Loading...
HomeMy WebLinkAboutCRISP II - FOOD LOCRISP 11 770 Main St. sterville lilt I CH#r BOARD OF HEALTH Town of Barnstable John T. Norman Board of Health Donald A.Gaudagnoli,M.D. arn,NgrACM F.P.(Thomas)Lee,. I'AS° Daniel Luczkow,M.D. Alt. 200 Main Street, Hyannis, MA 02601 xFb A1A'�q., 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: 434 Issue Date: 01/01/2022 DBA: CRISP TOO EXPRESS OWNER: CRISP TOO EXPRESS INC. Location of Establishment: 770 MAIN STREET OSTERVILLE„ MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 8 OutdoorSeating: 0 Total Seating: 8 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Qh FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE i Restrictions: June 14, 2016 meeting - Board granted variance for one restroom with the following conditions: receipt of written statement from landlord stating restroom(s) in hallway between the barber shop and dry cleaners will be available to restaurant during the hours the restaurant is open, and (2) the seating will be limited to 8 table seats and may have a bench (without tables at it) for people waiting. DOT n t' For 0°�' '�'q•� Town of Barnstable Initials: Date Paid Amt Pd$ ST,BM : Inspectional Services f Public Health Division Check# ( 1 Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 99 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT S DATE I NEW OWNERSHIP RENEWAL V NAME OF FOOD ESTABLISHMENT: UAsf? ADDRESS OF FOOD ESTABLISHMENT: 77 C-) Wa lb031agU,EM* (R� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: IJ q a TELEPHONE NUMBER OF FOOD ESTABLISHMENT: lam) ►0 - M7- v< TOTAL NUMBER OF BATHROOMS: I WELL WATER:YES NO—Z..(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: /_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS.IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? 014 IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICTE 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 Q:Wpplication FormsT00DAPP 2020.doc --- _ Y? OWNER INFORMATION: FULL NAME OF APPLICANT a --7 SOLE OWNER(YE /NO D.O.B �jaj-7QOWNER PHONE # ADDRESS- Y�Y�-s y' ?t\LLL f I Vim[ dZ�vS� CORPORATE OWNER: 1.WS 2lM CORPORATE ADDRESS: _770 MAIM Veil M '• �L(, ��� PERSON IN CHARGE OF DAILY OPERATIONS: �s"� � IL,L-yHA 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 I. 17 31,Jlmesv 03 2Z 2 ill- , 3 / ZZ- P felt UPI r 03( ;2--7 SI URE 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't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doe Qp THE ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: - 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 M639• �0� HYANNIS,MA 02601 .. M-8 -FRi. No Reference R-Red Item PLEASE PRINT CLEARLY gb a 508-862-4644 TFO MP+ FOOD ESTABLISHMENT INSPECTION REPORT AIZA SVIDN Name I Date Tvoe of T f Inspection 012erati 6o.tine--*,) l 'd Address � ' Risk od Se i e- ction Level Retail Previous Inspection S Telephone Residential Kitchen Date: , Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness �( C. 3-7 Caterer General Complaint Person in Charge(PIC) Time /I Bed&Breakfast HACCP _ In: 7yl/> Other Inspector S1 Out: � 1 " � Each violation checked req Tres an explanation on the narrative page(s)and a citation of specific provision(s)violated. fi Z Z .Z 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) ❑ Gtl l FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands 77 ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities ( 1 I / / EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ` ✓P� �C /7ty (/�Q CJ L ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives / ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals n / /� r� FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) K7 ❑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 Aze ❑ 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 s) n f /�� J p, ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories l " ww"�`' �� �"e �l✓t-tom ' Violations Related to Good Retail Practices(Blue Item Total Number of Critical Violations 1��/ �� CL Critical(C)violations marked must be corrected immediately. (blue&red items) 2� Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or 19 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 9 re ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 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 C=2 critical violations and less than 9non-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. 4 to 8on 29.Special Requirements (590.009) within 10 days of receipt of this order. violation, -critical violations=C. /�/J/ 30.Other DATE OF RE-INSPECTION: Inspector's ig tore Print),,, rint)///llJ�� �� 31.Dumps 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 136 igmadre 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 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 1 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 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* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR . 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 _ Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted I ise 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* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg 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 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 StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- * Ratites-165°F 15 sec* in mobile food,tem o and residential Sources 10 Proper,Adequate Handwashing g' P mil' 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 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* 3-403.1](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 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 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 _ 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance 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. 111 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:690Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `Op THE TpN, TOWN OF BARNSTABLE _ - HEALTH INSPECTOR'S Establishment Name: Date: Page: a--7-of v c 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.9. �• HYANNIS,MA 02601 - - MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �°rFD MPS►' 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Y/ � Name G Date Type of TyR&gf Ins ection outm Address, "� �� f7f Oil(`T Risk < Food Sen -Re-inspection Level Level Retail Previous Inspection Telephone Residential Kitchen Date: -F ,gr,�C 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 7L��/ ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS Apel X GC r/ ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives h 16 ❑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 04 `e9 Y r ❑ 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 J 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 G�'s r 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 El Yes Non-critical(N)violations must be corrected immediately.or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection 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 g ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=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 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 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation 4 o 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspecto /Sj nature. Pr' 31.Dumpster screened from public view Ij 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 EMPLOYEE HEALTH - 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to * 2 Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) liance 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 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'A6 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 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* Effective uuzoor 4-602.11_ Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* f Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Chemical Stuffing Containing Fish,Meat,Poultry or 590.009 3-201.15 Molluscan Shellfish from NSSP Listed * (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. 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 ( )( )O 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 * E5-203.11 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* 12Prevention 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 Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13Handwashing Facilities 3-501.14 A Cooling 3-202.18 Shellstock Identification ( ) g Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 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 I 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. `oF. ror� TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of " J P ° PUBLIC HEALTH DIVISION OFFICE HOURS8:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. g MON.-FRI. A ,639.p�0 HYANNIS,MA 02601 soe-ss2-asaa No Reference R-Red Item PLEASE PRINT CLEARLY.- . FOOD ESTABLISHMENT INSPECTION REPORT Name Date !, Tyne of T e of Inspection outin Address /'Lc�f�irt �'� i^r('f Risk ection j v" Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint i Person in Charge(PIC) Time Bed&Breakfast HACCP f Tj Y, In: Other / Inspector Out: � in 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) ❑ e Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ I'� �e Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ % l /� / � FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands �l ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities M� EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ^ I/1' GZ. ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 1 \ d- GL�1/- r ❑ 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) , t d de ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY j❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories C� 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 J 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 ❑ 9 Embar o 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 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 8non-Critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector;tre at Print 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N pIC's Print: 09 #Seats Observed Frozen Dessert Machines: Outside Dining Y N Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Chazge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 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 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 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 3-801.1](A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 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 -601.11 A Clean Utensils and Food Contact Surfaces of * Animal Foods That are Raw,Undercooked or 4 5-101.11 Drinking Water from an Approved System* ( ) Eggs-Immediate Service 145°F 15 sec Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg cri-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* 3-401.11(B)(1)(2) min* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source Pork and Beef Roast-130°F 121 Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g. P �' 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 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 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. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE. HEALTH INSPECTOR'S Establishment Name: ` ( � Date: 12-b& Page: Of 'OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 MON.-FRI. No Reference R-.Red Item PLEASE PRINT CLEARLY 508-8624644 FOOD ESTABLISHMENT INSPECTION REPORT Name Date Type of TyRe of Inspection - - L Ro Address D n ��7 Risk ood Sell e-inspe oni Level Re ai spection r Telephone Residential Kitchen Date: Mobile Pre-operation A - ' Owner HACCP Y/N Temporary Suspect Illness S f r Caterer General Complaint � - ' j� � Bed&Breakfast HACCP Person in Charge(PIC) � �� V�_l�__. Time Inspector Out 3.�� Other f I-et �� C� 6 r 1 S Each violation checked're Tres an explanation on the narrative page(s)and a citation of specific provision(s)violated. 1-, Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ �� I Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ �U. Z✓ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ qvv, FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands / L(� 'A�H ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities T i 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) {('jam CL ❑4.Food and Water from Approved Source ❑ J 16.Cooking Temperatures J L W (1`' CI CLQ�I Gf-✓ l D� ❑ 5.Receiving/Condition ❑ 17.Reheating � �I� ..r O r�L t El 6.Tags/Records/Accuracy of Ingredient Statements El18. oling �J - Al i,-I - d`7 r I (S ❑ 7.Conformance with Approved Procedures/HACCP Plans 9.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8. eparation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ( G _ L. 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP 1 `10 ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY �L 4 C e ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories 00, Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations rs -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 ❑ Empl Exc sion ❑ Re-inspection cheduled ❑ Eme gen Suspension C N Official Order for Correction: Based on an inspection today,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 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 re ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 4 non-critical violations 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 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot aggrieved b 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) agg y this order,you have a right to a hearing. Your request must . ) 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 Signat Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N pIC's Sin Print: #Seats Observed Frozen Dessert Machines: Outside Dining Y N g Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y IN Dumpster Screen? Y N - -- •--" _. _ r s -'^'. .�..-�--. .... .�-.+-.--..�..--.,.J.-i..: .--...... �--...� -�_ .. ._ �.� _� _.� �_ ._ � _. _ ...- -. , - - .ter - - _ ��--_. - W _ r � �.:�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 Temperature . 1 590.003(A) Assignment of Responsibility* 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45'F Within 4 Hours 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PIIFs Cooked and RTE Foods.*- - 19 PHF Hot and Cold Holding _ 2-103.11 Person-in-Charge Duties 3-302'.14' Protection"from Unapproved Additive's* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41 590.004(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* 3-501.16(A) Hot PHFs Maintained At or Above 140°F-. - ! 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* _ 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Piotection* 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 Rlated or of Food*, 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 1590.003(E) Removal of Exclusions and Restrictions � ° g Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing--Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* - 4-501.112 Mechanical Warewashing-Hoi Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* _, Sanitization Temperatures* I 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 AnimalConsu Fooer d That 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 I 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* Effective iiuzoot 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 IS 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 StuffingContainingFish,Meat,Poultryor _ _ Chemical 590.009 A - D Violations of Section 590.009(A)-(D)in cater- Chemical*Molluscan Shellfish from NSSP Listed * ( ) ( ) Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 1 o Proper,Adequate Handwashing 3-461.11(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* 2301.12 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 PHFs 145°F 15 sec practiceso be debited under#29 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding r a s. Special 2-401.11. _ Eating,Drinking or Using Tobacco* * Requirements. 5 - - - Receiving/Condition - � - - - g. � g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received_at Proper Temperatures* t _ 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 * 3-301.1f 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* �2 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F[0 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 i 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 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 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 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.QgO. I *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `gyp THE ro TOWN OF BARNSTAB.LE. .. :_HEALTH.INSPECTORS Establishment Name: `�" ''S11' I Date: 2 .Page:.. _;of. - "I OFFICE HOURS PUBLIC HEALTH DIVISION s 0o '9:30A.M. BARNSTABLE, = 200 MAIN STREET 330-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 MON.-FRI.508-862-4644 No Reference R-Red.Item LEASE PRINT CLEARLY rF°MI° FOOD ESTABLISHMENT INSP CTION REPORT Name S Da t e o Iyaonqt1papection 'I \ - g Routine Address c Risk < Food,Servi ion n `� Level Retail Previous Inspection Telephone Residential Kitchen Date: � - 'Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) + Time Bed&Breakfast HACCP II f / o In: Z �� Other t3 Q SILL Inspector Out:; LfS / Each violation checked req Tres 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) ❑ ovt� -G04M 1 Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ w D Action as determined by the Board of Health. Allergen Awareness 590.009(G) GwtS.l Gtil FOOD PROTECTION MANAGEMENT i ❑ 12.P vention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties r .Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS Lfil S GL1 i1 Z) C�J O ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 4/ ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals (• C FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Li r �/ ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating - 4 D F- ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18. ooling f+• . , ❑ 7.Conformance with Approved Procedures/HACCP Plans 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control �Z ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP U !.✓ t n ❑ 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 Nn a o 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 g l �a,l within 90 days as determined by the Board of Health. ❑` Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspe ion C N Official Order for Correction: Based on an inspection 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 9 re ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 4 non-critical violations 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 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 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: Inspector's Signature Print: 31.Dumps screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance.Letter Posted Y N Dumpster Screen? Y N 71­ Violations related to Foodborne Illness - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 6 Cross-contamination 14 Food or color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from1 3-202.12 -- Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* *- 19 PHF Hot and Cold Holding 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or-Toxic Substances 3-501.16(B) *old 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) ( )O P 7-101.11 Identifying Information-Original Containers * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F _2 590.003(C). Responsibility of the Person-.in-Charge to - 7=102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F * 7-201.11 Separation-Storage Applicants 3-302.11(A) Food Protection* 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 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 Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g - � ) Disposition of Adulterated or Contaminated 7.204.14 Drying Agents,Criteria* 21 3-801.11 A Unpasteurized Pre-Packaged Juices and Food n'� g 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 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 Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 ' Shell Eggs* - _ Sanitization Temperatures* 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 E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-00111(A)(2) Comminuted Fish,Meals&Game Pathogens* eff°"°°1/1/2001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Sfindards 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 rf 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 StuffingContainingFish,Meat,Poultryor - 3-201:15 Molluscan Shellfish from NSSP Listed _ _ Chemical* 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 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. $ - 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 * 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 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 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 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 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. �p IHE rq, TOWN OF BARNSTABLE _ _ _ HEALTH INSPECTOR'S Establishment Name: Date: Page:. of., �j Ol OFFICE HOURS n BARNSTABLE.e PUBLIC HEALTH MAIN STREET DIVISION =• a 30=s:30. M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3 30-4:30 P.M.P MAss.� HYANNIS,MA 02601 M-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY PrFO MPS p`0 r S08-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name . f/ Date Z/ Type o Type of Inspection X 1J. ( QW9901=941 utine Address "� J TJ'�- Risk 4Tood Service Re-inspection l! Level Retail Previous Inspection Telephone Residential Kitchen Date: /f Mobile Pre-operation )��� Owner HACCP Y/N Temporary Suspect Illness 1 A /� Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: 7 Other Inspector Out: �L i� b d 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) ❑ CQ�/ e r �'�-� Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ �` LJ . "I FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands (i✓ ❑ 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 r /(�� j�✓� �� ❑ 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 PR78Separation TION FROM CONTAMINATION ❑ 20.Time As a Public Health Control Via 4/ /Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ✓� �l�Pf G ( C �ood Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ` ❑ 10.Proper,Adequate Handwashing CONSUMER ADVISORY e ob/ ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Ctj If 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: N v _ ❑ YesC 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 mergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ m go Ebar checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency Closure Other: Voluntary Disposal ❑ 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 9 if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less 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 violations observed,7 to anon-cri 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address 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 Signatur ::;r,int..rnt: 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 Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N f' ,•r-::.-r_s,.+.-_�--.�:;_ar..._.-�.'r.n.....,_.v r;`"-•--_--_ r s-.w.r+larr.+r_�...+.�.�.---�..-�_r/-^.'-wr-..`..+-T._'�....^.-r•....s.r•-r.r•to..•'+.r..'�'..w--�'�.r�^+�.. �^a�"+`•-., r. .-- -..�.-.t._ _..ram..w•. Y.-. yo rr.F•r-..-. - a ._ t. .-..--.. _ .-.. r .s;.. -. . .�R1�-w �{°r.rti..,+r_ nr•+•a"ti= a .�• A �y�_��+•���L.e v .- �., z- �. 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-Chazge 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* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to _- - 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An _ 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance 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 Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents;Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4- Food and Water From Regulated Sources' g -- Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004A-B Compliance with Food Law* * 3-801,11(D) Raw or Partially Cooked Animal Food and ( ) Com P 4-SOLll1 Manual Wazewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201:13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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 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 Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.1](A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed _ _ Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under - Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 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 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* I t. 2-301.12 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 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 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* 1 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 1Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans i' 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 1 8-103.12 1 Conformance with Approved Procedures* 1 S:5.90Fomtback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical,item in the federal 1999 Food Code or 105 CMR 590.000. oF. ► TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: i. h 42( ' Date: I Zf Page: of PUBLIC HEALTH DIVISION 8:00ICs:3oaMs BARNSTABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified esq: �•� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �p�FD MPS a - 508-862-4644 - FOOD ESTABLISHMENT INSPECTION REPORT Name Dat e o of Inspection /mod outine Address /��1 S� b� Risk ood Service on ' Fe Level Previous Inspection Qrr f C- Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time -gyp Bed&Breakfast HACCP In: 2°.-O f im Other Inspector ��jj 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) ❑ O Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health.. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities ! cal EMPLOYEE HEALTH - PROTECTION FROM CHEMICALS En ❑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 he 1 111L ❑ 5.Receiving/Condition ❑ 17.Reheating C1yY ✓ hey(I . ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PRO CTION FROM CONTAMINATION ❑20.Time As a Public Health Control 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) l ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY Jk ❑ 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 Emergency Closure El 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 if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 = 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8raon-critical violations C. 30.Other DATE OF RE-INSPECTION: Inspector's Sign Au Print:1 31.Dumpster screened from public view I �� Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N T III #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 fir, Dumpster Screen? Y N k -- -• - _ --_ > -... .`.w. Y -.r.�-..... ti_, _. �. -- - _ ,,.__�..._.�.. .,.. z._v. - .. --f -z �^, -r�2 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* $ 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 1-2- 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 * 590.004(F) ( )O P t 7-101.11 Identifying Information-Original Containers * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge-to - 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - Applicants* - - - - - 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* 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 Variance Requirements ) 590.003(G) Reporting by Person in Charge*" 7-203.11 Toxic Containers-Prohibitions* (11 Contamination from the Consumer 3 590.003(13) JExclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 1590.003(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* q Food and WaterFrbin Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Cfitefia* 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 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.f If 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 Eggs 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or - Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef cdw 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* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 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- 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 -- - - -- - - * -2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 3-202.18 Shellstock Identification Present 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. 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 PreventingContamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* d 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the Foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification* 3-501.14( ) 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 V6-301.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 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* 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/ Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 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 1 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.O11 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. F. E► TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: D ' J- PUBLICate. 0//? Page: of G OFFICE HOURS C HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ' 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified .Ass. MON.-FRI. ocbprEDpa� HYANNIS, MA02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY F OD ESTABLISHMENT INSP C ION REPORT Name Da t Tvoe of s c i n i /- T s outi . J Address Risk Fo Service -mspe lion Level _Reta' Previous sp zdl Telephone Residential Kitchen Date: Mobile Pre-ope a i Owner HACCP Y/N Temporary Suspect III It ) / Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Inspector ut Each violation checked requires an explanation on the narrative pa e(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Ris Factors(Red Items) Anti-Choking 590.009(E) ❑ 1. 1 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 v ❑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 HS V ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY �o ;)-,lr�l 1 1 Iq ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories /V I Y 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 it m ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food C de. 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 rib violationscal violations g 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 6rion-criti =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 vio ations. If 1 critical refrigeration. vio on,4 to 8 non-critical viol ions 29.Special Requirements (590.009) = within 10 days of receipt of this order. ati b 30.Other DATE OF RE-INSPECTION- Inge dr Si n re t: 31.Dumpster screened from public view J Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y IN #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen o Y N (�� Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) �De_. signment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) onstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 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* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eryecnve uvzoo/ 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* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Chemical Stuffing Containing Fish,Meat,Poultry or 590.009 3-201.15 Molluscan Shellfish from NSSP Listed * (A)-(D) Violations of Section 590:009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential* Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.l l 2-301.14 When to Wash* A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )ro) 3-201.17 Game Animals* it 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 CommerciallyProcessed RTE Food-140°F* (Blue Items 23.30) 3-202.15 Package Integrity ( ) Critical and non-critical violations,which do not relate to the 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 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °p 11HE Tpk, TOWN OF BARNSTABLE. HEALTH.INSPECTORS Establishment Name: Date: Page: of ti OFFICE HOURS 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 p39:a m� HYANNIS,MA 02601 MON.-FRI. No Reference- R-Red Item PLEASE PRINT CLEARLY - TFD MPv 508-862 4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Date a of Type of Inspection O e Rout' Address" Risk od Service e-inspection Level ion 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: 09.1 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 Chemicalslic- �{ FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ W.Reheating .77 ❑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(HS ) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY �.l ❑ 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 ction 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 items checked indicate violations of 105 Embargo 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 B=One critical violation and less than 4 non-critical violations 9 )( ) cited in this report may result in suspension or revocation er 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. 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: Inspector's Signature Prin 31.Dumps r screened from public view- Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted• Y N Dumpster Screen? Y N Violations related to Foodboine Illness Violations Related to Foodborne Illness Interventions ' Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.),s s 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. Law Cooled to 41°F/45°F Within 4 Hours* __.. _.. __. Food or Color Additives. 590.003(B) I 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 590.004(F) 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* 7-102.11 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=20L11` Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 7-202. 3-501.19 Time as a Public Health-Control*, 3-302.15 Washing Fruits and Vegetables * Applicant To Report To The Person In Charge* * 7.202.12, Conditions of Use 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) I 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(A7B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed'Sprouts Not Served*` " ' 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 76 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY * Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water 3-401.I lA(1)(2) Eggs-155°F 15 sec 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145`F 15 sec* Animal Foods That are Raw,Undercooked or _ _ _ - - gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Battled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg m'°e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* - Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 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* 10 Proper,Adequate Handwashin ing,mobile food,temporary and residential P q 9 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* ( )O P Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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 PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 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* * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non critical violations,.which do not relate,to'the foodborne 12 Prevention of Contamination from Hands O g illness interventions and risk factors listed above,can be found in the 3-101.11 Food Safe and Unadulterated* - `"_"- 3-403.11E Remaining Unsliced Portions of Beef Roasts* 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 3-50.1.14(A) Cooling Cooked PHFs from 140°F to.70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F., Item Good Retail Practices FC 590,000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003- - - 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45'F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006- - 590.004 Labeling of Ingredients* Supplied with Soap and hand Drying Devices (J) 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 T,. 29. 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. - p 114E r TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: Date: 1 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 M. p MON.-FRI. ,,39,a. HYANNIS,MA 02601 508-862-4644 No Referent R-Red Item . PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT Name Dat Type of T e of I s ec io i L p outine Address Risk ood Service Level- Previous Inspection Telephone t Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness e y", Caterer General Complaint \ Person in Charge(PIC) Time Bed&Breakfast HACCP O In: Other O 4J 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) ❑ i Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑V FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands L- ❑ 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 �,.�` f ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals r A AL 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 ✓ ❑ 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)n( i ❑ 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 re D Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations 1 �A lq Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action r lot' o ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compli ❑ 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 B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste = (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,.or lack of violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8von-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 screen from public view . . Permit Posted? Y 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 1q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding . 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved 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* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F- - Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 1307-102.11 Common Name-Working Containers* � Applicants*_- - - - - 3-302.11(A) Foo 7-201.11 Separation-Storage*d Protection* , p g 20 Time as a Public Health Control 590,003(F) Responsibility of A Food Employee or An 3-302.15 - Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public.Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 590.004 11 Requirements Variance Re 3-304.11 Food Contact with Equipment and Utensils* ) 9 590.003(G) Reporting by Person in Charge* - 7-203.11 Toxic Containers-Prohibitions* ( Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* - 7-204.11 Sanitizers,Criteria-Chemicals* _ REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated I - - - 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 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* i - 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 Drinki ng Water-from an ApprovedSystem* Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* sffe cri,c 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 Chemical Stuffing Containing Fish,Meat,Poultry or 590.009 3-201.15 Molluscan Shellfish from.NSSP Listed * (A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 1 p Proper,Adequate Handwashing g' p � Game and Wild Mushrooms Approved By-- - - _ * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 1 * Other 590.009 violations relating to good retail 590.004(C)__ Wi1d.Mushrooms _ _ _ _ _ _ _ _ _ _ (A)( )(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. $ - Receiving/Condition 2-401.11 Eating,Drinking or UsingTobacco* 3-403.11(A)&(D) PHFs 165°F IS sec* 3-202.11 PFIF'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 Tune* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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) Coaling Cooked PHFs from 140`F to 70°17 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 r5-2O5.11 1 Numbers and Capacities* Within 4 Hours*. 23. Management and Personnel FC-2 .003 I 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* 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 Conformance with Approved Procedures 1 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 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. _ OptNE ipk, TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page: of w - P� do OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. - 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ` BARNSTABLE. ` A Maw;a m HYANNIS,MA 02601 MON.-FRI. No Reference R.-Red Item PLEASE PRINT CLEARLY rFn MPS 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Date / ype of T ns ec ion i �iq era ' outine Address Risk F Service ection Level revlous 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. i 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 (Upv Y_ ❑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 „ Pe 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) ! 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 1l)5 CMR 590.000/Federal Food Code. Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC•4)(590.005 B=One critical violation and less than 4nori-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 al8.n violations non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8rion-critical violations=C. _ 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted, Y N ( Dumpster Screen? Y N ' t Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility F 6 Cross-contamination 14 - Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* *- 19 PHF.Hot and Cold Holding 2-103.11 - "Person-in-'Charge Duties - - 3-302.14 Protection from Unapproved Additives - Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F' 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* P n' 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 590.003(F) Responsibility of A Food Employee or_An .3-302.15 _ - Washing Fruits Restriction-Presence and Use*its and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 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 Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated Food - 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* I Beverages with Warning Labels* 4 Food and Water From Regulated Sources "- 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 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. 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* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg Breve 11112001 4-602.11. Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source- ._ ._ _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702:11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* - - 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and 3-201.15_ Molluscan Shellfish from NSSP Listed Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Chemical* _ _ _ __ _ _ Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 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 Piesent* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* j*qhen 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* ood Hygienic Practices -17 Reheating for Hot Holding practices should be debited under#29-Special atin Drinkin or Usin 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* ischarges From the Eyes,Nose and Mouth* - 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * reventing 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 revention of Contamination from Hands 3-403.11E g illness interventions and risk factors listed above,can be found in the 3-101.11 Food Safe and Unadulterated* O Remaining Unsliced Portions of Beef Roasts* 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 Handwashin Facilities 3-501.14 A g 3-202.18 Shellstock Identification* 9 ( ) Cooling Cooked.PHFs from 140°F[0 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.148) 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>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. �p THE Tqy TOWN OF BARNSTABLE _ _ HEALTH INSPECTOR'S Establishment Name: Date: Paget of c` OFFICE HOURS LIC HEALTH �,R'Ni'sr`E Q PU62 0 MAN STREEETSION 3::30-0-4:30 P.M.:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 MO8N - sos- . FRI.RI. No Reference R-Red Item PLEASE PRINT CLEARLY �p'FD1AP`p FOOD ESTABLISHMENT INSPECTION . EPORT " Name Date ! Tvne of o s e ion O n Routi Address Risk ood.Service on r v Level Previous Inspection Telephone Residential Kitchen Date: Pre-operation Mobile Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP I� In: Other Inspector Out: t Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ �J !/lil 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 af Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations AI Critical C violations marked corrected immediatel y.. blue&red items d must be ( )( Y N Corrective Action Required. o Yes q ❑ Non-critical(N)violations must be corrected immediately or Overall Rating . within Health. Voluntary Compliance Employee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension 90 days as determined by the Board of Heat ❑ ry p ,❑ ❑ P ❑ 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 El 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 B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8raon-critical violations=C. 29.Special Requirements_ (590.009) - 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) • FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) I 8 Assignment of Responsibility* _ Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45'F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in--Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding _ Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2• 590.003(C) ,•Responsibility of the Person-in-Charge to Other* 7-10211 Common Name-Workin Containers** 3-501.16(A) Hot PHFs Maintained At or Above 140°F* . Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* - - Applicants* -" 3-302.11(A) Food Protection* 1-201.11 Separation-Storage* 20 Time as a Public Health Control _ 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* - - - -- 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003 D Exclusions and Restrictions* 7-204.11. Sanitizers,Criteria-Chemicals* ( ) 3-306.14(A)(B)Returned Food and Reservice of Food* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11_ Drinking_Water.from an Approved System _ _ _ gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* 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 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 Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* • Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11 C Game and Wild Mushrooms Approved By - -- - - - * ( )(3) Whole-muscle,intact-Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-361.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* _ 2-301.12 - Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 2-301.14 When to Wash* * 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 11 Good Hygienic Practices practices should be debited under#29-Special 3-201.17 Game Animals* 17- Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the Foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 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 Labeling of In redients' Supplied with Soap and hand Drying Devices (n g g 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 1 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 - Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:59017ormback6-2doc `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in federal 1999 Food Code or 105 CMR 690.000. •� � Town of Barnstable BOARD OF HEALTH John T.Norman r1 Board of Health Donald A.Gaudagnoli,M.D. B,AWNSTADLE, PaulJ.Canniff,D.M.D. ° 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 434 Issue Date: 01/01/2021 DBA: CRISP TOO EXPRESS OWNER: CRISP TOO EXPRESS INC. Location of Establishment: 770 MAIN STREET OSTERVILLE„ MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 8 OutdoorSeating: 0 Total Seating: 8 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: June 14, 2016 meeting- Board granted variance for one restroom with the following conditions: receipt of written statement from landlord stating restroom(s) in hallway between the barber shop and dry cleaners will be available to restaurant during the hours the restaurant is open, and (2) the seating will be limited to 8 table seats and may have a bench (without tables at it) for people waiting. For Office Use Only: Initials: Town of Barnstable Date Paidl Amt Pd$ BAMSPABLE, : Inspectional Services 9cb 1639. ,0� Check# l�� Arfo,,,o�• Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,N A 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A� FOOD ESTABLISHMENT DATE J///L//g0 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ayise -MD tEx� ADDRESS OF FOOD ESTABLISHMENT: �. V A— MA I Q OZ�oSS5- MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: V��7CAAW`U k,"c llDl TELEPHONE NUMBER OF FOOD ESTABLISHMENT: - D"l 70— TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO k ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION: / /_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: le SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q\Application FonnsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT y �/� SOLE OWNER: Ot� /NO D.O.B Z� / OWNER PHONE# UW -770 &3� ADDRESS W�AI FAk�WQ - CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. N<jkf'l� V k4- ;4 22- a) �-f t 6 �2-3 1 27 2. -T-&t Z ILLV(+4 1 Z 1�1 .2U&) SI A RE OF APPLICA T DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openine!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec. 3 V each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:\Application FormsTOODAPP REV3-2019.doc p'P Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. Paul J.Canniff,D.M.D. MAS& MA 02601 F.P. Thomas Lee Alternate 1659. , 200 Main Street, Hyannis, Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 434 Issue Date: 12/10/2019 DBA: CRISP TOO EXPRESS OWNER: CRISP TOO EXPRESS INC. Location of Establishment: 770 MAIN STREET OSTERVILLE, MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 8 OutdoorSeating: 0 Total Seating: 8 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G A FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: June 14, 2016 meeting- Board granted variance for one restroom with the following conditions: receipt of written statement from landlord stating restroom(s) in hallway between the barber shop and dry cleaners will be available to restaurant during the hours the restaurant is open, and (2) the seating will be limited to 8 table seats and may have a bench (without tables at it) for people waiting. For Office Initials: °'E'°"yti Town of Barnstable Date Paid Amt Pd$ BARNSTABLE, : Inspectional Services RFD MAy � Public Health Division Check# Q � Thomas McKean, Director 4 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 u A /APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 0 NEW OWNERSHIP RENEWAL_L/ NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: !D D A- V V M N MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO L/ ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) je/FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:Wpplication FormsTOODAPP 2020.doc -Y OWNER INFORMATION: FULL NAME OF APPLICANT cJ l-I I i 1��� 5) � -�1�l SOLE OWNER: YES/NO D.O.B OWNER PHONE# 5U �CQ CfJ � ADDRESS,�v� �.Utlrr�u� � �` YLVI,C_LE✓� CORPORATE OWNER: Cpe-,je rm-� CORPORATE ADDRESS: II PERSON IN CHARGE OF DAILY OPERATIONS:List(2)(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 1JN1� %e�d 3 / ?7/ ZZ 1. J4Mt:5 Sx)I - J / Z3 / ZZ 2. T-6� kL\1 R11 13 l SIG TURE OF APP CANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.ast). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January Ist to Dec.3Is`each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:1Application FormsTOODAPP REV3-2019.doc d c �^ Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. BARNgcABM John T. Norman Thomas Lee Alternate q, aq. ti 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 434 Issue Date: 12/20/18 DBA: CRISP TOO EXPRESS OWNER: JAMES SUPRENANT Location of Establishment: 770 MAIN STREET OSTERVILLE, MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 8 OutdoorSeating: 0 Total Seating: 8 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: Gr'� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE I Restrictions: June 14, 2016 meeting - Board granted variance for one restroom with the following conditions: receipt of written statement from landlord stating restroom(s) in hallway between the barber shop and dry cleaners will be available to restaurant during the hours the restaurant is open, and (2) the seating will be limited to 8 table seats and may have a bench (without tables at it) for people waiting. FSHE Initials: o� Town of Barnstable Date Paid XT Amt Pd S �BAMW^MA-MIM� Inspectional Services 16.19. �0 .eTFO�p Public Health Division Check# Thomas McKean, Director UV 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 i APPLICATION FOR PERMIT TO OPERATE A F OD ESTABLISHMENT DATE I P51I I NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: (21V_( S p —1 b-I-) If x ra'� S ADDRESS OF FOOD ESTABLISHMENT: �)-_] O VV A I J ST a 11�AL L MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: V/ TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (y) ) D�Z� TOTAL NUMBER OF BATHROOMS: I WELL WATER: YES NO y ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:_� SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: 9) OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V 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 FormsTOODAPPREV2018.doc ------------- PLEASE CALL 508-862-4644 OWNER INFORMATION: c ` FULL NAME OF APPLICANT NZZ-�, "�f JU�Eyq ' SOLE OWNER: ES/NO D.O.B OWNER PHONE # HIV 7760 Oo ADDRESS_ (2s W u r �Cstz o=1�1jOy 0S IA CORPORATE OWNER: �S�T�U� Z FEDERAL ID NO. : I (qq CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: ZQG�`YL 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 ,ta, q OZ3VO061 ec I "TV—I I 1 2-L Zo-z 2. JPtM en, �'5J y9IGar 3 / 2-7 2yZ SIG O P %LICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec. 3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q\Appfication FormsTOODAPPREV2018.doc Bellaire, Dianna C Vq From: McKenzie, Marybeth Sent: Wednesday,January 02, 2019 9:21 AM To: Bellaire, Dianna Subject: RE: Crisp Express t OK then From: Bellaire, Dianna Sent: Wednesday, January 02, 2019 8:47 AM To: McKenzie, Marybeth Cc: Bellaire, Dianna Subject: RE: Crisp Express They sent me the two Servsafe Manager's certificates and the allergen. 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 From: McKenzie, Marybeth Sent: Wednesday, January 02, 2019 8:07 AM To: Bellaire, Dianna Subject: RE: Crisp Express They needed a CFM they have a CFH on site at this time. From: Bellaire, Dianna Sent: Friday, December 21, 2018 1:58 PM To: McKenzie, Marybeth Cc: Bellaire, Dianna Subject: Crisp Express I bet you couldn't guess this one was next? Same thing, I have everything. Are they okay for 2019, no grade on last inspection. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 1 4 � 1 5roq Are nAen! (A-,om�v� roofQpS- siol ww - f a Of T � p ® 8 -DO Li �, fl 3/7/2008 • 1138 Noah's Item Qty Description Sell Each Sell Total 8 1 ea WORK TABLE,72"LONG 299.00 299.00 Advance Taboo Model No. ELAG-306-2X Work Table,30"wide top,without splash,72"long,w/adjustable undershelf, ! galvanized frame&shelf, 18 gauge,type 430 stainless steel top. I Weight: 87 lbs.total Extended Total for Item No.8:299.00 9 1 ea EQUIPMENT STAND, FOR COUNTERTOP COOKING 436.00 435.00 Advance Taboo Model No. EG-LG-305-X Equipment Stand,open base with bottom shelf, 30"x 60",24"high, stainless steel I r top,gals. legs and undershelf Weight: 84 lbs.total Extended Total for Item No.9:435.00 10 1 ea HOTPLATE,COUNTER UNIT,GAS 1,598.00 1,598.00 Bakers Pride Model No.XOB-636 Packed: each Countertop Range,gas, (6)bumers, 36"W x 30-1/4"D x 13-1/4"H,cast iron top grates,s/s exterior&s/s drip pans,4"legs, 180,000 BTU 1 ea One year parts&labor warranty std 1 ea Natural gas Weight: 400 lbs.total Extended Total for Item No.10:1,598.00 11 1 ea REFRIGERATED COUNTER,WORK TOP 1,660.00 1,660.00 Beverage Air Model No.WTR48A Packed:each ` Worktop Refrigerator,two-section,29"D,s/s top with rear splash, s/s exterior, anodized aluminum interior, rear-mounted self-contained, 1/5 HP,front breathing, 77. N g Energy Star Rated 4 1 ea Limited Warranty:One(1)year parts and labor 1 ea Additional 4 yr compressor warranty std. 1 ea 115v16011 ph,std, Weight: 242 lbs.total Extended Total for Item No. 11: 1,660.00 12 1 ea FOOD SLICER 2,095.00 2,095.00 Globe Model No. GC512 Packed:each i `^ Chefmate Series Heavy Duty Compact Manual Slicer, 12"diameter knife,top mounted sharpener,stainless steel food contact areas, and anodized aluminum base,gear-driven,cutting capacity 8-3/4"H x 10"W or 7-1/2"dia., 1/3 Hp, ETL, NSF, 115/6011,4.8 amps 1 ea 1 year parts(excludes weadexpendable parts), 1 year labor warranty -CONTACT FACTORY FOR DETAILS Noah's Hallsmith-Sysco Foodsery ices Page 3 of 5 l� 3/7/2008 i 1138 Noah's Item Oty Description Sell Each Sell Total 4 1 ea _COLD FOOD PAN,DROP-IN 2;350.00 <alternate> Vollrath Company L.L.C. Model No. 36434 Packed:each 4-PAN NSF7 REFRIGERATED COLD PAN MODULAR DROP-IN, 18-8 s/s,drip-free flange, polyurethane foam insul.,6-518"deep well, 1/3 HP compressor, 120V, 7.2A, v 5-15P plug, OA dim 54-3/4"x26",cutout dim 54"x25-1/4",7/8"comer radius,display area length 50-1/4", 5 business day leadtime, USA made Weight: 235 lbs.total Extended Total for Item No.4:2,360.00 5 1 ea DISPLAY CASE,REFRIGERATED,COUNTERTOP 1,588.00 1,588.00 ,; --; True Food Service Equipment, Inc Model No.GDM-9 IQ _ ou rtop Refrigerated Mer dicer,9 cu ft., Oshelves, laminated vinyl exterior, a e luminu 'n erior w/3 0 s ries s�floor, Low E thermal glass sliding doors, li to sign, g le elers, /5_ 11 60/1% / ea arranty 5 ear co ressor elf-con ined only) ea arranty year its and I or 1 ea :Permane non eel on- ip white vinyl,sid. 1 ea Illuminated sign panel:S-TS-01 "TRUE Stripe"graphic,std. Weight: 240 lbs.total Extended Total for Item No.6: 1,588.00 6 1 ea CHARBROILER,GAS,COUNTER MODEL 2,100.00 2,100.00 Magikitch'n Model No.APM-RMB-624 Radiant Charbroiler, counter model,gas,24"wide, 13"high,free floating round rod top grate.w/EZ tilt to front grease trough,s/s radiants,stainless steel front, sides and 6"service shelf,cleaning brush 1, ea Natural gas,specify elevation If over 2000 feet Weight: 190 lbs.total Extended Total for Item No.6:2,100.00 c 7 1 ea PIZZA PREP TABLE REFRIGERATED 4,250.00 4,250.00 Beverage Air Model No. DP93 Pizza Top Refrigerated Counter,three-section, 93"W,39.8 cu.ft.,(3)doors, s/s top ®- , with refrigerated pan rail, s/s exterior,anodized aluminum interior,with side-mounted self-contained refrig system, 1/3 HP, 3"casters(2 w/brakes), 19"cutting board, NSF-7, Energy Star Rated 1 ea Limited Warranty.One(1)year parts and labor 1 ea Additional 4 yr compressor warranty std. 1 ea 115vI60/1-ph,sid, 1, ea Left door hinged on left,center and right door hinged on right, standard Weight: 541 lbs.total Extended Total for Item No.7:4,250.00 .J Noah's Hallsmith-Sysco Foodservices Page 2 of 5 NoFEiii.............-._a....... -�- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �16 W..14...............OF........... ............................. Applirdtion for Dispasal Workii Toustrurtiou Vamit Application..is.hereby made for a Permit to Construct ( -1'*or Repair an Individual Sewage Disposal System at: 0.5 TL 7;Z-V 1 j L-F— ............... .................................................................................................. Location-Address or Lot No. ............................... ....... ........LM-40 ro Ownr�ar) Address t C4 ......... ............................ ............................. .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of BuildinglZA17ARAM.0 No. of persons..........oZe&....... Showers Cafeteria Otherfixtures ......................................--------------------------------------------------------------------------------------------------------------- Design Flow...................3 ...............gallons per person per day. Total daily flow............9..40..................gallons. 9 Septic Tank—Liquid capacit3Z.PiP.-Ptgallons Length________________ Width..............._ Diameter_-----__-______- Depth_....__......_.. Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. f t. /.Z I If Seepage Pit No.......4--------- Diameter....... .......... Depth below inlet.....4;........... Total leaching area.14�.sq. ft. Z Other Distribution box( )k) Dosing tank 01?F-AS F_ 7-R4 I= -/0 0 0 G. 0-4 41—.ZZ—&3 Percolation Test Results Performed by.B4_%T49*14Yr......Pn!134i..................... Date.... .................................. Test Pit No. 1................minutes per inch Depth of Test Pit----IZ---------- Depth to ground water. 614FL------ I Test Pit No. 2.Z.:tZ...minutes per inch Depth of Test Pit.....1Z......... Depth to ground water---MWIF------ ------------------------------------------------------------I-------------------------------------------"-------------------*----------------------*---------- 0 Description of Soil....ja 0.4.y G.I.Came LV4....ro.....j a k". .I M S.D-w M_--'s.4 m.D. ........a.... �4 -)F_'31GN!NG 04_61WMA MU -1 ou "-ISTALLATION AND�E'fff-[FT GQ -----------­*---------------------------------------------- ------*-------------­*------------------------ - - __A............................................................................ ..................... ......... . ...... Z S-INSV-X:CEL# U Nature of Repairs or Alterations—Answer when applicable_____________'-____iE SYSTEM W ;._­; )--P'­X-------------------------------------- LA - ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal S in accordance with the provisions of T IT LE 5 of the State Sanitary Code— he ersigned further agr !s no to place the system in operation until a Certificate of Compliance has beenjs u by e o h. ... ..... . .. ... .. .. .... .............. ... ... ....l te =5 Application Approved By.................... ........ . ........... .......................... --------- ----- / 5;-.77---------- Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo................ .....:!�---- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD A) rQF HEALTH ..........................................of.............................. ...................................... %'Urrfifiratr of Toutphaurr lql?osa;T�g 1,,-.TO C-EURTIFY, That the Individual a a, Di I System constructed or Repaired by. ....... ---- ....4141.jLL ........................ _ZAC�C, Install,4Z '�V rj._C a: .. __D--_---------_-------J----------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of T 1 5 of The State Sanitary Co asas,deqcribed in the application for Disposal Works Construction Permit No_ ........ dated-.... .............. ---- ------/. - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARA ilE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..........................I...................................................... Inspector.................................................................................... t--JZ Fmc.............-............. THE COMMONWEALTH OF MASSACHUSETTS BARD OF HEALTH ..to ew..d...............OF.......... �'�.! ............................................. Appliration for Uhipasal Works Tonstrurtion ramit 110, Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at TE --- --•-- ----------------- ' - .. ---••--- ._.........---•- ----------------------.........--------•-- Location-Address or Lot No. ... ! l -c.�: _r�. ,r /.: . , i,�,j �r .tt..r�.�1 Hyr:Nti�`.s--- -----•---•---------- / Own Address Installer Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms_........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Buildiu i - ?'e ?la_1__. No. of persons___-____-,; ______,_ Showers — Cafeteria p•l Other fixtures.•------------------------------ -- _ W Design Flow................ ................gallons per person per day. Total daily flow........... f.: _: ..................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.___.. .-,e-........ Diameter......l.e. .-_. Depth below inlet.... ra._ ....... Total leaching area..1. Z Other Distribution box ( k;) Dosing tank ( ) C 4' cR Percolation Test Results Performed byre "t .. .......... Date_.° :._A Z `-a Test Pit No. I................minutes per inch Depth of Test Pit----Lk.......... Depth to ground water.. Test Pit No. 2 .2.B...minutes per inch Depth of Test Pit..... �....... Depth to ground water--- '_w....... t ................---..........•---....•.....-------------•-•---------•-•-.--••- O Description of s ......��--- ............................................. . _. ---------------------------•--•---•--•----- x U ------------------------------------------------------------------------------------------------------------------------•------------------•---------- •--------- .................................. --- -----------------------------------------------------------------------------------------------------------------------= ••----•. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ..............................................-..........................................................................................-------------------------------=-----------------------.:---•-. t'," Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the rovisions of Ti i.i». p 5 of the State Sanitary Code The undersigned further agrees not°to place the system in operation until a Certificate of Compliance has�b�een issued by the board of health. Signed4►' .....................` ----- --------------------------•---------------- ................................ f ate Applica ion Approved BY ..._ _... _.�...���.. -- ! - .._.... r Date Application( Disapproved for the following reasons--------------------------------------------------=----------=-----------------------------------------------••-- . ----------------•-•------•-•-•-....-----..........-•-•-•--•---------•--•------••---•--.................._............ -------•---••----•---•------------•---•---••----......--- .----.......-- Date Permit No........ -..... = - ..��' Issued..............• -•-•-•-------•-•----•--------•---•- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Ff`J.:...............OF......... lt:......... ...................................... . � �rr�ifirtt#r ,af f�um�li��trr THS IS TO CERTIFY; That the Individual Sewage Disposal System constructed (._ ) or Repaired ( ) by .......... ------- t ' .. .... f'. :-1 .....{.... p........k.... ! Installer at .L f f •F''{ f t�F�' (` 1 has beer. Installed in accordance with the provisions of rl i j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.,_ ` : ._` _ j, ......... dated---- kN`4d1E THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................--............-•----•-•---........_....--••------•••._.:_. Inspector...........::--------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................OF.................. b ........... a.� . Permission is hereby granted-...'.1.G tl s_} Z�: UL ....... 14 . ...:.•............................ .............�...... . to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No........... --. V... ....-- �'==='_<__ Str�t• as shown on the application for Disposal Works Construction Permit No FDated......:Y. .c,� t:�___ of Healt�i✓�� __.. DATE................................................................................ Board FORM 1255 HOBBS & WARREN, INC., PUBLISHERS r f �v OWN/F BARNSTABL LOCATION^1 f?7 /fi_/ SEWAGE# VILLAGE U���IQ-1,�I�J F ASSESSOR'S MAP& LOT y 3 7 NAME&PHONE NO. �✓''- ' G//� /USt�.��� /� SEPTIC TANK CAPACITY n / ! OTV r LEACHING FACILITY: (type) LE AG Yi S (size)( NO.OF BEDROOMS BUILDER OR OWNER c �E� �1 t �T I PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: i Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet - Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching f ility) Feet Furnished by .IZ �t J u �. cr��+lry o`� '9 f� JO Health Master Detail Page 1 of 1 Lt Logged In As: TOWN\.sousav Health Master Detail Tuesday,October 17 2017 Application Center Parcel Lookup Selection Items Reports Parcel Septic Perc I Well I Fuel Tank Parcel: 141-034 Location: 770 MAIN STREET(OST.),Osterville Owner: HOSTETTER REALTY COMPANY INC Septic 1,9/4/1998 1New Septic... Permit number: 1998578 Permit type: I Select type — vl Complete system: ❑ Issue date : 9/4/1998 Complete date : 9/30/1998 Septic tank size:0 Type/Size of SAS: Installer:I Select Installer v Card on file: ❑ I/A service type: Select service Innovative/Alternative Technology type: Select IA type Variance date : Abandon complete date : Abandon permit number: Repair deadline date : Repair notification date : Keyword: Comments: EX 2000 ST DBOX 10-500 CHAM W/STONE Delete Septic Inspection 11/20/2002 New Inspection... Number Inspection Date Inspector Result 963 11/20/2002 Macomber Jr.,Joseph,JOSEPH MACOMBER&SON v P(Pass) v Received Date Comments C1 Delete Inspection Save Septic Changes Return to Lookup i I http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=141034 10/17/2017 DATE : 11 /20/02 PROPERTY ADDRESS:770-Main-Street - ------- RECEIVED Osterville,Mass. ------------------------ 02655 DEC 1 0 2002 TOWN OF BAD<i ISTABLE HEALTH DEPT. On the above date, I inspected the septic system at the above address. This system consists of the following: MAP 14-1 1 . 1 -1000 gallon grease trap. PARCEL : A - 2 . 1 -2000 gallon septic tank. 3. 3-Distribution boxes. LOT 4 . 10 H2O 500 gallon leaching chambers. ( 2-t6ws of five) 50 'X13 'X2 ' Based on my inspection, I certify the following conditions: 5, This is a title five septic system. ( 95 Code) T 6. The septic system is in proper working order at the 1�. present time. 7 . The leaching area is presently dry and shows no evidence of solids carry over. S I G N AT / URr Name :— J .— Macomber Jr . -- ------------------ Corhpany : Jos Puft Pam_ -A-,Son, Inc . AddFess :__BQ; _�_C�_____-__---- -_Gen-S2r�tt-l-f-,-Na--2?.632-0066 Phone :--508- 775- 3338 ------------------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connectlons P.O Box 66 Centerville, MA 02632-0066 775-3338 775.6412 i -\ COMMONWEALTH OF MASSACHUSETTS r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL. INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 770 Main Street P, Uass Owner's Name: Hostetter ReaY Estate Owner's Address: 11 /20/02 00 Date of Inspection:Hostetter Real Estate Name of Inspector: (please print) Joseph P.Macomber Jr. Company Name:,T P Mae()mhPr & Son Inc. Mailing Address:Box 66'_ 02632 Telephone Number: 508-775— 3 CERTIFICATION STATEMENT I term 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 ;raining and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP appt oved system inspector pursuant to Section15.340 of Title 5(310 CMR 15.000). The system: ! ✓ Passes _ Conditionally Passes _ Needs Funher Evaluation by the local Approving Authoriry Fails Inspector's Signature: Date: The system inspector sha ubmit 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 now 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. Notes and Comments '•"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. - Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 770 Main Street Osterville.Mass. Owner. astetter Real Estate Date of Inspection: 1 1 1 2 o/0 2 Inspection Summary: Check A,B,C,D or E/ALWAY complete all of Section D A S tem 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: The septic system isin pr9per working order at the + presenttime- B. System Conditionally Passes: tf)29 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. A.10 The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: �s X'y 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 obstruction is removed distribution box is leveled or replaced ND explain: /()�) 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 obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address770 Main Street Os ervi e,Mass. Owoer: Hostetter Real Estate Date of lospection: 11 /20/02 C. Further Evaluation is Required by the Board of Health: VQ 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 envirorunent. 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 wbich will protect public bealtb,safety and the environment: A�b Cesspool or privy is within 50 feet of a surface water .b Cesspool or privy is witbin 50 feet of a bordering vegetated wetland or a salt marsh 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: 1!C11 The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or rributary to a surface water supply. A.b v _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supple. 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 10 feet b�j 50 feet or more from a private water supply well••. Method used to determine distance 1.Q1�.G •'This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nirrogen 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 770 Main Street Osterville,Mass. Owner: Hostetter Real Estate Date of Inspection: 1 1 /2 0/0 2 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of th2 following for all inspections: Yes No _ ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge 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 bo above outlet invert due to an overloaded or clogged SAS or / cesspool �44 67699l*v.lmtu rUj Alt WI� C 4l w ) _ t/ squid depth in sesspeel`is less than 6"below invert or available volume is less than 'h day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped 0. — y 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. /arty portion of a cesspool or privy is within a Zone 1 of a public well. � any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.) _ !�(Yes/No)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. You must indicate either"yes"or"no"to each of the following: �. (The following criteria apply to large systems in addition to the criteria above) yes no _ 2the th system is within 400 feet of a surface drinking water supply system is within 200 feet of a tributary to a surface drinking water supply _ Zthe system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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 I 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:770 Main Street Osterville,Mass. Owner: Hostetter Real Estate Date of Inspection: 1 1 /2 0/0 2 Check if the following have been done. Yoil must indicate"yes"or"no"as to each of the following: Yes No/ /Were �✓/ umping information was provided by the owner, occupant, or Board of Health P any of the system components pumped out in the previous two weeks? r —Z 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,*Xcluding the SAS, located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of tii baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? -Z_ 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: Yes no YExisting information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CMR 15.302(3)(b)J i 5 Page 6 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 770 Main Street Osterville,Mass, Owner: Hostetter Real Estate Date of Inspection: 1 1 20 02 FLOW CO ITIONS RESIDENTIAL Number of bedrooms(design . Number of edrooms(actual): DESIGN flow based on 3l0 C 201.(for a mple: 110 gpd x i;' of bedrooms): Number of current residents: Does residence have a garbage grinder(ye o):_ Is laundry on a separate sewage system (ye r ): _ (if yes separate inspection required) Laundry system inspected(yes or no): Seasonal use: (yes or no):_ Water meter readings, if available t 2 years usage(gp Sump pump(yes or no):_ Last date of occupancy: COMM ERCLALJ "U�TRIL Type of establishment: ? Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persggs/sgft,ctc.): �1 Grease trap present(yes or no): � Industrial waste holding tank present (yes or no):,&P Non-sanitary waste discharged to the Title 5 system (yes or no): 4 Water meter readings, if available: 2000-771 , 000 gallons=21 1 2. 33 GPD Last date of occupancy/use: Sam 9-y, 000A2001 —745, 000 gallons=2041 . 10 GPD 2002-271 , 000 gallons= 742. 47 GPD OTHER (describe): . GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): _ If yes, volume pumped: _Mgallons •- How was quantity pumped determined? ,f)/9 Reason for pumping: xhl TYKE OF SYSTEM t/ Sc ptic tank, distribution box, soil absorption system ,0 Single cesspool /Lo Overflow cesspool Privy Shared system(yes or no)(if yes, attach previous inspection records, if any) Olnnovative/Altemative technology. Attach a copy of the current operation and maintenance contract (to be obtained from systep owner) &Xight tank 414 Attach a copy of the DEP approval X16 Other(describe): 141yl Agroximate ae_e of all components, date tos talled i own)and source of information: Were sewage odors detected when arriving at the site(yes or no):I& I 6 Page 7 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 770 Main Street Osterville,Mass. Owner:Hostetter Real Estate Date of Inspection: 1 1 /2 0/0 2 BUILDING SEWER(locate on site plan) /tr Depth below grade: Materials of constructionycast iron XX_40 PVC NO other(explain): NIA Distance from private water supply well or suction line:1 0 'X Comments(on condition of joints,venting, evidence of leakage,etc.): Joints appear tight.No evidence of leakage. The system is vented through the roof vents. 01 SEPTIC TANK: /(locate on site plan) AXO�Awxls a Depth below grade: Material of constructionX X X concrete N OmetaNO fiberglassNO_polyethylene tMother(explain) NA If tank is metal list age:_UD Is age conftrmed'by a Certificate of Compliance(yes or no):NO (attach a copy of certificate) Dimensions:1 2 ' long, 5 ' 8" high, 6 ' 6" Wide Sludge depthTrace Distance from top of sludge to bottom of outlet tee or baffle: Trace Scum thickness:Trace Distance from top of scum to top of outlet tee or baffle: Trace Distance from bottom of scum to bottom of outlet tee or baffle: Trace How were dimensions determined: Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of.leakage,etc.): Pump the septic tank every 6-12 months. Inlet & outlet tees are x�Ace The tank is structurally sound. and shows no evidence of leakage.Has been Maintained. GREASE TRAP:YFc,(locate on site plan) 11300 gallons Depth below grade: Material of constructionYESconcreteNOmetaVO ftberglassN_polyethylenFO other (explain):H-20 Gease trap. Dimensions: ' 6" Long,`"Ad— Wide, 5 ' 7" High. Covers to graderCast iron rings Scum thickness:Trace Has been maintained.P17mp .'every 3 .months covers to Distance from top of scum to top of outlet tee or baffle:Trace grade. Distance from bottom of scum to bottom of outlet tee or baffle:Trace Date of last pumping: Unknown Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): The grease trap is stucturally sound. Inlet & outlet tees are in )lace.Liquid level at the outlet invert is fifty one inches .The grease trap should be pumped every 3-months. 7 f Page 8 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 770 Main Stree Ostervi e,Mass. Owner: Hostetter Real Estate Date of Inspection: 1 1 /2 0/0 2 TIGHT or HOLDING TANK6r2e,(tank must be pumped at time of inspection)(locate on site plan) Depth below grade:A Material of construction: concrete W,4 metal_4y_fiberglassA/,!LpolyethyleneA�o other(explain): Dimensions: IV Capacity: 114 gallons Design Flow: IM gallons/day, Alarm present(yes or no): oo Alarm level: A),4 Alarm in working order(yes or no): Date of last pumping: AA Comments(condition of alarm and float switches,etc.): Tight or holding tanks are not present. G3 -) DISTRIBUTION BOX:Zif present must be opened)(locate on site plan) Depth of liquid level above outlet invert* 45 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.): . 1 Rix ha-, 2-1 atPral c�2163 hnxPS have t-wn 1 at-Pral s api PAP_ Ncz 'ovi Aonno of snl i d.s carry oo c n 0 0 0� =Qo a==-r-.00ve�.Na ev�de�e� of leakage in.to or out of the boxes.Covers to serface. PUMP CHAMBER4ke— (locate on site plan) Pumps in working order(yes or no): A4 Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Pump c1iamher i.- nni- resent. 8 l Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 770 Main Street Osterville,Mass_ Owner: Hostetter Real Estate Date of Inspection: 1 1 .9 n/n? / SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan,excavation not required) 1OH2O 500 aa11_on leaching chambers packPd in 4 ' of 14" ctnnP _ 2-rows of 5 chambers 50. 5'X 12 ' 10'X2 ' If SAS not located explain why: Located' SPP pgP 1n Type A,lo leaching pits, number: 0 "'�� leaching chambers,number: /0 �O Q1t�4(Ami 4)6 leaching galleries,number: 0. v leaching trenches,number, length: O leaching fields,number,dimensions: O x) overflow cesspool, number: 4 Xto innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Sand/ loam to madium sand to -naRSF. SAND Nn GiTS of h�� r3ullr failttrpnrnondinT Soils are dry.All under asphalt parking lot. Cast iron rings & covers to grade for service access. All of the leaching c ambers are presently.dry.No solids carry over. 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 laver: Dimensions of cesspool: AM _ Materials of construction:_4 _ Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): -Ceps heel s-are net present. PRI /�(locate on site plan) Materials of construction: A/X Dimensions:_/O Depth of solids:-WX Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): 1??,i3 y i -, not prPCPnt M I 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77n Min Street - - --- - -- Owner: Hoste�ter`�Pa1 Est - ------- ----------------- - - • ------------ - ------- '4 to of Inspectit. —' -OCH OF SEW Y. . 1V , de a.sketch of .�e, yst �c ing.zi to at leasty anenf't ererlce Ian arks benchmarks. Locat all a in 1 0•fetca he public water's y enter buil o - Alp y ( Mti � +� -34 00 ' v to \_ A k0l; �• s _l _ 116 to r I OW 6D Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 770 Main Street Osterville,Mass. Owner:, Hostetter Real Estate Date of Inspection: 1 1 /2 0/0 2 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water Od feet Please indicate(check)all methods used to determisae the high ground water elevation: V F G Obtained from system design plans on record-If checked,date of design plan reviewed: 11 2 0/0 2 YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: NA YES Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: http: //town.barnstable.ma.us. You must describe how you established the high ground water elevation: I' Jsed: GahretY & Miller. 12/16/94 Ground water elevations above sea level. Jsed: USGS: Observation well data- `Tune 1992 Jsed: USC;S' Terhninal Rnlletin 92—nnn-1 Plata#2 Annual RangPG nf�rnunrl r 0 500 gallon eaching chambers -20 ' s Cast iron (.J ing & covers to eec rade. Groundwater:J/Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bott of the leaching pit and the adjusted groundwater table is feet. 11 rr.�r+.-n•r�—•rr +.'n•.-'r.-•rmr:�..-ren.m.r.:-.n+•.v.r:-rrrm-nm--+z*+r'v�r.�-n •�, TOWN OF Barnstable HOARD OF HEALTH 1 0SUIISURFAU SN4(;F DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION •••T•'t�T••.••.' —T.11�^.�.T.r'.�11•n:1TTTTTTII S'T'TT,'.r'.'f�-t.�T.�i�1TTiT•Tf'f.i9q�R1"M/fitfR'RTf RfffR -TYPZ OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 770 Main Street Osterville,Mals)s. ASSESSORS MAP , DLOCK AND PARCEL # OWNER' s NAME Hostetter Rsealty PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr , COMPANY NAME Joseph P. Macomber vion Inc 00 COMPANY ADDRESS Box 66 Centerville Mass 02632 Street. Town or Clty Stat• Iip COMPANY TELEPHONE ( 508 ) 775-3338 FAX ( 508 ) 790-1578 CERTIFICATION STATEMENT 4I certify that I have personally inspected the sewage disposaj system at this address and that the information reported is true , accurate , and omplete as of the time of .- inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : Syste6 PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public he-alLh or L11e environment as defined in 310 CMR 16 - 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I have conducted has found that the system fails to Protect the 'public health and the environment in accordance with Title 5 , 3.10 CMR 15 - 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date //,L :�Zef'D� and copy of this rt.ification must be provided to the OWNER, the BUYER here applicable ) and the 130ARD OF I(EAL1'll. * aYete If the inspection FAILED , thl; owner or���oparator shall u within one year of the date of the inspection , unless alloweddorthe requiredm otherwise as provided in 3.10 CFJR 15 , 305 . partd . doc 1 ' 411, VC Q.D. ` _ / b ^• Gt ,, ! '• . ._ r ' , t Tie fm CARW on , } 1 • _ ':,,;r�: ;/ h4� yim' �.__. cif . /1-7 — as_ ' COMMONWEALTH OF jvIgSSACHUSETTS EXECUTIVE OFFICE,OF ENVIRONMENTAL AFFAIRS �"�►" DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. NIA 02108 61 7-19'_'- $00 ' TRUDY CORE wILL1ANI F.'wELD• Secretary DAVID B.STRUHS ARGEO PAUL CELLUCCI Commissioner Lt.GOyemOr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: �� r� 6STF-evi � Address of Owner: Date of Inspection: �f o�/—� (If different) Name of Inspector: —,,W111j0 77 7"Al// 5-)e 1.am a DEP a proved system ins ector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: 2.6S- 7w 4/ Mailing Address: 4 'z . Telephone Number: Sow -- S/32 — '?7945 CERTIFICATION STATEMENT I certify that l 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 inspection. The inspection was performed based on my training and,.experience.in the proper function and t ii maintenance,ot on-site sewage disposal systems. The system: JGPasses / SJ�.57t /Y1 t .. LCX•4TG1� , '� " i912 "(�,, U//��' _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails •`•,, ., Date: _ Inspector's Signature: •. The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: ' Check A, B, C, or D: $ A].,SYSTEM PASSES:. �.ers D �7`' ®f I have not found any information which indicates that the,system violates any of the failure criteria as.defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI SYSTEM CONDITIONALLY PASSES: One or more system components as described ip 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the woad Wde Woo: httpalwww.msgnetstate.ma.us/dep del Printed on Recycled Paper r; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM "� • PART A , CERTIFICATION (continued) Property Address: 770 1&41ti �T Owner: ' .4��° !�O✓Japi9� Date of Inspection: B]SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed �f�;,,.;, ;fit;•; pipe(s) or due to a broken, settled,or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system,will pass inspection if(with approval of the 3oard of Health): , broken pipe(s) are replaced obstruction is removed - 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 the IVIA public health; safety and the environment. :> :• ., :- 1), ; SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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. 2 • SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IVAPPROPRIATE) DETERMINES,THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water,supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50.feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from"a' private water supply well, unless a well. liform bacteria and volatile organic compounds indicates that water ate analysis for co the well is free from pollution from that facility and the presence of ammonia nitrogen`and.nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance; (approximation.not valid). ,.., 3) OTHER (revised 04/2S/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION (continued) Property Address: 720 0,411V ST Owner: 4-y`e C7 Date of Inspection: DJ' SYSTEM FAILS: SYSM" _* 02 �/l�T You ust.indicate either "Yes" or "No as to each of the following: n' I have determined that the system,violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what'will be necessary,to_correct the failure. Ye No Backup of sewage into facility or system component due to an 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 1/2 day flow. `,•,a Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipets).) ! Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well: Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. _ El LARGE SYSTEM FAILS: /►' �7 You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office.of the Department for further information. �(revvisod.04/25/97) Pays 1 of 10 Zt 6 �. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: fD 5r � Owner: Date of,Inspection: Zl, �7Fl Check if+the following have been done: You must indicate either "Yes" or"No"as to each of the following: Yes No fL Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during Oat period. Large volumes of water have not been introduced into the system recently or as part of this inspection. /v�• As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. , The system does not receive non-sanitary or industrial waste flow.—?,ex _ The site was inspected for signs of breakout. All system components, hl Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank'was"inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of ''Sub-Surface-Disposal System. , _ Existing information. Ex.•Plan at B.O.H. I _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)J (revised 04/23/97) Page 4 of 10 }, , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r. PART C SYSTEM INFORMATION Property Address: ?7a fzli9�M ST ••Owner: Date of Inspection: !/. /= f� ` 1 FLOW CONDITIONS J RESIDENTIAL: Design flow: tt.p.d./bedroom for S.A.S. ' �"•� '' ' Number of bedrooms: Number of current residents:_ /�J¢dt� i�m �7�Y��/ `�"" ;• 6SZ !-'!�/ �, -Garbage,gnr_der(yes or no):_ ,r;. _..j'. •GWo���C Laundry connected to system (yes or no):_ 401 10010 �/'�'! ����• Seasonal use (yes or no):_ Water meter readings, if available (last two (2) year usage (gpd): �On gyp/ Sump Pump (Yes or no): 404. qei3'`S . Last date of occupancy:dirY"IV7 COMMERCIAUINDUSTRIAL: . Type of establishment: Design flow: gallons/day !/✓�/E/Id'v✓/v . Np p1.01r7 • Grease trap present: (yes or no) 1 Industrial'Waste Holding Tank resent: (yes or no),4—/ Non-sanitary waste discharged to the Title 5 system: (yes or no)Al Water meter readings, if available: Last date of occupancy: If/I�j✓T ` ,' . OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING AECORDS and source of information: / -!7 • /Cj C' _ f�i .CMG/' `,_ J ...r ', , , :,6•g.•.. . ' System pumped as part of inspection: (yes or no)- - w If yes, volume pumped: Q allons jPzwj4>�! ��r�� -77ZAoO Reason for pumping: f1A— TYPE 9F SYSTEM ►/SrJ Septic tank/distribution box/soil absorption system �'2FJ�S1F' -7nA'j? Single cesspool Overflow cesspool Privy '; .r• �.Shared system (yes or no) (if yes, attach previous inspection records, if any) ,C.. VA Technology etc. Copy of up to date contract? Other ' - ., yr?i?1 :,�;; ... ,••,� 3 APPROXIMATE AGE of all components, date installed (if known) and source of information: d zf yi23 Sewage odors detected when arriving at the site: (yes or,no) �✓ ' �j(revised '04/15/97) Page 5 of 10 r - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 770 00?/9in Xr Owner: i4-t'P' Crd Date of Inspection: !/—Z/ BUILDING SEWER: f PS (Locate on site plan) Depth below grade>7-T Material of construction: _cast iron:40 PVC_other (explain) Distance from private water supply well or suction lire _ Diameter Comments: (condition of joints venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) A Depth below gradev�y ' Material of construction:�oncrete _metal_Fiberglass _Polyethylene _other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance _(Yes/No) Dim ensions: 6d1,o w D Sludge depth: 1 ' •fwf • Distance from top of sludge to bottom of outlet tee or baffle: n 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: How dimensions were determined: •Q- e- Comments: (recommendation for pumping, condition of inlet and,outlet tees or baffles, depth of liquid level in relation to outlet invert, structural .integrity, evidence of leakage, etc.) GREASE TRAP: (locate on site plan) Depth below grade; Material of construction: oncrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: /� r° • Scum thickness:Q,• Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: r Date of last pumping: L4=Y-9 Comments: (recommendation for pumping, condition of inlet and outle!tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ~' PART C SYSTEM INFORMATION (continued) Property Address:770 AfK'1V S T Owner: i4'7F0- Date of Inspection: e/_u pe? A1TIGHT OR HOLDING TANK: (Tank must bepumped prior to, or at time, of inspection) ,4 (locate on site plan) -,,---Depth.below grade: Material of construction: _concrete_metal _Fiberglass _Polyethylene —other(explain) u t Dimensions: Capacity: gallons Design flow: gallons/day Alarm level; Alarm in working order_Yes; _ No Date of previous pumping: Comments: „. (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:I� (locate,on site plan) i (' Depth of liquid level above outlet invert:/YlJX/�W'*2— Comments: ; (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) AYamow P25t_ N1PUMP CHAMBER:_ ' (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) r (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM —. PART C SYSTEM INFORMATION (continued) Property Address: 770 .4,1414.1 Sr Owner: 14f10 &6101".V. Date of Inspection: j/-2/p8 SOIL ABSORPTION SYSTEM (SAS) (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: Z leaching chambers, number: leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: . Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) CESSPOOLS: _ (locate on site plan) �� Number and configuration: ; Depth-top of liquid to inlet invert: Depth of solids layer: Depth,of scum layer: r, _ Dimensions.of cesspool: Materials of construction: Indication of groundwater: " inflow (cesspool must be pumped as part of,inspection) 4 Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revitedd 04/23/97) Faye 8 of 10 u J R SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION (continued) Property Address: Owner: 7,CS dl?/9!/1✓ ST' ®S�"€ie lr/� Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (locate where public water supply comes into house) F/zn wr SEA Z C? CA R • G 40 fI = G7 Aildfe %ems T Lc.49 (revised 04/25/97) Page 9 of 10 A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C —� SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: Depth to Groundwater_ Feet Please indicate all the methods used to determine High Groundwater Elevation: 'Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine-it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) • r (revised 04/25/97) Pays 10 of 10 SKE7'Clli OF SEWAGE DISPOSAL SYSI"ENI (Include ties to at least two permanent references,landmarks,or benchmarks: locate all wells within 11M feet.) ��p2 of Sfo°c6. F �sld�� Ut std� iQ p (jol �8� p Z2- �j©�- 1 D lotlb � 6� A -� 6 . Sz 4.Ed D6 ' pA31JJ. ` - , �T► "l,e'" �� o�.E 0 �' tit'•c 3 s.2" s��f . sj 1� _ � . �• R�r'�I� . �.�>�. = zoo � Q�r 1 � O i .. . 10 G ,. 9A t J EY ST -6A. a C/I i<p N G- I C A�A OF IG = SHORT I W U IVIL v, Zz /� tr \ AJDs LOT LINES laNE�S pTN6� E�EyH�► P SaI�TE6TL E,yF- I . •-.:� _:. ; 1 p E�� R x I t I�1�.., o u Rev. ` s" E l/e, SITE PLAN TADCO CONSULTANTS 0 P.O. BOX615 EAST DENN/S, MASSACHUSE7`TS 02641 REP: C��! ' -s p 1 (617) 385-2425 PREPARED FOR:_joF41V SHE ET / 0 f_ WALE� -L f s 87 _. T F- S 7` 140L E S � P /7 3 4-- i TM Z i EL. 33. 0 y3's.0 i � x, T3oN y Y. IST,� GRefv�L c �.es� 'd F ND, h C taAa1 $AND at.G Ism V.D j ro EL . z 1,2 Esrpr�+-is►f No /i T Er / c E.x1s tN FRo>� 6if T. a OUTLET' EL, EfIfST 0 Q 1r: G.L .P. �.i<% BY 64XTER- d NYC ZA/C. `' � t F� 1-Z. L. • O N S G I- E.. B aTTorr d P - OF l N MoL�. T. A. 3 / /I Co T /�' Z L oA Z7 11TE� 1Pa EM ri N � . .� S E r4.T �k e s ru,eR n�- q/! PIPE t Z(o X 35' G. P. S PIZoV l D /-/E A�'Y DvTy FRpm f j J9 GG Gi5 S 7-0 S Tip'C-r& t E-S 5 S l r�c�0 cv.,9/. Gkepsz 7-RR P U / oT P/�' /© " 7-0 .Gox/S7'O�f/C!/o OF i 9 o G.P,a. X /sue /.D = l 3 �'"G►,P, zcRaic E USE. 2.000 a oq4 S E P IC., -rdgA)< � SHORT �o I L L-E Q C/-//AI l�'' t T.$ u S E_ Z 274 k s7'o�11 E. SE /STER�G�`a`� i DE,IGN%4G ENGINEER MUST SUPER",WR►TING S/pNAI 3. /4 X�. X x /.Ce t 3. /4' X (a )C/.2 : ) G•• "aTALLATION AND CERTIFY E .S / 7 rA'D• IN STRIGT .4L. SySTEM WAS INSTALLED t , c G s 67 TGTgL �Etg�,t,J FL�kJ = 6`(a � ,P��� TADCO CONSULTANTS 1 BOARD OF HEALTH • BOX 61 5 E. a E N N I S MA 0 2 6 4 1 APPROVED DATE MA A ------'-"-. Tot,..-'.:.. ..:,w.•...:,.r..w...:..,.c _. .>. . 10 4- i I j � I I fi b f , ; h ; I , I G � m --T �7 ti �y., f 1r ;V t tor N 49 ............ 3 `, PvJds goa a ' ow Ilk 35 Aj . p I 34 s Fes' R H H. r y _ . r . t I,- O C� R 3 C 3 Z ' �Jtd� fi .. -,4 , i :� , f l 1 ' GbS i � ` U G � � � 34 ' a. C. G j44 - •> I iF I � ' 'PRe!; ' St4C> IF�-cjote- I t r 1 1 _ hs}��~1 !� ,►-� ° T .a�i r�r - ?c r�N Tw�ens rz; Sn VarvTZ a f wr \ I f'A �s�eAGTO5L c..t.. 16 f�,•T"A�'.n...Kf� �(fST. " _ ... Ty i • 1" ----- -...' - I ----"___ _ 2 t�A5To1Jfs { � ~'XC��/AT1uL •� t "-� •N �T l Box �� �-- I4 � w _ e ' G;'� i i Cu:A -Tr�� -Sew ►� k4k4 4ot -T-A 14-- �'fF. DJ,•t. LA 5y TW Cci.! r-• 1 � y ��� f �cxary5 E - v :.vttu rat' I o,q 34.-5F ,�v t Gp L.-f-p� - rJ S7- E...:�17f ' �� �_� r�•,,!•-._. � �t' i2r, V� Q6), 1) �7 Cs f'D. �C I So' , - j4'=i � i%,-..uF � �jG�l_� ' `- ('Z, ( Ipi�j �at,ar �`'� A " �' F �>cT�_C�. � 1 t+a► SA 15F �4'�;°: ., �i1.! T`4cS+t� �1� 4 vD X 2 t ��� �s I T�. . , d L... - �r�, \� • + ��,��., ��T E'�.�! ' �...` �..� M p,;�� ( 4 r 1 , , Olf 3 3c •� _ 33 33�9 33' a,h f S3A9�►s �'-� F o R +: 0 6 dam, „ p �/ ( !.. 3 5 Z Y✓`6' 3418 �\ M (&Tti,oJg VA.VA, s C K I After d ` _o.x-; F � p C� R 3� � Z ���'• �� prao!' �,_ �4; 51 1 J G Tt?A 341 ' '�' ' `�G 4•S 3 4 a �>Ct Tt NCB Ul LD � N � sereUL - u� c�ofZ 4t 1 1 � C ��.-E I t ►� - ��FT i �; (+ i�::4IriGV>iis ��ltST�iJG. S�`Y'T1 G SlST�i/IJL pav Qt>►- AeS cu!TI4 ��, �4rr.,aQv✓,41Z.. :��r„� rc►JKil��v �2�►`�'?�' �t't' �.aNt� • t"�.'��tT' — �tTG�issD Tv�nt�5 �� �51�15 ' �-'--3-� ----- /1AA . rx;c.l n .. �'''� � -i-- I �'�v1!tT.� ��A•,/`� DUr'� �TLa1N6 y. loc?A't�6 r� G,F?A-�S T--c A t.� e�� ?'U 5ru uGTuR is$ ~--1-......... T 2' I�Aimijr& �JCt�,�; ;- UT'i LtT Go►v� AU'`(`� '3r�T=CIE ^T xc.A"ATiu4�1 , ALA=A9 .� I �- w+rN c -54F"Tl C— AA g34-SF �� - 5►�[o G:r'G N -FL V! UCoT AjPS �j D,dv 5(% I `�rz G r� c*DFFiCS T- �r c cco T'A'411 L PJC> !I r4e tst� G�V. ,c ISO i4cll G 141 _ - �At-� T 2 c'� �. ��:�r � • •�:c.. �i �„tiy+��.-,"�' i..'Q.E`�' L./t.1�i© '3L�4~`✓E`t:_+fi2.,r, ''i+61.1 F J g14 � �> ;r _.. , I��1F1I�-,��,I.k�,:HIIII 1�I1'I�I I I�I I-1,III­�,,�,,—��,-"�'II,1.I,I,—,t -���,I-I.I,-1I,,,I 1I:1-I�1��,-I:1"1�-_I.I,--I1,--I-I�I.1I I-�-_I 1,,I-­I--1I,-,­1.-1­III�1I���1_1,II—�I-:f,1�I��,�I.II.�.�..I,�"�-�"II I.-1IIT III.,I�:-�-,1 I I I I,--I�1 11-���_�I."I,7�-I-1�.I,II-II l�,I-I)-�-;��I,.I I;I�I 1I—�;,.I 1�II��-'_'I I�-t;�,-­II-- ''III1�I1 I--.,�­1I II i 1'�I I,�,,I I"I'--w I a---1.�-I_/'--I�I-I,�I I I,1'-,..1,I-��1 l�II�:�1 1­1iII.-,II..I1 I I I 1 II IIr 1�,II-­I1 t.��II--1I­I I 0I I�-_��-1I I��I-I-I,-:-,I�-I,--I,���I-::-"I-I,1 I­-�I.-I II,m_1,,I I 1�1 I-I 1II-�I'I I_­I 1,II I_"II1I-,I I-.1�I I-.-�I_I-:,,l���I..1-­�.-_III�,­II1I1I-.:�._I-I­-�,I 1�II1,I.I.,�I-I�I--II­I,I_II-I-�1­-."lI I.II.II I,I,-,,,1 ,�_I-I 1:I-­'r.-�II II1 I�,�I.I_�­I,�-I,t�,,_�.I�1-I,III'..II I I.-I.--L,I,I-1--:�.1�11-.-,I I.­-1I.I1,:`,1'-�,aA�-"1,I,II-II.I.'",,I�II_Ii II�II­I��­-��I,_,I1,I'rI,,.'I_I I1:I�,,-1 I-I�I1,I-1,"---:�,­�­,�,I­1I,�I1I._I 1.I,I,-I-,�I I-I�-1,I-I­-I,­_I,1.�I I-,III1.1 1 I-:I l.-�1�I�l I..1l,�_1141 I1,—I--�I_-1.1 1-r II��1IAI1I.I11�I I-�11I.�1,_-I,,"I-.-II­-1I.1I,��-,,.II,1.I I-.I,�,.�,.­I���..I I-_,­I,I­i1,-1�I.,�.I-.--I 1_�-,_­,.1I-I.­I_-II.-.�-I'I�I"1I�1 I-,.IIl�I-1 1 II-I.I-I­'1,��,I I.I�I 1 I 1 I­II1 1�.�--I1�II�-,I,,l 1_.1I,.1 r1_I'I.-I I I I 1�-1'I-I�_­,II1-.-I�-1�I--I��I-I,-���. _ .II�,�­�I"iI":I-II:I I1 I 1-I�I�-.��-'II1-I II—r1 I1�._I.t­I�I-I�­1 III II,I I,:1I�I I 1'I-..I,I�I��I t.II-I-:I-.-I II 1 I,...-�I�IIIE­_;1I�"1-_,Ie­I1"�.I II I,II II�;2_­�--.lI�I 1,�,I.I I�1-1��.I_,�_-.I II;­ a . �1I1 I IIi�.I.­I.�I-�—III�1"I 7.I��-I I 1,"1_�I�Ir�2-"I.,IiI­-�I"I-�I 1 I II1�_-I I.I 1�-I_1-1I�,I,I.�7I/1-,.:.,�1-�I-:I1_1 I�,:.,IIII.1.""-I,�����.I_.M-I-I.1�-1 I r I�_'...1---I,Iol--,-I.�r�I-I I1�I I I,II1 t\II.-I__.I'Ir,,,�1�II?,�-.,I_-t1.,­I�-I.1I I I-,.II�I I,�,�I'�1"�,'II��,:1 I1,I,r%I-­k II I 11 II—,�1��.-II.o::��I�I�.I-II,..1­1 1'-­I I-1_.1��.:I1I..-1 l I1�I�-,I 1�I—,I-.I.II:I�, 1I_I I-.,1�,I iII_I II.I-:,1.I-I­�,1 I-­1,I­I1 i I I1 1�-III��II�I II-.�1I T.1.IIII 0 I�I�`-I I 1I I,,I1��1 11 r-­,,,­II I�I'II 1I1-�'�I1 1�I.1:I I,,,1lII I�I,�"��1.I_I�I--���".1�-,I-II,-/,",-I,.,,- I 1I1I-I.�I'—1,'.I�­-,1-'I�-I:II.�I1I1-r­'�1 II,I1-Il 11I.1I I,II I-I,II I1,l..I 1IIII,I:-II�R��,�I�-I�II�_!-I�Il1 l 1 II�I­,�I.I I��,11-1 I.,,I,­--I I,-�—�:�.,1�.II 17l�I'1 I-II�I1�.11�_I II-�,l 1�1 r _. - �"1,-I­�1.��,,1I.-1,"_-1--,-',I-:�:�I:I,.--�I I II--­..I��:—�..I�­�I_-1 I I-,.�-I�,.rII--�N.I:,­—----1,E I.�,I,��III�.I�,,I 1,,I�1 I-I,I11.I>I�II�:II I.1-,�I1.,I I�"-­.7I-1.-I,I.I-1-II I 1Il."�I1 II�1I Ir�'-1 1�.�-- mow. _ . :_.,_ I I1-,I I_,_1 I..I�.I I I"-,�IIIIII�1_,.1,I,,I�:--,I_1 I_I I.I1 1"I I,I�I..1�1�I-­�_­.I 1­III,1 1_�II_�-I-'I�.I-I1I-,,I III.1,,�I�­I'I�I--I�I II-�.��I_I-,�l­1-.I�"�1 I1I,,I�,;I_1,­-I�,I�I I II,­I1 I<�-I-1 I-�II-III,..-II�1,�-I1.-_,_.I­.II-�-I�,1,.-�I 1I-.III 1_� �I I_-I,I I-­-I III'I I��-i,"�I_I�I 1II I�l-.II_I_�I-�-�I.,'-7 I,I�"��III:��.�I 1`I�II:_-II,I'II=1I_11I,-,I-.I=1 I1��-I­.­.lIII-I"-1�I--,I_-I11�-�I-­_-­�1-II I�III.lI I'I 4 1I,-1--.I�-­I�-.I-I-..._I 7,'II.�I.,III 1 i,-�I rI I l I-,I-I I.I 1I1-_;:�,;�.,I 1 I.-I�I 1 I1"I;_-,I.,I II.I-__�I..,I II,,1-.,lI-I,I.,�-II�"­'1 I-I�1..11�1 1-I,---._,I�I'_,I-�.I.I:.1,.­I�II,�_I I II_—�II I"-�1.1--��I-1:,I�.1___",I�lI-,,.�..�_­I�.,-��1--I SI I-_I I"-,I�I-I-_"I I-.I7I I,I..-III�,I I I��I I �I I l-1I--"II1�1­�I,1I.-I�I,,�1I'I.I-.1II'--I,,II-1 II-I1 I-I�.,-1 I I�I.�_I ,�,�,,�-,�I1,l IIII1`.I.I�I�.�_I-,",l�7�1.�.�II,"I II--,,I,-�_I-I-'�II,-l I 1.,­,I'V�I,�­I�I.--II-�j_1I'.I:I 1_�,_l�-,­,­.I1,_II I.-'I�;:-I I,I----,-I.,--',.:.,"I - L-,l,I0 I"_1,_I A11�.�.,I"-�I—I�&II,I,-�EII=II I_II11,1I I I I"1 I,.t�4 I1tI1,��­i,--,�"I,,II1 I_,II-,I�'I-,�I I-I1I,I I-1 I 1..-1 I I I_17 I&��I��-_."1"_I-_.1 I=I_1...II,'1:.I_�1--f I��-�,1�I.­..II,'-�',II II IL�_��,I9.�,.,�I-I 11�"*-..I,I,I'�1�_f I I--.._,_,11 I�� I-.I'1 II�I-,.*1,�-,,�I.I,I,-.I II;.��I 1 I 1I-.1 1��-�-�1'�1I.I-I,­-2I—1,,��'-1 II-I II-11�-I 1�-�II1,1��11,,�I 1I1�,-�"I II I,.I-1 I1-,I I*�\�I.:I�,I�.I�­1-I:_I"II,,'­i�."-I-.I,I11��-..'Ir-III 1II-I�__1�-1I II--I,.��-:1I I*-.�O,I I1III.I 1 I.I'I,�.j_,1;1 I/II'1�II�-1 II�I1;Ii­-�I I:I1.�I-�l'_III�-1�­t�'III�,-I-5-f—,I I II.I­.1"I,II I,I""1 I,­.-I�I:,_--II.;III�I-I"I-1�1 I._I�:L I�._,III-I-__-�I III-I\I�.�1II�1��v�--I�II,I 1 II I I�.I-,I��,-�I I�I-�I II�1I:I I-I::-III I-—I,P�.'-�'..�-.,I I�-,,I I-.,-II1".I�I;.--,.I-I;,I�I­­--III,�11.�I1�,,1 I:.-II L­�I1­,,,.-I,I,I.,I-',I1�--I 1.7 I-e-II I-I,I�I.II�"-I,I.II1I I�"I,­�I7 f w I-I,.-I�I I I'I I,1.-I 1-­--,�I l-.I.--�_III1I�-I -_,I-I`­..11I-�v-,I II.I":�-I IT'1"I�.I 11�I�_IA6-1_-I-11 I I 1�I I III,,,,,III'­I',i_.1A I 1I, _�-.1�-_I-I�I 1,�II.­�I�I-�""I�I,1�1,I��I�Ii I"_�.,"1I II.1,1-I1,,.II 1,-,'��:,:_Il,I,­I1,I I.--I�I�-".I��I 1,II,I,-.,-�DI�_I�--'-��,r1-,:1�1 1 I-,I.�-�1-II��,_­I�I 1,I-I,:"1,,�I 11.'I I1,I11.,1II-,-,-:-,-.�,I I-_I,-I�,,I---I.:l.�1-IIII-__,"­,��11 I.1lI"I:I I�I,-._I I�II�I�,�I I�I,,I-I�I 1,,II V��-rI"I I-II-1.�-I,I"--.I'f1-.-I1-"��,-r,I,I1'4,I;11'-�iI1 I_1 I..�I\,II-1-i­I I:_V II.,��_1 I�I,-_III Il�,I�--II-1".,t.I��I1I,I I I��IIII I�,I I­�I 1.I",�1 l,I 1-`,­,,���I_-I,-. 1�­�j1 O,I­1j--.:-.1.1-"-�I 1­l,­,,--.1I�,�l I,,,.-I1,­I�.IIII�1-,I I_F.,I�,.I11 A1-I1 u�"I�I-�;�1 ,�,1,'I.I,-I1 I,I�I.I 1I�,'�,�1 I,,_1,-_:-I­5.:�"­�,1-,,41,I�-�1-�I.,.I,4 1-I�,I­,,i�III,­%I.I��I.,1.�I.I�I'l-,.'�1I,�I'.I 1�,�1 II-—r I-II I 1�1I�I,,1 1 I.1­I,",��-.I�I�I1I I.--I I1-,,,�1�1Ii1 1 I.I"1_�__I I.l_I�",I I1-I.,, I 1_I.I�.-.11,-I.I1-,-1__�,s 1-,I,���I I-�I"�II._I 1�.,I 7'_'I I 1II-1_-I,�'..�II 1I��-1�"II-.1, I_,II�-1,--",Ij.I1r I�.I_-I II IIl1II1".l_.'-.I,,,-,I-1I,I­I _1,5 I�1s_-,­I1�I,"_I-"-II­,I leII.-II-0"I��­,.­I1I"-—1 I I I�­.�I I'I�_I­-II,­�I�I�".'II I I',I,�:I I--.I I.�4'-;-,III II�-_.__-I.II_II�,I,.II II_.l,�­,�.I�.��,I'.��I�I_I�_I I.,I�I-I.I.l II I I�,,',.�I1�1,.-._IIl�.�1 I 1III-,1__1�-I.�-II_. I,I,1-I",_�1.I II�11—"%II.,I-��I II-�"I,';I I.I'�1_,IIII;�—I�-II_��II I�:IIII_,._I I�­)III"�-,I,I��-1I I_%I-,I�;--_I.,.�II-II..��,I�1I IIS�I_.1'I-,,�1s­,II"�I,­�-�I,,I.,ZI 1_Il 1�I..III�I1I_I 1 -1 I IW,,:­I�"I­­.,­__�-._II-­,-IIICI�I II�- II I I_"�-��w,,,.�I�.,I��I 1.I_.I1"1_I-",1I1�1�::I I 1I,-�II-i 1_��1.I�,I�IP II.�':II I-.I I I--I"-I.,I-I I,I-�"I.I..IIII11'�_I1 IIII,I" ,'.._1 I-.0 Ii*II1-­-�1-�I�1--I..I-.0.�_I,��II�I-�II.1II 1-l I 1-: I_1,-�­4 I�-/I-,lrII-I,,�-I,�4��1 C.-�­,,_1 I,I�I_(kz--I I I;.,-,-­-,___0L;I.-.11�I-o-,.-II�.��II-I -,C I�1 III I_1.,I�1-�I I,.�."I!I Ie1 N 1/I�-�I..1-.,I­I I.�I1,I��J I"I_,I�IJ,_�II1:I�III�I,�-_6 I�I I1 _. , _ ,. _ .., , ,_ ., .' _ _ _ _ �1I 1 II1:1_",--N r - ; -1,�"1r���-I-�:_II-�-,-_I I:,l­_I�.I(�,11II-�I1,I-�1 II 1 6 I-I�--'1-,I,1�I�II_r�I1�.,1I-III III�IN­�� �-I,_.1.I"I���_I�,.1­%I,�.I-I�/1_ -.,Q,1",17 -1 IiI-I,_.7I_IIl III�I Y I_��I�,I 1��� 1_,,1�­-1,_.1I-�-I-S-�Il I I,,�,1 I --I 1 I, �,..�-�I�__I1"�1I_'.-:�-II 1 1l.1�­I"-,_��I'1 I.I.I-_1-_�".I-1"�I1-�.-,`­l� �'�l-­--.-,I.,1I,1-_I..-,11: .�­III I��-I I,,r1,,,:I,I 1.1'I::II I I,_ 11I-,I'11-"l-—1I-7'4,-�:�"I,�.1_II�-1�I,--I I-"-.­�,�,,_,_I-��:"_1,� U 1'-1I11I__-z�I,�_�-,_�I I',-* 1-, 1 I III'It,,iII7Ii�I,�I�iiII 1Ii._If1I�.1'I,I.zI1j�il'��,�4II"i.11!i1i,,I�,,," _, _ - < _ ,, _ I I1�--:-I,l,I _ .,_._ t ! _ w _ _I.'I�t.�,-,I II,-­,�I I,-,­,�",�.-1 p �-,�I1 1�II-I-liP lII, _--:I�-,�'­,,_.,1.'�,��1 I II-�I­.�I­-,--­�1I,�-II,_I 1-I, I­�"'-�I C1lI I.I I I-.�,(-,II II1'II-I 1_I..I� ry - -, :.. r , . ,_ _ :, ,,, , 1 w x _.»,: C :. .- .,. - .,v ., v, - , :;.T ..> { - ... - .. 9 . , .w. • ., ,.� \ '.. ' - .:a .. :, -..-.: ,. , ti.. - ` __ ,. - J ., , ,. - N - � _ x " s ,( ' ;.. `p ing 5 ^ I _., �°^5 »t ' 6 pppyyy ,' tF d .:. - ` .. , x « ; .. l . ,A\V :+ is N yam. -� R, _. 1 I cot), }} 7 �, �" :. - - .., EY� .: i `... , , 1, _ - - .. :, I '� . N_ _ Y € w r �,1�k.-���,,,-1_":,1IrI�_,��I.r I-�:,1 1,,--1 II1-,I�-":"1I�.I�'I��-.1 I I II,I"I.I,.I-��I�:'-_I1,J��.­_�,.;rI 1"'I-"-�I_�­�1�,lI1-,I��II-�,-I I1 I�-"l.,l,I,I-1I,,_-11I:III,-,:�I 1I,.��1 1_I�t,I,:1,,ll_�1�l,z�,1l,_,.,�­,1 I�­1I-�1_I11"�1I,'1�I�-��^I-I_,-�.��,r,-I---I,,"'1""f",1 I,I1 II-'_­l,I`,:I1_,II_"II_1,1I1I l.�,II�:II�lI,11�I-;II 1I I-�,1i,,L0-1"6.I'�r.�'1,-1._-�,,.i--I I Ie 1l--+I"g,�-�II�4I,I"_-�"-,I1�1-,,:1,.-,"�.1I�I I I���I;I��-I-III II�I,L.� :II.�I�-I�I��1- �­., IA-I"I 1 I�,,L -,1II��1I� .. , `4 _I.II" -:. t _I. .I�I.:�I.I-.I I--I-l-��,'.III-I I II.II.��_I"II,I I.1-,II.-I I,�I IT.,�l�IIcI:I I-I I I-I I-,�I,�II,I-%q.II,II 1 I I I�I,I 1��I �I--�I�I-I.,II1..ITI II.,�I..'��,II-I\\I"I1�'�-I,,II.1:.1 II'-,.�I.�I,­.�­III II,Ii I�I I.�IIs1"I�.�\I-,X�1 II I I-,,,I-��1�I,,.1.I I��I II I\.-,,,�I I\II.1r11.,lI',I II 1.I.1��..,--,1�,lIl I i I,,,1_,-1 I:,�I I1I-�I--,I I 1-I�II'.1I.��-.1��A I lI I:I�1.II,1I--:11I1-y-I 1�.p,--.�I 1-1'�II,_1'�,I I 1.I 1I,-eI,,1�A�1��--.�_I,I\I�I�-I'�I...�1I-.I I�_�-1"l�1I���r IILLLI,�II-I1 1.I-�--I-I�I1� I 1��I,-�I I-.��Ii­�1�I---II..-,I_.���­>.1-I-II.-':Z-1,��iI�,.I-i._I-.1_e IIIq,I,I J.r,I�I�I,�`'..­I,�i-,-I-I,�--�,�l,I�I N�II-,-I,'--II IlI-I,,_,.�1,-11,.�1�I�I 1/,,)I,'I�.­.'-l.1,.i­-1 11-�_I-I��I,.I1-1-,1II"iI,III,I 1tI�.��-­I,IF-I-­�LI;,.a1 I�,,i,I-,ur,�v IIIk_1.IQ-J��I1I_-I I_I1��,.I�__,"-,:-.LI%1,I;1.—_,1��1 n "II:,I-I�":,1�I.�1—1l,1�,,I_II�/;I,.LI'---.,1 Q"I.',�N1�.)�-�1"-I,:I--I I­�I.,III I,,I­.,,1,II L1 1�I I�I z,--I�­�I-,-0-I��I-1III.t�­II,�%,I�..�I�,I1..I`,­1­�I,-Er�-��I"I A--�_-...�I 'I':,._t�iG I.I��.1�--�11�,-­-,-1"��I)-I�-I­l.__Il�c I I-,,--:I,'I1 I r�1,—,�_-�1 I-­,-.I-I1---1�,�-�II�_..�I,I­,�1 I­II I.I.T'­I-1I 1 1�.�:,II--7��I.I1.�,,I,I-1I,00I,II�,-,:I t,F,�,I�­�'-1 I­�1-�.:1"II I,71,_..-�_-�"�1",I.I-I,�_I'0,'_�.t 1 1--eI­­.,I"I:,-�1I,.1/1,�III.1­I,�­��,­I���:'-..���II,-:�v1,�I I I­�,II,�I I,-,,-I-I-.­­l,._:.�-I­.I I�I1'.II;1"1-,I 1�,,.�i�-,,�;I�1R_-I I I.,,I I-I��I�l,'I I:I1I-­.-�I,,i 1_.1�_,,�,1 I;,-1,.-��,I-"-1,,.I-�l"�,I I�.'.I,�II g1,.,�_-l,-,.I.I I�1 I-,,.,II,�,�I1'-I1 I I---.;I L�,�,,��*-l-I��O�,,-__,I Z,I,-I'I4'0,,II-I,.I,,,I.�_,1 I I-�I�_I..--I:A,,�",:_I,I.1,I I-A-­Ll,1"_I;---,I_-�I 1_,.�'�1�I_�I..I f'I 11 1-I�._-,'-I 1.��-,"�),_-"1 II�II-"�,l,-y,.-�,I� -_2-,!�I-.�_�I­-��.I­­14II,1-I-I"1-I I�I,%1,I�.I,�,�I I-;I�.I I-�-�:-�I�,'I I��I';�-4"-�1I.1-I'�IIIII,I1.,�--I.,,_,-I1 I-1�,,0,,.:I,,1­�-1�1I,I,,-­­1t�1�1 I_III��-/-1 i,�I,I.,.,1--II.,I­1 1-,1I-.1 ,"­--_II1I,,I"",I 11�.-­,,I,�I I_-—I1�I�.,-eI I-:-1.f.I1­I.I I I 1-II,1I-II,.I IIIiI " 1I II_ .- 1I,I�- II � Ii y ' .. . - :: l ...� �i. r/ # i / ,.; - o , , - c a' "t. f •" _ _. - , P' I,-. . , - - - v -::t - .p : ..y,� ` - _g _ f _. , ,. t .. ,. ,,- / 'k 1 .Q , :. , _ K . , �, !� ' r , . i y,.^ j »- ----' _ _____ _�._ - - -. :- - __ __ _ , --- „ , -,> - __, A r .._ -- ._ O 1_. l 7 n "s = ," _ -. O I - „:. - _ 4 . X ' , ; , _ t . ,,. E _ 4, nn I ,. ' - I . _ C , . ;.- _ -M . u � - r _ __. Y - • a „ _ �; .;� ,r-, . _ ". .. :_z STo�lf= � + s. , , ,� Tc . » ; r- ,, '. ,4 T ..�,. J4,,l., !6.#JA .fir u1( - - � ,. /x /r1Glr 2 m: - 4C, a�fir;_ _ L . -. , __ r,a6 . :. . r _ , , _ f _ _ € - . - J t �' s k ,: .� , - - , , :� _ r- ;,x. ,� �� , , . 4� "1, -_, y, @I - ti i ,. , e„r.. "- _r - 11.. {�; ,. r I 1 T­,-I�­.�ZII Iz­,'.II-I I1�I"I I,1I.sL_;2--I1.,14-I-�_.I----I r�I-'-I.III�r,-=,--,I I�..-�,--I�l­,I1s-I_-1o,I-�l I1"_1�1 I.-,,,I�'III�-:-",II�II I,I�I4,—--I,,-_�:�1-.,I I�".-�1 t�-:�'I 1 I 1I 1.I,:,.I1_­�,I 1 II l I1�-.1I�1 I,-IIII,�-I I-I"1,II,1�­�I�1.­I�I,II�":-�I I--1I,I.7 i1I 1,,I,,,1.II_I­�1 I,I­��.III I-I II 1-_iI I�_II_I�-1_".-_I1�I',.1-1-_­-I 1,�--Il-1,�1 I.11II'�I�1 SY III 1�--I�7*­I,�-�,_1.-,.,...Ir�l-I-II.-,I i1_I,,-��1-I.,��I��II1�r�I�_��I.'II1I­,�1'_Ie--,�,,II,�-�-I I�I P I-'�-'l,I1.-I,,I I i�I.�I_.1 I'�-I-1 I_�-,1-1.I�I-"I�_1-11'-_II.�I1-I,I'�I1 I.�IY IIl,I 1 i�_ d a - ! / ,`,' - �, "I.'I.�.-Ai.'I-,,I�� a ,.j�'_�Y - _ - /,. I 1��I�I­-­;1�1;.-II'',I I11I'�- .II I"�..I 1--I I-`��I�11�qI,I,I I II_I.—�I��I I IIIII�Iq I.-�II I1I,­�I I-II-'-I I"�..-_'�I,I1I-1I I l I,1:1 1 I-I-_4.I.I'!�.I.1��I1_�,1,:­-�/.-�II,I,i�'I­r-I.�I,1I,I I"­1 I1I I VI�rI 1�1I I I1�1 1 I�,:,I-II�-I1 I�_I-"II 1 1 I­;1 1I I"II�:II.1�-1III,-,IIi1,1III1-II­I:1 I�-��I"III�.-I�-II\I-1 I 1�,-)I---�--,,I­-;I,-,!.�1��1--�1I I�_�lA I.I.-I-I1-�_�'1,1 I� v:: --�-; >` - „ A hR 3 _ �p .. 4 i, ,mod' i:': ,. _ .� „. - ._- _, _ r .-:. ... ,-;.c- `.-:.z... '�, -,..�... .>. .. ', ..� ....,«.a"..�..,:.w..;.:,�..�:....� ...�wx-�s+..�.-.w�*�-.�..�...,.«,.......;�.,.,.,.a�..a,. ..a, .+�c:-._.....e�.Us„u-•s^'a,�..,.-.,,.....,,�s�o,a.�.,�.o,m,•..,�' :.�r„wsc.�:,�..- s.�. :-_. �.�.« , >• , r .._.' .. M - - a y ate-,. _-�-,_-•--.---��._. .. , w. rR s .,i 4 . - S , , 1, :. .. ` A',' _ . ,,, - v... _ _, „ , ', ,: _ , x _ , -, _ r � — �. , _, I, — •� — — s \., f x k 1(1 S } _ :,i A n y, i r /► - - ._i: , _ vd t • - .. - �: r - _ � _ .�� „��� _�, _ _ ., : : .. , , -. - ,.'. A `. _ .-. , m , I $ - _ , ., - �`: r M ♦T. - r - s. r F� .ter +�. �+....a. .�..w� ....�...n ...:.. - �.,....«,.�. �.• :' - ..., ...-_.. . s ..^ - ,. -, :. ' '* . _ _ �,. , w. U ' _ _ , j --- -, ` . MI - ;: �' " —, 4x p - 1. ., .r ". ., _ f3, iw_ . . u W _ _ 1 a M ,. - y, e W" ,, . : , j 41.. 3 J ,. _ b `," 5 ,,',, -... u. , y - f - ' .n - " .. , �., ., m n. ..- . , 1 - .•F ` .,-I, $ , - r r , I. . f , _ ., " t - -r- ,Y •yak ,"' , , .. . . I r - • ^ _ _ . , - `x -. Y r -, «.a. _ K .. -. < . _ . "_-1,II I�����-I-1,:-1 l,-_��_-..II�II,1,�-''­-''-.�,II l-r,.II-z�_I1--I I�I 1�,1 I�1��1,11,�-,1�-�_—-I�I._.-�-I,.,I 1 1-I",-I-I-I,�1 I.�-�I I�,_III.-�,-1 I'-�II I--,��.-_.I1�_1�.1r­­,"��I11-1.'",--,-­I_�-;I��I I.%��-,I1­�"1�':I�_-.r--I-I_,�,I�.I.�1I",,11 1,I'1I 1I,,I,.I-1,,�I,I1_I�II1�I,I II I'.,,I I�1 IP.I.1 I\,-1­.I"I�:I1�I-I.II I,I,I 1I.�-I�".IlI�.�l,1�:'�*�II1--''I,1�,�--�II_,II'17-I,I�I,-I--.-I 1 I I..I-,-,:�1�"-.�"_-I-�I�7-.',II1-7�.11:I',,,'­7 I I 1II-�,���lI.,.1III-,`-���'-­I-�-1--IL 7�'1 1-,,II II,I)',,�I_1�I-I I-,:,",-,,,_..1I-'�I1,­�II,I,,I 1 4,-.,,-'1:i—�I',1,'II III1-II_��I.I-_-:1I I1I"I--.-_,-I,�1_�­-�;I-1I_III,,1 I,;­1I II I_,,I.'.1:I,II1_:�­_I!�I._�'%I-.,'�.I_,�I",.­�I�,�r,.,I lI I I I�1­,,1�,-.I_,�-.-�,I,-­.1-�II,lII��I_�-�I.�1�.—,�I I,_'.-�'I'I��-I.I,�_-I-:.��I-'-'I�7.-I,I I,1'-._��1,0I�%/,,r,,I­­�I I',I'1�,.-,-:-1�-�---II._'�iII­1,1.:.-�-.Il,",X I--­-I-I�_',I,�1I,1�I:I-1,-., II�.I 1-I�I,��,-,I I I�1 1"',��1'l-_P I-IIII,�II�1r r,I11Il 0���.I-I 1��w�-I III 11I I 1_wI'.­"��"I I�-.,.�I.I-I.I k-I­�I,II,,I.-1,,II��'1.,-�-,.I,�1III1�1-I­-I,II,�.--,I--�-�r�-�tI�.-�I�,I,-I.�,.I II-I1".�jI_I-1��­-I1l"I'I�­I-A�.-1�.—�"I III1 v_1,,I,.,-I-III'Il I_��*I I�,-1,,--I,1 I��-I,I II.-��:IA-II;�,If:Ii.I--�-I 1I I.I I./�-�.-I.I�-I I._I'�I 4�,�,�­�-I:I I,,I­--I �-I��,.,,_1"I-,,III,.—I/.��I,I"I IIII��,l I�I.-,1�Ieri�I,'I e�.I I-��I,I1II,Q I-1�I I I,I.l 1 II_I II-l I I I I-.,,--,-,II�.I1 1�I1_,I,I�.--II I�I,11-I I,,1Ij,��III�I I���1_�1 II��1 II.,,I..1I.,��I I�\.I—N>,II-I III���I1-I�I_t:I-I,.:P-I��-�III�II-i--I I II�IIr II ... X .v m_ __ 1-,,­1,I Il,-II.II�I�.��III,f,�I I­,,,I I z I�;I...r L I,I�_-%­i�t4 II�­.II�.,,,�,I-'-,,I.I I,I1 1�19I�I1.-I�l,I.I-.I�"I,�,"�1-,I:�1 II�,1-­;l'%�,,,,'.�I-_,II-I,".II I-I I,,c��".I 1-I"II.I,,II�1:_-.:� I,I,1I I�I I I-I:�,-�I I�i�III1cI�I:.,.-,r,-I,�.II�I1,,�1�,I�II I��*�,-,I1:I-�1-(,­I.Ol�x�I.jT_I lII�-I�nI II_I�A�II,,"I,I�-II1­I,I I j I-..,�"Ik 2 1I.14I I*L 1,,IIIIb I II,I��_I I I I I I'-p I:,:IIr I II1I�I I��-1I I-�\.)--1.I_I I:,I d 1�III-_I,-I 1I,�,I��I/�I l I�I�I�1,I�I,,I t4-I�-1�I 1��,,I-I:)._I­I1,���.---II,1—.-cII e,I�1,,II�1I,I-�I­I1,--I,--_,�-r.-I;I,�I�_'1_,'I.I-1 I,:I�I1 I,.I I;I�I t-I I 1I�,I-t�P.,�'I1�I��I:,��I,I I I�III_1 II,�,-I.�I_,I'I 1,-,.I-.u.I I1�,I(I.II I,-I..I�,II1 1..�,II"�1 I.1­�I^"L',,,r�I_�.�6/lI I1 1I I 1l - , x�', ,. _ ., -, - -,, + t • `' ,,,. 0" — RL . A.I. $ 4 i Y I. :. • - _ .. I r a , .: ® I - , � 1-I4 II I-I�-1�I a�II-'�-I1 1I,_.I_�,.III1I,I_II1I—II.,�I I 1�I_..�IIII'I-�I-I I_I1_I X.II_I .�1 II"I I I--.�,I-"I,E�-I.I11-�I�1>-.,���-I,,- I�I�,�r�1:I­.I 1I_�_',,I I I 11I"I-�1 II 1..I,II�­1 I I_1I-1 I II-�_I.�II K 1I II-­"II��,I,��1--—_,­I!I-I"II,,.�I,�I.,"-I.--_II�,�.I I�I I I_II._-�-_1I�"1"I�1'11I�_1 I�I,,.I1I�.��1 I I I'I,I I�I�I1­.I II_I��1 II I.1.-I�I,.-1"��I��1I­,III�1-...-�1.�_I 1I-��­,-'���1II. -_I._­I,,­,I1I,-I II�1 I-I_.II1­I:�tI­�I--II,�I Ir�_II 1-I_—_­iI r_-1 I�—-"�I"1iI 11-�,I­I,_I�1 1I��I I 1.,.II'l,�-I�Ir 1-I-.1"�iI-�,,�--LI I1.I t,I-I,-II I-1j�I,1I I-I�-­ I,---II 1-,.,-I-.--_%I I�_II�I,­�I 1 1.-,,2�,I_..�".I 1�1,,I-".�I1-- . t� - � } _._� ; 11_��I,I I�1�.,1,..;IIII,1-,1 I . _ , _ .,. , y _ , , - , . , _'! w . �r _ , , _ . _I - . ` � • .. . . : £, t s. ;,A u " :: , - � . , _ , � ' : ' �� f%1 - I - __ m., . >, . ._. , ,_a.., s ,, .. tJ _ _ _.. - _ ....-. ., • '..r .,..,. , • J' $$$}{}{}{''' . ,. «. _ _ .�_.