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HomeMy WebLinkAboutSALTY COW - FOOD Salty Cow Soft Serve 776 Main St. ®st. t 1'1—_OAS I Town of Barnstable BOARD OF HEALTH OJohn T. Norman Board of Health Donald A.Gaudagnoli,M.D. BARNST,ABLE. ` F.P.(Thomas)Lee t 33 y 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. s9• � Phone: (508) 862-4644 Fax: (508)790-6304 www.towndbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR S90.000 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: 1104 Issue Date: 01/01/2022 DBA: SALTY COW OWNER: ANDREA MEAGHER Location of Establishment: 776 MAIN STREET OSTERVILLE MA 02655 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - — -- --- - MOBILE- FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: $30.00 Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE M I Restrictions: N ' • Initial : Town of Barnstable —W�i 1-�� Date Paid Amt Pd$� ,ARNSTpgyg, : Inspectional Services . a�� Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWN�^ERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: _ykxNi CI]\ ") ADDRESS OF FOOD ESTABLISHMENT: -:ID4 GSM Qq s,\` f\j&L mpt ®c MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ES ABLISHMENT: (%'I)LZU -�O TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO ... (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 D . ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? _ IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE �y 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 508-8624644 Q:\Application FormsTOODAPP REV3-2019.doc i a OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER/NO OWNER PHONE # ADDRESS & V�U %t, C�v'����� h& ) " CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: C 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 bb 2. / OA/ AN — IGNAT ICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openi:ng!! 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. j NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPP REV3-2019.doc i w 04tKETp,. Town of Barnstable BOARD OF HEALTH John T. Norman `3 Board of Health Donald A.Gaudagnoli,M.D. uAn LL Paul J.Canniff, D.M.D. �$ ya319. ,�� 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate ' o ° 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: 1104 Issue Date: 01/01/2021 DBA: SALTY COW OWNER: ANDREA MEAGHER Location of Establishment: 776 MAIN STREET OSTERVILLE, MA 02655 Type of Business Permit: FOOD SERVICE Annua'd: Seasonal: YES Indoor5eating: 0, OutdoorSeating: 0 Total Seating: 0 FEES --- ------- --------- FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: _ MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: $30.00 Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: r , i ,r 'c q• Initials: n�� do ; . Town of Barnstable Date Paid 4 1J 21Amt Pd$ �V R- Inspectional Services g '�. 2i�i639.►`0� Check# FDMA� Public Health Division Thomas McKean, Director t.200 Main Street,Hyannis,MA 02601 r Of6ce: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 3 >a NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: &A,61 06 43 ADDRESS OF FOOD ESTABLISHMENT: 7 Co Q.t r►- uL+ DwtAAj MAILING ADDRESS(I DIFFERENT F M ABOVE): E-MAIL ADDRESS: - ►l A E) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 45*) - 773 v( TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO �.(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: `/ DATES OF OPERATION: .S /I /fib II NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: 0 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. y ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD v FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REOUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: /� p FULL NAME OF APPLICANT SOLE OWNER YE /NO OWNER P ONE It V 4 3(p�` -24 ADDRESS CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date - ---� Val a�a� 2. SIGNATURE OF APPLI T 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. NOTICE: Permits run annually from January 1 st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application Fonns\F00DAPP REV3-2019.doc I Bellaire, Dianna Sai From: Soto, Kathryn Sent: Monday, May 17, 2021 9:36 AM To: Bellaire, Dianna Subject: RE: Barnacles and Salty Cow I asked them, including the owners husband that was involved with getting approval and they had no explanation. I noticed a letter in the file from Marybeth to the inspectors that alluded to approval based on flow but did.not reference the great trap end of it so I am planning on asking her tomorrow. There has to be an explanation because Marybeth and Donna would not have let this go you know what I mean...very curious as to what From: Bellaire, Dianna Sent: Monday, May 17, 2021 9:31 AM To: Soto, Kathryn Cc: Bellaire, Dianna Subject: RE: Barnacles and Salty Cow No variance for Salty Cow? Is that all good? Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The informatior-contained iii this electronic transmission("e-mail"),including any attachment(the"Information"),may be confidential or othen�nse exempt from disclosure.It is for the addressee.only.This Information may be pr7-6leged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.As such,it is for internal use.only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the 1'o-vvn Attorneys Office of the'Town of Barnstable. If you have received this e-m.ail by mistake,please notify the sender and.delete it from. your system.Please do not copy or forward it.Thank you for your cooperation. From: Soto, Kathryn Sent: Monday, May 17, 2021 9:31 AM To: Bellaire, Dianna Subject: RE: Barnacles and Salty Cow I did them both on Friday afternoon,they are all set. I must have them at my desk, I got back pretty late on Friday. I was planning on stopping in this afternoor to look up a couple things, I will give them to you then. Also Barnacle too will be ready for an inspection next week I th`nk he said From: Bellaire, Dianna Sent: Monday, May 17, 2021 9:20 AM 1 os" Town of Barnstable BOARD OF HEALTH v? John T.Norman l` Board of Health Donald A.Gaudagnoli,M.D. BAnsisrAOL& + ' Paul J.Canniff,D.M.D. Asa 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A;Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1104 Issue Date: 01/01/2020 DBA: SALTY COW OWNER: ANDREA MEAGHER Location of Establishment: 776 MAIN STREET OSTERVILLE, MA 02655 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeatin,g: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL'BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Qn FROZEN DESSERT: $30.00 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, a Town of Barnstable For Office]Use Only Initials: a _ g Inspectional Services °2---�- ' ; h. ( IoLL ,� Public Health Division 1 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE L Zo?0 NEW OWNERSHIP RENEWAL ✓ NAME OF FOOD ESTABLISHMENT: Q� COCA-5 SO-4 art Q kWC,. ` ADDRESS OF FOOD ESTABLISHMENT:_ 7 t0 )14i'k S DS444jt 4 �Act. MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS:ax4to-o-va'tea& r 0 6j' —CQ IPA TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: k WELL WATER: YES NO ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: /11 /Low 10 A C a_0 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) FOOD SERVICE �RETAI.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*** RFiQIARED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 509-862-4644 Q:1Application Fomts1F00DAPP 2020.doc OWNER INFORMATION: ,� n FULL NAME OF APPLICANT (] .Q�, LA- SOLE OWNER-(Yy NO OWNER PRONE# ADDRESS_ 1 qt� V 1;Q� CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: Axaa fo — 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. 11•+� / /o`k 1. 4aArtoa / / SIGNATURE OF APPLICAN DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div, prior to ouenlug l 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 lownofbarnstable us/bealthdivision/anolications aso. 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 n each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC l st. Q%Appticadon Fonns1F00DAPP REV3-2019.doc 2@NV corn Z@ft zerwso �Rgo DoIn5,Mat 00 SWA h'9 Ha CQ 16 55 11C.- 50-164S-M37 Fa.no 50 8-47 -0429 andreameaither@hotmail.com April 7, 2020 FAX: 1-508-790-6304 Hello Donna, Attached is the application for renewal permit to operate a food establishment as well as copies of the certificates and copy of the check that is in the mail to your office. Should you need further information please call this office. Thank you. Sincerely, Deborah Deborah Tokarz Office Manager Salty Cow Soft Serve, Inc. 776 Main Street Osterville, MA 02655 pfrQk Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. MRMWABLL John T. Norman MA S& F.P. Thomas Lee Alternate ,, ,.bzs• 200 Main Street, Hyannis, MA 02601 � Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590,000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 1104 Issue Date: 05/30/2019 DBA: SALTY COW OWNER: ANDREA MEAGHER Location of Establishment: 776 MAIN STREET OSTERVILLE, MA 02655 Type of Business Permit: FOOD SERVICE Annual: NO Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - - - - - - - - - - MOBILE-FOOD: MOBILE-ICE CREAM: an FROZEN DESSERT: $30.00 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: 457130 o 0� For Office Use Only: Initials: Town of Barnstable l Q , • Date Paid �� r A�p� �Q , 10, r Inspectional Services ��'�� Public Health Division r rti Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE - `q NEW OWNERSHIP A RENEWAL NAME OF FOOD ESTABLISHMENT: CNC'i ADDRESS OF FOOD ESTABLISHMENT: SVe- Ct, � �[�/\1 tA\A O 2'(P55 MAILING ADDRESS(1F DIFFERENT FROM ABOVE):�V��/\` E-MAIL ADDRESS: (I)p6r '9.'Cw ag&JI 63 co f" TELEPHONE NUMBER OF FOOD ESTABLISHMENT: - TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO ...(ANNUAL WATER ANALYSIS REQUIRED) p ANNUAL: SEASONAL: DATES OF OPERATION: (D/ /14TO lI / 1 /-6 NUMBER OF SEATS: INSIDE: OUTSIDE:0 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 ANDMEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? 6 TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) XFOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST _CO E FOOD INDUSTRY(formerly residential kitchen) BILE 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 FormsT00DAPPREV2018.doc .r = PLEASE CALL 508-8624644 OWNER INFORMATION: r FULL NAME OF APPLICANT SOLE OWNER: YES/NO lOWNER PHONE# ADDRESS\CkQ) CORPORATE OWNER: FEDERAL ID NO.: `' n �j CORPORATE ADDRESS: ,1�U yya\ ��� \9.��C� V L` L 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 fa ' / Oq / p2 2. JS NA OF 4PLICANT 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 508-8624644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/hesithdivision/applications.asi). 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 I st to Dec.31'each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q:Wpplication FonmsTOODAPPREV2018.doc �p THE rpm TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: - Date: Page: Of ti OFFICE HOURS PUBLIC HEALTH DIVISION 9:00-9:30A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-'Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 9$A a3y: HYANNIS, MA 02601 sos-862 46aa No Reference R Red Item PLEASE PRINT CLEARLY ,F°Mp,a FOOD ESTABLISHMENT INSPECTION REPORT QI. Name ` r Date -� L type of Tyoe of Inspection / , e a ' Routine .Address �� 1..1�- �"�� S�- -f Risk Food Service Re-inspection � � / 0 ` Level etei Previous Inspection ! T'1 Telephone Residential Kitchen Dat ' Mobile re-operation Z � Owner HACCP Y/N Temporary ss Caterer General Complaint Person in Charge(PIC) \I� ,/� /�� / Time Bed&Breakfast HACCP � � `' ��J In: A Other f� Inspector IfD Out: ft n- A Each violation checked requl es 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) rO FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands �S C% ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities r EMPLOYEE HEALTH PROTECTION FROM CHEMICALS _ ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures W (� ❑ 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) 1719.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations `/#� Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No TO 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 9 ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and.Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4non-critical violations regardless of the number of critical,results in an F. 2 .Water,Plumbing and Waste (FC-5)(590.00 ) establishment permit and cessation of food establishment operations. if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If f 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 8 -critical violations=C. ' 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector' Signature Pint:_ r �1 31.Dumpst screened from public view (/y/1✓/ �U Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's natur Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen 9 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-]03.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives, Contamination from Raw Ingredients y 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 a 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 Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) i 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* 590.004 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 Roden[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* I 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* 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 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-001.11(A)(2) Comminuted Fish,Meats&Game Pathogens* effe cme iuizooi 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* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing ContainingFish,Meat,Poultryor 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the Foodborne * 12 Prevention of Contamination from Hands 3A03.I I E Remainin Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6. Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F[0 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °FINE r°y TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: 2 Page: of NP ° PUBLIC HEALTH DIVISION OFFICE HOURS8:00-9:30A.M. BARNSTABLE.^` 200 MAIN STREET 3:30-4:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date Verified 039, `0Q'p HYANNIS,MA 02601 NON.-FRI.508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY p'EDN`"`p FOOD ESTABLISHMENT INSPECTION REPORT Name Date TvDeofof Tvoe of Insoection f S a s Routine P1 Address Risk Fo Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile re-opera io Owner HACCP Y/N Temporary Hess ^ Caterer General Complaint f J f Person in Charge(PIC) �� Time Bed 8 Breakfast HACCPVXAC In: Z%10 PVL1 Other Inspector 3 1Out:Z,Zj fM Each violation checked Xquires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors Led Items) Anti-Choking 590.009(E) ❑ WCLJ �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) ❑ (t O r W, ,I FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives SfitNt�C �I f �1 l� (� ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) w�.• ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures e ❑ 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 Y PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) + ro Corrective Action Required: ❑ No ® Yes Non-critical(N)violations must be corrected immediately or Overall Rating 6 T within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4Hon-critical violations g )( ) 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 i non-critical. If f 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 I critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8Hon-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's natur Print: 31.Dumpster screened from public view LL �� 111d- 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 W✓ ' ° 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* $ 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 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 F 5 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) • EMPLOYEE HEALTH 3-302.1 I(A)(2) Raw Anima]Foods Separated from Each 7-101.1 t 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* Applicants* 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use*7-201.11 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 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and AdulteReserrated for of Food 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water I Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water 3-401.11 A(1)(2) Eggs-155 * Concentration and Hardness* °F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System Eggs Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* EX i-uuxmi . 4602.11 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* 4-703.1 I Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 1p 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 2-301.1 l Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14- When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 7 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 l65°F IS 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 Preventin Contamination When Tastin * * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3-403.11(C) Commercially Processed RT'E Food-140°F Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11E Remaining 3-101.11 Food Safe and Unadulterated ( ) g Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 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 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 1.003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Supplied with Soap and hand Drying Devices Within 4 Hours 2 . 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. I 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. TOWN OF BARNSTABLE EALTH INSPECTOR,s Establishment Name: Date. Page: of k1 0 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BAR- NSTAB�E. - 200 MAIN STREET 3:30-4:30P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MONHYANNIS,MA 02601 -FRI. O 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 08-8 FOO ESTABLISHMENT INSP CT ON REPORT Name Date Tvue of Type of Inspection g Routine Address sk ood Se Re-inspection vel a al Previous Inspection Telephone Residential Kitchen D ` Mobile re-operation Owner ' HACCP Y/N Temporary Su' ness Caterer General Complaint i. Person in C arge(PIC) Time Bed&Breakfast HACCP 1 . In: Other a Inspector Out: Each violation checked requires an explanation on then rative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ i FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives r 1 ❑ 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 -)4, A�_ -5; 110 ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding e 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 -❑ CONSUMER ADVISORY I 10.Proper Adequate Handwashing L ❑ 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 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 [:1 Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 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 C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical Violations. If 1 critical refrigeration. 4 to 8 non-critical viol = 29.Special Requirements (590.009) within 10 days of receipt of this order. violation, Sons � 30.Other DATE OF RE-INSPECTION: Ins or"s ignature 0 Rrint: 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 C's Si•n tune( Print: 1 f 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-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* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control O Responsibility Employee 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 590.003 F Res onsibili of A Food Em to ee or An 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge*_ Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003 D Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* ( ) 3-306.14(A)(B)Returned Food and Reservice of Food* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 1-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* I 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 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)t2) 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* Eg cfl-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* aces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.1](A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* 10 Proper,Adequate Handwashing 165°F 15 sec* ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Ratites- Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 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 3-403.11E Remaining Unsliced Portions of Beef Roasts* Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 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 I 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 Lid Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Location an acement 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 .006 Within 4 Hours* 26. Water,Plumbing and Waste FC-5 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 2 . Physical Facility FC-5 .00 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous ci Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special or 1 .009 3-502.11 Specialized Processing Methods* 130. 1 Other 11 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. pp THE Tp TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page: of OFFICE HOURS P ° 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 HYANNIS,MA 02601 M- -FRI. 5088 62-4644 No Reference R-Red.Item - - PLEASE PRINT CLEARLY . rfD MAGI FOOD E TABLISHMENT INSP. CT ON REPORT . Name Date e of Type of Inspection Routine Address Risk Foo ervice Re-inspection Level Previous Inspection Telephone Residential Kitchen D Mobile re operation Owner HACCP Y/N Temporary ness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP I Al n: Other I tie Inspector Ou • - Each violation checked requires an explanation on the narrative Wage(s)and a citation of specific provision(s)violated. C Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ r. 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) ❑ Ar 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) r ❑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 al ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY (�J hy-M6 (/,g 411 ILVE alpf ❑ 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: I❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo Emergency Closure Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-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 on-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-criti al viola'ons. If 1 critical refrigeration. within 10 days of receipt of this order. violati 4 to 8 non-critical violati = 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspe Sign lure t: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N / #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI s i at 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 * Other 7-102.11 Common Name-Working Containers** 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 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)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a 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 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* Eff h-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* � 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Cleanon Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) * 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 3-201.17 Game Animals Requirements. 5 Receiving/Condition 2401.11 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 foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.1 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 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. COW°FTC rqr TOWN OF BARNSTABLE , HEALTH INSPECTOR'S Establishment Name: Date: r age: of ti OFFICE HOURS PUBLIC HEALTH DIVISION ll// N 8:00=9:30A.M. BARNSTABLE. ` 200 MAIN STREET Q 3:30-a:3o P.M. Item Code C-Critical Item D SCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified .639, `0� HYANNIS, MA 02601 � U 8- -FRi. No Reference R-Red Item PLEASE PRINT CLEARLY �0rF0 MPS° 508-862-4644 FOOD STABLISHMENT INSP TI N REPORT Name Date I oe of TTvoe of Inspection n eration s Routine Address7-7 Risk ood Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation 17) Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast Other HACCP rl Inspector � alm Nil r V _M1 ,ILI 0 Each violation checked requires an explanation on the narra Iv p e(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) ❑ 7X7i 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 AdditivesIj ❑ 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 i 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 /� d"l - ' Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations l�J Y-t Critical(C)violations marked must be corrected immediately. (blue&red items) S�(a I Corrective Action Required: No ❑ Yes Non-critical(N)violations must be corrected immediately or I ` within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance Volunta Com ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. Embargo❑ ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-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 27.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must , 28.Poisonous or Toxic Materials. (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 Y of receipt non-critic violatio s. If 1 critical refrigeration. 29.Special Requirements (590.009) P within 10 days t of this order. violation,4 to 8 non-critical viola tio C. 30.Other DATE OF RE-INSPECTION: Inspe to Si ature 0 Pri t: 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 ign pre Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen o Y N Violations related to Foodborne-lllness 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 7-102.11 Common Name-Working Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 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)Resumed 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 C with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) om Compliance P � 4-501.111 Manual Warewashing-Hot Water _ 7.206.12 Rodent Bait Stations 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 1 g Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.]IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E 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* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective ronoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g• g 8 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 2330) 3-202.15 Package Integrity* g g 3-003.11(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 R Remaining nsli P 3-101.11 Food Safe and Unadulterated 3-403.11(E) e g U ced onions 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* Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F t and Accessible 3-203.12 Shellstock Identification Maintained* Conveniently Loca ed a e 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. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. I - SU11Engineering &. ivan Consulting, Inc. (508)4283344 • P.O.Box 659 • 7 Parker Road,Osterville,MA 02655 seci@sullivanengin.com • www.suilivanengin.com March 1,2019 Tim Meagher - Mcaglier Construction 776 Main Street Osterville RE: 776 Maui Street Osterville - Septic field Capacity Dear Mr. Meagher, Per your request,Sullivan Engineering&Consulting,Inc.. inspected the leach pit located in die back of your properly at 776 Main Street Ostcrville for its capacity as a leach field. The field was dug up for uispeclion and the top of die field was located approximately 3'down with a heavy concrete cover in good condition over it. Tlnc pit was 7'deep,and 6'across,with no visible signs ol.hydraulic failure in dle past and no water in the pit present.The pit is considered a 1000-gallon pit,and alter probing around die side,some stone was found to be approximately 1'around die piL I As per Ilse septic design code prior to 1995 bottom area was credited 1 Gallon Per Day(GPD)for every sf provided with tine sides credited 2.5 GPD per sf. Bottom area:pi"r^2=3.14"4^2=50.2sf 50.2sf=50.2GPD Side area: 2pi(4)=2"pi*4=25.1 25.1*h=25.1'5=125.5sf 125.5sf x 2.5=313.8GPD Total:313.8+50.2=364.0 GPD flow capacity for die leach pit. Additionally,per 310 CMR 15.203 design flow for an office is 75GPD per 1000sf of space. Retail has a design flow of 50GPD per 1000sf of space. Regards, Chuck Rowland,P.E. Sullivan Engineering&Consulting,Inc. Town of Barnstable �tTay Inspectional Services NSTAB Public Health DivisionBAR ' Thomas McKean,Director . 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 rX t�- .t. DATE As a condition of my Frozen Dessert License, I agree to have my products tested bacteriologically on a monthly basis by an approved laboratory. I understand that if my products have a standard plate count in excess of 50,000 bacteria or exceed 0 for Coliform, I must obtain a re-test within seventy-two (72) hours. If the count exceeds 50,000 on the standard plate count or over 0 on the Coliform, I will stop the sale of the contaminated product until counts are obtained that fall within the prescribed limits. In addition, I agree to conform to all the State of Massachusetts Health regulations contained in 105 CMR 500.000, Good Manufacturing Practices for Food. Monthly tes 'ng of the ice cream or frozen dessert mix is also required by 105 CMR 500.082 (B). Signature Nam ' f(Establish nt �:)G\A'�-8 Cnw Establishment Address �1(r� 1�C1 TeQ_t" CS-y—A V 'k— Q: Health/Applications/Frozen Dessert Testing.doc Stanton, David From: McKenzie, Marybeth Sent: Tuesday, March 05, 2019 8:14 AM To: Stanton, David; Miorandi, Donna Subject: FW: Ice-Cream Shop with Zero Seats at 776 Main Street Osterville/ Letter from Sullivan Engineering Dated March 1, 2019 From: McKean, Thomas Sent: Monday, March 04, 2019 9:10 AM To: McKenzie, Marybeth Subject: Ice-Cream Shop with Zero Seats at 776 Main Street Osterville/ Letter from Sullivan Engineering Dated March 1, 2019 Hi Marybeth, According to the letter from Chuck Rowland dated March 1, 2019 (copy in your in-box), the septic system at 776 Main Street showed no visible signs of hydraulic failure and has a capacity of 364 gpd. The heavy concrete cover over the field is in good condition. According to historical records on file, the 1,800 square feet two-story building was once used as a beauty parlor and office, which later changed to office use. I have no objections to a portion of the first floor being changed to retail space. The existing system has the capacity to handle retail and office flow. A new septic system is not being proposed nor designed. Therefore in my opinion, without a new design, a minimum design flow is not being requested and a variance is not needed in this regard. 1 ® Engineering & sullivanConsulting, Inc. (508)428.3344 • P.O.Box 659 • 7 Parker Road,Osterville,MA 02655 seci@sullivanengin.com • www.sullivanengin.com March 1,2019 Tim Meagher Meagher Construction 776 Main Street Osterville I1E: 776 Maul Street Oswrville - Septic field Capacity Dear Mr. Meagher, Per your request,Sullivan Errgincerurg&Consulting,laic. inspected the leach pit located in die back of your property at 776 Main Street Ostcrville for its capacity as a leach field. The field was dug up for inspection and the top of die field was located approximately 3'down with a heavy concrete cover in good condition over it. Tlhc pit was 7'deep,and 6'across,with no visible signs of hydraulic Gvlure in the past and no water in the pit present.The pit is considered a 1000-gallon pit,and after probing around the side,some stone was found to be approximately 1'around die pit. As per the septic design code prior to 1995 bottom area was credited I Gallon Per Day(GPD) for every sf provided With die sides credited 2.5 GPD per sf. Bottom area: pi"r^2=3.14*4^2=50.2sf 50.2sf=50.2GPD Side area: 2pi(4-)=2*p1'4=25.1 25.1*h-25.1'5=125.5sf 125.5sf x 2.5=313.8GPD Total:313.8+50.2=364.0 GPD flow capacity for the leach pit. Additionally,per 310 CMR 15.203 design flow for an office is 75GPD per 1000sf of space. Retail has a design flow of 50GPD per 1000sf of space. Regards, 4 R, F Chuck Rowland,P.E. Sullivan Engineering&Consulting,Inc. I tim@meagherinc.conn From: Andrea Meagher <andreameagher@hotmail.com> - Sent: — Tuesday,February 26, 2019 5:15 PM To: tim@meagherinc.com Subject: Fwd: Meagher R190226-2 Attachments: 876B, 876BRH, 877E &877BRH.pdf,ATT00001.htm; GES-5400_2_16_18v2.pdf,- ATT00002.htm; Fuzionate - Sweet choice.pdf,ATT00003.htm; booklet.pdf, ATT00004.htm;Coffee Program Pink.pdf,ATT00005.htm;TSSU-48-12-HC.pdf, ATT00006.htm; Maxx cold MCRT-49FD.SpecSheet.pdf,ATT00007.htm; MXDC4_MXDC8 _MXDC12_Dipping Cabinets.pdf,ATT00008.htm; FS2 specification sheet.pdf; ATT00009.htm; Regency 60 -3 bay sink.pdf,ATT0001O.htm; Regency 12 x 16 hand washing sink.pdf;ATTOO011.htm; 60100H Spec grease traps.pdf;ATT00012.htm; mop sink.pdf;ATT00013.htm; Meagher R190226-2 - Sheetl.pdf,ATT00014.htm -- Sent from my iPhone -_T__ Begin forwarded message: From: info<info@acananortheast.com> Date: February 26,2019 at 3:34:26 PM EST To:andreameagher@hotmail.com Subject: Fwd: Meagher R190226-2 Good afternoon Andrea and Tim, Attached you will the quotation and specification sheets as discussed with Hugh. Best Regards Anna Acana Northeast Inc Electro Freeze New England 800.922.2629 340 Commerce Way, Pembroke, NH 03275 www.acananortheast.com Demo 9 Flavor Automatic Soft Serve Machine 1 j i I i a i ACANA NORTHEAST customer T&A Meagher 340 Commerce Wav Address Pembiioke, NEB. city Osterville, MA 0327511 ZIP Code 02655 TEL: J-800-922-2629 Job Ice Cream Shop Attn Tim&Andrea Phone (508) 364-7737 DATE: February 26, 2019 quote No. R190226-2 ITEM CODE DESCRIPTION N/R HRS/QTY I ICE AMOUNT PR EF Slush Machine 876B-234 N 1 $7,933.00 $7,933.00 j EF 44RMTFB-137S 9 Flavor SS Freezer W/C 1Ph. N 1 $33,250.00 $33,250.00 i i EF GES5400-137 Twin Twist Floor W/C 1Ph N 1 $33,392.00 $33,392.00 i i WS 24 Flavor System 24 Flavor System N 1 $4,333.00 $4,333.00 i I WS Delightful Dips Delightful Dip System N 1 $990.00 $990.00 i WS Frozen Coffee Double Head Frozen Coffee System N 1 $2,680.00 $2,680.00 i Topping Table True TSSU-48 ITopping [Table c/w Sneeze Guard N 1 $2,799.00 $2,799.00 sneeze guard and sign N 1 $700.00 $700.00 MaxxCold MCRT-49FD Reach in Refrigerator N 1 $2,869.48 $2,869.48 MaxxCoId MXDC-8 Glass top Dipping Cabinet N 1 $2,022.00 $2,022.00 f i Federal Tax ID: 33-1223821 1 i i i i Fudge Warmer Server FS-2 Hot Fudge Warmer N 1 $390.00 $390.00 1 3 Bay Sink E-SK-AT.3 3 bay sink N 1 $416.00 $416.00 I Hand Wash Sink SSH-14 N 1 $64.99 $64.99 I Prep Sink SSP-24 N 1 $99.99 $99.99 i Mop Sink Service Basin N 1 $131.00 $131.00 i i Grease Trap Stainless Steel Grease Trap Interceptor N 1 $239.00 $239.00 START-UP/LOGISTICS Set in place,start up,test operation &adjust. 1 $3,283.00 $3,283.00 Includes training cycle/initiate warranty. Deliver, uncrate, install casters, dispose of packing materials as required TOTAL; $95,592.46 Applicable taxes payable at time of delivery with certified check or wire transfer i Offer is valid for 30 days. PAYMENT TERMS AS FOLLOWS: 30% Down payment due with acceptance of this proposal 70% Payable by certified check or wire transfer priori to equipment release from the factory Storage fee of$33.00/day if stored in warehouse for longer than 2 weeks Re-stocking fee equivalent to 30% of purchase priceiis non-refundable All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above the estimate. Purchaser agrees to pay all costs of collection, including attorney's fees. This proposal may be withdrawn by us if not accepted by the above due date. Federal Tax ID: 33-1223821 2 I i I N/U indicates new or reconditioned equipment. Reconditioned units subject to prior sale. Authorized Signature i Name In Print Date I I i I I i . i i Federal Tax ID: 33-1223821 3 i ACANA NORTHEAST customer T&A Meagher 340 Commerce Way Address Pembroke, NH city Osterville, MA 03275 i ZIP Code 02655 i TEL: 11-800-922-2629 Job Ice Cream Shop Attn Tim &Andrea j Phone (508) 364-7737 DATE: February 26, 2019 quote No. R190226-2 ITEM CODE DESCRIPTION N/R HRS/QTY PRICE AMOUNT . EF Slush Machine 87613-234 N 1 $7,933.00 $7,933.00 EF 44RMTFB-137S 9 Flavor SS Freezer W/C 1Ph. N 1 $33,250.00 $33,250.00 I EF GES5400-137 Twin Twist Floor W/C 1 Ph N 1 $33,392.00 $33,392.00 WS 24 Flavor System 24 Flavor System N 1 $4,333.00 $4,333.00 t4 I WS Delightful Dips Delightful Dip System N 1 $990.00 $990.00 WS Frozen Coffee Double Head Frozen Coffee System N 1 $2,680.00 $2,680.00 i Topping Table True TSSU-48 ITopping (Table c/w Sneeze Guard N 1 $2,799.00 $2,799.00 j sneeze guard and sign N 1 $700.00 $700.00 i MaxxCold MCRT-49FD Reach in Refrigerator N 1 $2,869.48 $2,869.48 i f MaxxCold MXDC-8 Glass top Dipping Cabinet N 1 $2,022.00 $2,022.00 i i i Federal Tax ID:i 33-1223821 1 I i i I Fudge Warmer Server FS-2 Hot Fudge Warmer N 1 $390.00 $390.00 3 Bay Sink E-SK-AT.3 3 bay sink N 1 $416.00 $416.00 Hand Wash Sink SSH-14 I N 1 $64.99 $64.99 Prep Sink SSP-24 N 1 $99.99 $99.99 i Mop Sink Service Basin N 1 $131.00 $131.00 Grease Trap Stainless Steel Grease Trap Interceptor N 1 $239.00 $239.00 2 START-UP/LOGISTICS Set in place, start up,test operation 8�adjust. 1 $3,283.00 $3, 83.00 Includes training cycle/initiate warranty. Deliver, uncrate, install casters, dispose of packing materials as required TOTAL $95,692.46 Applicable taxes payable at time of delivery with certified check or wire transfer Offer is valid for 30 days. 1 PAYMENT TERMS AS FOLLOWS: 30% Down payment due with acceptance of this proposal 70% Payable by certified check or wire transfer prior'to equipment release from the factory Storageifee of$33.00/day if stored in warehouse for longer than 2 weeks Re-stocking fee equivalent to 30% of purchase price is non-refundable All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above the estimate. Purchaser agrees to pay all costs of collection, including attorney's fees. This proposal may be withdrawn by us if not accepted by the above due date. i Federal Tax ID: 33-1223821 2 N/U indicates new or reconditioned equipment. Reconditioned units subject to prior sale. i Authorized Signature Name In Print 1 Date I I 1 ' } i i I i f Federal Tax ID:j 33-1223821 3 :3 1 . 5rn m 6: 5rnrn OD _ [ l IN �6 aQ [ ] [22.23] 061 ` Bowl size:20"X 16"X 12" CD CO �0� U CDBowl made of 16gauge 3045/S CD Overal size:25"X21"X 161' LO Apron made of 18gauge 304S/S 16GA.304S/S wall clip 7 3.5" Drain basket included CO � Carton box packing ED of 24.75" [628:65] 1 :5 75 rr�m R� � 'W OO 1.25" 131 .75J A 600SM162012 Tabi, . �S.A�.d snl<s A GREASE INN RCP RS APPLICATION — - - - For use in restaurant and institutional kitchens3nd all.types of food handling and-- ------- -"------ ---"--- --- --- processing areas yhere waste water contains fats,oil and grease(FOG). Adequate space and head room for removal.of cover:must be available formanual cleaning.: �E ---�{ SPECIFICATION JOSAM 60100H`Series_epoxy.cwted fabricated steel Grease Interceptor,no-hub connec bons,internal trap,;removable diffuser baffle,.gasketed non-skid cover,flow control fitting and PDI Seal of Approval.Conforms to Plumbing,&Drainage Institute Standard PDI G101: F i ii 11 4-40 onforms to Plumbing and Drainage Institute Standard PDI-G101. — ——— — - - — —-—-—-— Mom 1 Cover Recess for Floor Finish -HD . 'Heavy-Duty Cover.. 61 Flange and Clamp Device :' -SS, Stainless Steel Interceptor ` ISI., Integrated Solids Interceptor_ ♦.-GRD*..Grease Removal Device; GASKET ♦-EXT ..Extension 6"Standard. 60104H-601 1 OH (Specify Extension Height) t. -GRDP Grease Recovery Device Z.. ♦ RT, Recessed Type with Probe. D SAP Sensing m. ♦ ET Enclosed Type g and Alarm Probe SIZE ---------- _ SiZE n --�-- ISl and GR:Pzannot be fumished:toga6 r. t 60100H-GRDP meets ANSI A112,14.4 - -- -- STATIC G _ FLOW` GREASE ROUGH-IN --: -- -- - WATER— — —-- C.-- TYPE RATE CAP PIPE CENTERS - LGTH:- WIDTH HGT. C LINE NO. GPM'. LBS SIZE .C• D E: F G. tBS:r NO-HUB Un 60102H" 7 14'._: 2. 8-1/4 '3-3/8: .14,718. 13' 11-518 35- NO-HUB OUTLET 60103H. 10. 20 2 8-1/2 3-3/9 16-5/8 .14-1/2 11-7/8 4511, INLET 60104H .:. 15 30 2 9-1/2 3-N8 20*318 17. 12-7/8 ';60 60105H, '''20' 40` 3 12 . 4-7/8' 20-7/8 19, 16-718 70 MINH 25- 50 3: 13 4-7/8 23-318 21-1/2. '17-118 90 BAFFLE 60107H- 35:: :':.'70 1 3. 14-1/2 4-7/8, 26-118 23 19.3/8 110 60108H` 50`_ 100 3 :; '16-1/2; 4-7/8 27-7/8 25-1/2' .21-318 ` 135 - 601.09H 75 '. ::150: 3 31 1. 6 41. 31 27 220 6011OH... 100.: 200 4 23 8 47, 35` :,.31 325'.. APPLICATION For use in restaurant and institutional kitchens and all types of food handling and --:i processing areas where waste water contains fats,oil and grease(FOG).The Grease ■ Removal Device(GRD),with programmable timer,controls the internal pump to 4 a I remove grease on schedule. " vA.. SPECIFICATION JOSAM 60100H-GRD Series epoxy coated fabricated steel Grease Interceptor,no-hub connections,internal trap,removable baffle,gasketed non-skid cover,flow control fit- ting and PDI Seal of Approval.Programmable timer controls internal pump for E x F removal of grease at predetermined intervals. •.m>«t _ GASKET PUMP POW OPTION N/A: IL coRuD PIPE TO TTANE -I51 D PIPE _ _ PIPE C INLET OUTLETS STATIC WATER LINE BAFFLE �EDE PUMP MOVAL FLOW GREASE ROUGH-IN TYPE RATE CAP PIPE CENTERS LGTH. WIDTH HGT. NO. GPM InSZE C I D E F G LBS 60104H-GRD 15 30 2 9-1/2 3-3/8 20-3/8 17 12-7/8 90 60105H-GRD 20 40 3 12 4-7/8 20-7/8 19 16-7/8 100 60106H-GRD 25 50 3 13 4-7/8 23.3/8 21-1/2 17-7/8 120 60107H-GRD 35 70 3 14-1/2 4-7/8 26-1/8 23 19-3/8 140 60108H-GRD 50 100 3 16-1/2 4-7/8 27-7/8 25-1/2 21-3/8 165 60109H-GRD 75 150 3 21 6 41 31 27 250 60110H-GRD 100 200 4 23 8 47 35 1 31 1 355 ®Product Illustration follows. 211 GREASE INTERCEP RS ® APPLICATION --- ruseestaurant and institutional kitchens and all types of food handling and-- processing areas where waste water contains fats,oil and grease(FOG). Extended E�T top with fixed extension for installations requiring additional roughing depth from the cover of the interceptor to the inlet and outlet. SPECIFICATION . JOSAM 60100H-EXT Series epoxy coated fabricated steel Grease Interceptor,deep F roughing,integral extension,flush-with-floor type,no-hub connections,internal trap, -- ------- — removable diffuser baffle,gasketed non-skid cover,flow control fitting and PDI Seal of Approval. Conforms to Plumbing and Drainage Institute Standard PDI-G101. GASKET I' D t/i II I 0O J� �- SIZE SIZE ------ OC. STATIC --�++ -ROUGH-IN- WATER— — H- FLOW GREASE CENTERS LN:ET LINE Z TYPE RATE CAP PIPE LGTH. H-1 HGT. NO-HUB NO. GPM LBS. SIZE C D♦ E G LBS. B OUTLET 60102H-EXT 7 14 2 8-1/4 9.3/8 14-7/817-518 35 60103H-EXT 10 20 2 8-1/2 9-3/8 16.5/8 17-7/8 45 60104H-EXT 15 30 2 9-1/2 9-3/8 20-3/818-7/8 60 60105H-EXT 20 40 3 12 10-7/8 20-7/822-7/8 70 BAFFLE 60106H-EXT 25 50 3 13 10-7/8 23-318 21-1/2 23-718 90 60107H-EXT 35 70 3 14-12 10-7/8 26-1/8 23 25-3/8 110 60108H-EXT 50 100 3 6-12 10.7/8 27-7/8 25-12 27-3/8 135 60109H-EXT 75 150 3 21 12 41 31 33 220 DIMENSIONS BASED ON STD.6"EXTENSION. 60110H-EXT 100 200 4 23 14 47 35 37 325 60 (1OEnclosed 1 ' APPLICATION For use in restaurant and institutional kitchens and all types of food handling and processing areas where waste water contains fats,oil and grease(FOG). Steel enclo- sure cabinet for installation flush with the floor,completely encased,where adjust- RA GASKET ment of interceptor elevation is necessary for connection to a deep drain line. c ANCHOR SPECIFICATION '`-" HOLES ON 5-3/B JOB FOR JOSAM 60100H-ET Series epoxy coated fabricated steel Grease Interceptor,deep ATTACHING roughing,flush-with-floor type,no-hub connections,internal trap,removable diffuser FORME TO 1 baffle,gasketed non-skid cover,flow control fitting,PDI Seal of Approval and steel a14 rr---q f:% INTERCEPTOR 2 1-1/4 enclosure cabinet with non-skid cover and adjustable interceptor carrier brackets. SUPPORT 1-1/4 BRACKET 3 I-I/4 RE ESSED 4 1-1/4 Conforms to Plumbing and Drainage Institute Standard PDI G101. LIFTING RING s POSITIO 6 - NON-SKID COVER NUMBERS FLUSH WITH FLOOR COVER LOCK PIPE M7STA11C ° SIZE 1T B ° NO-HUBFLOW GREASE ROUGH-IN INTER ENCL. INL�TYPE RATE CAP PIPE WIDTH CENTERS LGTH. LGTH. HGT. SERIES GREASE N0. GPM LBS. SIZE B C D� E F G LBS. INTERCEPTOR 60102H-ET 7 14 2 15 B-1/4 8-3/4 14-7/8 23 25-3/4 143 60103H-ET 10 20 2 16-1/2 8-1/2 8-314 16-5/8 24-3/4 26 185 60104H-ET 15 30 2 19 9-12 8-3/4 20-3/8 28-1/2 27 232 60105H-ET 20 40 3 21 12 10-1/4 20.7/8 29 31 274 60106H-ET 25 50 3 23-112 13 11-1/4 23-3/8 31-12 32 356 BASED ON INTERCEPTOR IN POSITION tit,ADD 1-1/4'WHEN LOWERING INTERCEPTOR 60107H-ET 35 70 3 15 14-12 10-1/4 26-1/8 34-1/4 33-12 378 TO SUCCEEDING POSITIONS. 60108H-ET 50 100 3 27-112 16-12 10-1A 27-7/8 36 35.1/2 435 60109H-ET 75 150 3 33 21 11-318 41 49-118 41-1/8 7$0 INTERCEPTOR SUPPORT BRACKET ADJUSTABLE FOR VARYING DEPTHS OF FLOOR 60110H-ET 100 200 4 37 1 23 1 13-3/8 47 55-1/8 45.1/8 1075 CONSTRUC110N. 212 CREASE I fi RC P RS Nil APPLICATION - - For use in restaurant and institutional kitchens and all types of food handling and - -- -------------------------------_-------------------- -- .- ---- processing areas where waste water contains fats,oil and grease(FOG). Steel frame and cover for installation flush with the floor where adjustment of interceptor eleva- GASKET tion is necessary for connection to a deep drain line. ` ANCHOR E �15--"I DRILL TWO 5-3/8 SPECIFICATION HOLES ON 6-5/8 JOB FOR JOSAM 60100H-RT Series epoxy coated fabricated steel Grease Interceptor,deep ATTACHING roughing,recessed,flush-with-floor type,no-hub connections,internal trap,removable FORME TO 1 diffuser baffle,gasketed non-skid cover,flow control fitting,PDI Seal of Approval and B INTERCEPTOR 2 I"'/" steel frame with non-skid cover and adjustable interceptor carrier brackets. SUPPORT 1-1/4 BRACKET 3 1-1/4 Conforms to Plumbing and Drainage Institute Standard PDI-G101. iIFrINGES EKING s 1-1/4 POSITIO 6 NON-SKID COVER NUMBERS FLUSH WITH FLOOR COVER LOCK D' SIPE PIPE IZE GAs"'TT-I.-NIEF SIZE 1 1 Z. M T No .m ROUGH-IN HUB OUTLETFLOW GREASE— -- INTER. ENCL-— -- 0.=— TYPE RATE CAP PIPE WIDTH CENTERS LGTH. LGTH. HGT. GRE00HSERIES BA LE GREASE :N NO. GPM LBS. 512E B C D♦ E F G LBS. INTERCEPTOR 60102H-RT 7 14 2 15 k14-1 8-3/4 14-7/8 19 14-3/4 102 60103H-RT 10 20 2 16-3/8 8-3/4 16-5/8 21 14-3/4 120 60104H-RT 15 30 2 18-1/2 8-3/4 20-3/8 24 14.3/4 151 60105H-RT 20 40 3 20-1/410-114 20-7/8 26 14-3/4 175 60106H-RT 25 50 3 22-121D-1/4 23-3/8 29 14-7/8 197 BASED ON INTERCEPTOR IN POSITION#1,ADD 1-1/4"WHEN LOWERING INTERCEPTOR 60107H-RT 35 70 3 24 10-1/4 26-1/8 31 14.7/8 225 TO SUCCEEDING POSITIONS. 60108H-RT 50 100 3 26-5/8 10-1/4 27-7/8 33 14-7/8 258 60109H-RT 75 150 3 33 21 11-318 41 49-118 15-3/4 455 INTERCEPTOR SUPPORT BRACKET ADJUSTABLE FOR VARYING DEPTHS OF FLOOR 60110H-RT 100 200 4 37 23 CONSTRUCTION.13-318 47 55-118 15-314 625 x 213 ITEM#: QUANTITY: gel I. PROJECT: APPROVAL: d DATE:. _ ------ - . . REGG L �: Tables and Sinks i X +v t�`r G�NCY NSF. ' 20-gauge type 304 stainless steel Single bowl with 1%" IPS -� drain basket Easy-to-install 8" J gooseneck faucet included a Holes punched on 4" centers n 8" backsplash Perfect for hand washing 9 :.. throughout the workday a NSFT SPECIFICATIONS. � e •; � o e � ram` � � - ba 600HS12 I 12" 16" ! 10" I 9" 9" 4" 600HS17 17" 15" 13%" 14" 10" 5%" WW- - 01/2019 4 I� x� F�E`�ENLY Tames�anfflinks _ • • T F-m-® 12"-;- 1 i-4"-4-4"-4-4"-6 T 2» O T1» » O T .O -311 3%" I 14" 2 9" O ),t 4 f � 9"-� r 1 ® • ............ nQ : 1" 7/z O 3 if O 9% : r 13" 110 O 2„ t I T „ 5% 14» �� 1%Z" FAU CET 8%" 3-/4-� 5% P-4» 4�-6%- ® AB ® • 16GA.364S/S sink 60 [1524,00] 3comp: 17"X17"X1211 16GA.galvanized leg and socket 03 112(088.901 =- , N Plastic bullet feet No drainboard Centered drain with 3.5" drain .o W 2(50.80]— — 8(203.201 26(660.40] � N co, R314(R19,05] 01 1/8((028.5�= — I v r� o �n o c° —2 150,801 C') r N R314(R 19.051 M 0 co 17(431,801— —17 [431..80J 17(431.80 N o `t I 7(431.80 M ROGG-NUEY� Table And S I<s � NSF �-- 12 112 1317.501 50 112[1282.701 60OS31717 I SMALL ATIMPRESSIONS. SMALL CAPACITY WARMER Simplify specialty dipping — melt small batches of y chocolates and candies Lift-off lid doesn't SMALL FOOD WARMER O get in the way Model FS-2 while dipping Food Applications r • Melt small batches of - > chocolates and candies for dipping treats <>. Warm fresh sauces and dips for sides or starters Fast Facts T s Heat and hold small amounts of specialty dips and sauces in ` this V/z qt warmer. The water- 71 x� bath prevents hot spots for even . CAUTION HQT sss\ „N heating, and the water fill line eliminates overflow accidents. ' - v Set and forget — place pre-made S E V E h dips or sauces in.the NSF listed y rethermalizer. and let them heat s up while you prep other foods. Includes removable 1 '/z qt stainless steel bowl (827070) a 1 oz ladle and lift-off lid. Accurate, adjustable thermostat prevents scorching and burning 1.800,558,8722 S E R V E R Server-Products.com SERVE BETTER,.. T ; i EAUTIF UL, DIPPED DESSERTS A E SIMPLE. SMALL CAPACITY WARMER Model FS-2 - --- _ ---------. -------____--- ---_----.____ . - -T___ Specifier Staiterrient. Specifications Server Products Model FS-2 Small Capacity Part Capacity Dimensions Weight Electrical Warmer is constructed of stainless steel and comes Number (height x width x depth) complete with a 1 1/2 qt (1.4 L) stainless steel bowl, 1 1/2 qt 8 1/8" x 7 1/8" x 8 1/8" 6 Ib 120V 1 oz (30 mL) ladle and lift-off lid. The adjustable 82700 1.4 L 20.6 x 18.7 x 20.6 cm 2.7 kg 25OW .... thermostat controls a 250 watt heating element. 2.1A ...................................................................................................................... Temperature settings are marked on the knob - ranges 75°F to 210°F - and power is controlled O Plug is NEMA 5-15P with 72 (183 cm)cord by an ON/OFF rocker switch. NSF listed. C-UL-US .......................................................................................................................... listed. Two-year warranty. Ships FOB Richfield, WI CRAFTED fe THe 53076. NSF C �US LISTED *,j YEAR WARRANTY Prodt.ict Cody' Accessory itenns ---- �-Small Capacity.Warmer-.--FS-2 82700- -0-1__1/i of(1.4-L) stainless steel-bowl 82707 1 oz (30 mL) 4" ladle 82717 Width Rela-ted Gems Warm three squeezable syrups or sauces with Server's Signature TouchTM warmer and decorate your dipped treats and specialty Height drinks, or use for platescaping. The squeeze bottle insert lets warm water flow freely around the bottles for even heat. Server's Cone Dip warmer lets you warm up to three cone dip flavors, making it ideal for LTO flavors. Natural convection-style �E Depth heating allows you to keep dips at the perfect temperature. gx Signature TouchT"' Cone Dip 86810 DI-2, 92020 ® SERVER ;;_._,er P,.;ciucts, inc. 800.558.8722 1 Intl: 262.628.5600 3601 Pleasant Hill Road I Richfield WI 53076 spsales@server-products.com I server products.com Server Products,Inc,reserves the right to modify specifications without obligation. Printed in USA I ©Server Products,Inc 10.2017 1 8 02050 Projec ® M, AXX Location: Name: The Legacy Companies Item #: Qty: 3355 Enterprise Avenue,Suite 160,Fort Lauderdale,FL 33331 Model: Sales:(954)202-7419•Sales@TbeLegacyCompanies.com Tech Service:(877)368-2797•Service@MaxxHelp.com www.MaxximumFoodService.com r -_-�z .fit"' .� af4 a -`$ 'Yr �-f a*' �Y y.. ...� ,, "t _ >, fi .�� -sF. �'• +� :- ,4 f,f - r S -1 r - K - w �" xs, "d - DI 'PINGINT Icc Cream S14coopin Cabet v Glass`Canopy h - Y��: Model: MXDC-4 ❑MXDC-8 ❑ NMC-12 International Model:Add-50(220V/50Hz/1Ph)or-60(220V/60Hz/1Ph) Ice cream dipping cabinets offer an attractive way to display or serve ice cream product. Perfect for ice cream parlors,sorbet shops, restaurants,and concession stands.These cabinets can hold hand- dipped ice cream or novelties. The glass top allows customers to easily view your offerings. Heat-reflective glass ensures a consistent �?LL temperature,keeping cold desserts at the perfect consistency. > � A Y FEATURES -Flat-tempered clear glass sliding lids Lid lock and keys • Interior LED lights makes it easier to see selection and enhance product's appearance • Curved tempered glass sneeze guard(assembly req.) <l Molded plastic lid frame heated to prevent frost or ice build-up • Internal condensate evaporator pan. No need for a floor drain. • Bottom defrost drain with plug • Dual heavy-duty casters,two locking Removable rubber bumper guards,grill side TEMPERATURE • Adjustable temperature range-18°F to+10°F(-28°C to-12°C) • Thermometer display:external,analog,easily read CONSTRUCTION • Exterior Material:durable,white zinc coated,baked on enamel steel • Interior Material:painted white power coated steel REFRIGERANT STANDARD • Tubholders:powder coated,wire • MXDC4 and MXDC8:CFC-Free R-134A ►; • Skirts:plastic • MXDC12:CFC-Free R-404A i 1.27' • Insulation,Thick,2.5"foamed in-place,environmentally friendly, ELECTRIC polyurethane • 115/120V/60Hz/1-ph,NEMA 5-15P • 6-1/2 ft power cord and plug set W OPTIONS NEIdHSl5P • Custom Graphics Also available:S • Dipper Well • 220V/ OHz/1-ph An appropriate Int'1 Cord Set and plug to be Zeroll Scoops&Spades 220V/ 0Hz/1-ph provided when specified on the order.If no Cord Set or Plug is specified,NEMA 5-15 is the default. ��•■,/ Maxx Cold X-Series WARRANTY (USA/CANADA) ,.� C E One(1)year parts C us One(1)year on-site labor Intertek tisreo Certified to Certified to Four(4)years compressor(part only) ANSI-NSF 7 ANSI UL 471 Administered by The Legacy Companies,877.368.2797 Due to periodic changes in designs,methods,procedures,policies and regulations,the specifications contained in this sheet are subject to change without notice. While we exercise good faith efforts to provide information that is accurate,we are not responsible for errors or omissions in information provided or conclusions reached as a result of using the specifications. By using the info-mation provided,the user assumes all risks in connection with such use. The built in performance enhancing functions ensure that given proper attention and preventative maintenance, each Maxx Product will deliver years of trouble free,reliable,low maintenance,efficient operation. 8/24/2016 W The Legacy Companies 0 3355 Enterprise Avenue,Suite 160,Fort Lauderdale,FL 33331 MAXX C LD Sales:(954)202-7419-Sales@TbeLegacyCompanies.com Tech Service:(877)368-2797-Service@MaxxHelp.com MIR- '0 E��` �4 31.5" 51.8' 70.8" 29.3" 49.5" 68.6" of CF) Tubholder Tubholder Tubholder Tubholder Tubholder Tubholder Jubholder Tubholder Tubholder I 1 (2 facing) I ��Ml (2 king) 1,(2fixing) U2 ��J 12 kin I L12 f1cing.)JI L ('�far""" _(2 facing) cin (2 f.c�,n 2 ------------ in ------------------ to C14e�yot 0) 0- C14 0) yyo�Storage(2) Storage gew)- Storage-00) 0 MXDC-4 MXDC-8 MXDC-12 Mx0c.-B. -M-'M 5 M'EMIR. #of T ubHolders. 4 �'ME-N!181 NN of:Skirts. Tubs Exp,osed for.5coopingi, 8. Tubs Storage:, . 6:� 2- n:External Dimensions W x D x H.. . E. V.S..A 51.8".07.0' x-53.0" w mm:External Dimensions W x D x H 1315.7mm x:685.8mm x 1346,2mm §Pi7 .- Gross Cubic Feet 14 0.- Nettubicfeet Amps 4 1 P (14 2 220V) MOZ Compressor H/P" Umt Weightw 1- 2315,lb 107-k 9 �hipping Weight 262 lb 120,kg Internal LED Lights Temp Display Con,,rol Panel Upper Corner Connection Dipper Well (front) (right) Cma ,.:Oo norsuttowe&,,pmYh;a % STANDARD ACCESSORIES Fits around the top of cans to prevent ice cream from dripping to bottom of the cabinet. Tubholder Tubholder Skirt Tubholder Skirt Set Designed for optimum performance in climate controlled area at 85°F ambient and 55%relative humidity. Product design and specifications are subject to modification by manufacturer vAtbout prior notice. Printed in the USA 11.'i"O L:; Project Name: Maxx Cold I The Legacy Companies Location: 3355 Enterprise Avenue,Suite 160,Fort Lauderdale,FL 33331-- Item 4:- (954)202-7419-Fax(954)202-7337-(877)600-8401 Model: www.MaxximumFoodService.com- Info@MaxxColdFoodService.com .TOP MOVNTED.REACH-IN REF1aIGERATORS Model: MCRT-23FD MCRT-49FD MCRT-72FD International Model: 1:1 Add-50(220V/50Hz/1Ph) MCRT-23FD MCRT49FD rt Maxx Cold top mounted compressor reach-in refrigerators are built 5- b LOU- to last.Temperature is digitally controlled and easily viewed from the exterior of the cabinet.Stainless steel construction ensures years of reliable service,maximum durability and is easy to clean. Maxx Cold units are designed to meet the requirements of the most discriminating customer. FEATURES Easy to grip recessed door handles Adjustable heavy duty wire shelves(3 per section/door) p gqn Four(4)or Six(6)4"casters standard gq'ga Open door alert,beeps when door has been open for three minutes • Locking doors Automatic interior lighting Available in 120V/60Hz,220V/5OHz&230V/60Hz; 7,­ TEMPERATURE • Holding temperature:33'to 417(1'to 5°C) g 0 MCRT-72FD Utilizes environmentally friendly refrigerant R134A _V.2.. 0- Digitally controlled temperature system maintains optimum 71"M.7A V 2 temperature and LED display is easily viewed from exterior g- Large evaporator and condenser for quick cooling and greater efficiency Automatic defrost system 1.27'/32mm I REFRIGERANT CONSTRUCTION Environmentally,friendly R-134A propane - Durable,easy to clean stainless steel exterior and interior - Cord set includes plug&9.8'(3m)cord ELECTRIC - CFC-free Polyurethane insulated walls and doors 120/60Hz/1 Ph(NEMA 5-15) International 220V/5OHz&230V/6OHz models available as options NEMA 5-15P pf FR iEk���C Maxx Cold WARRANTY(USA/CANADA) Three(3)years parts and on-site labor C us Five additional(5)years compressor(part only) room 10 Administered by The Legacy Companies,877.368.2797 Certified to Certified to 24n tech support provided ANSI-NSF 7 ANSI UL 471 Due to periodic changes in designs,methods,procedures,policies and regulations,the specifications contained in this sheet are subject to change without notice. While we exercise good faith efforts to provide information that is accurate,we are not responsible for errors or omissions in information provided or conclusions reached as a result of using the specifications. By using the information provided,the user assumes all risks in connection with such use. The built in performance enhancing functions ensure that given proper attention and preventative maintenance, each Maxx Product will deliver years of trouble free,reliable,low maintenance,efficient operation. 1/5/18 D M_335 Cold I The Legacy Companies 5 Enterprise Avenue,Suite 160,Fort Lauderdale,FL 33331 MAXX-COL:;---- (954)202-7419-Fax(954)202-7337-(877)600-8401- ---- wwwMaxximumFoodService.com- Info@MaxxColdFoodService.com TOP MOUNTED REACH-IN REFRIGER�TORS- MCRT-23FD MCRT49FD MCRT-72FD 82" 62" 87' 1787m,,:, (787mrn) 67 ;141121.1.) 77' L— (1413—) 77" 77" (1956mm) ;N56Tmj 1456-1 —------------- 27" *Shorter caster options are available to bring overall unit height under 80" ;Average,pqn_p-. Capacity V's Voltage Unit--..Weight; /_M I -X 2 1 MCRT-23FD 81; r 8 3 18 M.49;.CuT MCRT-49FD 6 _.-'J 0 87:x.20V;.. -1 3704-3 8 87, i, �;5 I C_"'�' kg MCRT-72FD 9. -.2060 -; .1,�. Due to periodic changes in designs,methods,procedures,policies and regulations,the specifications contained in this sheet are subject to change without notice. While we exercise good faith efforts to provide information that is accurate,we are not responsible for errors;or omissions in information provided or conclusions reached as a result of using the specifications. By using the information provided,the user assumes all risks in connection with such use. Maxx Cold I The Legacy Companies 13355 Enterprise Avenue,Suite 160,Fort Lauderdale,FL 33331 Printed in the USA (954)202-7419-Fax(954)202-7337-(877)600-84011 www.Ma)cximumFoodService.com- Info@MaxxColdFoodSer-vice.com TRUE MANUFACTURING CO., INC. Project Name: AIA# ® U.S.A. FOODSERVICE DIVISION Location: 2001 East Terra Lane•O'Fallon,Missouri 63366-4434 a(636)240-2400 Item #: Qty. 5IS# Fax(636)272-2408•Toll Free(800)325-6152•Intl Fax#(001)636-272-7546 Parts Dept.(800)424-TRUE•Parts Dept.Fax#(636)272-9471 •www.truemfg.com Model#: Model: • • • - • • TSSU-48-12-HC Solid Door SandwichlSalad Unit With HydrocarbonRefrigerant e � True's salad/sandwich units are = _ designed with enduring quality that protects your long term investment �. Factory engineered,self-contained . _ ` t capillary tube system using environmentally friendly R290 hydro carbon refrigerant that has zero(0) k, ozone depletion potential(ODP),& 9• Eli 7 r three(3)global warming potential (GWP). . I. Patented forced-air design holds 33°F to41'F(.5°C to S°C)product temperature in food pans and cabinet interior. me ior. I.Complies with ANSI/NSF-7. I All stainless steel front,top and ends. -go4 Corrosion resistant GalFan coated . steel back. Stainless steel,patented,foam insulated lid and hood keep pan I temperatures colder,lock in freshness and minimize condensation. Removable for easy cleaning. Interior-attractive,NSF approved, clear coated aluminum liner.Stainless steel floor with coved corners. 113/4"(299 mm)deep,;lh"(13 mm) thick,full length,removable cutting board included Sanitary,high density, NSF approved white polyethylene provides tough preparation surface. Heavy duty PVC coated wire shelves : Foamed-in-place using a high density, polyurethane insulation that has zero:'_ ozone depletion potential(ODP)and. . zero global warming potential(GWP). ROUGH-IN DATA Specifications subject to change without notice. Chart dimensions rounded up to the nearest 1/s"(millimeters rounded up to next whole number). Cabinet Dimensions (inches) Cord Crated (min) Length Weight Pans NEMA (total ft.) (lbs.) Model Doors Shelves (top) W Dt H* HP Voltage Amps Config. (total m) (kg) TSSU-48-12-HC 2 4 12 483/a 301/a 363/4 1/3 115/60/1 5.8 . 5-15P 11 340 1229 766 934 % 230-240/50/1 2.3 ♦ 3.35 155 t Depth does notinclude 1"(26 mm)for rear bumpers. ♦Plug type varies by country. *Height does not include 61/4"0 59 mm)for castors or 6"(153 mm)for optional legs. B APPROVALS: AVAILABLE AT �MnDF 0lf YEAR C OL US m fNNOVATION` O ®C IH THE USA 6/18-A Printed in U.S.A. Model: . • • - • • TSSU-48-12-HC • s•. • 0 STANDARD FEATURES DESIGN DOORS ELECTRICAL • True's commitment to using the highest • Stainless steel exterior with white aluminum liner • 115/60/1 quality materials and oversized refrigeration to match cabinet interior. systems provides the user with colder product • Each door fitted with 12"(305 mm)long recessed NEMA-5-15R temperatures,lower utility costs,exceptional food handle that is foamed-in-place with a sheet metal safety and the best value in today's food service interlock to ensure permanent attachment. OPTIONAL FEATURES/ACCESSORIES marketplace. • Positive seal self-closing doors with 90"stay open Upcharge and lead times may apply. REFRIGERATION SYSTEM feature.Doors swing within cabinet dimensions. ❑230-240V/50 Hz. • Factory engineered,self-contained,capillary - Magnetic door gaskets of one piece construction, ❑ 6"053 mm)standard legs. tube system using environmentally friendly R290 removable without tools for ease of cleaning. ❑ 6"(153 mm)seismic/flanged legs. hydrocarbon refrigerant that has zero(0)ozone SHELVING ❑21/2"(64 mm)diameter castors. depletion potential(ODP),&three(3)global • Four(4)adjustable,heavy duty PVC coated wire ❑ Barrel locks(factory installed).Requires one per warming potential(GWP). shelves 219/1e1 x 16"D(548 mm x 407 mm).Four(4) door, • Energy efficient,factory balanced refrigeration chrome plated shelf clips included per shelf. ❑Additional shelves, system with guided airflow to provide uniform • Shelf support pilasters made of same material as ❑ Single overshelf. temperature in food pans and cabinet interior. cabinet interior;shelves are adjustable on 1/2"(13 ❑ Double overshelf. • Patented forced-air design holds 33"F to 41"F(.5"C mm)increments. ❑ Flat lid. to 5"C)product temperature in food pans and MODEL FEATURES ❑ Sneezeguard. cabinet interior.Complies with ANSI/NSF-7. , Evaporator is epoxy coated to eliminate the ❑ 19"(483 mm)deep,,/z"(13 mm)thick,white • Sealed,self-lubricating evaporator fan motor and potential of corrosion. polyethylene cutting board. Requires"L"brackets. larger fan blades roe True sandwich/salad units a ❑ 19"(483 mm)dee 3/4"(20 mm)thick,white 9 9 fe-in (299 mm)deep, rd-S mm)thick,full length board. Requires"L"brackets. — --more efficient,low velocity,high volume airflow-- -removable cutting board. Sanitary,higfi=density, `- polyethylene-cutting design. NSF approved white polyethylene provides tough ❑ 113/4"(299 mm)deep,1/2"(13 mm)thick,composite • Condensingunit access in back of cabinet,slides cutting board. Requires"L"brackets. preparation surface. outfor easy maintenance. Stainless steel,patented,foam insulated lid(s) El 19"(483 mm)deep,lh"(13 mm)thick,composite CABINET CONSTRUCTION and hood keep pan temperatures colder,lock in cutting board. Requires"L"brackets. • Exterior-stainless steel front,top and ends. freshness and minimize condensation. Removable ❑Crumb catcher. Requires crumb catcher cutting Corrosion resistant GalFan coated steel back. for easy cleaning. board for proper installation. • Interior-attractive,NSF approved,clear coated - Comes standard with 12(1/6size)67/e"L x 61/4"W ❑ Pan dividers. aluminum liner.Stainless steel floor with coved x4"D(175 mm x 159 mm x 102 mm)clear ❑ Exterior rectangular digital temperature display corners. polycarbonate,NSF approved,food pans in (factory installed). • Insulation-entire cabinet structure and solid countertop prep area.Also accommodates 6"(153 ❑ADA compliant model with 34"(864 mm)work doors are foamed-in-place using a high density, mm)deep food pans(supplied by others). surface height. polyurethane insulation that has zero ozone • Countertop pan opening designed to fit varying depletion potential(ODP)and zero global warming size pan configurations with available pan divider potential(GWP). bars.Varying size pans supplied by others. • 5"027 mm)diameter stem castors-locks provided • NSF/ANSI Standard 7 compliant for open food on front set.36"(915 mm)work surface height. product. PLAN MEIN 5217/32" (1335 mm) 2115/32" 301/16" (546 mm) (764 mm) 48s/16" 185/16" 1" (1228 16 (466 mm) (26 mm) 177/32" 447/161,---).I 61/8" (39 mm) (1129 mm) I (156 mm) _____ (13/mm) 1�/ 7 M . ' (274 mm 4611h6^ (178 mm) -' -- ---- - -- (1186 mm) ' 4215/16" n n �363/4" (1091 mm) (934 mm): 35t5/16" 293/4" i - (913 mm) - (756 mm) i , ' - - - _[(59 mm) �125/e" 195/8"—►I 63/16 37/8" (127 mm) (321 mm) (499 mm) (158 mm) (99 mm) ELEVATION RIGHT VIEW PAN LAYOUT WARRANTY METRIC DIMENSIONS ROUNDED UP TO THE Three year warranty on all parts NEAREST WHOLE MILLIMETER Model Elevation. Right Plan 3D Back( and labor and an additional 2 year . KCL warranty on compressor: SPECIFICATIONS SUBJECT TO CHANGE TSSU-48-12-HC TFNY04E .TFNY02S TFNY04P TFNY043 (U.S.A.only) WITHOUT NOTICE TRUE MANUFACTURING CO., INC. 2001 East Terra Lane•O'Fallon,Missouri 63366-4434•(636)240-2400•Fax(636)272-2408•Toll Free(800)325.6152•Intl.Fax#(001)636-272-7546•www.truemfg.com THIRSTING forn - L } MORE BUSINESS— M. ............ v - � �� yet 'F i•_ r•^ '^�` +�'� "t'4y" S.:H'�6� :C4 �w ' � F`�. ��� Y - ..� - A c '� -R 5•� Yd ``p` 3 ur, F. ., ® F® e ® � • e o .� 9 ��.�$ - air - ?�, �,;�� �A� Our frozen cappuccinos and coffee drinks will do more to increase your beverage station sales, with fantastic merchandising support designed to pull customers in and great flavors to bring them back again and again. l �VanMo h Specification: p MT2GL 2 BOWL UGOLINI •2.5 gallon capacity per bowl • 640 ounces total capacity e ' • 15"W x 18"D x 28"H �P 28" • 115V, 15AMP �� t Cr. • "" ,t��`; SMALL FOOTPRINT•EASY TO CLEAN•PREVENTATIVE MAINTENANCE-MADE EASY: C ��{�_ •Filter Indication Light-When the orange light comes on,it means that the condenser filter (or the ultimate vl �j �l needs to be cleaned. Washable Condenser Filter-Easily located through the side panel of jjlE�j � the granita machine.No need for any tools-as the panels are held on using thumb screws L � � r 1 8" " 15 �• �' a ,ef,� ..A i THIRSTING for MORE BUSINESS QUENCH your THIRST for .....--------- ® ti t x x q� .ter. - a:_u ez -.. '• ,:-- . ;,I gr)e A -t s k - x - r 12 oz Coffee 16 oz Coffee Profit r 3 bi ` g sold per day sold per day per Year l .t y ` s r J {2 f t �' f 1 cup 1 cup $810 *} Nun � 5 cups 5 cups $4 050 25 cups 25 cups $20,250 a Package comes with everything needed to p make over 39 gallons of finished product. • 1000 12 oz value plastic cups 1000 16 oz value plastic cups " wu I mmvz�m, 2000 dome lids for 12/16/20 oz cups ' ® �+ ® 6 cases of frozen coffee basePROFITbl s w � 2000 8 wrapped straws 4G clog ' -yq, � t�.�",� ., � �� "• �, �� _ tY_,�' Y "� �f Lin ;� ,�. � " �� '�' n�,�� ,�, y a'. h _ -x01 - k 'I =800=392=3336 r - ' 'V f-Fi- .. ff �S a ;t a : w T ; t •,a get ..w ,r mot. ,% "L�d' III ` a�J�"i�y,,��v �4� •r�� `i.yn. +g ��yx Rx irk I y i- " r, . _��-- - x r e r a 8 69 f B 0 is Almond Cranberry + Orange *+ Amaretto *+ Creme de menthe *+ Papaya + Apple pie Custard Peach *+ Apricot *+ Egg nog Pear Banana *+ English toffee Peanut butter- Blackberry *+ Espresso roast *+ Peppermint Black cherry *+ French vanilla + Piha colada *+ Black raspberry *+ German chocolate cake * Pineapple + Black walnut Grape + Pistachio nut Blueberry *+ Honey Praline Bubblegum Irish cream + Pumpkin Butter pecan * Kahlua + Rootbeer Butterscotch Kiwi + Rum *+ Cantaloupe + Lemon *+ Skittles Cappuccino + Licorice Strawberry *+ Caramel * Lime + Teaberry Cheesecake * Malted milk Tutti frutti Chocolate Mango + Watermelon + Cinnamon Maplenut * White chocolate Coconut *+ Marshmallow Cotton candy Mocha + * One of the 24 original flavors that are included in the 24 Flavors System + One of the 30 original flavors that are included in the 30 Flavors of Icebergs System �+� to�,^:t»�K,.-. - `!"' :.tea• .!'..a �'„ '"---5: �' `aF ,p•Ha y` �.°'df;w.": ."'�""a � �� �`•F�.��w j; Wit` a�� # ��° ;s -�a.�"' � '��"_ r, ���, �'IN 1:�r . r r fit`- • .y c, ';�„ a;�'Tom• ....i.i...o-.'3` -;.+�`b e "y� -R� y� '� 2=' - � wN � '�. s�t�- a ham" � �� � � `� " "`•�'`� s' .'�'=' '' � � �''' •"�'�, � y' � :_ z "'s 'fit ;�.- 3 3 w a Li* + ,.tj i Specifications: 22" Width /9" Height/ 14" Depth Weight: 25 Ibs E16ctricity: 115 Volts, 10 amps The unit fits easily at the back of a preparation counter and needs only a standard electrical outlet for installation. The kit contains: 1 or 2 warmers for 6 flavors of dip Flavors: Banana, Blue raspberry, Bubble gum, Butterscotch, Cherry, Chocolate, Cotton candy, Espresso, Grape, Lime, Orange, Peanut Butter, Pina colada, Strawberry, Toasted coconut. Dip once in Cherry and double dip the top in Chocolate! � ,� '�- �� �ii �q m alb ,;t•m - �•,'��yj-,,ems°° � ac. a. r"�.^ ,� �� -sn--, �� .:, -.s � �� �tJ] �H^k3, 4fR'A,� �-�sn��� �y� 'S.•. b�+p��'- I y���^ �1�4'�'�� #� a� � �� � � .,. e 1 -600=392=3336 Our family has been involved in the Dairy Bar & Ice Cream Store industry for more than 50 years, opening well over a thousand Ice Cream Store & Dairy Bars in that time frame. We were around when the very first automatic soft- serve ice cream machines rolled-out for the world to see. We were also pres- ent at the inception of Slush machine. Throughout the years, our family has established itself internationally as an innovator in the industry. The last half century in the Dairy Bar & Ice Cream Store industry has seen many trends come and go, some of them with considerably more staying "- - - - power than others.. In the intervening-years-since 1953,-our-family-has-wit=----- — -- nessed these many developments in the industry not only from the perspec- tive of equipment & supply companies, but as operators of retail Ice Cream Stores as well. i i We know from first-hand experience that while retail operators want to remain competitive in their new menu offerings, many feel strangled for space as it is and have, for the most part, very limited available capital for - - — new equipment expenditures.--- Having learned over the years which core menu items are the greatest profit-yielders, we have focused most of our energy on developing creative ways to increase the volume of sales on those high profits items, without needlessly tying-up capital in lots of equipment or squandering precious square footage. Thus, it is with a measure of pride that we introduce to you our uniquely profitable solutions for your business. �■ i s Rv 21N. t a m 4. '4`: 1? H.W, ��E � A C k^• 1R ��.�'rcp PE ,.g 2d g 24 FLAVORSF Top shops taste THE-- PRESS - s sweet- success- - IN _ W George Weigel �. Here ore the top Patriot-Neu% s leashers in The Pauia! s .' Ne+4 CR:s'8es1 tAk hethsx it's leaped on s sugar Here are a few newspaper articles from the reins"°°�"1fEdin r t k and chocolate sy'rvp,we liarns""Wd. love our ice CMaM_ northeast that mention the 24 Flavors System. l.tte We ex 24 qu=of h per vans pe ,per year—more Our particular interest is a feature story on the ? 2-38keCrum thanufycamq'mlhewodd—alto q (36) about o6e quarter of that total is tbM1 Harrisburg, Pennsylvania area's favorite Ice 3T 'TMM � ceam e o-ya,tr ,f� 4�1 iss m.n ia � ' Cream stores. Although there are only two �4- we,,T" , customers in the entire area the stores with s Gdloprq Goose N set mtty p ilk rratlers an r � (1>) ther tatotite ones,no kss Than 31 differ- 24 Flavors System came in first and third out s 6 ry(14da�"'°' Y' Annoy .. f of thirty-one stores! (second place went to a &ReeersSo B.ReesKs Soh Itt store that serves hard ice cream only). The 24 `r 9 F.Aw' rws(.-6) @ g o Flavors concept allowed those customers, in their first year of operation, to out-perform all 111p2 „ p l B the long established ice cream outlets in the A t = " R -Chacowe ft cooiir For others,a visit to a favorite ice- 4 -- greater Harrisburg area.— - -- =-daoQ3'th6edayz Aa- -�msiwp3strltreTtsanaswedtreat-=- - - tcork at them have lnd a(amity affair or a walk down them. - g rnutaptd yd W avvv- ory lane—or both,as Neuville's GlaM ' o' take ph"al wuta. Henry relates: Bunton 1943 I'm GI years old,and as a small read-ffits data hom chid.my dad would take us to Mhe the IitlemrCoaal ke woo`on a hot summer evening or for a y f. Crum Assoenobrt Sunday atternoon drive This was always here we ow lawree a big treat for my brother and me-I've ;�_�..r..,- -..,...,:�-<,_r.. ,: _-.., >......,,,_:..,..._.r., a.:...: ..._�.e• ..,,,-.,-,r_>. „_x ,,,._r�_:..;. .,.,......._.�� ... d -an eight grarid- 'r from the ll's 236 - —` t�ue Shops savor flavor of success mot PIV� trend- t3 ess came ur, hire lots of be - (Y The mare the lxnQ. } roar ct _� ?a few readers said it a i st a ieastlmh3c pnce r lawrite plain a -hops topped the poll' e e ' ;,stet ryas Ice Cream Qe 1 Q Q Q a.14 = ' At loth.ch, @ i .0 0 0 2 Q-• ,yy7. {CQ1Mry a .. kaGis .f a n+ontper crvn.and the peopk ree w {y,,qz i below friendly hrre.`caa:bids ICr Took If M H. hey unr 1.,hr r do ,tr toted for 1 r Crenrh fl- cr Inn wine of hit hest tclle+t, ? r vat k.-ird Ct i 5 t-,+:L ..iw.w,ra'>..wwr D..cwt..K:r• j ` uh rw LaDI Ir cr xnU W,,r d s to tt. r1 e rte T1 i ,wtd -. A.atrr�l -uu fr m11a i '^a murr rr V � 3H l Ct.M. h h n urn.- Tr tilt htRr 6 3u Oe nra 1 r n f r pM 1 .o•- mi-t.trr n-h is trr _ 's ��,yy��aaaa-�t,' ,r tren a. r d I r b— Rnh Iletiman>'If meb,[..rnr Lam.Q r^M1avJ+t1 in i Pr 3 II. f fr i{uri I!r C y R.sd 1H s T Th sl recr pi a�n:,r•bl Y 3R n p .ant,Po-LI r t ,any,.end a m - id ,stAfo- p Rwd mrt't u ti., I yhplr rl;:r dhr� i `"3 Psi n 1r 1 side 1 Aaiun `\y �,- .� •� i , y an•i N. •� �' .:ram - �s` - Id Vr-�. d thr jW.TY -1 3H "ID�LTw► 1 k I t or 'e.It t,, 1 Ti � >;i•LZ. s Q° ( t � d».uhcn h �,� I - t @ e 1 B *<a 3a hard aM1 At MM n intii.c.n Irmg a � ta rl w it tg At - iP 1P el" ro Q r �r�tir�'�hn �A ,�. .�+�� z � F ems. r �`"`� * � -� � � •. x � � ,-r". e � "„ `^,. ,r�,,,,,;-•s "' "c: Rr.,' 'sS .^Ag,�. "�� .zaa ti r.' ���r ��� ,,, ��'.�x �t` 1«����.,,.� � �- � .-sata � a�� •r sM s_ `r ��,L,:..P ,f 4 ll-ill..n:t.-.tr{rrJ l.Ilh�l.r�l tr:ritn". Sri.nl•:ri 1rc:t I::nu,..iimrp'r lr� d - ---- _ - -- CITY- - - I Mrrluls.ii i.r it yrwii 4r11Nltt�W++�_^s•:err�a�-.S_at.Y:vs�uc�.lnMii.rt.�n-. Flavor overload i Ij,%%,lmlwvvivani.Ulud.:cr%csup^18limethsInmlcwcol:deecppt:ii mast 1,161 - Aw Whlstlestop In Wilder: a dellClow departure minutes from Hanover 1 � f We ' T Ww B 1 t 4 t ' -- i z }_ f s � � 5' r ' T SE iz, 54 d At , 'G a t,m. :: a.ya I t t P.i •2 Specifications: 28" Width /25" Height/9" Depth (�O Weight: 7o Ibs OR 400 Electricity: 115 Volts, 2.1 amps The unit fits easily at the back of a preparation counter and needs only a standard electrical outlet for installation. 77.'�: The 24 Flavors System attracts more customers with the variety of flavors it allows you to serve, and the exquisite taste of these flavors will bring them back with their- friends. This unit allows you to make specialty recipes by - - -- - mixing flavors; adding fruit, nuts, chocolate chips, bits of candy, etc. - - - - -- ----- - How does it WORK ? It's as easy as sc f n g it The 24 Flavors System comes with everything you need to offer 24 delicious Y Yt g flavors of soft serve, including: • A variable speed footswitch • 5 special cups with caps • 24 - 8 oz bottles of flavor extracts giving a total yield around 7,000 servings • 24 special pumps to fit the 8 oz bottles of extracts • Effective trademark point-of-sale merchandising items • One special cleaning cup with brush Other advantages of the 24 Flavors System: • Operates independently from your soft serve machine • Stainless steel construction • Easy maintenance • Easy to use 6 >� on M {cv r �� 441 a w _ R b FLAVOR EXTRACTS NUTRITIONAL- - CONTENT- Nutritional Labeling and Education Act (NLEA) Nutritional Profiles Flavoring extracts, essential oils, colors, spices and other aromatic chemical compounds by definition are exempt as per the rules for compliance as publi- shed in the Federal Register on January 6, 1993, (Volume 58, No. 3). The strength and usage of such material in finished food products are deter- mined under normal usage to fall under the published guidelines to be regarded ------ ----- -as zero (o).---- --- - - ------ —— - — -- --- Total calories-. Less than 5 calories Total fat Less than 0.5 mg Cholesterol: Less than % nag. Carboh dratr_ Less thian 1 gin Protein, Less than 1 gi-r-i The flavor extracts have either no nutritional value or level of no nutritional significance in respect to vitamins, minerals or fiber content. Fat rontrnt; 0.00 _ C adDohydr :tes; 0.0O (in the form of sugari Each product has some caloric content derived from the solvents used in the production of the flavoring such as ethyl alcohol, propylene glycol, glycerin,etc. Also, some caloric content is derived from the essential oils, botanicals or aro- matic chemicals in the flavoring. - This caloric content ranges from 59-90 calories per 100 grams of material. Based on the usage strength of these additives, the value of these additives on a per ser- ving basis would be negligible or less than of nutrional significance. Using the most caloric extract in a 24 flavors cone, it is 1.36 calorie. The F.D.A. regulations are directed toward the nutritional value of the food con- sumed. Your processing or the consumer's preparation of the final food product may alter the nutritional value of our products in your customer's food product. GREAT REASONS - FOR OUR CONCEPT VS. ANY OTHER Get greater profits and expand your Ice Cream menu's RETAIL value with a 24 Flavors Soft Ice Cream Shop. Ap Regular 24 Flavors Cone Soft Serve Cone Break Even @ $0.35 @ $0.50 Selling Price $1.50 $1.52 $1.85 $2.00 Less: Cost $0.17 $0.19 $0.19 $0.19 Gross Profit $1.33 $1.33 $1.66 $1.81 t st Get an edge on the competition and increase the number of customers per day (Draw some away from the competition and see your existing customers more often) Given the double advantage of low start-up costs &greater profitability on every cone sold, the 24.Flavors Soft Ice Cream Shop is the obvious choice. -Example Was selling Now selling Added Yearly Profit per day per day 24 Flavors @ $0.35 50 cones 80 cones $17,928 150 cones 200 cones $29,880 300 cones 400 cones $59,760 Based on 30 days per month and 12 months a year Y"rd - i -«4c' ,'�".,. . 2nd Get increased profit on each cone sold Example. Cones Regular 24 Flavors Added 24 Flavors Added sold Soft @ Yearly @ Yearly per day Serve $0.35 Profit $0.50 Profit 50 $23,940 $29,880 $5,940 $32,580 $8,640 150 $71 ,820 $89,640 $17,820 $97,740 $25,920 300 $143,640 $179,280 $35,640 $195,480 $51,840 Based on 30 days per month and 12 months a year n _ _ -s t Why settle. for t just vanilla? A world of flavors for your customers to discover The SMART ay to Serve Soft. i; ERFRGS k+> F''#, 7 41 IN.Eli- � .�f Y"� :f� `� •:,. Y- .�-a$� � �' .$�� -�c ��_ e„'4" ,fig k� hr .*k"`.�, ���.ti,.{' ;�. �s�.a.y °k.MY•{ F '.=4,' i14''F'" •,�'��. .+'r,� ^_.fi�11x �, ��,�. , des.. �,•. - � ``�t�.r r'"".�, �f 'E,y. � 6 � 6 � s'•�Y .. w"'�c, J� ate- � T_j �e ` s r v Specifications: 28.5" Width 31.5" Height 18.5" Depth jV Weight: 85 lbs Electricity: 115 Volts, 4.5 amps U� The unit fits easily at the back of a preparation counter and needs only a standard electrical outlet for installation. Kids love the natural flavors of Icebergs with real flavor extracts like Grape, Watermelon and Strawberry (as opposed to Purple, Pink & Red flavored artificial syrup!). Most importantly, Iceberg's naturally delicious flavors capture the imagi- nation of Moms (who drive the kids in the minivans, making them your true tar-- - - - — - get audience) with frozen beverage treats like Mango, Kiwi-Strawberry-Banana & Pina Colada. The finished product cost on Iceberg is only 3 cents per ounce including the fla- vor extracts, making it a very high-profit, premium frozen drink. Like the 24 Flavors System, the 30 Flavors of Icebergs System is a sure fire customer favorite that will perform virtually maintenance free. The 30 Flavors of Icebergs System comes with everything you need to offer 30 delicious flavors of Icebergs, including: • Iceberg base (1 case) • 30 - 8 oz bottles of flavor extracts (enough for over 3,000 12 oz servings) !_30 special_pumps to fit the_8 oz bottles_of_extracts Effective trademark point-of-sale merchandising items 16 oz Iceberg serving Fruit-Ice Drinks Smoothie Drinks Selling Price $2.00 $2.50 Less: Cost $0.48 $0.50 s® ° Gross Profit $1.52 $2.00 Example Fruit-Ice Drinks Smoothie Drinks 16 oz cups Monthly Yearly Monthly Yearly sold per day added Profit added Profit added Profit added Profit 10 cups $456 $5,472 $600 $7,200 20 cups $912 $10,944 $1,200 $142400 50 cups $22280 $27,360 1 $3,000 $36,000 Based on 30 days per month and 12 months a year y W.r: r s r Nothing tops-off a Soft Serve treat like a Dip Top coating - but why limit yourself to just Chocolate and Cherry? In any retail sales environment, square footage is at a premium. If you're like most Ice Cream store operators, when it comes to - -- counter-top space;- square inches are at a premium! In the amount of counter-- - - top space a conventional Dip warmer holding only two number 10 cans would .take, one of our warmers can handle six delicious flavors of Delightful Dips! .s 4`_ _- _'apt.•_,y --'. '^. � ~".� - Regular Delightfully Dipped Cone Soft Serve Cone Break Even @ $0.35 @ $0.50 Selling Price $1.50 $1.54 $1 .85 $2.00 Less: Cost $0.17 $0.21 $0.21 Gross Profit $1 .33 $1.33 $1 .64 $1 .79 Example Delightful Dip Monthly Yearly Monthly Yearly Cones sold added Profit added Profit added Profit added Profit per day @ $0.35 @ $0.35 @ $0.50 @ $0.50 10 cones $93 $1 ,116 $138 $1 ,656 20 cones $186 $2,232 $276 $3,312 50 cones $465 $5,580 $690 $8,280 MA Based on 30 days per month and 12 months a year By now you have begun to notice a pattern developing - All of our uniquely profitable solutions for your business share at least three things in common: 1. You get the variety that would normally only come to those who've spent much more on equipment. 2. This tremendous variety does not come at the cost of tying-up your limited counter-top space. 3. These concepts require minimal cleaning &virtually no maintenance, helping you increase your proportion ( of sales on the menu items that bring in most of the profits! �¥;#�.' .w r� tt '•t q . f'M��,�� �. A« '_. �rf ff � fps -77 •. .4 C r�k. �'€a+cs� Y riS�; �'.�S�:�h+,�k;�� � �.' � - of . �c �-: .,.x.--p..�•,.�. _"'�.� .�: �; .� ,¢ fir. • .y� a t z- Y a,�.ter"�- z� '� 'w,}8•�'4 X+"q:� � 1 =800=392=3336 i For more information call toll-free; 1-800-392-3336 Email; info@icecreamflavors.com Visit us online at www,iceci-eamflavoi-s.com -TASTE THE DIFFERENCE- MODEL 44RMTFB PRESSURIZED This pressurized, 9 flavor soft serve machine SOFT SERVE FREEZER delivers valuable menu flexibility in a small footprint. By fully incorporating the flavor in every 9 Flavor Fuzionate bite of soft serve,this freezer produces the highest quality,most consistent and profitable product you can serve. Simply press a button to select flavors! The easy-to-operate features include: easy syrup adjustments, one button flavor selection and no s complicated attachments.This machine is perfect N " for high volume establishments wanting to serve sweet superior-quality,smooth and creamy ice cream, __ _ _ _ C e frozen yogurt or gelsto. Gf2at for co-branding k ,, - concepts as well as college cafeterias, buffets and Wk.-kb adding additional flavors to any shops. FL S °: The Electro Freeze Advantage • 9 Flavors To Choose From contained in ua'y 32oz. syrup containers located in the cabinet. = a Dispense the base product alone or press , a button to infuse the product with one of 8 additional flavors. • The Finest Frozen Product, consistently the best frozen product available. Smooth,creamy and profitable `� m • Product Flexibility serves a variety of frozen s products, custard, ice cream sorbets,water ice or yogurt • Flexible Mix Holding System pumps directly from bags or from mix containers ' • Patented Mix Transfer System*simplest and = most reliable pressurized system available a ' • Self Closing Spigots prevents the mess and eliminates waste i • Exclusive Auger Design gently blends, reducing agitation, maintaining product quality and consistency. d _ Energy Conservation Mode reduces energy `'' ' cost and holds product safely during non- business hours • Superior Low Temperature Refrigeration System provides the best in class production and product quality • Experience Tells Electro Freeze has been manufacturing quality frozen treat machines since 1929. *Shown with optional trimstrip decal HC164238. electrofreezeocom r 37.ti L 24.2 33 u A- - 13.4—� A W. ---- - -- — -__ d: 12.8 .47 4 11.2 10.6 10� 9.1 C) 7az .� IV 3 im 35.5 33.6 Model 44RMTFB Specifications Due to continual product improvements all specifications are subject to change without notice. Weights lbs. kgs. Electrical Net 652 296 One dedicated electrical connection is required. Crated 704 320 Manufactured to be permanently connected. See cu.ft. cu.m. electrical chart for the proper requirement. Consult Volume 58.42 1.65 your local electrical codes for cord and receptacle Dimensions in. cm specifications. Width 24.2 61.5 Beater Motor Depth 33 83.8 One, 2 hp. Height 70.2 178.3 Electrical Maximum Minimum Poles(P) Refrigeration Systems Fuse Size Circuit Ampacity Wires(W) One, 6,700 Btuh. R404a. 208-230/60/3 Air 20 20 3P, 3W Separate Cabinet Refrigeration, One, 1200 Btuh, R134a. 208-230/60/3 Water 20 19 3P, 3W Btuh may vary depending on compressor used. 208-230/6011 Air 30 27 2P, 2W Exterior Space Required 208-230/60'1 Water 30 25 2P, 2W Water Cooled-3" (7.6 cm)air space required on both Total Poles(P) sides and the rear panel for proper air circulation. Amps kW Wires(W) Air Cooled-6"(15.3 cm)air space required on both 380-415/50!3 Air 11.5 4.5 3P,4W sides and-the rear panel for proper air circulation. Electrical characteristics other than above available on request from factory or local distributor.,Check nameplate for exact electrical data. Potable Water Connection (For rinse line):3/8"FPT Bidding Spec Freezing Cylinder Capacity:one-3.7 quart(3.5 liters) Electrical: Volt Hz Ph Syrup Capacity: eight-32oz.(.95 liters)syrup bottles Cooling: Neutral Yes No Certified and/or listed by: '' Q Options: C ul US HS� LISTED 'UL listed and listed by Underwriters Laboratories under Canadian National Standard C22.2 No.120-M91 R2008 Electro Freeze div. of H.C. Duke&Son, LLC Authorized Distributor 2116-8th Avenue,East Moline,Illinois 61244 USA Phone(309)755-4553 •(800)755-4545 FAX(309)755-9858 E-mail:sales@electrofreeze.com•www.electrofreeze.com HC184807 Printed in U.S.A. 1/15 TM TASTE THE DIFFERENCE - MODEL GES-5400 SOFT SERVE FREEZER This extreme-volume 2-flavor soft serve freezer is GENESIS SERIESTM perfect for serving lots of product in a short amount 2 Flavor Twist of time! Features the GES-5400 Genesis SeriesT"' with the Virtual Quality Management SystemTM to featuring streamline your business. Includes a front-loading refrigerated cabinet with a high speed pump. VQM TM Our pressurized machines consistently produce smooth and creamy high and low fat products like Virtual Quality ice cream,custard, yogurt and sorbets. Excellent _Malla9el11@Ilt_$ySteM TM --. - -for full-menu ice cream and custard stores,sports --- -- - - - - — arenas&stadiums. The Electro Freeze Advantage • Pump Forward Design New pump forward , , design reduces maintenance and cleaning = � � time. • Sliding Drawer Mix Storage System Sliding g drawer mix storage holds 10 gallons of mix per drawer. }' ` • Virtual Quality Management SysternTM _ z monitors Temperature and Consistency to provide superior taste and quality. • Patented Mix Transfer System*simplest and _ � l most reliable pressurized system available. Y • Multi-function LED display with manager smart tools. • The Finest Frozen Product, consistently the F: r • _s. s®� best frozen product available. Smooth, creamy ;; _ and profitable. • Self Closing Spigots prevents the mess and eliminates waste I • Exclusive Auger Design Superior low I temperature refrigeration system provides the a ,. best in class production and product quality. • Energy Conservation Mode reduces energy cost and holds product safely during non- x business hours • Superior Low Temperature Refrigeration #'° System provides the best in class production M and product quality • Scroll Compressor Technology provides increased capacity, reliability and efficiency. Let VQM help manage your frozen dessert business more effectively. :} efectrotreeze.com - . 26 3/16 1 11/16 38 114 �& AIR OUT ELECTRICAL SERVICE Itr 3 7/8 CONNECTION [9.84J 68 1883 �- lol 59 13/16 A/�`. 49 5/8 �.`:. kIR IN AIR IN 38 13116 AIR IN O; [99.587 a 7 ALL CONNECTIONS ARE MADE THROUGH BOTTOM OF FREEZER MODEL GES-5400 SPECIFICATIONS Due to continual product improvements all specifications are subject to change without notice. Weights lbs. kgs. Electrical Net 914 414 A dedicated electrical connection is required. Manufactured Crated 1015 460 to be permanently connected. See electrical chart for the cu.ft. cu.m. proper requirement. Consult your local electrical codes for Volume 58.42 1.65 cord and receptacle specifications. Dimensions in. cm Width 26-3/16 66.52 Beater Motor Depth 38-1/4 97.15 Two, 2hp. Height 68-1/16 172.88 Electrical Maximum Minimum Circuit NEMA Refrigeration Systems Fuse Size Ampacity(Qtv) Plug Type Two, 19,000 Btuh. R404a. 208-230/60/1 Air 35(2) 29(2) 2P,2W Separate Cabinet Refrigeration, One, 1200 Btuh, R134a. 208-230/60/1 Water 35(2) 27.5(2) 2P,2W Btuh may vary depending on compressor used. 208-230/60/3 Air 25(2) 20(2) 3P,3W 208-230/60/3 Water 25(2) 19 (2) 3P,3W Air Cooled Electrical characteristics other than above available on request from For proper air circulation, unit requires 6"(15.2 cm)air factory or local distributor.Check nameplate for exact electrical data. space at rear panel or at both side panels and 24"(61 cm) Bidding Spec air space above unit. Electrical: Volt Hz Ph Mix Capacity: six-5(18.9liter)Gal Bags Cooling: Neutral Yes No Freezing Cylinder Capacity:two-5 quarts(4.7 liters) each Options: x- Certified and/or listed by: NSF C UL US LISTED *UL listed and listed by Underwriters Laboratories under Canadian National Standard C22.2 No.120-13 n Electro Freeze div. of H.C. Duke&Son, LLC Authorized Distributor a 2116-8th Avenue,East Moline,Illinois 61244 USA Phone(309)755-4553 -(800)755.4545 FAX(309)755-9858 E-mail:sales@electrofreeze.com•www.electrofreeze.com HC184805 Printed in U.S.A. 1/17 CUM ®' rwje - ._ ---- --- - - -TASTE THE DIFFERENCE- MODEL 876B & 876BRH COCKTAIL FREEZERS with Refrigerated Hopper Fast,easy,portion-controlled,labor saving frozen cocktails from a machine that will last!This high-volume, counter-model cocktail freezer is pre-set for a high-quality, MODEL 876E thicker consistency beverage,perfect for premixed MODEL 876BRH cocktails like margaritas,daiquiris and spiked teas.The large visual product window provides excellent display - u and merchandising of fun beverage colors. Product viscosity,or thickness,can be manually adjusted to dial-in t�( beverages to your serving requirements.The 876B can be water-cooled for large banks of machines in operations ter i • -- —— like daiquiri bars.There is an option for a refrigerated-- hopper(BRH)for serving real fruit or dairy mixes,like frozen cappuccinos!This model is perfect for bars, nightclubs,Mexican restaurants and taquerias. . MODEL 877B & 877BRH with Refrigerated Hopperti Fast,easy,portion-controlled,labor saving frozen _ cocktails from a machine that will last!This counter-model F cocktail freezer produces the same high-quality cocktails c as the 876B but at a size that's perfect for operations that do not require the volume. The pre-set thicker consistency is perfect for premixed drinks like margaritas, daiquiris and specialty cocktails.The large visual product window provides excellent display and merchandising of fun beverage colors. Product viscosity,or thickness, MODEL 877E can be manually adjusted to dial-in beverages to your MODEL 877BRH serving requirements.There is an option for a refrigerated hopper(BRH)for serving fruit or dairy mixes,like frozen cappuccinos!This model is perfect for bars,nightclubs, + { Mexican restaurants and taquerias. sy The Electro Freeze Advantage • Product Consistency Control provides a smooth frozen product with tiny uniform ice crystals. • Minimal Maintenance,simple to operate and easy to clean. y • Add to Your Profits with the sale of frozen ' beverages producing large profit margins. } Experience Tells Electro Freeze has been manufacturing quality frozen treat machines since ` 1929. Superior engineering,product innovations, sturdy construct ion,quality craftsmanship and dependable performance are Electro Freeze hallmarks. • Superior Service Support backed by a worldwide distributor network. eiectrofreeze•com r - d. 876E _ 877B N 30 5/8 177.79) 30 5/8 24 3/4 [77.791 1 =fit 17 3/16 211/2 162.871 ,w ([3.661� 154.611 17 3/16 21,/2 . U3.66] 154.E ' 1 i 1 36 5/8 32 1/16 AIR IN AIR OUT 3 7/8 AIR IN AIR OUT 3 7/8 r'� 1815/16 [9.8[1 {�. �y 1815/16 (9.84) I (48.11 3 15/16 4B.11 3 15116 I701 6 807 6 (15241 115.24) Jl MODEL 876B & 877B SPECIFICATIONS Due to continual product improvements all specifications are subject to change without notice. Weights 876B 877E Electrical lbs. kgs. lbs. kgs. One dedicated electrical connection is required.60 Hertz Net 255 116 210 95 units connects to a standard NEMA 6-20R receptacle. See Crated 274 124 245 111 electrical chart for the proper requirement. Consult your lo- cu.ft. cu.m. cu.ft. cu.m. cal electrical codes for cord and receptacle specifications. Volume 20.53 0.58 20.53 0.58 Dimensions in. cm in. cm Beater Motor Width 17-3116 43.66 13-15/16 35.40 Two, 1 hp. Depth 24-3/4 62.87 22-1/16 54.61 Height 36-5/8 93.03 32-1/16 81.44 Refrigeration Systems One, 6,900 Btuh. R404a. Electrical Maximum NEMA Btuh may vary depending on compressor used. Fuse Size Plug Type 115/60/1 Air 20A 5-20P Air Cooled 6" (15.2 cm) air space required on rear panel for proper air Electrical characteristics other than above available on request from circulation and be open on the top. factory or local distributor.Check nameplate for exact electrical data. Bidding Spec Mix Hopper Capacity:two-12 quarts(11.4 liters)each Freezing Cylinder Capacity:two-2.7 quarts(2.6 Electrical: Volt Hz Ph liters) each Cooling: Neutral-Yes-No Certified and/or listed by: � C o L CE ** Options: HS'f US LISTED "UL listed and listed by Underwriters Laboratories under Canadian National Standard C22.2 No.120-M91 (R2008) "Selected voltages only.Contact H.C.Duke to verify agency needs. Electro Freeze div. of H.C. Duke&Son, LLC Authorized Distributor 2116-8th Avenue,East Moline,Illinois 61244 USA Phone(309)755-4553 •(800)755-4545 FAX(309)755-9858 E-mail:sales@electrofreeze.com•www.electrofreeze.com HC184292 Printed in U.S.A.3/15 C co COPPER ROOF MATCH EXIT'G F L R EXIST'G OVER B" CDX CEILING OVER 2x8 046" O.G. R49 o INSUL. 1 NEW TRIPLE LVL HEADER MATCH EXIST'G WNDS AT MIDDLE CUSTOM SERVICE WND EA. SIDE MATCH EX1ST'G WNDS AT MIDDLE CUSTOM O SERMATCH EXIT'G iv STONE VENEER AND EXIST'G BLDG BLUE STONE SILLVICE STRUCTURE WND EA. SIDE NEW SLAB ON / GRADE v Section Detail Scale: 1/2"=V-0" / a / / PICK UP / / m First Floor Plan Proposed First Floor Plan Existing - Scale:3/16"=P-0" Scale:3/16"=V-0" N K� X - tA LO i - � ------------ --- PCK UP 21V -721 -7t X/ First Floor Plan Proposed— First Floor Plan Existing Scale:3/16"=F-0" Scale;3116"=1'.0" tt 7♦) t \ O O O OUP OCR O IO O Q a�a�D �aD�aD=�aD� T�[�)oo O� CD CD` OC3 a a D I 5 301 STORAGE Third Floor Plan Existing Scale: 1/4" =V-0" 004 BATHROOM 103 ICE CREAM SHOP 1 55 OFFICE 106 STAIRWAY 1oz ICE CREAM SHOP 101 COMMON ROOM First Floor Plan Existing Scale: 1/4=1'-0" 202 E DECK 20a 20s OFFICE OFFICE 203 --j TTTL BATHROOM 201 KITCHEN 202 OFFICE SPACE Second Floor Plan Existing Scale: 1/4"=1'-0" 301 STORAGE Third Floor Plan Existing Scale: 1/4"=1'-0" 10a BATHROOM 1 33 ICE CREAM SHOP 105 OFFICE 106 STAIRWAY 102 ICE CREAM SHOP 101 COMMON ROOM First Floor Plan Existing Scale: 1/4=1'-0" ti STORAGE 169 SO FT Third Floor Plan Existing Scale: 1/4"=1'-0" BATHROOM ICE CREAM 34 SO FT SH3P 124 SO FT OFFICE 215 SO FT STAIRWAY z 127 SO FT ❑�` 0 ICE CREAM A M SHOP Q M 227 SO FT COMMON AREA 183 SO FT First Floor Plan Existing Scale: 114=1'-0" OFFICE OFFICE 151 SO FT 151 SO FT BATHROOM 50 SO FT STAIRWAY 99 SO FT KITCHEN/OFFICE AREA 474 SO FT Second Floor Plan Existing Scale: 1/4"=1'-0" t TOWN OF BARNSTABLE SITE PLAN REVIEW DATE: February 12, 1998 TO: TomMcKean FROM: Anna Brigham, Site Plan Review Coordinator RE: SPR-006-98, Dunhill Development, 776 Main Street, Osterville (117/085) Proposal: Change the use from beauty parlor to office. No exterior changes. *This is on the Agenda for February 19* Please submit this form, with any comments or additional requirements you may have regarding the above referenced application, to the Building Commissioner's office by February 18, 1998. I have the following/attached comments/requirements regarding this application for Site Plan Review . I do not have any comments/requirements regarding this application for Site Plan Review at this time. ..e- JA (Signature) f I / le l e � Town of Barnstable Tc„m; QE BARNSTABLE Application for Site Plan Review SUiLDING DEPT. �s FEI 2 199� Location ` ;� �p ' Business Name: c���f I, D ��1 Co . L�►,• E 6 E V E i1 1 Assessor's Map and Parcel Number: ► ­7 ®t.� Property Address: -77G 09(0 5 5 Owner of Property ' Applicant % Name:`1 ,,\� 67 . Name- �,�;1� fi r, Ca. Address: -7 c ��er���- M� Address: �� �� ;•, S�-. a 5 `�<<' `��` D 4, Plione: Svc- % o " Phone: f�-Pi yoto FAX: �08 - 790- 9Vec� r"" ITE PLAN Engineer Agent Name Name VAJ Address: Address: Plione: Phone: Storage Tanks Utilities Zoning Classification Existing Proposed Sewer District: l Number: O 'Number: O Public Flood Hazard: Size: Size: Private Groundwater Overlay: Above Ground: Above Ground: Fire District M� Lot Area: 6 ZZq Underground: Underground: Water Number of Buildings Contents: Contents: Public: Existing- Private: Proposed: Cv, L,�Q Parking Spaces Curb Cuts Fire Protection:�S Demolition: 0 Required: Existing- (�k Electrical Total Floor Area sQ Provided: Proposed: /v o CL G f Aerial: Residential: �7yD On-Site To Close: 0 Underground: Oftice: 7ya Off-Site: Gas / MedicalOtlice: 0 Natural: Commercial: ye 5 Propane: (Specify Use) 0( .,(c Wliolesale: N v In Area of Critical Environmental Concern Institutional: NQ (E.O.E.A) Yes& Industrial: Project within 100' of Wetland Resource Area: Yes No 4 Old King's Highway Regional Historic District Approved? Yes, Zoning Board of Appeals action? ILIA Listed in National and/or State Register of Historic Places: QC2 Perimeter setbacks: , Front: C�b Side: _' Rear: Y6 96Lot Coverage: ag°`b Number of Floors: Floor Area: MV First: T(O Second: 7(I0 Other (Specify): Parking Requirements: Required: Provided: Handicapped Spaces: Are there Accessory Buildings? N 0 Accessory Building Floor Area:_N Please provide a brief narrative description of your proposed project. �CC tOJ�`f VJ°`S by' dC @ o. e.J-4-Y n a� �',+�, 'ro C.,�mac C. e�CK-� e� S�,c.\� oL" �� �•�`^�' �� An��' G✓ aZ I assert that I have completed(or caused to be completed)this page and die Site Plan Re Tie wApp ' anon and that, to the best of my knowledge, the information submitted here is true 1 Signature Date - 5 t� GcTUen = ` c sr �G. Kr-y MAP \� O u.scto.a e..nr Conwr G.- :O �F aso2 < /3.890ra A a. w Qo•�6jc • ce s r ' R Ira �• ;c \ - La.� ` P� , 0 r 7« CONTROL LAW. � 7: 9ARN57A&LE PING IOARD Suaaivislo►.+ Ora LOT A OSrr-FtVILL.E. MASS. `r 4� MoTcr ScUDpER -TAVLOR O1L CCL.JuC. 0SCALLf-L- i rccl Az/obeincorx�o ad�;J�-i a1 !w 20E-ir. AuG 23.1973 " H1.10..u4A3t-Pic o LAvv•Svwvlroas 879p25 odJoinri�p /ond�fbiinR.G/ge�.slvr. 6567 17 27 c.40, 3356 '9O ce LRr l`, i R. a L �\ 2 3Z� Pub 0 Suea�v� sioN O� Lo-t-A Osrr-;ZVI .L-E , MASS. SCUoor-R -rAYLChq OIL ca.lic. SCALE !N =20 Fr. Au G 23.1973 �� fo6cincoraoro cdrr�h5 N&ISIOA. b4-.ax .QIC.I.A^0 •54jaVF-Y0ws �o /on G� �f.�ohn R.CJgirr,s jcnr. �i '�E:.,•'=ems :\ jai w F irk•,:•._„ * n. �,a� .� ` � � tl TA alp loe`t 1 ;` ,µ -�' ..� ,._; �'C: .}. t,i^ 3. WIN €. _ _ .Jam,.�.w_.' i.�,�e,.+\�+.,�}r•�+r"�,z �SEt �" . -`'a C-; y c a4 tt 2 {� Iv .r t ..�. i : :� ���z���� �o�✓i A� F,eoxl T .� ��� �'.Y fi� v�y� �. YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 for 4 years]. A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI.,367 Main St., Hyannis, MA 02601 (Town Hall)and get the Business Certificate that is required by law. DATE: y'I I I) Fill in please: APPLICANT v YOUR NAME/Sn� t� YOUR HOME ADDRESS: L 9 v L u Jl� iS CIS R c)Y Ot2S 4 TELEPHONE # Home Telephone Number NAME OF CORPORATION: LL 0— S ( C- u-A �. NAME OF NEW BUSINESS `yvS 1�C4�',y.r�w�TYPE OF BUSINESS CO n VLu t3k IS THIS A HOME OCCUPATION? YES NO 1C /h� ADDRESS OF BUSINESS �, SS�119 _cam 6AP/PARCEL NUMBER I ) ©S 5 [Assessing] When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St.-(corner of Yarmouth Rd.&Main Street) to re you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ISSIO R'SQ9FICE This i ' ' III e i o d f an er u' t rtain to this type of business. o i e Si ature** COMMENTS: 2. BOARD OF HEALTH MUS Ct�MpLY WhTH ALA This individual has been inform d e permit requirements that pertain to this type of business. HRDOUS MATERIALS REGU�TIOIS Authorized Sig a ire* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. I " Sewer Information data,CnErytate 2/1 o/ss �A�ssessor"s AAapz be 776 Ct "�+ Main Street Osterville MA 02655- p Dan Speakman, Dan Speakman Construction,N.H t' Petinits 0 gF' .,aneit McKean Thomas From: McKean Thomas To: Brigham Anna Subject: Dunhill Development/ 6-98 Date: Thursday, February 19, 1998 4:06PM I am in receipt of a site plan review application to change the use at 776 Main Street Osterville. I have no objections to this proposal because the septic system was inspected, as required, and passed. Also, there.are no fuel storage tanks at this property according to our records. Page 1 McKean Thomas From: McKean Thomas To: Brigham Anna Subject: Dunhill Development/ 6-98 Date: Thursday, February 19, 1998 4:06PM I am in receipt of a site plan review application to change the use at 776 Main Street Osterville. have no objections to this proposal because the septic system was inspected, as required, and passed. Also, there are no fuel storage tanks at this property according to our records. Page 1 i Engineering & Sullivancon.Affig, Inc. (508)428.3344 - P.O.Box 659 • 7 Parker Road,Osterville,MA 02655 seci@suilivanengin.com • www.sullivanengin.com pn: QD March 1,2019 Tim Meagher Meagher Construction •4: 776 Main Street Osterville RE: 776 Main Street Osterville - Septic Field Capacity Dear Mr. Meagher, Per your request,Sullivan Engineering&Consulting,Uic. inspected die leach pit located in the back of your property at 776 Main Street Oslerville for its capacity as a leach field. The field was dug up for inspection and die top of die field was located approximately 3'down with a heavy concrete cover in good condition over it. The pit was 7'deep,and 6'across,with no visible signs of hydraulic failure in the past and no water in die pit present.The pit is considered a 1000-gallon pit,and after probing around die side,some stone was found to be approximately 1' around the pit. As per die septic design code prior to 1995 bottom area was credited 1 Gallon Per Day(GPD) for every sf provided with die sides credited 2.5 GPD per sf, Bottom area: pi*r^2=3.14*4^2=50.2sf 50.2sf=50.2GPD Side area: 2pi(4)=2*pi'4=25.1 25.1*h=25.1*5=125.5sf 125.5sf x 2.5=313.8GPD Total:313.8+50.2=364.0 GPD flow capacity for the leach pit. Additionally,per 310 CMR 15.203 design flow for ari office is 75GPD per 1000sf of space. Retail has a design flow of 50GPD per 1000sf of space. _Regards, --- - -- - - . =— Chuck Rowland,P.E. Sullivan Engineering&Consulting,Inc. 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , M 776 Main Street Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2012 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not David D. Coughanowr, R.S. use the return Name of Inspector key. Eco-Tech Environmental � Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site M sewag disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of -j- Title 5 310 CMR 15.000). The system: CID N ® Passes ❑ Conditionally Passes ❑ Fails 1GC _. ❑ Weds Further Evaluation by the Local Approving Authority O r o �J• �`— October 3, 2012 ems+ Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 } f Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 776 Main Street Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3 2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following state ments.•If"not}- determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Boardof Health. ' w *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 les's than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 776 Main Street Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2012 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9c� 776 Main Street M Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 776 Main Street Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2012 page. Cityrrown State Zip Code Date of Inspection B. Certification (cost.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 776 Main Street Property Address p Y Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2012 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 776 Main Street Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2012 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Real Estate Agency Design flow(based on 310 CMR 15.203): n/a - no planGallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): n/a - no plan Grease trap present? ❑ Yes ® No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: 102 gpd - last 2.5 years t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 776 Main Street Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: current Date Other(describe below): General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): Septic Tank and Leach Pit t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form _ - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 776 Main Street Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Age: 34+ years. Certificate of compliance for new Septic tank was issued 3/24/78 (Permit#78-132 at Health Dept). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 4feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: 4 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1.5 x 5 x 6 - 1500 gallon tank Sludge depth: 4 in l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 776 Main Street M Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30 in Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 10 in Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? Design plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is not required at this time. Maintenance pumping is recommended in 2-4 years. Tank and tees appear structurally sound and functioning as intended. No sidewall staining of septic tank above the normal operating level was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official ,Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .'' 776 Main Street Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 776 Main Street Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Pump Chamber(locate on site plan).- Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 776 Main Street Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2012 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology.- Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils above leaching pit appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. No sidewall staining of septic tank above the normal operating level was observed. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 776 Main Street Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 776 Main Street Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately `7' f�- C V�' � R - D = 3>' ° I � f (Sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 776 Main Street Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: Barnstable GIS Department records You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is over 20 feet above groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 776 Main Street M Property Address Dunhill Development Company LTD Owner Owner's Name information is required for every Osterville MA 02655 October 3, 2012 page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I J No........................ .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _........ ........................._......OF.................................I................... ......... ........................ Appliration -for Bi,iposal Works Tonitrurtion Vrrniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at d—h I S Location-Address F4 L 1 4� or Lot No ..•••••-•-•-------------• ........-----•••-------------------.............................. .. ddress� Own r _` &;&'- R �.. ..J/................................... M. !.......................... Installer Address UType of Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons------------------_--------- Showers ( ) — Cafeteria ( ) dOther fixtures ....................................................................................... W Design Flow--------------------------------------------gallons per person per day. Total daily flow.........................................---gallons. 94 Septic Tank—Liquid capacity_.-----_---gallons Length................ Width.___---_-..__ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching -area....................sq. ft. Seepage Pit No--------------------- Diameter..................... Depth below inlet-................... Total leaching area-----._ ----------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date.......................---------------- Test Pit No. I......_---------minutes per inch Depth of Test Pit.................... Depth to ground water.-.-_-_-----_.-..-.----- (Xq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 9 -------------•--••--------- --- G Description of Soil pt x .!'... . .........•. .........................------------------------------------------------------------------------------------- --------------------- -------------------------`------------------------------------------------------------- ---- Natur of repair or Alterations— nswer whe plicable._.--/.-"....��.. ____ U , 'j' Ji;-ice, ' . .. .. ------ --- -- - - 1 -- -- ---p-�-�d��'�n . Agreement: _L) The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordanc"wiF the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en 'ssued by the b rd of e th. igned..... .. �-L 1 �� �- ---- -- ---�c1 Date Application Approved BY / � - �� -------------- Date Application Disapproved for the following reasons:................................................................................................................ .............••••-••-------------••••-----•--•---.._...---------••--------•---•-••--•--..._.......------.I------------•-•--•---------•---------•--------------•-••-----------------------••--------------= Date PermitNo......................................................... Issued................................. Date - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _................OF......................................................................................... Appliration -fear 113wvoiitt1 Works Tott,strnrtion Vrrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --f t . r Location-Address �� or Lot No. I Owner Address . - -- }� G............................................... CP Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................... . .Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) QOther fixtures --•-------------•-----------------------------•------------------..-.........------------•------------------...-•-•----------•-•-•------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter--------.------- Depth-_---.._....--- x Disposal Trench—No. ..................... Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet-.---_---_-_--__--- Total leaching area..._.......-..-_.-sq. it. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------- ------------------• - Date..-..-------------------------------.... a Test Pit No. I----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water...........---------. -- (14 Test Pit No. 2................minutes per inch Depth of Test Pit....-----_.._--.--. Depth to ground water_.------..-..-..-----. 9 ) -------------------------= --------•------•-----------------------------------------------------------------------•---....---------------------..-..------ O Description of Soil_.:':'.a r x - ----------------:� ---------------------------- ----------------------------------------------------------------------------------------------------•--•-••---••-••--••-•-----•-•---..._.........------•....--•-- W _ x -y-J -- ----- t - V Nature of Repairs or Alterations-Answer when applicable-----_..------f.---..._-_-.-----.� __°�------------I-- 1.?---- t----. . 1 `. i�-_!- > C „tea'I , e 1 >_ 1 = = , . a t ., �,-- ,, 1 ^ -- ----------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance wi h the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in i ned.:.e d by the board of-health. operation untila Certificate o Compliance has be��tt= �� �l-6�'l Date Application Approved By__~------- --- -- , .. .r��3 "7W-~ r Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- --•--------••••--•-------------------------------------------•-•----------------------•--•--••-----------•-•---------------...----••••-•---•-----••-•----••-------•-•---•-•....-•----------------------. Date PermitNo................................-........................ Issued..................... .......................... ' Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. O F.......: `........................ Tntifiratr of 10Tontphattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (i' ) Y .......... ............................................................... ----- -- -- - ------ f t � 2 ' ��! - 1, Inst111er I I ref s'� at I ---------- L l ✓1,,,._..�^ r ! r t�M.o ( /' /� / r has been installed in accordance with the provisions of Ar ' XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. -_ U-2,............. dated...3`N- ,7-..eT .-.._-.......... THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CO TRUE S A G RANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... ....................................... Inspector-- . •-- -- --- ---- ---•.. ----- ------- THE COMMONWEALTH OF MASSACHUSETTS , BOARD 'OF HEALTH / ..........z 3 OF FEE.. :... `'?...... �i��o,�ttf1 ork,� �o�t�trnrtto$t �rxntit , ,� Permission is hereby granted ' ,r. l its ,...4`-.. aZ-- �.ti c. ------------ ------ to Construct ( ) or Repair, (x ) an Individual Sewage Disposal System ' t ► 1 at No.- I/O a= ^^- =' '�;, t v_e a s t.t ...... '. �.� .............. !_ail.�1... �....................�a Street w as shown on the application for Disposal Works Construction�Reit N ....... ..... ... Dated...`. .......-----....... -- ------ - -�'� d1 Board of Healt DATE.................-.............................................................. • FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS s-` •' , CO'v MO, IWE.ALTH OF WSSACFR'SETTS n , EXECUTIVE OFFICE OF EWRO\\1ENT.AL AFFAIRS ✓ ,r�C�� - %' DEPARTMENT OF ENVIRONMENTAL PROTECTION t04 V n e ONE ►►'11TER STREET. BOSTOA. h1A G=1PF tit'-=9:•'�00 (P a WULI.AM FANTLD Gevenie l ' D elu?% ARM PAUL CELLUCCI Lt.Govemm SUBSURfACt SEWAGE DISPOSAL SYSTEM INSPECTION FORM DA�Confm�sban PART A /9i4/d) 5 CERTti1GlT10N Property Address: p5l�W?(//C.Gel oi.F/i, Address of Owner: ATt/STq (:;i 00,D?0S Date of Inspection: (if different) Name of Inspector: I am a DEP approved system inspector pursuant to Section 15.340 0(TI11t 5 1310 CMR 15,000) Company Name: Mailing Address: Telephone Number: CAMMifilillctlan �oylnp fi Trllta a Ena tliv. • SER7IFICATIOh STA1Eiis18beekwfay pH,���� res I ceni(y that I have personally a�L:h� e a vstem at this adds and that the information reported below is true,accurate and complete as of tine time in nspsnRe rns was performed bated on ins•training and experience in the proper (unction and maititenance of vrnsite srw-age dnpusel s)•sterns. The sysie:n _I.,pas te, Condueonally Posses :_ Neacls ►umber Evalua o, n 3 ocal AAproving Authoriq• Fails 1 Inspector's Signii i Dale; The Svaiem in►peno, shall submit a copy of this inspection repon to the Approving Authoriry within thirty 130)days of corn leling this inspection. If the svitern is a shored system or has a design f-ow of 10,0D0 gpd Or greater,the inspector and the system owner shall submit the repot to the aporopiiile regional office of the Department of Enviroaniii i Protection. Tne original should be sent to the system owner and copies sent to the buyei, if applicable, and the approving authorits.. INSPECTION SUMMARY: Check A, B, C, Or D: A) SYSTF SSES: 71 have not found any information which indicants that the system violates any of the failt:re crit rij as defined in 310 CMR 15,303. Any failure critoria not evaluated are indicand below. COMMENTS: B) TTIM CONDITIONALLY PASSES: One or more system components as described in the'Cond0ional Pats' section need to be teplacied or repiired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pea. Indicate yes. no. or not determined IV, N,of ND1. Describe basis of determination in all instance►. If^not deterrrsined', explain why,not The septic lank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance tanached) indicating that the lank was initalled within twenty(20)years prior to the dale of the instiMion.or the septic tank,whether or not metal, is cracked, structurally unfound, shows substantial infiltration or esfittration, or tank failure is irnrntnenl. The system will pass inspection if the existing septic tank is replaced with a COnfortning SMIC tank as approved by the Board of Health. ire-i■.d 04/aS/sti Dove 3 at la DEP or,ins Wont:Yoogl tat hap:/wN1e.t11apriet.Vag.ma.etiMlp (y Pmttad an R"ejad Papal G t. l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A t CERTKICATION (continued) Property Address Owner; Date of Insoection:k ,>< • r r BI SYSTEM CONDITIONALLY PASSES IContinuedl I(I-1A 5ewagr oactwp or breakout or high static water level observed in the distribution bog is due to broken or obstructed pipers}or due to a broken, settled or uneven distrlouuon bog. The system will pass inspection if(with approval of the Board of Health). Describe observation&: broken pipets)are replaced obstruction is►e nvved distribution box is levelled or replaced '•he system required pimping more than four times a year due in btnken or obstructed pipelss The system will pass mspeclen If Iwith approval of the Board of Health): broken pipets)are reolacec obstruction is removed CJ FURTHER EVALUATION 15 REOUIRED BY THE BOARD OF HEALT14: ter'1 Londntons exist which require further evaluairon by the Board of Health in order todetetertine if the system is failing to proton the puolir rwallh,safety and the environment. 1) SYSTEM WILL PASS UNLESS 1QARO OF HIAL'M DETERMINES THAT THE SYSTIM IS NOT FUNCTIONING 1N A KAN14IER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 ieei of a,ufact,water Cesspool or pri.1• is within 5o feet of a bordering vegetated wetland or a sal: marsh. 71 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM 15 FUNCTIONING 1N A MANNER THAT PROTECTS 7HE PUBLIC HEALTH AND IAFLTY AND THE ENVIRONMENT; The system has a septic tank and soil absorption system(S45)and the SAS it within 100 feet to a surface water supply of tributoy to a iiur1ACe water supply. The system has a septic tank and sail absorption system and the SAS it within a Zone I of a public water supply well The system has a septic tank and soil amortmon system and the SAS Is within 30 4"of a o►iwu water supply well, — The system'has a septic tank and toil aasarpuon systen,and the SAS is less than 100 feet but So feet or nwre from a private water supply well,unless a well water analysis for collform hrcterie and volatlle organic COmpOundl IndieXtits ftt the well is free from pollution flora that facility and the prryence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance Csypraitibsation rat valid). 31 OTHER frevsaed 0//2l/F7) rep a of le I t r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIOts FORM PART A CERTIFICATION (continued) Property Address: r7-ro r 5i T. ; O'✓/GGc� Owner: 47e/S TA Date of Inspection: re 12 3 /�7 DI SYSTEM FAILS: Yo��,�st indicate either"Yes' or"No"as to each of the following: 4r r�i t 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. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ discharge at 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 elOggeo SAS or cesspool. Liquid deptn in cesspool is less than 6"below•invert or available volume is less than 112 day flow, Required pumping more than 4 tunes in the last year NOT due to clogged or oostructed oipe(si, Number of times pumped____. Ary portion of the Soil Absorption System, cesspool or privy is below the high groundwate, elevation Anv portion of a cesspool or privs 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 30 feet of a private water supply well. Anv prsnron of a cesspool or privy is less than 100 feel but greater than 50 feet from a private water supply well with no acceptable water quality analysis. it the well has been analvied to be acceptable, attach copy of well water analysis for coloorm bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: 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,D00 gpd or treater(Large System)and the system is a significant threat g b 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 sensitiye area (Interim Wellhead Protection Area -IWPA)or a Mlpped Zone'll 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 progra n requiremenu of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department (or further iniormation. (sraoia�d 0�/?S/991 iag� ] a! �0 Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST '1 Owner: Date of Inspedion: Check if the following have been done:You must indicate either"Yes"or°No" as to each of the following: Yes No 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 that period. Large volumes of water have not been introduced into the system recently or /1 as pan of chi! inspection. IV"� As built plans have been obtained and examined. Note if they are not available with N/A. !� The (acuity or dwelling was inspected for signs of sewage back-up. T The system coes not receive non-Sanitary or industrial waste flow, Tne site leas insr*mpd for signs of breakout. _ All system components, excluding the 50i. 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 pt baffles or tees, material o`construction, dimensions, depth of liquid,depth of siudge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facilm, owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. J Existing information. Ex. Plan at B.O.H. Determined in the field (ii any of the failure criteria telated to Part C is at issue,approximation of distance is .� unacceptable) 115.301011b1] (revised 04/25/011 page 4 of 10 i r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEVION FORK, PART C SYSTEM INFORMATION Property Address: Owner: ��/� Date of Inspection: FLOW CONDITIONS RESfDENT1At_: Design flow-:WO n,p.d.Amdroorn for S.A.5 Number of bedroams: I Number of current residents:, Garbage gr.;-der(Yes or no`:A/-19 Laundry co-ected to system (yes or nol:Z4�1 Seasonal use (ves or no):,�'D Water meter readings, if available Oast two (2)year usage (gpd): Sump Pump (yes or no):WG Last date o'.occupant-.• GOMMERCIAG'INDUSTRIAL• Type of establishment: r— Desigr flow 0005tallonsrday Crease trap present: ryes or nol ACK3 Industrial Waste Nolcrng Tank present: cues or no:A/o Non-sanitary Waste discharged to the Title 5 system: ryes or nol Water meter readings ii available: Last date or o:cupancy��T OTHER: (Descricie. Last date of occjoanc,.•. GENERAL INFORMATION PUMPING RECORDS and source of information 5rstem pumped as pan of inspection: Ives or no).Up If yes, volume Pumped: ._w�_eallons Reasor for pumping TYP�STEM Septic tank/distribution box/soil absorption system Single casspoo`• Overflow cesspool Privy Shared system (yes or no) (if yes,attach previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (If known)and source of information: C`� IT Sewage odors detected when arriving at the site: (yes or no) ?tea sot to ti SUBSURFACE SEWAGE OISPBS T CSYSTEM INSPECTION FORM PARSYSTEM INFORMATION (continued) property Address: Owner: Date of Inspection: BUItOING SEWER: (Locate on site Plan' Depth below grade; � Material of Construction: vcast iron_ 40 PVC—other te>,p4irt) Distance from puwate water supply well or suction It•e Diameter q' Comments (condition of joints,venting, evidence of IeakagS, etc.) 6000 C',J 4/ v SEPTIC TANK: (locate on site plan! Depth below grader v Polvethylene—Other(explain Material of construction: —concrete —meta —Fiberglass -- 11 tank is metal, I1st age h age conitrmed by Cer{ntcate of Cornpliance (YeslNoi Dimensions: a �" Sludge depth Distance from top of sludge to bonorn of outlet tee or baffle:32L Scum thickness' of outlet tee Or baffler Distance from top of scum to top Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: Comments: of liquid level in relation to outlet invert, structural (recommendation for pumping, co ndttion of inlet and outlet tees a baffles, depth q integrity, evidence of leakage, etc.) CREASE TRAP:J (Ivcate on site plan! Depth below grade:__._ -concrete —metal fiberglass _Polyethylene,other(explain) Material of construction: conc Dimensions: Scum thickness:_... Distance from Iop of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: h of liquid level in relation to outlet invert,structural (recommendation for pumptng,condition of inlet and outlet tees or baffhes, depth integrity, evidence of leakage,etc) page s of 30 (�rvire•0 o1/7f/f7) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTInN FORM PART C SYSTEM INFORMATION (continued? Property Address: 7�(p i j q e,_) S/ , ne Date of inspection! TIGHT OR HOLDING TANK!N r 0!Tank must be pumped prior to, or at time,of inspection; (locate on site planl Depth below grade. .Material of construction: —concrete —metal_FiberglaSS Polyethylene __olher(explain) Dimensions CapaCity gallons Desigr floN gallon$lda� Alarm level Alarm in working order Yes; No Dale of previous pumping. Comments. (condition of inlet tee. condition of alarm and float switches,etc.) DISTRIBUTION BOX:A)4 (locate on site plans Depth of liquid level above outlet invert Comments- (note if level and distribution is equal. evidence of solids carryover, evidence of leakage into or out of box,etc.t PUMP CHAMBER,AJ (locate on site plan; Pumps in working order: (Yes or No) Alarms in working order(Yet or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 06/75!971 Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of inspection: SOIL ABSORPTION SYSTEM(SAS):�I' (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methodsi li not determined to be present, explain; Type: leaching pits,number; leaching chambers, rurrtber:— leaching galleries, number,,,__ leaching trenches, number,iength:, leaching Melds, number,dimensions: overflow cesspool, number:_ Alternative$),Stem: Name of Technology: Comments: (note condition of Soil, Signs of hydraulic failure, level of ponding, condition of vegetation,etc.) /'j v A-JQ CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of houid to inlet mverr Depth of solids iayer. Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwatef: inflow lcesspo6 must be pumped as pan of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) PRIVY: 'f (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.) (revised 04/35/97) page 1 og 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propvrty Address: Owner:" Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties id at least two permanent references landmarks or benchmarks locate all wells within 100'(locate where public water supply comes Into house) /31_ A 3 i ' 0 = .35 ' V o � ` ���lC _ •2nc� rcov2 I f y Q �77� 1 t (T�vie�et 04/35/91) Per& 9 of to r. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: Depth to Groundwater Feet p 'I Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record observation of Sile(Abulting property, observation hole, basement sump etc.) Determine it irom local conditions Check with local Board of health Check FEMA maps Check pumping records Check local excavators, installers R'USe USu5 Gala Describe in%ou, own words how you established tie Nigh Groundwater Elevation. ust be completed) Izwised 04/25/97) taps 10 of to i sulli'vanConsulting, Engineering & Inc. (508)428-3344 • P.O.Box 659 • 7 Parker Road,Osterville,MA 02655 seci@sullivanengin.com • www.suilivanengin.com March 1,2019 Tim Meagher Meagher Construction 776 Main Street Osterville RE: 776 Mavh Street Osterville - Septic field Capacity Dear Mr. Meagher, Per your request,Sullivim Engineering&.Consulting,Inc. inspected die leach pit located in die back of your property at 776 Main Street Oslcrville for its capacity as a leach field. The field was dug up for inspection and die lop of the field was located approximately 3'down with a heavy concrete cover in good condition over it. The pit was 7'deep,and 6'across,with no visible signs of hydraulic failure in the past and no water in die pit present.The pit is considered a 1000-gallon pit,and alter probing around the side,some stone was found to be approximately 1' around die pit: As per die septic design code prior to 1995 bottom area was credited I Gallon Per Day(GPD) for every sf provided with the sides credited 2.5 GPD per sf. Bottom area: pi'r^2=3.14"4^2=50.2sf 50.2sf=50.2GPD Side area: 21)i(4.)=2'pi*4=25.1 25.1*li=25.1*5=12.5.5sf 125.5sf x 2.5=313.8GPD Total:313.8+50.2=364.0 GPD flow capacity for die]each pit. Additionally,per 310 CMR 15.203 design flow for an office is 75GPD per 1000sf of space. Retail has a design flow of 50GPD per 1000sf of space. Reg rds, � - Chuck Rowland,P.R. Sullivan rahgineering&Consulting,Inc. -aa :�` � .i;"�� i.1-> ':'�• r, +,a � � a-�, � 1�3 r sfi '3•s '.......... EEB ,__ £. .'_sa—_3IIIf�IYliYi�1 µ,• . i V 33 -r • • A • i 1 — . { s 42'-9' 42'-9' r ----- ----- ----- ------ PICK UP 2'-r 9'-72 10 Q. N / j N W Ji ProposedFirst Floor Plan Existing First Floor Plan a �' Scale: 3/16" = 1'- 0" Scale: 3/16" = 1'-0" � c ' 14 16 STEP DOWN co ID DESCRIPTION 12 I 13 20 1 Triple Bay Sink 260.0" 2 Maxx cold 49 cubic foot REFRIGERATOR 4 117.0° 3 ELECTRO FREEZE 876B SLUSH MACHINE r 4 Swift shake/ FLURRIE WADDEN 10 0 0 0 19 15 2 5 Wadden 24 Flavor System $ 6 7 11 3 6 Electro_Freeze-9 FLAVOR_MACHINE -- -- - - --- -- _ - - -- - 9 ---- -- ---5- --- _ __ _- ------ --1 ----- -- -- - ---- - - - -- - - 7 Low Refrigerator or work table 8 ELECTRO FREEZE GES 5400 W/C S/P 1 17 9 Counter with hot fudge warmer 10 True toping table TSSU-48 with sneeze guard . 5 11 Wadden Delightful Dip System. Warmer on counter Sliding glass top MAX cold FREEZER for ICE CREAM ~ 12 on a stick (PALLETAS) 13 Counter with spoon, napkins,straws. TRASH under counter. 14 Cash 15 Dry Storage 16 Frozen Coffee i 17 Grease Trap i 18 Mop sink 24 x 24 } 19 Hand washing sink 20 Prep sink f GENERAL PLAN SCALE: 3/16"=1'-0" TITLE: SHEET: ICE CREAM STORE DESIGNER: OWNER OF PROJECT: DATE: SCALE: 25/02/2019 3/16"=1'-0" - - _ - 43.89 OSTERVILLE S53•5320"W BUILDING #778 = 24.34 `U-, _ = N56-44'30"E UPOLE 0 9 / \ ��_ �P'j/ // O7 OCUS o 19.5' \ / PARCEL ID: / C0 `\ ORAvEt �' l 117/84 PARCEL ID: _ _  -_ �9l oo '.: . � ��� �l PAR Noy � �oPp /yiyN� hh / AREA1 51288 S.F. _ �0& KllyG O _ - _ 18.6 ° _ _ _ _ _ / LOCUS MAP I\tx �P� LOCUS INFORMATION 40��� � _ \ /W O PLAN REF: 275/89 BUILD. HEIGHT MAX: 30' L_ TITLE REF: 28237/124 PARCEL ID: MAP 117 PAR. 85 Qqp'0�CP BUILDING #776 �� ZONING: BA SETBACKS: 20'F-0'S-O R FLOOD ZONE: "X" o� \ OHW- (MEAGHER CONSTRUCTION) _= 0 COMMUNITY PANEL: 25001 CO544J DATED:07/16/14 (OCEANSIDE REALTY GROUP) CERTIFIED PLOT PLAN ° UPOLE ` oo=_ __= 60 Q (ICE CREAM SERVICE WINDOW) �// �+'L ti� 2 \\ \ _ � _ _ _ 4� / o LOCATED AT: °�+ \\ _- '�� __- G / 776 MAIN STREET \\ os�FA G OSTERVILLE, MA. \ \ T" = G PREPARED FOR w2-___ _ M E A G H E R + C3 \ �9� °o CONSTRUCTION \\ 70.1 �\���Ql \ / MARCH 27, 2019 \ F` QP� ` w \ 6 PARCEL ID: / \ 9 \ `\ � \\ 117/86In y \ 'G� w \ .•� \ v SIGNl . 5 � rr• -9 re \pAS t�i E . A. S. GRAPHIC SCALE SURVEY, INC. � o �/ ,o o ,o zo 40 SANDWICH, P.O. 729 �\ -\ i I MA. 02563 MEMEL IN. FEET ). BUS:(508)888-3619 CELL:(508)527-3600 1 inch = 10 ft. J 1664SP