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HomeMy WebLinkAboutDUNKIN DONUTS - FOOD LDun�kin Donuts 4 Main St. Ost. pt1t7 „ Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. oARNsrABm F.P.(Thomas)Lee,. NASA $ 9. 200 Main Street, Hyannis, MA 02601 Daniel Luczkow M.D. Alt. a 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: 658 Issue Date: 01/01/2022 DBA: DUNKIN DONUTS #658 OWNER: CAPE COD ENTERPRISES LLC Location of Establishment: 804 MAIN STREET OSTERVILLE„ MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE-ICE CREAM: G FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: I FINE Town of Barnstable r For Office Use Only, Initials: ti sae , : Inspectional Services check# ,Z &�� �Fa p"'� Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 12/20/21 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Cape Management Team, LLC DBA Dunkin' ADDRESS OF FOOD ESTABLISHMENT: '�"$✓z Main St., Osterville MA 02655 - 1 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Go Couto Management Group,169 Main St,Stoneham,MA 02180 E-MAIL ADDRESS: office@coutomanagement.com LA TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O8 ) 420 - 7398 IK TOTAL NUMBER OF BATHROOMS: 2 WELL WATER: YES_NO V ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V _ SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: 0 OUTSIDE NA TOTAL: 0 I SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. i ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? i TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE _RETAIL FOOD-,ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST _CONTINENTAL BREAKFAST _COTTAGE FOOD INDUSTRY(formerly residential kitchen) _MOBILE FOOD _FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) _CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE &NEW FOOD ONLY*** I REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:1Application FormsTOODAPP 2020.doc i I s I OWNER INFORMATION: FULL NAME OF APPLICANT Salvl COuto SOLE OWNER: YES NO D.O.B 3/7/1979 OWNER PHONE# 781-279-0290 1.(� ADDRESS 169 Main St, Stoneham, Ma 02180 CORPORATE OWNER: Cape Management Team, LLC CORPORATE ADDRESS: 169 Main St, Stoneham, Ma 02180 i PERSON IN CHARGE OF DAILY OPERATIONS: Ruben Dias List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div.will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date I.Ruben Dias 10/ 2 /2024 1. Ruben c.a�Du 1 / 14 /2025 Dias��. t(viazvett I 1 Z- 010 ?�Z� 2, Mina Chattri 2 / 15 /2023 i 12 / 20 / 21 SIGNATURE OF APPLICANT DATE i i ***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 whc 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/aaalications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(3)AND REQUIRED FEES BY DEC lst. Q:tApplication FormsTOODAPP REV3-2019.coc Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. a�at�rsrA�e Paul J.Canniff,D.M.D. � 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: 508 862-4644 Fax: 508 790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 658 Issue Date: 01/01/2021 DBA: DUNKIN DONUTS #658 OWNER: CAPE MNGT TEAM, LLC Location of Establishment: 804 MAIN STREET OSTERVILLE„ MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: , Q.p FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: JD6o For Office Use Only. Initials: Town of Barnstable Date Paid Amt PdPd$ o�•� { "RNSTAHLE, r Inspectional.Services °°•� Public Health Division Check# 1--�� �. Thomas McKean,Director 9 200 Main:Street,Hyannis,MA 02601. Officer 508-862-4644 Fax: 508-790-6304 i APPLICATION FOR PERMIT TO OPERATE.A.FOOD ESTABLISHMENT i DATE 11/16/20 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMEN_ T: Cape Management Team, LLC DBA Dunkin' <30 ADDRESS OF FOOD ESTABLISHMENT: Main St., Osterville MA 02655 MAILING ADDRESS(IF.DIFFERENT FROM ABOVE): c/o Couto Management Group, 169 Main St,Stoneham,MA 02180 E-MAIL ADDRESS: office@coutomanagement.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5{ O8 ) 420 - 7398 4 TOTAL NUMBER OF BATHROOMS:. 2 WELL WATER: YES_NO V ... (ANNUAL WATER ANALYSIS REQUIRED) ; ANNUAL: V_ SEASONAL: DATES OF OPERATION:_/ / TO i i I NUMBER OF SEATS: INSIDE: 0 OUTSIDE: NA TOTAL: 0 t SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. i i ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING i REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? f IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICEDOOR(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 C _FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) i _CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) I ** SEASONAL.MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV,FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:4Yppli6tion FormsTOODAPP2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT Salvi_Couto SOLE OWNER: YES NO D.O.B 3/7/1979 OWNER PHONE # 781-279-0290 ADDRESS . 169 Main St, Stoneham, Ma 02180 CORPORATE OWNER Cape Management Team, LLC CORPORATE ADDRESS: 169 Main St, Stoneham, Ma 02180 PERSON IN CHARGE OF DAILY OPERATIONSt Ruben Dias ,� € List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff 1 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.Ruben Dias 10/ 2 /2024 1. Ruben Dias 1 / 14 /2025 2, Mina Chattri 2 7 15 /2023 11 i16 / 20 SIGNATURE OF APPLICANT DATE i ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including.mobile trucks must be inspected by the Health Div. prior to openingll 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,sainple results submitted to the Health Div. Failure to do so will result in the suspension orrevocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTo-wn by fax or mail prior.to catering event. You must complete a catering notice found at.http://www.townofbarnstable.us/heaIthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits rWannu.ally from January l st to Dec.3151 each calendar.yun IT IS YOUR RESPONSIBILITY TO.RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. I i Q:\Application Forms\F00DAPP REV3-2019;doc t 1 i I °F^HE*ok TOWN OF BARNSTABLE HEATH INSPECTOR'S Establishment Name: Date:' Page: / of > ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. g MON.-FRI. �A ,639•e�m HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT il t`f lllU �t�ia f' G/col Name 1 11 T e o T f InspectionJL ` t f �oC�la OW outine Address rL(A,;.z f D Risk c Re-inspection Leve Retail Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness 3 IIII/L Caterer General Complaint Person in Charge(PIC) /��/n,, , Time Bed&Breakfast HACCP `� V` In: ,/,,,, Other V t oL Inspector 0 Out: _ r Each violation checked equires 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) f _ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals ' OF FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) G ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures 0 l ❑ 5.Receiving/Condition ❑ 17.Reheating e I ❑ 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 Asa Public Health Control K �jJ��;IyS+ rX-11 41 AA 0b� ❑ 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 e d Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 6=One critical violation and less than 4.non-critical violations 9 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 n-critical violations=C. 30.OXer DATE OF RE-INSPECTION: Inspector' Signa rem Pri t: 31.Dned from public view Permit Posted? N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' nature 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.) t FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding _ 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 7 5 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * 2 Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulteated 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* 3-801.1 l(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* - 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef cnw 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing g' P � Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11 A)( )( )1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g• g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C CommerciallyProcessed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 : 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans �6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 1 Specialized Processing Methods* 130. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `oF. ►owti TOWN OF BARNSTABLE HEALTH,INSPECTOR,s Establishment Name: Date: Page: of ' '2- OFFICE HOURS AR E° PUBLIC 0HEALTHNSTRETSION 8:00-9:30 A.M. 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified a39. �•� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY °lEo MPS° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT U Name Date Z -Type of T f Ins ection O a o outine Address Risk ood Se ection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness .Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: (/)�� Other `� / p Inspector Out: Each violation checked.requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ lNy 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) ❑ .Z_-- FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands I '� ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals �� FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) `t ' Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ go Embar checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency Closure Other: Voluntary Disposal ❑ 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than non-critical violations 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to S non critical violations. If 1 critical refrigeration. FC-7 590 28.Poisonous or Toxic Materials .008 9 29.Special Requirements (590.009) within 10 days of receipt of this order, violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Sig ature Print: 31.Dumpster screened from public view (! Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si t e 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.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous dr 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*2 Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-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* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or ' S-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* Ey crive 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 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 Surf of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* 10 Proper,Adequate Handwashing g' P � Ratites-165°F 15 sec* in mobile food,temporary and residential - Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165°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 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 TagsiRecords: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 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 i 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. OF IKE. TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: ow•`iI/"`. eAlwffs, Date: q617,1 Page: . of OFFICE HOURS O` PUBLIC MAIN HEALTH DIVISION : 0- :30 M.3:30-4:3o RM. BARNSTAN6E. 20 STET - - Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ,asq: � HYANNIS,MA 02601 -FRI. 08-8 508-862-4644 No Reference .R-Red Item PLEASE PRINT CLEARLY M°� FOOD ESTABLISHMENT INSPECTION REPORT �'OrFD Name Q� 8ylflfi S Date 3� Tvne of Type of Insoection O Routi e Address Ssf- Ste} Risk ood Se Re-ins ec i n Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) 1 Time /��.y�,,.� Bed&Breakfast HACCP t In: l�-"l` ' Other d. Inspector � �i� Out: �� � - � - ,C� �1 Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. - h Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ _ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ .L, Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ F � a FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ^ � J ❑ 1.PIC Assigned/Knowledgeable/Duties Handwash Facilities �r�it c� EMPLOYEE HEALTH PROTECTION FROM CHEMICALS �wi j C- an ❑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) '� 1714.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 ��.7PROT TION FROM CONTAMINATION ❑20.Time As a Public Health Control l �./� .Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 1/� h Q�t G7 d.`t o ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY �� /y :� ; J� ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 8=One critical violation and less than Orion-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 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 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address ical violations. If 1 critical refrigeration. violation,4 to 8rion-critical violations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. = 30.Other DATE OF RE-INSPECTION: Inspector's Z Prin 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 Signatu Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N " Dumpster Screen? Y N - ^ Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003 A) Assi Law Cooled to 41*F/45*F Within 4 Hours* ( gnment of Responsibility* $ Cross contamination 1q Food or Color Additives 3-501.15 Conlin Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 8 Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 590.004(F) Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140'F* Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 1307-102.11 °F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage*8 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 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(13) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reared 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 17.206.12 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 1� 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* ef/cnw rmzonr 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130*F 121 min Eggs* 4-702.11 Frequency r f ces of qui of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-.(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements.practices should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B). Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C CommerciallyProcessed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) 8 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 Conlin Cooked PHFs from 140°F[0 70°F 3-202.18 Shellstock Identification ( ) g Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 590.004(J) 9 9 Y� tY 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 HandD Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �p THE ram, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: PLAU,�e,1 amt,�s -Date: ( L/ Page:�_of -Lr OFFICE HOURS �Y 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 .A-: m� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY 508-862-4644 FOOD ESTABLISHMENT INSP CTION REPORT j Name Urn D Date I 2 Tvoe of T e f Inspection ® outine Address &4 �en s' aJ Risk R inspection A. rr Level Retail Previous Inspection _ Telephone Residential Kitchen Date: < �� (� Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness I ` Caterer General Complaint Person in Charge(PIC) f Time Bed 8 Breakfast HACCP In:-&I'3p FM Other Inspector n ern SOS Out:3 ;11 r- L Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ d� Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 2 evention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties 3.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS `r v ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑5.Receiving/Condition ❑ 17.Reheating hZ Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling er /y e f S Atw j w�L, ❑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) �a Ile �j.P/ ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP A & ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY Lo V av ❑ 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) "11 O Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ® Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ® Embargo Emergency Closure ❑ Voluntary Disposal Other: ❑ 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. B=One critical violation and less than 4non-critical violations 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Othcr DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpstel screened from public view JA d�CJ 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 19 L 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)(]) 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 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* . Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Se azation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time.as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* . Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package NotRe-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. L16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * Equipment 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective uuzooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009 A (D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004 C Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( ) practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED_ TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* r 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3 403.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* �) g illness interventions and risk factors listed above,can be found in the . 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* _ Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Supplied with Soap and hand Drying Devices Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 I 590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6.2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF,NE roh TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: � ��� J Date: Page: off q 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 MASS., -'g HYANNIS,MA02601 MON.-FRI. NO Reference R-Red Item PLEASE PRINT CLEARLY DIED M°�°• 5OM624644 FOOD ESTABLISHMENT INSP CTION REPORT Name ` Date - Type of Tygg of Inspection errs+L! '► s outine (/� "" Ct Address Risk ood Se is Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation , Owner HACCP Y/N Temporary Suspect Illness K , Caterer General Complaint q Person in Ch rge(PIC) Time Bed&Breakfast HACCP In: Other (� Inspector Out: �1 Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 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) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ( r` ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities O. Y EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ' ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling -❑7.Conformance with Approved.Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time Asa Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion [] Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ® Embargo ❑ Emergency Closure Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. B=One critical violation and less than 4non-critical violations 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i cal violations. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 30.Other DATE OF RE-INSPECTION: InspZi4gn Print: 31.Dumps screened from public view k�A-�t-k-A(57b Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC,S Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N l* Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Chazge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) * 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* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations I 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and i 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3 2 1602.16 Ice Made From Pntahle 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 Surfaccs of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* E.B cnw 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- * Ratites-165'F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing g' P �Y 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. 5 Receiving/Condition 8. g g 3-003.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* Contamination When 3-403.11(3-301.12 Preventing Continati Wh Tasting* C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* L 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 3-501.14 Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement �) g * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 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. °F. rok TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page; of 1 OFFICE HOURS nnNsrne�e.° PUBLIC 0 MAW STREET DivoON 8:00-9i30A.M. 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mnss. g, MON.-FRI. HYANNIS,MA 02601 No Reference R-Red Item PLEASE PRINT CLEARLY �p 67q• �0 508-862-4644 ' 1p0 MPys - FOOD ESA LISHMENT INSP C ION REPORT Name Date ✓' le of Tyne of Inspection nil Address Risk Food Servi -LevelAA ai n cti Telephone Residential Kitchen Date: Mobile Pre-open ' Owner HACCP Y/N Temporary Suspect Illnes 111 ri Caterer . General Complaint 41 Person in Charge(PIC) a Bed&Breakfast HACCP M Other Inspector I_ .� C- Each violation checked requires an explanation n the narrativ pa e(s)and a citation of specific provision(s)violated. l Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ v Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ o Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ �' " FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives _ a ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures i ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY O ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations O( Critical(C)violations marked must be corrected immediately. (blue&red items) "� Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance, ❑_Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations.and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-cr ical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 no viol ons 30.Other DATE OF RE-INSPECTION: I spe o Si n lur - rint: r 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 Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N LLZd 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 R 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination LL4 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 - PHF Hot and Cold Holding , Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 590.004(F) 7-101.11 Identifying Information-Original Containers 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 P g Separation-Storage* Applicants* 3-302.11(A) Food Protection* 2_0 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* * _ 3-302.15 Washing Fruits and Vegetables 7.202.12 Conditions of Use* 11 Applicant To Report To The Person In Charge * 590.004 * 3-304.11 Food Contact with Equipment and Utensils ( ) Variance Requirements 590.003(G) Reporting by Person in Charge Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(13) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* -REQUIREMENTS FOR - 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 _ Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 8 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.1]A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* eg cr;vc irtrzom 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 3-201.15 Molluscan Shellfish from NSSP Listed 4-703.11 Methods of Sanitization-Hot Water and Stu Chemical* Ratites-165ffi °F 15 sec* ( ( )Stuffing Containing Fish,Meat,Poultry or 590.009 in cater- ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3 401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17, Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g� g g � 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 _ Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbome 3=101.11 Food Safe and Unadulterated* 3AO3.1I(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* 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 1 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S.590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. � p IME r - TOWN OF BARNSTABLE - HEALTH INSPECTOR,s Establishment Name: pakTS Date: Pager of�- ° OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. '200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. n 39 m� HYANNIS, MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD STABLISHMENT INSPE TON REPORT Name ' Date r vpe of I s ection Route Address ` Risk Food Ice -Inspect' n 4/TN i PIN ^ Level Retail Previoy c o Telephone Residential Kitchen Date: Mobile Pre-op io Owner HACCP Y/N Temporary Suspe In Caterer General Comp aint Person in Charge(PIC) Time Bed&Breakfast HACCP - j t Other N f ' Each violatio checked requires an explanati n cn the narrate page(s)and a citation of specific provision(s)violated. .' Violations Related to Foodborne Illness Interventions an "Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ IL Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 690.009(G) ❑ FOOD PROTECTION MANAGEMENT 12.Prevention of Contamination from Hands - i ❑ 1.PIC Assigned/Knowledgeable/Duties 13.Handwash Facilities EMPLOYEE HEALTH ROTECTION FROM CHEMICALS If ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) - ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP n A A ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY j ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories �v , Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations vv Critical C violations marked must be corrected immediately. blue 8�red items �.. ( ) Y ) j Corrective Action Required: No Yes q Non-critical(N)violations must be corrected Immediately or Overall .� �Rating within 90 days as determined b the Board of Health. Voluntary Compliance Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension Y Y ❑ ❑ C N Official Order for Correction: Based on an inspection today,th l ms ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4von-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8non-critical lations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. iolatio to 8 non critical viola' ns 30.Other DATE OF RE-INSPECTION: I t is S natur V n Print: 31.Dumpster screened from public view -�� Permit Posted? _ Y__ _N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI s Signature Pri 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 15 590.004(F) 590.003(C) Responsibility of the Person-in-Charge[0 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 7-102.11 1 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.1 I Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P - - 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Equipment Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* - 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef/crave////zoo/ 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 ofP Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 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 * Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated 3 403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products [5-204.11 03.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 00 oFIKKE - - TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: ' Date: Page: of. ti OFFICE HOURS AR'Ni'sr!e Eo PUBLIC 2 0 MAN STREET 3:30-4:30 P.M.SION : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MON.-FRI. No Reference -R-Red Item PLEASE PRINT CLEARLY HYANNIS, MA 02601 �A ,a3v n 0 � 508-862�644 'EO1A1" . 00 , E T LISHMENT INS-PEJUJON REPORT +� C3 Name Date of Type of Inspection p-j A)/ Operation(s) Routine wilyll Addre Risk Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness aef Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP i In: Other Inspector Out: Each violation C ecked requires dnjexplanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals / FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures n n ❑ 5.Receiving/Condition ❑ 17.Reheating & e ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling . ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(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. I ❑ 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. Equipment 590.005 25.E ui and Utensils (FC-4 B=One critical violation and less than 4non-critical violations q p )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9,non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29:Special Requirements )(590.009 within 10 days of receipt of this order. violation,4 to 8 non-critical vi ati C. = uirements 30.0 her DATE OF RE-INSPECTION: sp ctor's i lure /' rint: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N - #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC s Signature Print: Self Service Wait Service Provided Grease.Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions I.. 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* L 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Chazge Duties - 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F EMPLOYEE HEALTH 3-302.11 A 2 Raw Animal Foods Separated from EachContainers* 590.004(F) ( )O P 7-101.11 Identifying Information-Original 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 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F* Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) _ Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) I Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1112001 4-602.11 Cleaning Frequency of Utensils and Food- Animals-155'F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-0Ol.l1(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency rf cesSanitizationquof Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145*F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 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 t129-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g� g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 PreventingContamination When Tastin * * (Blue Items 23-30) 3-202.15 Package Integrity* g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs -_ following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures I 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1 .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Ir oF.HE ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: P Date: Page: of OFFICE HOURS AR E. PUBLIC 0 MAN STREEETSION - - 3: - :30A.M. :300-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. 0 MON.-FRI. p to ae HYANNIS,MA02601 soa-aszasaa No Reference, R,-Red Item PLEASE PRINT CLEARLY 'FO MAR o FOOD ESTABLISHMENT INSP C ION REPORT Name Date e o Tvoe of Insgection d _ O _ Routi Y Address 1 Risk % ; II ood,Servi e-inspectio" ` Level Retail s o ' Telephone r esidential Kitchen Date: r Mobile Pre-ope ti r Suspect Iln ss Owner HACCP Y/N Temporary Sus P Caterer General Complaint Person in Charge(PIC) T' a Bed&Breakfast HACCP i Other Inspector ut: Each violation checked requires an explanation on the narrative page(,)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and isk Factors Red Items f ( Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ �j FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities i ! EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals 0 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 k _ J ❑ 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) /1 ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP F ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY p Ph 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories LV ^ 7 "Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) ` Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Ratingb 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 B=One critical violation and,less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9-non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violat' ns. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC 7 590.008 9 + _ 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violatio s-C 30.Other DATE OF RE-INSPECTION: In or's ign to ° R - 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N N #Seats Observed Frozen Dessert Machines: Outside Dining Y N C ignature Print: I . Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y Nam'O 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) [Demonstration gnment of Responsibility* 8 Cross-contamination 14 Food or Color Additives j` ' . Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) 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) 2 590.003(C) Responsibility of the Person-in-Charge to Other* 9-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control i 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* ._REQUIREMENTS FOR _ 3-306.14(A)(B)Returned Food and Rrated or of Food 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions � Disposition of Adulterated or Contaminated � ) + Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils an ContactEggs d Food Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009 A - D Violations of Section 590.009 A in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) ( )-�) Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under 2-301.11 Clean Condition-Hands and Arms* the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. i 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition I 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 Commerciall Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 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 590.004(E) Preventingontam Contamination from Employees* Proper Cooling El * 18 6 Tags/Records:Shellstock I P 9 of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 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. f� s Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNWAIDIe. S Paul J.Canniff,D.M.D. e 9. 1 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 658 Issue Date: 12/10/2019 DBA: DUNKIN DONUTS #658 OWNER: CAPE MNGT TEAM, LLC Location of Establishment: 804 MAIN STREET OSTERVILLE, MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G h FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: -THE r, For Office.Use Initials: -` Town of Barnstable ii • - Date Paid i 1 Amt Pd$ k. MAS& . Inspectional Services - ' vG Mass. $ '-- �• °renrap,'�° .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 11/14/19 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Cape Management Team, LLC DBA Dunkin' Donuts ADDRESS OF FOOD ESTABLISHMENT: 792 Main St., Osterville, MA 02655 MAILING ADDRESS(IF DIFFERENT FROM,ABOVE): c/o Couto Management Group, 169 Main St., Stoneham, MA 02180 E-MAIL ADDRESS: office@coutomanagement.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O8 � 420 - 7398 TOTAL NUMBER OF BATHROOMS: 2 WELL WATER:YES NO V ..."(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:�_ SEASONAL: DATES OF OPERATION: / / TO L /_ NUMBER OF SEATS: INSIDE: 0 OUTSIDE: N/A TOTAL: 0 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES....(MONTHLY LAB ANALYSIS REQUIRED) CATERING (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ...(ANNUAL TOBACCO SALES APPLICATION REQUIRED) i *** SEASONAL,MOBILE& NEW FOOD ONLY*** REOUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q\Applieatiou FormsTOODAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT Salvi Couto SOLE OWNER: YES NO D.O.B 3/7/1979 OWNER PHONE# 781-279-0290 ADDRESS 169 Main Street, Stoneham, MA 02180 CORPORATE OWNER:Cape Management Team,LLC FEDERAL ID NO. : 01-0769146 CORPORATE ADDRESS: 169 Main Street, Stoneham, MA 02180 PERSON IN CHARGE OF DAILY OPERATIONS: .. Vitor Freitas List(2) Certified,Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The-Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1.Vitor Freitas 7 / 19 /2024 1, Vitor Freitas 9 / 13 /2024 2, Vonda Brown 3 / 15 /2021 J �y 11 / 14 %2019 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by 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 mai1prior to catering event. You must complete a catering notice found at httv://wwW.toWnofbarnstAble.us/healthdivision/op fications.asy. 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 lst to Dec.31s1 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC ist. Q\Appfication Form TOODAPPREV2018.doc 0{IKEI Town of Barnstable BOARD OF HEALTH . Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. E E John T. Norman F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 a www.townofbarnstablems Permit to Operate a Food Establishment promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections In accordance with regulations y p 305A, 30513, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 658 Issue Date: 12/20/18 DBA: DUNKIN DONUTS #658 OWNER: CAPE MNGT TEAM, LLC ' Location of Establishment: 804 MAIN STREET OSTERVILLE MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G�,� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE ` Restrictions: t FI"E r EQr OfficeInitials: •,' o: Town of Barnstable Date Paid Amt Pd$ ` _ • Inspectional Services 9�'°lEc Check# Public Health Division ,.t Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ' APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 11/17/18 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Cape Management Team, LLC DBA Dunkin' Donuts ADDRESS OF FOOD ESTABLISHMENT: Main St., Osterville, MA 02655 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): c/o Couto Management Group, 169 Main St., Stoneham, MA 02180 E-MAIL ADDRESS: office@coutomanagement.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O8 ) 420 - 7398 TOTAL NUMBER OF BATHROOMS: 2 WELL WATER:YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V _ SEASONAL: DATES OF OPERATION: / L TO NUMBER OF SEATS: INSIDE: 0 OUTSIDE: N/A TOTAL: 0 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 W.AITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES... (MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE& NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:4lpplication Forms'kFOODAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT Salvi Couto SOLE OWNER: YES ED D.O.B 3/7/1979 OWNER PHONE# 781-279-0290 ADDRESS 169 Main Street, Stoneham, MA 02180 CORPORATE OWNER:Cape Management Team,LLC FEDERAL ID NO. : 01-0769146 CORPORATE ADDRESS: 169 Main Street, Stoneham, MA 02180 PERSON IN CHARGE OF DAILY OPERATIONS: Karen Wass 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 ler en Awareness Expiration Date I.-Karen Wass 4 / 25 /2023 1. Karen Wass 7 / 13 /2023 2.Lauren Christiansen 2 / 15 /2023 11 / 17 /2018 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7),days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townotbarnstable.us/healthdivision/appli0tions.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January Ist to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q:1Application Forms\FOODAPPREV2018.doc I TOWN OF BARNSTABt LOCATION yYJa '5 -SEWAGE # VILLAG ASSESSOR'S MAP & LOT I INSTALLER'S NAME&PHONE NO. O-z q3,2-0S 3a SEPTIC TANK CAPACITY ASUU LEACHING FACILrrY: (type) �y-S�y�a.�,mil,�" -�"" (size) NO. OF BEDROOMS BUILDER OR OWNER CI PERMITDATE: © COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 170 Vz JW, Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) '46A.2- Feet Edge of Wetland and Leaching Facility(If any wetlands exist , within 300 feet of leaching facility) 60-U- Feet Furnished by A ej A- 0 10 o C a- 0z -12 0 13- F_ _ q2� -�-- p O O O T -asoo ( l y-soo�uP,Fw,�d.�,,7 1— 1 0 0 0 S c'L(-- T""'" 1- n r� �IJrJ r3o Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppiication for Oiopooal *pgtem Conotruction Permit Application for a Permit to Construct( '-)'Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner&kame,Address id Tel.No. ( ry A JL�h t ti Conn rc 5 T Assessor'sMap/Parcel "'� I� 01 sS Ins s Name,Address,and Tel.No. De er's Name,Address and Tel No. �.�� (� Ol,�►- C.0 � rn�s-k c 4 1 G s 1,n r �4 I/ 4 t4 rd � �4 Y1'1 -, 7 I t3 Os v t(w. wt. co a-G 4 5 Mgt, Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Buildin ` CeNo.of Persons Showers( ) Cafeteria( ) x Other Fixtures Design Flow Q_C-o V-304; gallons per day. Calculated daily flow I 0G2) gallons. i Plan Date Number of sheets Revision Date Title Size of Septic Tank 'S 7CX n Type of S.A.S. SM Leo_ k Description of Soil 1 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: raO�JE CeFcC- Agreement: ��� et,15TA The undersigned agrees to ensure the construction and maintenance of the afore descrAedPon site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss a by this Beard ealth. Si gne j' i Date Application Approved by Date Application Disapproved or the following reaso Permit No. Date Issued i' Entered in computer: t THE COMMONWEALT O:F MASSACHUSETTS ti p Yes ,PUBLIC HEALTH DIVISION-TOWN OFBARNSTABLEs;MASSACHUSETTS . 0(ppYication for �DtOozal *proem Con!6truction Permit 4 Application for a Permit to Construct(4epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components • Location Address or Lot No. —(9 \"Yla-A n Owner 5 '�vame,Address �. � f'Y)j� (�d Tel.No. 11 Assessor's Map/Parcel "�"jG m0.I,, � S�V 1 17 U� 5 S Install s tN�ame,Address,and Tel.No. �t De er's Name,Address and Tel.No. X� C fY1� 5 �'1G tI G 5 l`jn G 24 V- j4 � _ c.)a G 4 5 S5 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Build'n �eNo.of Persons Showers( ) Cafeteria( ) Other Fixtures �P Sa•�-^-oa lG©� U�o Design Flow v�-C� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets_ Revision Date Title Size of Septic Tank �--5GY.:) O n �, Type of S.A.S. —CiDO C_e a.ck l n 1 , Description of Soil 4 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: So? Agreement: r��Oo��FR VT E� The undersigned agrees to ensure the construction and maintenance of the,afor_d"a%�b6A i aw ge disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to_piace,thegsty��n in operation until a Certifi- cate of Compliance has been iss ed by this B and . ealth. �� O I''!! Signe Date Application Approved by, b Date Application Disapproved or the following reason Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructe O,Upgraded( ) trilGL�t= t t�afi,1;�T � , Abandoned( )by at ha b bnstructed in accordance with the progo' ns off Title 5 and the for Disposal System Construction Permit No. ted Installer ��, .il IC�I 1 t Designer The issuance of this permit shall not be construed as a guarantee that the syster�i ill f nc��tiolln as es gne . Date 11141 H 001 Inspector a-16i Tr - ----- �ro No. ----------------------------- . , qq Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE1.MASSACHUSETTS ntgogaf Ior �,a�ac 0, Permission is hereby r o Construc (ap �U e �pgra e( . ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cos cti n nu b completed within three years of the date of t e t. Date: Approved by ! NW 26-2001 09 : 11 AM DANIEL JOHNSON 50e 420 9316 P. 02 DOMESTIC SEPTIC DESIGN, INC. 804 MAIN STREET,SUITE R OSTERVILLE,MA 02655 Phone:(508)420-1904 Fax: (508)420-9316 November 26, 2001 Board of Health Town Hall 367 Main Street Hyannis, MA 02601 RE: Septic System Installation 792 Main Street, osterville Dear Board: The subsurface sewage disposal system installed at the above referenced site has been installed according to the approved septic system design. If you have any questions, please do not hesitate to call. Sincerely yoVson, Q Daniel Jo .S. , C.S.S. • No. ' Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes fi/ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Zipplication for Wood *pgtem Con.5trurtton Permit Application for a Permit to Construct( )Repair( )Upgrade(✓)Abandon( ) ❑Complete System MIIndividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel � Installer's Name,Address,and Tel.No. ' V Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building A2,t1O01�3� 'No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) G �?'i� ' � �. c Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has beerVisNed b is Bo d o ealth. Signe ' Date 6—A//° Application Approved by PI _ Date Application Disapproved for the following reasons Permit No. Date Issued Fee`--' 111 x THE COMMONWEALTH OF MASSACHUSETTS -r= Entered in computer: V _.. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 0[ppYicat on for Digpont *pztem Construction Permit Application for a Permit to Construct(4-)Repair( )Upgrade(V)Abandon( ) O Complete System [Individual Components 9t Location Address or Lot No. n,� Owner's Name,Address and Tel.NO./ _ 6l/ ,t�u�A/// ��eaIV Assessor's Map/Parcel �v O��p rv�//Lp � � Installer's Name,Address,and Tel.No. / ` Designer's Name,Address and Tel.No. �OGO//-f Cdr/5�`, j Q-hG a-5le/V/ Type of Building: % Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building AP 1-10 S1`4R°No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date ' Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) _Z:,e 5,�1� ;®®� �1�� g /Z4o- e Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been ' ed b t is Bo of ealth. / p Signs Y Date s��/�/ Application Approved by f P �� {� 1 Date 'Application Disapproved for the following reasons Permit No. 9 CE21--Rf2 Date Issued ———————— —-———— THE COMMONWEALTH OF MASSACHUSETTS 7" BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( ) Upgraded Abandoned( )by Z31" at D"S h,01-1,1 e— has been-constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Na. OO/l+�,f-s!lated Installer Designer The Date Ins issuanc, f this� t shotttrued as a guaranteethat th�ny 'e ill functior�,as desi ned� ,�� ,,......._ -- � -- No. tN � .��1' ----------------- 1� / j Fee v: THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS MisSpoga[ 6p5tem Construction Permit Permission is hereby granted to Construct( )�epair( )Upgrade( f/"Abandon( ) System located at T a L/ X4 e J ® 5 -'e xy/Ile and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction 7st be ompleted within three years of the date of fhT� ': Date: Approved by _ /I ' v v t r 1 8 { nra a',ri vmlmm"Mm�nl- R,;M l M1q . 2-IN'M - �h ay^a4y.(f°' _zz all 'x'`h5 t� v T s Y 77t-� '..i a.,.A,r 1 's t- ,fir .,�' v �., a 4{s�'yo-a_ -a.,�,. tr�u•-. Er•.o r� l TOWN OF,BAMSTABLE LOCATION SEWAGE # t. VILLAGE f T��. L�� fa v� ASSESSOR S MAP & LOT Ze IIVSTALLER'S:N PHONE NO._�P/LToCD Fti SEPTIC.TANK.CAPACITY SOD 0 4'4t" LEACHING FACILITY::.(type ; ).. (size) BMDER OR OWE)2 F -114 PERMITDATE � /` q C : _ OMPLIANCE Separauon•Distance Between the:. r „ MaiumumAd�usteii Groundwater:Table.and$otom'b Leaclung''PaciLty_ Feet Private Water Supply Wel'1 and Leaching Facilaty.;:.(If any-.wells`exist on site or wtthm 200 feet of IecFung fact ltty) ;. Feet Ec#ge of'Weaand and etching Facib f 'ty(IF any weiIands east , within 300 feeti' leaching fach ) 1 eet ,r Furrushecl:by•_ ¢ � ? "55 t tY a. r a a, ..: .. - r 1 • 1 u, 0 a � r � I 1 _ } TOWN OF BARNS 1 ABLE LOCATION -7A,1, IYl a j p 6 k 11 x Y.n M SEWAGE # VELLAGED5 ASSESSOR'S MAP&LOT INSTALLER'S.NAME&PHONE NO.Stf, ���^^�h Q�' `—ins 775-3338' SEPTIC TANK CAPACITY l SC LEACHING FACILITY: (type) y`3342 er—VQ5 g14, (size) i NO.OF BEDROOMS BUILDER OR.OWNER PERMTTDA'TE:. COMPLIANCE DATE: .wj,?N6 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water.Supply Well and Leaching Facility (If any wells exist on site or:within 200 feet of leaching facility) Feet Edge of Wetland.and Leaching Facility(If any wetlands exist within 300 feet of If leaching facility) Feet Furnished by 4YI OM�::2 i � o� SO b m y l , N ❑ CB/bN alloy square South Condo W.n 100.89' I a CBpN LEGEND: 0 9 a v f Total Area 45,OB2tSF m Sewer Manhole p ® Catch Basin O O O Cal:h Basin (round) wa rms Q �i sav<r1�tM Q V® a� ASSESSORS REF.: -0 Guy d Q Map 117 Parcels 176,82, & 83 O Utflity Pole °°°'•are„r sign ax ®' OVERLAY DISTRICT: # Light Post t.... en on. 0 Monitaring Well O a AP — Aquifer Protection District & m Gas Gate — lety w/Y GP — Groundwater Protection District m Water Gate m, „ Garage Pipe ' Shown Plan Entitled O Vent R � d® / 'Revised Groundwater Protection ��""''L%� ® - / Overlay Districts" — April, 1993 ?'ft� Deciduous Tree *`_0 �441133'' ° !a FLOOD ZONE: Coniferous Tree ® N ZONE. ':;® n . o nit'Panel O New Shrub m0 0 OO16D New Tree -_-• / -ray-. CoIs mmunity o. Setbacks." New July 2, 1992 N Side 15' 5-s —oa—Overhead Wires ;'a: .......� �;....:� Rear 15' ig OWNER: Dunhill Companies, LTD 0 ® =(nz 776 Main Street u^ ro f Osterville, MA 02655 Q N / f7V2 ®2 REFERENCES: / aly W/F j aaaeA=atae Deed Book 12530/78 stir 12451/16 wn. Utz /f7eeeao /ew i 2-112 aty W/r / y - omce cor.,alox/ AV Q sty W/F aWW � ayn. t th OMca i 'moo or CI a0 E �ylN Of 80.50' 21.74 LS5370' 4- @� FUCKARD N 7470'10"W 101.6 — .L=47.77' # i 0 r- a �G 701.46 ♦ 87 If :!a'b°°e N _ ® LHEUREUX e .00, 2s0o • t«., 0 I 3'"J' 9FGlSTER�0 t Main (55'Wlde-Public Way) Street eet # Title:Existing-Conditions Conditions Plan of Land r p red For: -visions: scondltrona nform sa Scale: 9> ape&� P :Dunhill Companies, LTD .ae obtaned by an an na nd y '*".xca^c5_...`^ '�" P ')made an September 14tt2001 atua Date: �s p r o at 7��"8e�v�4"Main•Street 7 Pa ker Rcod 776 Main Street 15/SEP/Ol Ostervllle,MA-02655 r ay ' .r._c:: :T r'-":. Osterville, MA 02655 e� wg: Barnet ble (OsterRle) MASS (50e)420-3994(506)420 J995 fax C336-1pl l cgp...rv°oopeoad.net 2VI S��N Cf� 71 r+ G1 rvNv�cr��" QA T� a :� 52 a L S In 13 i,j�N✓� .J _'.l y2aNc:o ' � •, Y C.rwe, 4s O LL �a �r q � Y - -- •��Ttl iL- C�N Qt••- r - - 1 1 Q6 P r 1000 GALLON GREASE TRAP MODEL: TK•1000H (SHEA CONCRETE) (OR EQUIVALENT) FINISHED GRADE = 24"DIA _ 24"DIA. -9"(MIN) 24"DIA 3" 3 H.20 24"DIAMETER 4"SCH 40 RISER COVER TO BE 4"SCH 4C 27' FLOW LINE CONSTRUCTED TO GRADE (COVER TO BE MOUNDED GREASE TRAP TO MEE SLIGHTLY HIGHER THAN THE 4'LIQUID LEVEL . REQUIREMENTS OF MR 15.226 FOR G SUROUNDING GRADE) 310 OVER INLET AND OUTLET ACCESS 10 ER TIGHTNESS, COVERS. 4"SCH 40 TEES 12" ETC. ALL WALL SLEEVES/GASKETS SHALL BE CAST IN PLACE OR o 6" (MIN.) �' o a MECHANICALLY INSERTED AT FACTORY. �= c� a a COMPACTED CRUSHED STONE STABLE LEVEL BASE 24"RISERS TO BE WATERTIGHT AND COVERS TO t=314"DIA. BE CHILDPROOF. GREASE TRAP DIMENSIONS: "0 S. 8 LX5'10"HX5 2 W Dom--stic Septic d esign, Inc. ,,,one:508-420-1904 Fax:50'�420-9316 804 Main Street,Suite B,Osterville,MA 02655 Daniel B.Johnson,R.S.,C.S.E. President Certified Title V Inspector Septic Designs Registered Sanitarian Title V Inspections Certified Soil Evaluator Soil/Percolation Tests Over 15 Years Experience ------------ - - i y APPLICATION FOR PERCOLATION TEST AND OBSERVATION P Tb gQ / NO. LOCATION DATE VILLAGE FEE TELEPHONE NO. � - APPLICANT (Non-refundable) ADDRESS TE E NO. '`_ • ENGINEER - DATE SCHEDULED '�' pp i s signature • • • • • • • • • • • • o • o • o O o 0 0 0 • o o • • • e e o •o o• • • •\ •.�• • • • • • • • • • • • o o e o • • • • • • . . . . . . . . . . . . . . . s ASSESSOR'S �tAP LOT NO: S� T c / n_r,I�7ISION NAME IV ATE .-U ENGINEER ' �- _ _• EXPANSION AREA: YES NO..�..,�.�. �-- ,� • � BOARD OF HEALTf TOWN WATER ,PRIVATE WELL_ EXCAVATOR dimensions of lot, exact .location of test holes and SKETCH: (Street name,etc. , to test holes) percolation tests, locate wetlands in proximity NOTES: ,�`"'�'S Ae= T,. 'EK, 5z�i t G LT p /K2o ��t✓L i Tl 10 A PERCOLATION RATE: ELEVATION: TEST HOLE N0: ELEVATION• TEST HOLE NO: 1 1 2 2 3R 3 4 4 5 R 5 6 6 . 7 7 S S e 9 9 ~C ` 10 10 11 11 12 12 13 13 16fo 14 14 0 vUA"7&te-, 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE LEACHING TRENCHLEACHING E§ „ HING PITS UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SjjOW NUMBER ASSIGNED ON PEOC TEST BOARD PP ICA HEALTH TION ORIGINAL: N ENXIBETY BY P AND TURNED T COMPLETED r t COPY: RETAINED BY APPLICANT f 7 S yS TES Sf F j-,Sao GAt:con/ PRoPuIE�. log-SSF '�or-F�cL� use, o PO ExtSr��rG E Ark p,�oro�E� r,�c Dh1Ly4oJCr�� ��}PPitoJE�� D-B oX ' hcr�nc E (oFF,c�� _ /SQ �s� �ovosA. S�Pr/� rsrrlK I { RcrvAL To 7-A4. b�4 I4Y 4=401►. 36.�6•pD Pit-°FvSro I IJ Gfo/SL-'r!i Tc /D SE..�rs; = /S-O (TPv y`sctt9 0 s o, - �}cruA4 ror.�c ow SSG.?GPo Pita lSi;� SEA FoR. ���1 = /SO GPQ , z kt>':eVtj �/Cof�S6a. roo.o �a�t.or� v pAc�ry TO BE Co.JTi .tlrt="sT E�EhSE T �P r SS RS r��oo•'� cL� ..��� Upor;F E�-t47'lN(r PdBL�L � �� t_ Qr, ozoP.0sE-0 F" p - �t Tl4. � - ��� y q'ScH4� 6`) 7'hFE ��f}R-a0 Sc.14e°�oALE OF EL6Y4-r+iaNJ Ie-�tSr,rtG 11vq, o.ir &ovN9�4TtON I � 0.0, LCI 0 Fi F a p (. f,v�j, � S C p 7-1 L (G`► t S tl 6- rA I �ui1.�71P y.► CE��SrIRP��. x� — _ _ � trite ��ttsrir�tG gLf'•FTto� or �..rc..:;r se'Prc� A- w�t�E M•�t�tr.4-dnt� rlfes p,�-oPos�a v+�rr�+t^%'vrK �e.��r1 fp�wnt any TI*rc (,•� View, 't OF Q SEir A-7-r.+ch4E0 bd'lf/L FoK (ILL4SE TA,}P si PT(L 5ySiEM DEil6-Al - l'-1 001 ric+..ric��/ ,4 M,4)N srR.Et T O S7-ERJrccE lot 46' 12s', oc ° .. QIieTEQ4�'� q 1 z� I `�- o' . riAir� sr;�6 Er .4�ITq sc� c.� . :-aV,�JH,cL oEv, 4 1r.Egccs7-,+7-E 776 MhIH sr, oS7 v;uC �� v�Le'PRlct'p Qy z?sD,/MG , 63 PrhM4 0C'iS U,) 0Sre9VILLE I E�ISr�tilr Vdrage SWSouN tl► tondomfnNms ° d y S 73 7'10 sr.am*rw.:, r: °- Cl.�c4.d>TJ ,C.r»41c�O�FrGL�j 29 '71" � M:3 CB/tH e d f .82 x C_Lg d LEGEND: Total Area 45,082±SF o ® S7 C) -'r (996 Sr �t-or�►L� ® Sewer Manhole o -cam p ® Catch Basin o.+i.a stm:P■,�, V® Catch Basin (round) 0. k p��,w■1 0 0 ® L.- ASSESSORS REF.: O CB/OH MOW Am- -0. Guy O `> 0 Map 117 Parcels 176,82, & 83 o Utility Pole 0 - '■F OVERLAY DISTRICT. -e- Sign en Dfw .'-, Light Post &PsN,p '® an on. 0 Monitoring Well y AP - Aquifer Protection District & IN Gas Gate L■■• L OA( wa 1Garage GP - Groundwater Protection District D Water Gate s ® -- a zr�Nw------ J OJO ���K \� O Vent Pipe � Q n / As Shown on Plan Entitled o U , / "Revised Groundwater Protection rCV_kDeciduous Tree `t ® - Overlay Districts" - April, 1993 Vt 43 N Q .eod a O g Slat p .� � ZONE: Coniferous Tree "d' i FLOOD ZONE: .— 1 • Zone C BA C,3 IST New Shrub /NG Community Panel No. Setbacks: .. q � A.aP � ': k Y ' #250001 0016D Front 30' New Tree P yt �-� v 7W am Overhead Wires :• �SQpGq(� July 2, 1992 Side 15 � � •®�: '•,- .. a, u � � 6 q Rear 15' � 77�'P...T�� ,t� � ��, OWNER: A� u 91. 14; Dunhill Companies, LTD O ot*,2 775 Main Street Ostervill e, MA 02655 ta 1792 o � REFERENCES: rficy W " / z St w/F P2 4USE n,,■ / oe/treran x 56 L Zc 1© K� Deed Book 12530/78 cmm. . �oZ G e" 12451/16 2 sty Y//F Olfice/Retad LLLJJ! 1804 -- 2-1/2 sty w/> P7� r1 orrr3 camplax/ J aiVQ0 7br o r= eAj p Cuu Apron (fs LSTa) _`/6c ......�cns,,,1,d• nnP,L'/1J ��? �t�Srisv(,• �/OE err, �.+� 7-ID c�,�.,rt,�8--J) i...... 2 sty W/r ` 6v Sim. / i 3 Car y Office - sD i......: i j limp - � o f Lam ................ /1-t�sEli2vG At 7 C � 3� a r C11-Ate, �NtA Ut 41 9 s�C zW! 9-e:)&L- s RICHARD 80.50 . s L5370 m R. N 74+0'10" W 101.64 L=47.77' t} t° 4� `® ®R'"'B` coo LHEUREUX v+ C-c wea - 107:46 faux,, elm a, � � N 870'40" P{o.34312 cr ay ca:" --=w 91 AD O L Mhos a,n (55' ode - Public Way) Streog C ,,. N.2at Prepared For: Notes Revisions: Scale: Sheet � Title. _ Existing Conditions Plan of Land (; E� +�� tff Companies, LTD . i') The existing conditions Information shown N _ was obtained by an on they round survey 1" 30 .: , �w ■ R mode on September 14, 200E Date: o ��- ��' `®�� '6➢!/al7n � ��� Dunhill mpg ie- n Str et. 02655 1 - 7 Parker. 776 Main e 15/SEP/01 r Osferville •hfA Osterville, MA 02655 - Ba' nm_ble (Osterville) .�a$S (508)420-3994 (508)420 39J5 fdx DWg. C336_1pl capesurvftapecoa.m t C0 Otlf? // 7-- C-1 Y(- ttk A(1� . 26 -10 3/8 _ -70.5B 70.56 _ 9l l 41 tlEIZ -yZl "24 do TABLE 96 112 SlZ FRZ. B KE Y B Et � t2oF _ 9 AS S 12oF ° tlsla Hand VDU--'EXISTING EXISTING inter ESPRES O 1 and Oasis Sink FMB SANDWICH STATION BACK ROOM cV WORK) n.Y 46"DMB Needs 172"Land 26"H (NO YY ORK) ENO c0 5'-8" 9'-6" T-O"STATION 120E >NNIS lOd „9—r9 POS STATION COFFEE STATION ICg Hand panel Sink ICE 201A 102A sandwich T O O O o station � � � � � � "655' n Support � � - Order Pr o o � N ' 1 s N TE/HAND-OFF area "291" EXISTING RESTROOM ,� 3'-011 O m o O -HALL N � o m Z U), Z . _n Q � cn T26-10 3/8" EXISTING Lux RESTROO :CASH s , O = PRINTER (optional) 5' 10' VIDEO DISPLAY UNIT I ,I NOTES I�I S 1. THE LOCATION OF EXISTING UTILITIES AND SEWER SYSTEMS WERE OBTAINED FROM A s PROJECT PARKING DATA PLAN PREPARED FOR L COMPANIES, LTD, 776 MAIN STREET, OSTERVILLE, MA 02655 10 LOCATION REQUIRED: BY CAPESURV, 7 PARKER ER RO ROAD, OSTERVILLE, MA. 10 " BUILDING AT 804 MAIN STREET 2. THE LOCATION OF BUILDINGS,, PAVEMENT AND PROPERTY LINE INFORMATION IS TAKEN O CONSULTING PROCHBBIONAL CNGINCER9 UNITS A, B & C TOTAL AREA 9,860 S.F. OF OFFICE SPACE FROM A PLAN PREPARED FOR DUNHILL DEVELOPMENT CO. LTD. 776 MAIN STREET, Oi ANBERRYHIGHWAY,UNIT5B, /OSTERVILLE, MA 02655 BY CAPESURV 7 PARKER ROAD, OSTERVILLE, MA. DATED 07 20 2000. Bay a 3119CR PARKING = 9,860 S.F./300 S.F/SPACE. 33 SPACES / su t Fl WAREHAM MA025389 • BUILDING AT 792 MAIN STREET 3. PROPOSED MODIFICATIONS SHOWN ON THE PLANS ARE ASSOCIATED WITH THE CONVERSION ° d „ R TEL•(508)759-6260 FA&(508)759.6230 FIRST FLOOR : CHRISTY'S C-STORE (RETAIL) 1,400 S.F. 1,400 S.F./200 S.F. = 7 SPACES OF EXISTING FIRST FLOOR RESTAURANT TO CONVENIENCE STORE WITH DUNKIN DONUTS R O� p a NO SEATING AT 792 MAIN STREET, OSTERVILLE MA. �o a www.cboubahgroup.com TAKE-OUT WITH NO DRIVE THRU DUNKIN DONUTS 4/5 EMPLOYEES, 1 SPACE PER 2 EMPLOYEES = 2 SPACES / o TAKE-OUT (DUNKIN DONUTS) 5 PER TAKE OUT AREA = 5 SPACES SEPARATE ENTERPRISE = 2 SPACES 4. FLOOR MODIFICATIONS ARE TO ACCOMMODATE NEW CONVENIENCE STORE WITH DUNKIN Project: SECOND FLOOR OFFICE AREA: 1,000 S.F. 1,000 S.F./300 S.F. = 3 SPACES DONUTS AS SHOWN ON NEW FLOOR LAYOUT (SHEET #2). a PROPOSED MODIFICATIONS : 5. THERE WILL NE NO CHANGES TO BUILDING EXTERIOR FROM PROPOSED MODIFICATIONS. AT TOTAL PARKING REQUIRED = 52 SPACES LOCUS MAP 792&804 MAIN STREET 6. PROPOSED MODIFICATIONS ARE SUBJECT TO THE INSPECTION AND APPROVAL OF THE NOT TO SCALE OSTERVILLE TOTAL PARKING PROVIDED = 52 SPACES LOCAL BUILDING INSPECTORS IN COMPLIANCE WITH THE APPLICABLE BUILDING CODES. MA 02655 LEGEND i Prepared For. t SYMBOL DESCRIPTION / \ I CHRISTY'S OF CAPECOD,LLC EXIST. CONTOUR 105 PLEASANT STREET TOTAL AREA -�PROpri?rr lNf S? PROP. CONTOUR HYANNIS,MA 02601 45,082 +/- S.F. rx;�' \ llr40 EXISTING SPOT GRADE PROPOSED SPOT GRADE CRUS: PROPERTY LINE P!1RKNG,1 NE.P qRR! � SETBACK LINE / FIELD STONE WALL EXIST. RETAINING WALL — —S— — EXIST. SEWER LINE S— PROP. SEWER LINE 'p —w— — EXIST. WATER LINE W PROP. WATER LINE WGlyf S?R,=fS/ — EXIST. ELECTRIC LINE - � —E— PROP. ELECTRIC LINE —a— — EXIST. GAS LINE U.P —G— PROP. GAS LINE fie rIlk —7— — EXIST. TELEPHONE LINE Issue Date:620 —T— PROP. TELEPHONE LINE Revisions —Omr— — EXIST. OVERHEAD WIRE No. Date Description 804 MAIN STREET %mae� i / /�s/ / '2 —OHW— PROP. OVERHEAD WIRE 1 8/01M6 Revised Parking Data&Notes i E+' r-7 1 ® CB EXIST. CATCH BASIN L L= / °' 0 CB PROP. CATCH BASIN / a / S 18' •' Q OMH EXIST. DRAIN MANHOLE / • OJ/ 40 - `.,� \ (TYp) /i is *DMH PROP. DRAIN MANHOLE m p sw EXIST. SEWER MANHOLE Project Number:06-167 r-r 10SMH PROP. SEWER MANHOLE y onp �(Ll/1 O EdlH EXIST. ELECTRIC MANHOLE Scale:1"=20' i L J / '- %>'m EMH PROP. ELECTRIC MANHOLE Designed By: /.'•; _—J < Drawn RAA Checked HC WON A'LIP EXIST..UTILITY POLE BY: BY: LANDSCAPE AREA \ apy 10,UP PROP. UTILITY POLE Sheet Tide: pp LP EXIST. LIGHT POLE PROP E'�,*ay9 CRUSHED STONE AREA E3G LP PROP. LIGHT POLE PARKING LAYOUT PLAN \fRIY GN EXIST. GAS PUMPS f , % CONCRETE AREA O O PROP. GAS PUMPS 1 TREE GRAPHIC SCALE \O� �" 3 EXISTING NUMBER OF ssl Tom- �QI� ,":; �,j :..,•.:..�- .._i PARKING SPACES �y EXIST. EDGE OF PAVEMENT Il0,6, J' � PROP. EDGE OF PAVEMENT 0 10 20 40 BO _pVB� / ' ' �� ' _roro CUT & MATCH PAVEMENT EXIST. SIGN I p (SCALE IN FEET) T�� /� rr�ey�� 44�� 1 20' ryf 1 011..i d� J i PROP. SIGN ✓.., �;1� ctn vzzz CO�a.,� ✓vl 3' 13 SB EXIST. GRANITE BOUND Gy ,�(i r44 Sheet Number. 1 OF 2 a SB PROP. GRANITE BOUND O CB EXIST. CONCRETE BOUND L7 CB PROP. CONCRETE BOUND 1 y ■ R.LH.B. R.I. HIGHWAY BOUND i t i GENERAL NOTES: j COMPRESSOR ❑ ,,����''AD.SMITH C E G 4FUSN93A45 1. IT SHALL BE THE CONTRACTOR'S SOLE RESPONSIBILITY TO OBTAIN ANY AND ALL PERMITS REQUIRED BY THE STATE OF MASSAGHUSETTS AND THE TOWN OF OSTERVILLE 5 DOOR WALK-IN COOLER Gas PRIOR TO COMMENCING ANY WORK CON-ING PROCESSIONAL ENr.IN EC RB �® O 36 BA KE _ "A"� TURBO ®� 60•FILLER 2 s 2'•3' 0 FOO THEPSTATE AND MODIFICATIONS BUILDING CAND FIRETCODESALL CONFORM TO THE REQUIREMENTS OF 119CRANBERRYHI�2AnYg[J]VIT 2. I 35B, SINK TABLE N CHEF S DONUTS B B TS OEM 0 CUTTING BOARD - - 2'.5' 3. THE C THE I r--� BA ELS E CONTRACTOR SHALL VERIFY ALL DIMENSIONS AND CONDITIONS ON E JOB SITE. TEL•(508)759-6260 FAX:(508)759.6230 1~ '- SLICER J/'� TAL RACK DISCREPANCIES SHALL BE BROUGHT TO THE ATTENTION OF THE ENGINEER BEFORE ;....._........... :................_ :_.............-., ;.................. :.........._.....I � 9 www.c6oubahgtroup.com 34•FILLER SANDN7CH STATION PROCEEDING WITH THE PORTION OF THE WORK. SERVING AREA W/DELFIELD UNDERPREPARATION AREA $zo ^ (DUNKIN DONUTS) 3•_0• �� R� Project: BEV.CTR. 4. DETAILS NOT SPECIFICALLY SHOWN SHALL BE SIMILAR TO THOSE FOR MOST NEARLY ! CUSTOM e'-6•COFFEE w/ICE CADDY W/UCR SIMILAR CONDITION AS DETERMINED BY THE ENGINEER W ODCM APPROVAL COOLATTA 5'-6•POT SINK PROPOSED MODIFICATIONS ;Q 5'-B CASH 000 ® ® ro 342 sow 5. THE CONTRACTOR SHALL SHORE,BRACE,SHEET PILE OR OTHERWISE SUPPORT THE AT STRUCTURE AS REQ.TO MAINTAIN STRUCTURAL INTEGRITY AT ALL TIMES.SHORING DESIGN 792&804 MAIN STREET sPR SHALL BE PROVIDED BY THE GENERAL CONTRACTOR © ® ® WO / OSTERV I F. CBTP DISPLAY CUSTOM 14• / \ O 6. HEADERS SHALL BE PLACED ACROSS TOP OF SHORING POSTS AND SHALL BE TIGHT MA 02655 SALES DROP 1 2•FOR ICB FILLER BY G.C. BR ,l V AGAINST UNDERSIDE OF STRUCTURE ABOVE. 0 I N 10 AREA SALES SEATS) E TS 1- ` -1. SHORING SHALL BEAR ON SLEEPERS TO PREVENT DAMAGE TO STRUCTURE BELOW. Prepared For. m / S.TEMPORARY SHORES SHALL BE DESIGNED,ERECTED,SUPPORTED,BRACED AND CHRISTY'S OF CAPECOD,LLC i MAINTAINED BY THE CONTRACTOR TO SUPPORT SAFELY ALL DEAD LOADS PRESENTLY 105 PLEASANT STREET u, CARRIED BY THE STRUCTURAL WORK BEING SHORED,AND ANY CONSTRUCTION LIVE LOADS. e HYANNIS,MA 02601 9.NEW STRUCTURAL SYSTEMS SHALL BE COMPLETELY INSTALLED AND CAPABLE OF T 3,-0„ g_5 BR ` SUPPORTING DESIGN LOADS BEFORE SHORES ARE REMOVED.SHORES SHALL BE RELEASED F-711 GRADUALLY. 10. ALL ELECTRICAL AND PLUMBING TRADE WORKS MUST BE COORDINATED WITH / STRUCTURAL WORK PRIOR TO CONSTRUCTION,ANY DISCREPANCY SHALL BE REPORTED TO �q THE GENERAL CONTRACTOR IMMEDIATELY. II. ELECTRICAL AND PLUMBING WORK SHALL BE IN ACCORDANCE WITH THE GOVERNING CODES,REGULATIONS AND ORDINANCES. THESE REQUIREMENTS ARE MINIMUM CRITERIA AND 9 Ea FIENO REDUCTIONS IN STANDARDS PERMITTED BY CODES WILL BE ALLOWED. i+tZE CASHIER 0 50'-9" r PROPOSED FLOPIR LAYOUT / -0 Issue Dale:6l20/06 REMOVE EXISTMG �® Q 0 Revisions EMRIING RRE ALARM LEGEND DECORATIVE WALL Fd� No. Date Description 1 8/01/061 Revised Notes Fr-A-r_`­P1 FIRE ALARM PANEL © FULL STATION BLOCK EXISTING DOOR TO EXISTING REMA M SINKS M ACCOMODATE DUNKIN DONUTS TO QH • HEAT DETECTOR(CEILNG BELOW) PROVIDE A FIRE ALARM SYSTEM TO AREA(PER PROPOSED FLOOR QN • HEAT DETECTOR(ABOVE CEILING) COMPLY WITH THE MA FIRE SAFETY LAYOUT) T O IC.O '-6•POT SINK 08 SMOKE DETECTOR CODE 4 THE REQUIREMENTS OF THE REMOVE AND DISPOSE v LOCAL SUPERINTENDENT OF FIRE ALARM - EXISTING SINKS Project Number:06-167 0. HORN STROBE UNIT REQUIREMENTS. 3 ®• STROBE ONLY UNIT K KNOX BOX l / \ ;�� Scale:1/4"=1'-0" REMOVE � 1 By: �• EMERGENCY LIGHTR4G EXISTING D Designed EXI9TING GOLUMN9 BR TO REMAIN REMOVE AND DISPOSE1 Drawn W RAA Checked By HC ®' EXIT SIGN 0 { EXISTING WALL ©• EXTERIOR LIGHTING m .t EXISTING COLUMN Sheet Title: S Ib DRY ABC EXTINGUISHER TO REMAINEXISTING&PROPOSED FLOOR LAYOUT NOTES REM BREXIS I.PROPOSED MODIFICATIONS SHOWN ON THE PLANS ARE ASSOCIATED WITH THE CONVERSION EXISTING DECORATIVE REMOVE AND DISPOSE OF EXISTING FIRST FLOOR RESTAURANT TO CONVENIENCE STORE WITH DUNKIN DONUTS WALL 7o REMAIN EXISTING COUNTER / TAKE-OUT WITH NO DRIVE THRU/NO SEATING AT�92 MAIN STREET,OSTERVILLE MA. T OF �', 2. FLOOR MODIFICATIONS ARE TO ACCOMMODATE NEW CONVENIENCE STORE WITH DUNKINa ." DONUTS AS SHOWN ON NEW FLOOR LAYOUT. 4•rjuua . 3.THERE WILL NE NO CHANGES TO BUILDING EXTERIOR FROM PROPOSED MODIFICATIONS. O 4.PROPOSED MODIFICATIONS ARE SUBJECT TO THE INSPECTION AND APPROVAL OF THE aF3 LOCAL BUILDING INSPECTORS IN COMPLIANCE WITH THE APPLICABLE BUILDING CODES. 1 W Sheet Number. 2 OF 2 EXISTING FLOOR LAYOUT ��`� I„ O NOTES PROJECT CHOUBAH ENGINEERING GROUP, P.C. 19• LOCATION � !� 1 . THE LOCATION OF EXISTING UTILITIES AND SEWER SYSTEMS WERE OBTAINED FROM A 0- now PLAN PREPARED FOR DUNHILL COMPANIES, LTD, 776 MAIN STREET, OSTERVILLE, MA 02655 �0 CONSULTING PROFESSIONAL ENGINEERS BY CAPESURV, 7 PARKER ROAD, OSTERVILLE, MA. o- 3119 CRANBERRY HIGHWAY, UNIT 5B, 2. THE LOCATION OF BUILDINGS,, PAVEMENT AND PROPERTY LINE INFORMATION IS TAKEN 0i WAREHAM, MA 02538 FROM A PLAN PREPARED FOR DUINHILL- DEVELOPMENT CO. LTD. 776 MAIN STREET, gay Su Street OSTERVILLE, MA 02655 BY CAPESURV 7 PARKER ROAD, OSTERVILLE, MA. DATED 07/20/2000. n et "I", TEL:(508) 759-6260 FAX:(508) 759-6230 Q ,Q www.choubahgroup.com 3, PROPOSED MODIFICATIONS SHOWN ON THE PLANS ARE ASSOCIATED WITH THE CONVERSION OF EXISTING FIRST FLOOR RESTAURANT TO CONVENIENCE STORE WITH DUNKIN DONUTS �o� o„ Project: TAKE-OUT WITH NO DRIVE THRU/'NO SEATING AT 792 MAIN STREET, OSTERVILLE MA. 4. FLOOR MODIFICATIONS ARE TO ACCOMMODATE NEW CONVENIENCE STORE WITH DUNKIN o- PROPOSED MODIFICATIONS AT DONUTS AS SHOWN ON NEW FLOOR LAYOUT (SHEET #2). 792 & $04 MAIN STREET 5. THERE WILL NE NO CHANGES TO BUILDING EXTERIOR FROM PROPOSED MODIFICATIONS. LOCUS MAP OSTERVILLE NOT TO SCALE MA 02655 6. PROPOSED MODIFICATIONS ARE: SUBJECT TO THE INSPECTION AND APPROVAL OF THE LOCAL BUILDING INSPECTORS IN COMPLIANCE WITH THE APPLICABLE BUILDING CODES. PARKING DATA LEGEND REQUIRED: ` I PT Prepared For: * BUILDING AT 804 MAIN STREET SYMBOL DESCRIPTION UNITS A, B & C CHRISTY'S OF CAPECOD, LLC TOTAL AREA 9,860 S.F. OF OFFICE SPACE �pROP �' ��� �- EXIST. CONTOUR 105 PLEASANT STREET PARKING = 9,860 S.F./300 S.F/SPACE. = 33 SPACES ERn' S PROP. CONTOUR TOTAL AREA ��NE 2 HYANNIS, MA 02601 * BUILDING AT 792 MAIN STREET 45,082 +/- S.F. 11X40 EXISTING SPOT GRADE FIRST FLOOR CHRISTY'S C-STORE (RETAIL) 1 ,400 S.F. 1 ,400 S.F./200 S.F. = 7 SPACES PROPOSED SPOT GRADE DUNKIN DONUTS 4/5 EMPLOYEES, 1 SPACE PER 2 EMPLOYEES = 2 SPACES a TAKE-OUT (DUNKIN DONUTS) 5 PER TAKE OUT AREA = 5 SPACES 2ED SrON PROPERTY LINE .0. P SEPARATE ENTERPRISE = 2 SPACES . PA�KIN�.SppgRK�NG - - - - - - SETBACK LINE SECOND FLOOR OFFICE AREA: 1 ,000 S.F. 1 ,000 S.F./300 S.F. = 3 SPACES " . Fd� ' FIELD STONE WALL + Of A? TOTAL PARKING REQUIRED = 52 SPACES 2`" `-= �'���` EXIST. RETAINING WALL TOTAL PARKING PROVIDED '/ : ' — — S— —= 52 SPACES EXIST. SEWER LINE /; / // - S PROP. SEWER LINE QRUSN eeif lJumosfer — —VY— -- EXIST. WATER LINE •a .. - - / G 'S Rkti PROP. WATER LINE / G — — — �• —E EXIST ELECTRIC LINE E PROP. ELECTRIC LINE G— — EXIST. GAS LINE Off 9 i leaPROP. GAS LINE F . F tic'Tank q _ �C r— EXIST. TELEPHONE LINE T PROP. TELEPHONE LINE10 se Trop J I OHGY — EXIST. OVERHEAD WIRE 804 MAIN STREET /� Laa�h ' �'° %� / Ir I S OHW Issue Date: 6/20/2006 �� / /, 1 Q PROP,P/ J2 0 . OVERHEAD WIRE /• =a `. .fie.-s !�� EX�s % �'` '1 / Revisions ® CB EXIST. CATCH BASIN No. Date Description ' I '�a / �'�� 0 CB PROP. CATCH BASIN 1 8/01/06 Revised Parki �A ng Data & Notes 1 Al 0 OMH EXIST. DRAIN MANHOLE ' 792 MAIN STREET /' 0 DMH PROP. DRAIN MANHOLE 0 SMH EXIST. SEWER MANHOLE a 0 SMH PROP. SEWER MANHOLE air ij Q EMH EXIST ELECTRIC MANHOLE Project Number:06 167 ,/ 0 EMH PROP. ELECTRIC MANHOLE / I � � P _ � ,... o� .:/ � � '; /`' Scale: 1"- 20' /� <-a- UP EXIST. UTILITY POLE LANDSCAPE AREA Designed B C0_1 UP PROP. UTILITY POLE y' EXIST. LIGHT POLE Drawn By: RAA Checked By: HC �o LP PROP. LIGHT POLE Sheet Title: ;•. ,` !, CRUSHED STONE AREA _ A s tT �`�► ER7y c7 �`� % ❑ ❑ EXIST. GAS PUMPS PARKING LAYOUT PLAN pr' p PROP. GAS PUMPS CONCRETE AREA O ! ,, TREE • ` . EXISTING NUMBER OF GRAPHIC SCALE ss, �1 ;� O PARKING SPACES EXIST. EDGE OF PAVEMENT PROP. EDGE OF PAVEMENT CUT & MATCH PAVEMENT 0 IO 20 40 80 SCALE IN FEET % a �- EXIST. SIGN 1 20' 1` '�/j! ,,�. � � PROP. SIGN E SB EXIST. GRANITE BOUND El S8 PROP. GRANITE BOUND 0 CB EXIST. CONCRETE BOUND Sheet Number. 1 OF 2 ID C8 PROP. CONCRETE BOUND 0 R.I.H.B. R.I. HIGHWAY BOUND CHOUSAH ENGINEERING GROUP, P.C. 61'-011 NOON CONSULTING PROFESSIONAL ENGINEERS GENERAL NOTES: 3119 CRANBERRY HIGHWAY, UNIT 5B, WAREHAM, MA 02538 ❑ 1. IT SHALL BE THE CONTRACTOR';5 SOLE RESPONSIBILITY TO OBTAIN ANY AND ALL PERMITS REQUIRED BY THE STATE OF MAS5ACHU5ETT5 AND THE TOWN OF 05TERVILLE TEL:(508) 759-6260 FAX:(508) 759-6230 PRIOR TO COMMENCING ANY WORK.. www.choubahgroup.com 2. PROPOSED MODIFICATIONS 4 CONSTRUCTION SHALL CONFORM TO THE REQUIREMENTS OF R�> FE THE STATE AND LOCAL BUILDING AND FIRE CODES, Project: REMOVE EXISTING FE 17 FAGP DECORATIVE WALL 3, THE CONTRACTOR SHALL VERIF"r ALL DIMEN51ON5 AND CONDITIONS ON THE JOB SITE. PROPOSED MODIFICATIONS DISCREPANCIES SHALL BE BROUGIHT TO THE ATTENTION OF THE ENGINEER BEFORE AT BLOCK EXISTING DOOR TO EXISTING SINKS PROCEEDING WITH THE PORTION OF THE WORK. 792 & 804 MAIN STREET ACCOMMODATE DUNKIN DONUTS TO IREMAIN 4. DETAILS NOT SPECIFICALLY SHOWN SHALL BE SIMILAR TO THOSE FOR MOST NEARLY OSTERVILLE, MA 02655 AREA (PER PROPOSED FLOOR EXISTING COLUMNS SIMILAR CONDITION AS DETERMINEID BY THE ENGINEER. LAYOUT) TO REMAIN '-6" POT SINK REMOVE AND DISPOSE 5. THE CONTRACTOR SHALL 5HORIE, BRACE, SHEET PILE OR OTHERWISE SUPPORT THE EXISTING SINKS 171E STRUCTURE AS REQ. TO MAINTAIN STRUCTURAL INTEGRITY AT ALL TIMES, SHORING DE51GN e , 0 SHALL BE PROVIDED BY THE GENERAL CONTRACTOR. 0 / \ 6. HEADERS SHALL BE PLACED ACROSS TOP OF SHORING P05T5 AND SHALL BE TIGHT REMOVE f AGAINST UNDERSIDE OF STRUCTURE ABOVE. EXISTING COLUMNS EXISTING DOOR BR TO REMAIN I� 1, SHORING SHALL BEAR ON SLEEIPERS TO PREVENT DAMAGE TO STRUCTURE BELOW. � REMOVE AND DISPOSE Prepared For: EXISTING WALL O m EXISTING COLUMN / S. TEMPORARY' SHORES SHALL BE DESIGNED, ERECTEp, SUPPORTED, BRACED AND CHRISTY'S OF CAPECOD LLC y ti. ,� ,, ,„�, �� MAINTAINED BY THE CONTRACTOR TO SUPPORT SAFELY ALL DEAD LOADS PRESENTLY ' TO REMAIN .� CARRIED BY THE STRUCTURAL WORK BEING SHORED, AND ANY CONSTRUCTION LIVE LOADS. 105 PLEASANT STREET HYANNIS, MA 02601 g. NEW STRUCTURAL SYSTEMS SHAL1L BE COMPLETELY INSTALLED AND CAPABLE OF SUPPORTING DESIGN LOADS BEFORE SHORES ARE REMOVED. SHORES SHALL BE RELEASED GRADUALLY. REMOVE AND DISPOSE BR. I EXISTING WALLS / 10. ALL ELECTRICAL AND PLUMBIING TRADE WORKS MUST BE COORDINATED WITH EXISTING DECORATIVE REMOVE AND DISPOSE / STRUCTURAL WORK PRIOR TO CONSTRUCTION, ANY DISCREPANCY SHALL BE REPORTED TO WALL To REMAIN EXISTING COUNTER / THE GENERAL CONTRACTOR IMMEDIATELY. 11. ELECTRICAL AND PLUMBING WORK SHALL BE IN ACCORDANCE WITH THE GOVERNING CODES, REGULATIONS AND ORDINANCES. THESE REQUIREMENTS ARE MINIMUM CRITERIA AND NO REDUCTIONS IN STANDARDS PERMITTED BY CODES WILL BE ALLOWED. FE O EX15TING FLOOR LAYOUT ❑ SCALE: 1/4"=1'-0" 16'-3" 50 -9" . F A. r I f _ rim r_ COMPRESSOR , ❑ A.O. SMITH 4FUSNS3A45 GAs Issue Date: 6 20 06 EXISTING FIRE ALARM LEGEND 5 DOOR WALK-IN COOLER Revisions 15'-3" X S'-m" R / � Q No. Date Description FAGP = FIRE ALARM PANEL \ FE HAND Y 1 -g .TURBO 60" FILLER 2 2' x 3' � FE 36 BASKETS Z SINK CHEF(S) ❑11 TO�❑ 5 TABLE 0 FAGP 1 $/01/06 Revised Notes ❑ PULL STATION _._., _ _ _ _ _._._ . DONUTS Eg P = o CUTTING BOARD 2' x ;5' PROVIDE A FIRE ALARM SYSTEM TO ___ _ .-^ ^^ SLICER METAL RAC' H HEAT DETECTOR (CEILING BELOW) K 34 FILLER Q HEAL DETECTOR (ABOVE CEILING) COMPLY WITH THE MA. FIRE SAFETY -~ - - - T-9" SANDWICH STATION CODE E THE REQUIREMENTS OF THE W/DELFIELD UNDER PREPARATION AREA dY Q SMOKE DETECTOR SERVING AREA oZo Q = HORN / STROBE UNIT LOCAL SUPERINTENDENT OF FIRE ALARM (DUNKIN DONUTS) 3'-0" O g� REQUIREMENTS. R CUSTOM 9'-6 COFFEE w/ ICE CADDY W/ UCR © = STROBE ONLY UNIT COOLATTA 5-8 CASH W DDCM A7-1 PPROVAL 342 HAND CE W 5'-6" POT SINK Project Number: 06-167 K❑ = KNOX BOX ® ® m 3'-0" SINK 50 B o 0 0 CJ EMERGENCY LIGHTING GATE EMERGENCY 0 Scale: l/4"= 1'-0" Rg � ❑ ® ® SPR TAYLOR / = Designed . H❑ `\ g B Y O = EXIT SIGN - CBTP DISPLAY CUSTOM 14"FILLER BY G.C. Drawn By: RAA TChecked By: HC = EXTERIOR LIGHTING SALES DROP 12" FOR ICB BR ID C14 AREA SALES AREA FE 5 Ib DRY ABC EXTINGUISHER CA (No SEATS) 4 Sheet Title: Q EXISTING & PROPOSED LL � IL _ FLOOR LAYOUT NOTES m 3'-0II � � 1. PROPOSED MODIFICATIONS SHOWN ON THE PLANS ARE ASSOCIATED WITH THE U- U- U- U- N CONVERSION OF EXISTING FIRST FLOOR RESTAURANT TO CONVENIENCE STORE WITH i = _ / DUNKIN DONUTS TAKE-OUT WITH NO DRIVE THRU/NO SEATING AT -192 MAIN STREET, 05TERVILLE MA. 2. FLOOR MODIFICATIONS ARE TO ACCOMMODATE NEW CONVENIENCE STORE WITH DUNKIN DONUTS AS SHOWN ON NEW FLOOR LAYOUT. 3. THERE WILL NE NO CHANGES TO BUILDING EXTERIOR FROM PROPOSED ® FE MODIFICATIONS. ®FE Sheet Number. 2 OF 2 4. PROPOSED MODIFICATIONS ARE SUBJECT TO THE INSPECTION AND APPROVAL OF CASHIER @ THE LOCAL BUILDING INSPECTORS IN COMPLIANCE WITH THE APPLICABLE BUILDING ' CODES. FfROF'05ED FLOOR LAYOUT SCALE: 1/4"= '-0" d v Q 3 G P T I C J 1 / G►/'1 - `'- --- - GLAJ(L PAR.Krhy LEACHING DRY WELLS 500 GALLONS zp"rjN a \ APPROVED DESIGN CALCULATIONS (Existing) ! "END"CROSS SECTION MODEL. SHOREY PRECAST CONCRETE �'� '"V� 1770 SF (Retail ) X 50 G/1000 SF = 88 . 5 GPD (Use 2?00 GPD; ! FINAL GRADE TO BE STABILIZED `INbrid rytoN t�.j; Ga LcerL/Es i Ex,s r,.vo- � , Et�`P h;,t ; ' NI 91WJLSNI SVM W31SAS 3v'�xl b LfRcMrN(r C•B. r� �aJ1 iVl Ila3� OPIV NOilV-Il�t / CAD aE �g�+ovco� ' " � 1095 SF (Office) X 75 G/1000 SF = SpD (Use 2?00 GPD) ; ^S . Sf3V`d +NI�n3 �Ivp^I� EWsr„uG � ` Total Leaching Capacity 200 . 0 GPD FINISHED GRADE(SLOPE m 02) i IIl = ill � III�I I � .2 4'f}OS A2�4N� ) i 12' MIN) i r'lPr? ExArriNo- 3y• \ ACTUAL PROPOSED DESIGN CALCULATIONS 1 ' AN/t I /'�o/'oSFd o 0 f /n SE,tE•�odcc T L / hRA ,E( PA�K,K(T / 2412 SF (Retail) X 50 G/1000 Sr' = 120. 6 6 GPD + LEACHING DRY WELLS 14 0 0 0 7/4 1/2 DOUBLE `` f � i - T B 6"LX4'10 WX2'1"H c� 54d (Office) X 75 G/1000 SF = 116. 1 GPD WASH PEA STONE ' 0 2 75' I OVERALL LEACHING AREA , 22 (Restaurant Seats) X 35 G/SCAT - _7 , 0 . '� ;pr, 314" 11/Z'DOUBLE ' ��34 t� I 65 L X 17''W X Z H o 0 2 1" o WASHED STONE f (, I ✓ Total Leaching Capacity = 1006 . 7 GPD I ;F. HMAF K -� I I !9 (,E AcNiH6r Ct �"8Ern; ,. V 4 Seatsion Rate - < 2 MPI (TP-! ; rJ ! I DEL"or MN� C� cK/4,X 17�ri/ X1N�LFfE�T� Soil Class : Class ? (0. 74 C-/Sr) A- gx/yr„vr �`l j�F x - O I ;3 ( !E P rA L rA,*I< J ' y I' l �* � ) ' j'RaP�Sfa t� - J �" PROPOSED LEACHING AREA: 0 EETLEACHINGTHE HAMBERS ' ,�soc ( �LLa� .__---- i I ! rA+PasEO CArc04 0 Ak/n) B 6'. REQUIREMTNETS OF C f a L04�/q(, t Se'P*+c r4,V^c Ex/ir/�v(� Leaching Dry W 5' L 1 x 2' H l:r�)'�Mv Wells : i 4 at 6 X 7 W '� 310 CMR 15.252 ' (0,)� LrACLor/ i 1 e N ide Area :/ I 328 S�' X 0 �4 �I�F 242 �' D -- - i�5 (2£Alf rx40 WIA `� .4t__ Bottom Area: 1105 SF X 0. 74 ._ . = P 7 GPD IS _ _7 i i Piz .o ;ot�I i 7g Capac�� 1060 4 ' each . Arc1+ &A>/ _.------ -- -- - -._ y GPD ----- 0 9.2 Phi.4F-v� I i I _ r GREASE TRAP DESIGN (Existing) 2500 GALLON SEPTIC TANK 1- 4 icd4o �<1 I EXIS rinl fj PR�'c in, I "� ve,v � r-----------•T MODEL. ST•25MH•20(SHOREY PRECAST CONCRETE) ' PIVE r /jfe I Gf,01LC/AeTA/4 Co 'Y. '� _ i ��ravE t 22 Seats X 15 G/Seat = 330 GPD 6ViLbI'VtrLe FiNISHEOGRADE t sJ * 100 0 Gallon r ! _ _ = I f-- R j lon Existing i I PRalusEi✓ - _-_._. I g_ease rap I 24"DIA 24•'DIA L91MN) 24"DIA , 1 TC 1 c�FwcE I 3.. 3,. H -20) :�r' c; �� i w� ✓S T S 6„ 1 I ��Q� _._ _.._.._ INLET AND OUTLET 24" -71 4"SCH 40 RISER 1rAc` CONSTRUCTED GRADE 4 'CH 40 10. FLOW LINE 24• DEL FILTER A 100 I I I z t (COVER TO BE MOUNDED 4"SCH 40 TEE I! r jl SUGHTLY HIGHER THAN THE / _ U�!MCA¢ GR•JN! Q t SEPTIC TANK TO MEET �E,i T,'v!i ! I ;7 4 � ! r+ 4'UQUID LhVEL REQUIREMENTS OF I ;J t, nG, EE/►trf/W(s A- r+ I Fir` P+^'BPS �� y r� �✓ 1 GAS BAFFLE 310 CMR 15 226 FOR � ! SUROUNDING GRADE,OR IF NOT r' ! ! ETc OSTE VILL� I d"SCH40 WATERTIGHTNESS. '' USED,MUST BE SEALED <<fv RG c,F r R WATERTIGHT F II Yd 4 I 1 o L ro 10L q ' 1 � TEE ji ETC. �7 I I 0 P4 9pGp. a �p 70 POND.-, 'vti 0 i t o a ALL WALL SLEEVES/GASKETS y SHALL BE CAST IN PLACE OR 6" (MIN 1 MECHANICALLY •r�� � • INSERTED AT FACTORY. o COMPACTED -0A/cr CRUSHED STONE oP�Q �Q A�� a?ems ;� n M o� si�'ys APPROVED PENETRATION SEAL STABLE LEVEL BASE <-3/4'DIA. QO j r a ti METHOD REQUIRED ----- a� p SEPTIC TANK DIMENSIONS 11'10"L X F 4• ',0 , P 6"H i �L---- r 79.2 e+IS r,nr G I 1 ,�ES�TiJE ABLE _-- T ,c• � i S/C K/l jv ! �L'LPti vE A,LEA -- I 6S - ----_. a4 L J,W C S'F E SrT.�t • ��` ,a P� p t'' N -.- -. • --- - F'��,S+nr � .P S�O�7D �orn s� Cnx .q iPD IL 53.70 >.>>. - 9 t+ -+- _ �1 i S rrAt(r o ,r o' AV I LLJ4t N/N� to = ca9r� GP� P0.Y o A , �aJa1 QY o 0 + TO, N tr,t� °^' , SCHEDULE O!' ELEVATIONS �AMI E !` /� ✓0` PICK d �!� MvR MY • s f 8Ar EA L t= ` 2 Air' �7 Inv. In Sept , yTerik Inv. 22 .25 Out Septic ;t2 .no p t Tank%---- �, �gc�ay r per. ,�.,�, • • �c �f ;^ ° Inv. In C)iStribution Box (exlsting) 21 . 4 / .� 7-I 6- 7' - Inv. Out Distribution Box (exist nc�) 21 . 7 C.r�iCS^�°- J � � DAV 4D •w �^CYO ~ Inv.`r� ` Begin Dry Well 21 . 30 - _- - -- Sot tom of Dr Well 19. 30 :r o r� o Bottom of TP-2 12 . 5 ,o 1 � I Finishod Floor Elevation FIFE B.-xsement Fluor Elevation BEE Water Line W Gas Line mil( F S6 P r L 5 Y S%`E M _- - ---- - - -----____ _ -- - ---- - �4- ,Ec rf o n/ - A - NOTES 1 . All construction methods shall conform to the Title V ( 310 LALECMR 15) and the Barnstable Board of Health Regulations . 2 . There are no known private or public wells within 100 A� ,-Fi _ feet/400 feet, respectively, of the proposed leaching area . _ 3 . Existing Dry wells to be pumped ( iz needed) and used ir. 19 DiA. 1L11C+LS r/N/sNEa (-t406- /RNO CovexL nN �pg2r�+IV6' LoT� addition to the pr ,pesed Dry Wells . &Ac'4DE 4 . No changes are to be made in the field without the approval _ of the Board of Health and the design engineer. Proposed leaching field is not designed for use with n,# E•�Je�S I gar:age disposal A,Ja C�vflLl E-,L.06 �LNIGDI/t0•�� 1�,D± _ 6. Contractor to nor_ify D; g Safe 72 hours prior tc .4 tc AN v 1EtW i-oty ¢ construction . (600) 344-7233. ? rocerty line information, existing sructures etc. taken r II q `, vE"� from "Existing Conditions PIG;, of Land at 792 and 804 main •Z1.:tr, �,�� Street, Barnstable (Ostervilie) , MA, dated 9/17/01, prepares , �ScE pL/trrwE�� Ca^F Oste_vil ' Richard ne :reaux LS. Seir,_i , by r_surv, iA L , P' , c P•1an r4 ( p^ a not to be used as a property line survey. � 'tFPCALr Remove 5 feet horizontally around the proposed leaching area s 19 LEACHIA& DXy wirLL'S r9,3 O S�! ,jorf _ . vs'� 17'� x �r;FE�� I and vertically, approximately 6 feet (topsoil/fi il) and F4 = Ex,tir/,NLr PRoPQJE, ( , replace with Tlt' e V fill tRefere::ce 310 CMR 15 .255 for r B Lize DE7AiL� / ( 0 00 6AL.L tent ,Z4'00 rA�C orY * specifications of fill (sand) l . The total amount of fill �{-� 1 � required is approximately 360 cubic yards . LALC Etta iN.< LOJEkS n tS-0J I / l b CrALk 0,4 SC/r'C T,~,vK ro tve� - 25a� > ( SEpTitC T Nf< z s u I 0 I '1 - a SUBSURFACE SEWAGE DISPOSAL SYSTEM LJr < ' 792 Main Street, Barnstable (Osterville) .. s see p&g,u i v✓s AI+PA 41JEO gFC�N F.+� rwwr.fet r7erar�s} o SCALE: APPROVED BY DRAWN BY L.` No +,7 DATE: 9/17/01 Da"al H Johnson D.D- Johnson �t$��a{;u Prepared Dunhill Caapanias LTD (508) 420 - 9222 ror: 776 Main street, Osterville, MA 02655 a r-0b ^+to otx0 $0 �fy0 %�JD +' 0 red D•hR3TZC SLPTSC DESZ(ai, Z]iC. ,(S06 0-1904 DRAWING NUMBER NDR / i/0 'l !l\� ( �( Fy 904 Main Street, Suit• H, Ostev zi_ I WA026SS 5-705