER BJNN M.v2 Y4• - VW 120T I • Lb, I L I J L I �- e 38 1 NOT C110CN.OICPENSER JET SPRAY WC-2 120 I • i. ♦ �,--- 1 3v 1 DRINK(.IS?ENUR JET PRAY TJ�3 t 0 1 • 4 N_ T� ✓ �+ ---- - 40 1 ICE TEA M:LF.N:.F.R LUNN-.-- T� 4 _ -i-- ( �✓T " �A� �(�h I r' 4 I 1 IJJi I I 1 WAI MI I H IINN wx -• -24 __ _ ._ .... i' -M / Cam' r07 \" I r`rT AA''�� �;�✓yV �' 42 N FLbISTF.kS OMkON F5 2E• -t- 20 I • BY OWNER To�t7""_ 1'1 �"7✓C7T• 111 3 BA.CKB S P RP N - -�--- - - i -- -- TO �` 1 4 I f PIG 1 v 43A 1 REFRI SECTION 5=COL DEIFiEID v+BsG� _T (> • yA 3B SNELViN,SECTION 2'-0'L tfLFIELD _ + ram•<� I ��' ►'IG t.{.t` V - -- -- -I I - - 43D l END tGIASuE nNE�53'-0'1? DELFi LU -- /z' h' E ITEN030 .lT p� A: �, I I_-�- 1►' -- - - - ` 44 - — - -_ Pr Etr - _ - as t� d 46 i MUFFIN PREP TABLE CUSTOM PER P_A 47 1 MIyER-200T t40CdRT A-200, 2 • OPTIONAL 48 2 LLEBAGuOI ER C ST M PER FLAN -. -- -_. ----- (' � --- - - It.- _ ` ti- `` - lJ- ��I�.7 -N FAG_ -'"�►K' '--'[-� ' --- --- { ,•.- 1� 50 1 WALL Dr PLAY Gas UST OM NG - 120 I -+- • LI NT5 �CI�,T• I I `� w N�V SI COFFEE SERVICE STATtOM CUSTOM 3O'IDNG 120 • .IS - ju 52 CASH REGISTER STATION CUSTOM 3 ^'LONG IL__- _ .-._ _i I J ,t L�/� -1 ( IL_- L�^ -{=J Ili �►L 2� 11� f�j� `y/ ------- -- -- I Y 53 1 COLD DPINK STATION CUSTOM 2'O'LONG �1' 120 I • IS ICE BIN UNDER - ---- I - � � � � - � _ l CA R @.BE V.T E A C I I fit' - f��ArP 1"' I "I=P I F. I 1�G'I 1 EF'` 1.6 Q I ^L' I'i I` •'i -E 4 -j - `S 1 MENU SYSTEM CUSTOM •0_L4NG _ I • 1 _ I� -- 5I 1 REFRIG I CASH STAND CUSTOM 3'-01 LDNG _I _ '.0 • DRIVE UP ONLY) _ r I�TW"� I I' E�� _ I--- - - 57 .I COFFEE STAND - CUSTOM 3d'LONG _ IV -UP LY _ , / A U G� ?� � I 58 1 ENO-PANE.LtGATE C TOM _ + --- - - - --- --- --- - I I l'31�43�,, I'�121 1G6 �AcIG � - K p p1 rvl - -- 59 1 SALES NIT CUSTOM 0- ONG A •�� / M IS J I �`�' SA U -- - - - +- -- -1P�.lo _ --��� I � 59A 2 SOUP WARMER-II OT WELLS 1•w IL160 '20 1 • Ib5 NEAT HOLD - L11`IC.1'' � r I •.�.,I cc•�r r-4.� .�,.� 1 "yib"-•� `_ - -' - - � �- 5 6 SOUP WARMER• 7g WELD uw-IO6O _- �-- t2p 1 • IG5 T 140LD - }� JCL -� 3I t- --- - - A�� --L - - 60 1 CARS.BEV TANK STORAGE CUSTOM I 120 G - 61 1 TRAY TRASH STAND T M 4'O'L•2'-0`W __ - M - '- - - _- 1 s �•"y""T-' /,' N - I J / J / - _ --- - - E� p 71A BENC:N SEATING SAI 51 71 El CLUSTER SFATIN4 4_EAi Al - -- --_ -- T" 710 CLL+,TERSEATING( SEAT SAI JA' GI►E9Fi &p1 -- 1� 1 t + �..E�'rF �l.��. ®r• � � N I� rl IF•lvu. r✓�P� ��Te�ul�� Bo t TIME CLOCK SIMv � 1 8111 FILE LOC:KER COMBINATION COLE CAB.CO 1370L -- _.--_r. v I 8211 2DRAW FILE COLE CA&CO 202 1 M��/IF 83 1 LINEN LOCKER NORTHERN MFR-- _ -- -' y ""ram � �----- + � I ,��y_I� 85 2 FOLDItZ CHAIRS KRUEGER - -----a - J�TUf-r.� lax ,� I�r►S �� _--_ _ NOLMAN NN-2 _ 120 I • 1.4 14. A 5 t VNRM�NG UNIT MO EASTERN N T-42•IG•3 - ---�- 3G0 L TOASTER W ' .s l01 I 544EET PAN RA.-K �c,It to OULE CUSTOM - �1 T06 I _4 EE BY Ib GRINO(':R EUNN G-3 '-- _t _. • - OPTIONAL ! C �4 ---- 3t'7 1 rCFFEE BY IU SCALE DETECTO aP T L...,.r • OF'110NAL � I I I - - I -- T� I - --- --- ^� ui W y c� a i — t I .1 E L' [-I ^_=_ ty�.�T I�i N l,t I�, I I•- 4 EV1_ - - _ -- — - �1 , e U OC a Gt,1 T L. U. NET F � L - r I t .. 1 _ 4-7ew oc7i"1 O pw w P� I C (n Q u a ' 71 L,► 4 v�l�2 i Mo.rE C ., -- SEW I ' f �! �' Tim l \[G p� �P1�E� �x••.►ri�,.lcrx� I �'1 Etr►-k E Tc� h.L�I.•E' GPI�..I I�6 PLQ�I� j ' I — _ _ — l I 11 I 1 _•.- -}- � r --� WT�'(J li• � Gbl� o -- - ► N _ '� �,�„ ; amp„ �,.'�, ___ �Et`'NE�1 -la'= 1 � 1 Q To ►.A�co blur -lo -- --- ----- -- - - - -- <C S N .. ►CIE �ol.�r•l Lei ' I I II I I II �` II (�'df'E. ��`{v�' oar/ �.-1'P ✓, lr�/7. I /�. c ' '�4 ( 13��. 3-1 4a 1 6D, - i / 1` ° cn �I�T"t�l� ' P2`� -:ter-= W i.r L.I�D4 (7t 14 t > ^ _ - PI �3�9� L "Iv �� E!.l� �I v LL1 LSE r� o IIJI rc o�� EST :r 1 To f 'Z..4--Ira - - .1, �g / -- - — All I _ _ } � `aye-- _ — _ _ V `J F+� —__ - �`..:n.,:.h - ,f•iriii -+-.x.Ly�- II``II �Lu[1 ,� Iro'IC>•G �� 2j<o � � t _ 311 -`��,�' � . ._, 4�•rs- Gr � �"t-,{� �-r-+ _ - -� _g s 19 rc},j (1PIL- G ,op{Z cl rt--„ 2�� u I - Tv M r�•ra �1�-T �� ;� - - u EP LJ L.r-� e�sT (e,"0Ti 1 NUJ L. i► � TIC. A , /' I I`�TE$-Iyl=1= �1.��/,�•F�'10 '� _ ---- - t L3 � G✓r�'r1 G• r ICo V G - - - - - � I /4'� i i s ✓1. 1 v� P ►�o c T`w.) — - - �i L _ �P I4� 114 E)c I�. Cam-ti ' I - " P I L c� !- 't ; ��I WPI.I. Gr���►�" � �/vI.1.6Y %L�NIr�L-'- � I I L.I�E . I • r I � Gw�- I _ �� t Ls/ (iPl<-IGPIi- • �c►� �16 � — -� 1 �i �1i. 1 •L, I C`�-(f�'� _ __ . _. � - -��PI� To I �_ :, -- - _- __ _- += �•�E IrJ (i�I' �> �� �1hv - - E �,• i--�-- _. .- - -- M�T•c� 6+�1�1 rJC� b�" c V`�W,l► T� LI i r .ejJ K 1 rr�j alp n PL _ :.. I ' _ 1 , ->;.1.a�+r �+w,i�e«i. � Imo': f�-�-�I'ot�i '� 3•��I _-- I I� 2�.13 - -.- � =—�} I M aTc.� Ems•-�-T- �PtLT I>� 1`{� �Iz'��✓1 f�Ca f�N �.M I L �/C{�vl� I 11 , I) 7► f`TE✓ V`x� G,I 7L;" 71 IotJ X 4 rdo+,� G�Dvic MIA ..l,010rll! \ 1 Uiw '2,*-r- `ZA'-IV G dX,1, T I ri li k • I. '�IATGN Gxr��.,q •. ,, 1 N-•'?JT +OI ` ✓I 1 i I ! ! I �`V� I �V 4 ! ! I i �A(7 i Lot J �}��X<o Nth ����,r I I -- 3 IL • r, _ I ,r,b °° t�,, -� p I A- { -- .t i I I. C rA /�. `�J ( ` M �' R X I �/ �' ' LOB bra ,✓! �U �� X + I _( ------`±-- -_J I - ;r✓------ - �- 3`• C� �I� _ ---_- --- -- -- a U �l FiVJ '�I N Q 7 �-- o c� /I R 6L'` S,rAK // Q�� V �.O k 1 J =+ ' ( I i �-^x�n�'vj� oo�.- �7 -� x n"wn �s1 � N `'- � �"x�''�� 0 �Pt�-- ' j �/ ,I /- •� 1. I /4 �/ //fjV' „ ✓/A Y�(-� ' ., , I �.( '.x a 'T I `V `k _ - _ -1__ -41 -- �jIG!G-t.1`\ I 'I �y / 1 1 — _ --- -- -- --. .�.r� ��-- --- -- -- ---- —•� �—�..► - )- �jXIST1 N 6 G U N Cr 1 �'_g•• � 1 '- r � 1 1 �r -� --- �- -C i j I �r C�i i I � s�-- _ � ! ` 17"`fir I'-.�''f �yl_.• " �,d• v- G" --- �— -- ' CAI ITI'd(i i. n � � L1�.NT -o of • ` .. � � ✓• . it � -__—'--___ __.. ._ - - _. _-... _ - �� ry > / � f� 3'_4' oN•�i v 4 r - i --- ---- - - ---- --` — �' •i rDic t� --- - --- I e - r - . . ✓QN1�C�p4�E _ PETER F. DIMEO. ASSOCIATE T2t��nF?PllEZ`.1,— `�• G1-" 4'- ,' vol ��,-�� S, INC. r 4 ARCHITECTS—ENGINEERS - -van 546 MAIN STREET STONEHAM MASSACHUSETTS 02180 TEL. d 1 7-438-0600 �f _._.- -- FAX 617-438-5840 _ _ I PROJECT: -�Dr ,- rT� 215 �.a�N�TC7N M�i L LA; MA , OWNER: W I N r,),\-1 DATE: I 1/22lq(, REVISIONS: NO. DESCRIPTION DATE EVLED ARC D W)G. N 0. 4 r� i 5� 2or 3 STO T LL OFoel _ - �► GENERAL NOTES TOP OF FOUNDATION FINISH GRADE OVER D-BOX= 69.8'± ELEV.= 71 .3 ± FINISH GRADE OVER CHAMBERS= 69.4 - 70.2 PROP.VENT WITH CHARCOAL FILTER TO ABOVE GRADE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION PROVIDE H-20 CONCRETE RISER WITH PROVIDE H-20 RISER w/SECURE SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE SECURE CAST IRON FRAME&COVER TO F.G. STONE TO CROWN OF PIPE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. CAST IRON FRAME & COVER TO F.G. ! 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OVER TANK COVERS AS SHOWN (TYP. OF 5) 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS MIN SLOPE 1% BOX TO F.G. (SEE NOTE 20) 2"OF 1/8"TO 1/2" DOUBLE WASHED OF HEALTH AND THE DESIGN ENGINEER. 5" DIA. OUTLET(S) STONE OR GEOTEXTILE FILTER FABRIC 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL F.G. OVER GREASE TRAP EL.= 70.3' - 70.7' F.G. OVER TANK EL.= 70,4' - 70.8' t I BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. 9"MIN. TOP OF SAS= 67.20' PROVIDE H-20 RISER 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN 9" MIN. 4" PVC TEE 36" MAX. , 9�MIN. w/SEiCURE C.I. FRAME ELEVATION =66.70' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. PROPOSED 36" MAX. PROPOSED 9"MIN. 66.20 36 MAX. BREAKOUT EL= 66.70' &COVER TO F.G. UNLESS A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. 4"SCH. 40 PVC 4"SCH. 40 PVC 36"MAX. PROP.4" 1 SCH.40 PVC (PIPIED INLETS ONLY) AND THE TOP OF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 3" 3" TO D-BOX L=68'± PROVIDE WATERTIGHT' 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. " 2"DROP MAX. L=6'± U�:3"DROP MAX. 9�� o min. 6" 3" g" 3 4" PVC IN FROM JOINTS (TYP.) I o �_o 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 69.00' _ =9 _ =_ si oPE 1%min. SEPTIC TANK 4 PVC OUT TO O O , o 0 7- LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK FILLING WHEN N 48" 36" 67.75 13 } 19" 10" 19" • LEACHING FACILITY o0 0 0 O SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS NOT TO o LIQUID MIN 5'-0" oo 0 = 0 BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH. 68.00' LEVEL SUPPORT OUTLET TEE LIQUID - 67.40' 12 6 0 00 INLET STRAP(TYP) 67.65' (in from g.t.) LEVEL 66.60' MIN- 66.43' 2' o 00 0 o0 8. ELEVATIONS BASED ON APPROXIMATE U.S.G.S. DATUM. ELEVATION OF 71.00' TEE 12"MAX 67.65' in from bld 0 0 C o ESTABLISHED ON TOP OF A STONE BOUND w/DRILL HOLE AS SHOWN ON PLAN. ( 9) (1,500 GALS.) (1000 GALS.) OUTLET 6"CRUSHED STONE o 0 0 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION TEE OVER MECHANICALLY I o0 00 0 0 0 0 o THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE GAS BAFFLE 8"DIA.ZABEL FILTER COMPACTED BASE - 6" CRUSHED STONE INLET TEE MODEL#A100-8x26-VC 5 3.5' 8 5� (TYP) _ I 3.5' AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY OVER MECHANICALLY (GAS BAFFLE ON BOT.) OUTLET DISTRIBUTION BOX 3.5 4.83' 3.5 DISCREPANCIES TO THE DESIGN ENGINEER. I COMPACTED BASE 6"CRUSHED STONE TO BE INSTALLED ON A LEVEL STABLE 32.5' (TYP.) 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE WATERTIGHT. OVER MECHANICALLY LENGTH 12�-2'� WIDTH 6�-8�� DEPTH 7'-2" BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 59.00, 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR COMPACTED BASE PIPES TO BE LAID LEVEL. 64.20 11.83 000 GALLON 3 - 500 GALLON CHAMBERS , MIN. CHAMBER END VIEW ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH PROPOSED 1 ,000 GALLON PROPOSED 1 ,500 / 1 , CROSS SECTION VIEW DETERMINATION FROM APPROPRIATE AUTHORITY. H-20 DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE H-20 CHAMBER DETAILS 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS H-20 GREASE TRAP 2-COMPARTMENT H-20 SEPTIC TANK LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE NOT TO SCALE NOT TO SCALE _- - - __ _---- ___ NOT TO SCALE - NOT TO SCALE --------------�----- - - THEY SHALL WITHSTAND H-20 LOADING. FALVIOUTH ROAD ROUTE 28 REMOVE ALL UNSUITABLE MATERIAL I TEST PIT DATA 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. (VARABLE WIDTH -STATE HIGHWAY) DOWN TO"C" SOIL& REPLACE w/CLEAN PERC NO. 14493 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND COARSE SAND PER 310 CMR 255(3) Donna Miorandi IRS UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF ---------------------------------------------- _ -__-__-__--------_--_ EDGE OF PAVEMENT(TYP) �` -� ---"------------_ - -- _ __- ---------- LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN _ � ._ INSPECTOR: ' 69- --- .^ Michael Pimentel, EIT, CS 70 -- EVALUATOR: E - - , - _-__- --- _ \ , . COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN / 10.00 SPOT LIGHT --GRASS- _ C.S.E. APPROVAL DATE: Oct. 1999 ACCORDANCE WITH 310 CMR 15.255(3). S'0o°05-15"E G " --GRASS- -70--- �� September 12,2014 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN yYp ---- - --- /� _ DATE: P ' '� i SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. LAND COURT DO NOT ENTER/STOP SIGN ZONE 2 v TEST PIT#: 1 and 3 N89°5445"E r ` `�`,,\ - r' ELEV TOP= 72.00' 16. PROPOSED PROJECT IS LOCATED WITHIN: LOT 2 --- -- _ _ _ _ 120.34 4 LAND COURT LOT#1 AREA=93,254 s.f. -_ __� SIGN --- a o �. r� ELEV WATER= <59.00' -L.P. (TYP) o � = 71--- � $ �' r ,jl, FORMERLY PORTION OF ASSESSORS MAP 54 PARCEL 4 (PREVIOUSLY APPROVED '- --------- ---- / TP 4 O ----------------- o PERC RATE _ <2 min./inch DESIGN FLOW FOR EX. 1 \ > -` --- --72 - ---_- -- ' f 1 OWNER OF RECORD: WINDMILL SQAURE LIMITED PARTNERSHIP BLDGS ON THIS LOT= z / OVERHANG & ISLAND TO BE REMOVED �- Ai ��� ay pia* $ r �. DEPTH OF PERC= 48"'-66" 72x0 \ ADDRESS: 297 NORTH STREET N I0 H c� 2,354 GPD G, o m �\ �' ' TP 3 0 `� '� a HYANNIS, MA 02601 TEXTURAL CLASS: 1 102 \ ISLAND under overhang) 7 x ' �� o' ,� 1 LOCUS 1 1� 2 _ 17. FEMA FLOOD ZONE X < CPS9) RE,' AR A 2 0 ti L v V \ (CAPACITY=415.7 gpd) AS SHOWN ON COMMUNITY PANEL# 25001CO543J TP Z � 72x0' • �' d 18. DEED REFERENCE: LAND COURT CERTIFICATE NO. 137678 g I PROPOSED 3 - 500 GALLON , • o 0. 72.00' cn -- H-20 LEACHING CHAMBERS rn Fill Q Q , ° '�_, -` ,\ - WITH AGGREGATE ) 19. PLAN REFERENCES: cn w �,, -- S89 12 22 6 /� ' (7 j �, ^ �, Q` 1.)L.C. PLAN 15069A w !Y \- PR. 4 PVC 24' 70.00 2.)L.C. PLAN 39483A,B U Q w 20. �, VENT PIPE Q�1 Loamy Sand 3.)L.C. PLAN 38112A Q ``\ - -- _---_--BC-3-- - bg p N p B 10Yr 5/6 4.)L.C. PLAN 39614B PLAN - r 48" 68.00' 6.) 1975 COUNTY COMMISSIONER'S ALTERATION PRO'. WINDOW 20 8' -PR. 4" PVC - �' �o `� Perc TO PUTNAM AVENUE, RECORDED IN PLAN BOOK 5) ,\ 8)'� INSPECTION -`� } y, - 66 66.50 233, PAGE 92. 1 PORT L PLAN 7.)"DEFINITIVE SUBDIVISION PLAN OF LAND LOCATED 22 #3821 O C U IN BARNSTABLE-MARSTONS MILLS -MASS., EXISTING VACANT BANK(PREY. AP'D FLOW=291 gpd) PROP. H-20 5-OUTLET N PREPARED FOR REAL/PROPERTY SERVICES INC.," TO BE CONVERTED INTO A DUIKIN DONUTS w/ " - \ y DISTRIBUTION BOX - SCALED 40 FT TO AN INCH, DATED JUNE 28, 1 9 , < �, 1 DRIVE-THRU, 15 SEATS&200 s OFFICE SPACE .� _ - __ Med.to Coarse Sand - I ,o / / / ALE 1 1000 9 5 j TOF=71.3'± i -�/ EX. LEACH. CBN TO DESIGN DATA C 2.5Y 6/6 g.) 93D1 STATERECORDED IRAT ON O PLAN F RTE.OK 18(FALMOUTH ROAD) BE REMOVED& LAND COURT-OT 1 I j REPLACED w/ NEW PREVIOUSLY APPROVED DESIGN FLOW: 20. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A AREA=14,860#. NON-LEACHING L.C. LOT 1 PER AS-BUILT PLAN DATED 7-19-05 291 IGPID DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A RAMP/WA�K 1 i ' CBN AS SHOWN ( ) REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. L.C. LOT 2 (PER AS-BUILT PLAN DATED 7-19-05)= 2,35e4 GPD ' ' 156" 59.00' � I ' FORMERLY PORTIOu OF MAP 57 i ' � � � TOTAL FOR BOTH LOTS= 2,645 GPD LEGEND i I PARCEL 4 NEW REALLOCATION OF DESIGN FLOWS:: No Mottling, Standing or Weeping Observed WALK , 108,114 S.F.i �O / Benchmark x 50.0 EXISTING SPOT GRADE L.C. LOT 1 (NEW DUNKIN DONUTS)= 415 GPD I (PREVIOUSLY APPROVED DESIGI FLOW=2,645 GPD) /' Top of SB/DH I L.C. LOT 2 (REMAINING EXISTING BUILDINGS)= 2,2301GPID= TEST PIT DATA 15 EXISTING CONTOUR PROPOSED Elev. =71.00' TOTAL FOR BOTH LOTS= 2,645 GPD I ' W 'R. MENU BOARD ENCLOSED Approx. U.S.G.S. *DEED RESTRICTION TO BE FILED PERC NO. 14493 50 PROPOSED SPOT GRADE I I = - /� DUMPSTER ON 50 PROPOSED CONTOUR - - INSPECTOR: Donna Miorandi, IRS C n PROP. 1,000 GAL. / CONCRETE PAD I m _ I W' H-20 GREASE TRAP PR. ORDEI SPEAKER PROPOSED USE (LAND COURT- � RT 1 EVALUATOR: Michael Pimentel EIT, CSE ' -����-� - --�-/� � PROP CBN f � -�v-----w-__ - EXISTING WATER SERVICE / /�- j TYPE OF ESTABLISHMENT= RESTAURANT(FAST FOOD)& �) �' ±-, / C.S.E.APPROVAL DATE: Oct. 1999 � z r- (NON-LEACHING) / / 200 S.F. OFFICE SPACE 10N 2nd FLOOR --- 0/H/w EXISTING OVERHEAD UTILITIES w19t �' 1 / BC-2 /-' GRATE EL.=69.20' /11 ,/-- I NUMBER OF SEATS = 15 DATE: September 12, 2014 Cn NIT I ,- w CV) i �'11�/ }/'� / INV.(12")=66.70' / -/' _._.___._ EXISTING GAS LINE DESIGN FLOW = 20 GPD PER SEAT GAS------- if � ¢ ( o I o P�,� O / 39n''' PROP. 6' DIA.. x 6'DEEP TOTAL DESIGN FLOW = (20 GPD x 15 SEATS)= 300 GPD TEST PIT#: 2 and 4 TEST PIT LOCATION I w o 3.1 / '� = �� /�M� ELEV TOP= 72.00' w o o in o \G� /'� 636 L.P.w/2'CRUSHED / DESIGN FLOW = 75 GPD PER 1,000 S.F. OF OFFICE SPACE U Q w y� /� Fc, g°`L STONE; INV.((in)=66.00' i" - OF <59.00' Q ; I v,I Q, / S� /G� TOTAL DESIGN FLOW = (200 S.F. / 1000 S.F.)x 75 GPD= 15 GPD ELEV WATER= PROPOSED 1,000 GALLON H-20 GREASE TRAP ILl /�' GRAND TOTAL DESIGN FLOW = 315 GPD 0 ( / 4 - _ _ PERC RATE _ I s 3 ) o �G �� GREASE TRAP SIZING: ^ i DEPTH OF PERC= PROP. 1,500/ 1,000 GAL. 2-COMP. H-20 SEPTIC TANK o in EXISTING DRAINAGE I I ��,� / 't�\ -�1 CTRIC METER I USE PROPOSED 1,000 GALLON H-20 GREASE TRAP TANK N °'• LEACHING PIT(TYP.) p /-- DESIGN FLOW NOTE: 15 GPD PER SEAT= 15 x 15 =225 GPD(REQUIRED) TEXTURAL CLASS: 1 1 N (2 //' 92 ��n /~- IN ORDER TO ALLOCATE A TOTAL OF 415 GPD ON USE 1,000 GAL. TANK(PROPOSED) PROPOSED 500 GALLON H-20 LEACHING CHAMBER I I :..:::.- i . s ! L.C. LOT#1, A TOTAL OF 124 GPD IS PROPOSED _ _ / '/' ` `i TO BE REMOVED FROM L.C. LOT#2 TO MAKE UP PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE GUYWIRE o� <� w SEPTIC TANK SIZING: o" 72.00' �q I y /-' J�`v THE DIFFERENCE BETWEEN THE PREVIOUSLY ❑ PROPOSED 5-OUTLET H-20 DISTRIBUTION BOX ��� /�� USE PROPOSED 1,500/ 1,000 GAL. 2-COMPART. H-20 SEPTIC TANK D �E cs �i /-' _A P` ��� 1 APPROVED DESIGN FLOW OF 291 GPD FOR THE Fill 1 OTC' -' PROP. 1,500 / 1,000 ww``P` 6p VACANT BANK ON L.C. LOT#1 AND THE TOTAL COMPARTMENT 1: 2 6-26-15 MCP JLC Eliminated 150 gpd per Tom Mckean &redesign SAS PR.E RIVE-' GAL. 2-COMPARTMENT / "\ FLOW OF 415 GPD PROPOSED FOR L.C. LOT#1 0 " ' 6� 0v DESIGN FLOW x 200/o =315 x 2 = 630 GAL/DAY(REQUIRED) 24 70.00 1 11-6-14 MCP JLC REALLOCATE DESIGN FLOWS THRU SIGN / H-20 SEPTIC TANK Q (i.e.415-291 = 124). L.C. LOT#1 IS TO BE DEED (PROPOSED) REV. DATE BY APP'D. DESCRIPTION % CAPACITY = GAUDAY ROPOSE EXISTING DRAINAGE - �l�` �,O (i.e. DESIGN CAPAC 1,500 Y P D /'� O \9 RESTRICTED TO 415 GPD AND L.C. LOT#2 IS TO B Loamy Sand CATCH-BASIN (TYP.) - /�� 1 /-' i \-EXISTING 1,50( /-- � BE DEED RESTRICTED TO 2,230 GPD (i.e. 2,645- COMPARTMENT 2: o - 10Yr 5/6 PROPOSED SITE PLAN GALLON SEPTIC TANK ��� 415=2,080). BOTH LOTS ARE LOCATED WITHIN DESIGN FLOW x 100/o- 315 x 1 = 315 GAUDAY (REQUIRED) /-'/- TO BE REMOVED / THE ESTUARINE WATERSHEDS. DESIGN CAPACITY = 1,000 GAUDAY(PROPOSED) 48" 68.00' PREPARED FOR: .-/- ` COUTO MANAGEMENT GROUP, LLC LEACHING FACILITY SIZING: SWING-TIES INSTALL 3 - 500 GALLON H-20 LEACHING CHAMBERS / o BC-1 BC-2 BC-3 j WITH AGGREGATE LOCATED AT: xyT2 I / -EXISTING LEACHING PIT T) /� DESCRIPTION I . - Med.to Coarse Sand 3821 FALMOUTH ROAD (ROUTE 28) / BE PUMPED & FILLED IN w� /�� C : GREASE TRAP COVER IN(1) 23.0 34.9 SIDEWALL CAPACITY 2.5Y 6/6 MARSTONS MILLS MA 02648 - - (LENGTH +WIDTH)(2 SIDES) (2' HIGH)(0.74 GPD/SF)_ GPD ' NOTES: -- = 131.2 GPD -- CLEAN COARSE SAND GREASE TRAP COVER OUT(2) 27.0 37.7 ! (32.5'+ 11.83')(2)(2')(0.74 GAUSQ.FT.) -- --- ---- 409 \ - 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP SCALE: 1 INCH = 10 FT. DATE: OCTOBER 2, 2014 SEPTIC TANK COVER IN(3) 29.7 29.1 - / / EDGE OF EACH SEPTIC SYSTEM COMPONENT. BOTTOM CAPACITY o 5 10 20 ao FEET �,E, SEPTIC TANK COVER OUT(4) 37.8' 22.0' -- (LENGTH x WIDTH)(0.74 GPD/SF)=GPD of / \ �/ / 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION (32.5'x 11.83')(0.74 GAUSQ.FT.) = 284.5 GPD �� JOHN L. `�' PREPARED BY: Z •.r1 /j" OF THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY CORNER OF STONE (5) -- 42.4' 21.1' 1 156" 59.00' 1 CHURCHILL JR u WITH THE TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO TOTALS: No Mottling, Standing or Weeping Observed IViL JC ENGINEERING, INC. ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CORNER OF STONE (6) -- 53.0' 22.4' I TOTAL NUMBER OF CHAMBERS: 3 A , b7 2854 CRANBERRY HIGHWAY / / CONSISTENT WITH TEST PIT DATA. CORNER OF STONE (7) -- 72.3' 53.9' TOTAL LEACHING AREA: 561.8 SQ.FT. 90� NTt. EAST WAREHAM, MA 02538 SITE PLAN 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE CORNER OF STONE (8) -- 64.9' 53.4' TOTAL LEACHING CAPACITY: 415.7 GAUDAY(RESERVE AREA) 508.273.0377 SCALE: 1"=10' WATERSHEDS AND NOT LOCATED WITHIN A DEP APPROVED ZONE 2. _T_____ __.__ Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.512-B } I - C t"n C\j oo , 'n r. CD J' EXISTING 51 e 1 1 58'-3V - - RAMP DOWN EXISTING STAIRS - - DOWN TO 9Z l 117DI -- - BASEMENT _ 4x Ell � P w W EX. I w HkND n - SINK -- I � 0 w w 9Z N ON I % — Hot — F Chocolatetillpr 1 V^) O l V/ O 40 - - z NOTE: 70.5 70.5 - 110 �' g `, ( o e 120 0 F'EE AND FIELD TEAM TO _ � 0 0 O JE. DI PL Y —® DETERMINE IF BACK ROOM ____ __AC o °�EQUIPMENT AND COLD/DRY Han a' �o.s �51 �o.s 0 STORAGE CAPACITIES CONFORM TO _ __ _ >� `�UNDER 64 Sink �;COUNT, R 3p" FILLER 30" FILLER 2,—Q„ CURRENT STANDARDS 1 ; _J ` X m as i' ICE BIN COUNT K SE AREA " HAND—OFF z M Q o CO B, „ 5a_ K 9 . ; CUSTOM » -- -- ~ 4 O j ICED 3 —0 N �z -- - - ri _, , - � to COFFEE. STA"� uN POD STA- !LN COFFEE STATION E J ❑ _ �,� -- e- (n x COFJ TEA — - I - n w .. _ Qlw 01A 01 120 0. - -- a -- - -- - X E3 IQ O - - - i 101 101P r.. X� ; 91.1 O UNDER COUNTER - 0 ICE BIN __- EXISTING Tl:jl 00 SALES AREA f 1 i I (18 SEATS) � I �- - OFFICE F (EXISTING) TO sLET — . . a . ._.. _..._ I >i, a�i �' NOTE: � - NEW FINISHES & LIGHTS m >,; N EXISTING STAIRS UP IN TOILETS & HALL. TO 2nd FLOOR e p o r K - , ^ m TOILET HALL o � (EXISTING) a (EXISTING) s s I� INTEF IqR MONOLITH ® 682 NOTE The placement of the interior TRASH monolith is approximate. It is the responsibility of the architect to locat it f I correctly in the final architectural dra`inj S. Ld HIGH SEATING I I BOLT DOWN TABLE HIGH SEATING 930 930 30 938 938 d 629 t 938 938 938 938 . I2; 610 610 ((WC W) 610 •-1 G ,y5 VESTIBULE rn Q 930 930 930 938 938 �� -- �--- - - - - - ---- - ---- - EXISTING q o _ z r FLOOR PLAN SCALE: 1/4 = 1 —0 _ i x 1 ,ems' yu qi 0-'141 D 08010 . . LL-/07 f 08 �( ..• M R. J.R. {, • ..,...�....; ... ..., .. ,.....,. .,..,,•, .. . ,. .. ....r:. ....w.r...,. ,.....,, .,,...._ s -.- -n. _.::e+cr<.ms-n. -,-Re.... _ .. ...-+F ems.-.