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HomeMy WebLinkAboutGONE CHOCOLATE - FOOD _ al-o?r GONE CHOCOLATE -col l$y�Main Street, Osterville 4 Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. RAWNseABLE 3 F.P.(Thomas)Lee,. MAS& IDaniel Luczkow,M.D. Alt. dyq. 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 60 Issue Date: 01/01/2022 DBA: GONE CHOCOLATE OWNER: SIMONE NUNES Location of Establishment: 858 MAIN STREET OSTERVILLE„ MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 6 OutdoorSeating: 0 Total Seating: 6 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE- ICE CREAM: an FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent i FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: t' p Initials: Town of-Ba`rnstable -For Office Us" : ' Date Paid �Amt Pd$s:X�V .. , Inspectional Services ' 1639- •`e� Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ` APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL` NAME OF FOOD ESTABLISHMENT: �n e, cy, o o)aTp— ADDRESS OF FOOD ESTABLISHMENT: rn cU n S `LJ 't E'.r yl C, MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS. a he�U'CK i-�F, 'k,000�GA�P (�Q i C � TELEPHONE NUMBER OF FOOD ESTABLISHMENT:.,(Cip� )42�0 - Q2 CO TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO_Y ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: �Z SEASONAL: DATES OF OPERATION: Gt /'01 / O 1 Z / 31 /z o Z Z NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. -***OUTSIDE DINING REMINDER*** - OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD ZFROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT �5)'nO rW S� SOLE OWNER: YE /NO D.O.B OWNER PHONE # s SE® O I q ADDRESS CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. \,S tl�1ij l U G �Q Q �1 flk 1 Z 10/ 60- z( 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 508-8624644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at ►ttn:/iwww.townofnarnstable.us/healthdivision/aDolications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3V each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q\Application FormsTOODAPP REV3.-2019.doc p? Town of Barnstable BOARD OF HEALTH r John T.Norman Board of Health Donald A.Gaudagnoli,M.D. Paul J.Canniff,D.M.D. qMAW F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 60 Issue Date: 01/01/2021 DBA: GONE CHOCOLATE OWNER: SIMONE NUNES Location of Establishment: 858 MAIN STREET OSTERVILLE„ MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 6 OutdoorSeating: 0 Total Seating: 6 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: i �TNE Tp� Town of Barnstable For Office Use Only: Initials: i Date Paid 1 � � Amt Pd$ BARNMBLE, : Inspectional Services 1639. ��� Check# ArFo ,. Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE��� NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: C-50 r�P_ GO k ADDRESS OF FOOD ESTABLISHMENT:o.t/n a - 0 Z 6 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: e 1 4_mcu I tc lr � Ix TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( 508) �120- ©Z Q 2 TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: 3 TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc k OWNER INFORMATION: FULL NAME OF APPLICANT S( Mo rw SOLE OWNER: OE /NO D.O.B Z? G1 OWNER PHONE# 50� 560 0 j ADDRESS_ICI C �O n- (,IV- 11 - 1 fXe. LA A 02 GY-- CORPORATE OWNER: SA, Mow V 1/12-m s CORPORATE ADDRESS: n n PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Ex iration Date Allergen Awareness Expiration Date jz1 d-z -2� 1. Con- 1101 W-0 1.69)VIli 44PI 01/ es- / Z-5 0j 0C- / .21 ; 2. �1`VY�J rye /UW V S O Z. T SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/api)lications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FonnsTOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BAPb ,B�, Paul J.Canniff,D.M.D. es , 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate x 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: 60 Issue Date: 02/03/2020 DBA: GONE CHOCOLATE OWNER: SIMONE NUNES Location of Establishment: 858 MAIN STREET OSTERVILLE, MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 6 OutdoorSeating: 0 Total Seating: 6 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: CQn FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: 16\V oFt rq�, For Office Only: Initials: , Town of Barnstable Date Paid AmLPsI$L�� - ,AMSrAB,E : Inspectional Services F;ter"`� Public Health Division Check# o� Thomas McKean, Director a 200 Main Street,Hyannis, MA 02601 r' Office: 508-862-4644 Fax: 508-790-6304 �. APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP (�R�ENNEWALX NAME OF FOOD ESTABLISHMENT: 0"rc C wlak ADDRESS OF FOOD ESTABLISHMENT: 1 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): (r1 R Sg 0urn E-MAIL ADDRESS:Ytcy*)MC 6dQll°e - orn TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( S01)�-OL O Z TOTAL NUMBER OF BATHROOMS: Z WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/ / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. �I IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? —! IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?���1-. TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) 'C FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL, MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV. FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q\Application FormsTOODAPP 2020.doc S� s OWNER INFORMATION: FULL NAME OF APPLICANT 11 ► goty U SOLE OWNER: � E /NO D.O.B� ^ `^OWNER PHONE # 5/►�� g 5i.0 0 3 1 G ADDRESS_ 1`��1c��soh U/t CORPORATE OWNER: d�►nory CORPORATE ADDRESS: �J$ �►. ���YRJ�ZIl 'plc /A,& 0 PERSON IN CHARGE OF DAILY OPERATIONS: T' 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 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January Ist to Dec. 31`each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q\Application Forms\FOODAPP REV3-2019.doc Op TMET TOWN OF BARNSTABLE. _ HEALTH INSPECTOR'S Establishment Name: Date: ,Page: of t OFFICE HOURS PUBLIC HEALTH DIVISION e00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 M-8 -46 No Reference, R-Red Item , PLEASE PRINT CLEARLY prFD MPS°' 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT _ �� (J� Name Date (' l2 Z TyRe of Type of Inspection j u me oL Address ^` Risk t pod Servi e-inspection Level Retail Previous Inspection SFr Telephone Residential Kitchen ry' Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint - Person in Charge(PIC) CA ^ I Time Bed&Breakfast O AC In: Inspector � Out: �- Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. S &„4-- 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) g� A p FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ) l l T ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities ✓ `Y 1 bJ EMPLOYEE HEALTH PROTECTION FROM CHEMICALS L ( P Z2r - L4 Jt" ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives S`��tx� tti 'k'U vvLQ14X- ❑ 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 � XJ L �/ ❑ 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 4 t PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control �Pl h ❑ 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 Bf s� �C�1LtE� Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations iCLO C Non-critical(N)violations must be corrected immediately or ritical(C)violations marked must be corrected immediately. (blue&red items) �` / 1 Corrective Action Required: ❑ No ❑ Yes Overall Rating 1 I within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Susp ion C N Official Order for Correction:Based on an inspection today,the items Embar o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. B=One critical violation and less than 4npn-critical violations re 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 9 than non-critical. If no critical water,sewage back-up,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 9 p,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials FC-7 590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. ( )( within 10 days of receipt of this order. violation,4 to 8npn-critical violations=C. 29.Special Requirements (590.009) 30.Other DATE OF RE-INSPECTION: Inspector's Si ure Print: 31.Dump ter screened from public view Permit Posted? V Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed 'Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N -1 _ �. y... .�......�....w,�.-r..-...--..� 4...... .mil•..... r�+. n_ "--�.:z ..a..--.a. ---.� ,. r�.�.•`.�..�•.1,.'.a.f^'---.Ly-.s�..J`:.�y1-�.�-+..:�r�.y��.�w.u�'...r..w ti., �v+.--��+-.,.-e..'F-�,.� .. ....-y-���. �. i. .� Z.l �s� ,-'^r.'�r..-.+sY--�•�.ty�..-r..±.r•..r�.�}.^3 _ � - Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions. Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 6 Cross-contamination 1 q Food or Color Additives Law Cooled to 41°F/45*F Within 4 Hours* * * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives Cooked and RTE Foods.* * 19 PHF Hot and Cold Hording 2-103.11 Person-in-Charge Duties - 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 7 5 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers*Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original 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 7-201.11 Separation Storage** 3-501.16(A) Roasts Held At or Above 130°F* - Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 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* 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 Surfaccs of Equipment* - _ 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding 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 165'17 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165`F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140`F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41'F/45'F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. 1 Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. yoF�He rok TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Page: __2 of ti "OFFICE HOURS q ° PUBLIC HEALTH DIVISION 800-9:30A.M. BARNWABLE. ` 200 MAIN STREET 3.30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified v MASS. MON.-FRI. ,679. .m HYANNIS,MA 02601 508-862-asaa No Reference R-Red Item PLEASE PRINT CLEARLY. p FOOD ESTABLISHMENT INSPJECTION REPORT Name _ ,� Date( L Type of jy4j&Qf Inspection _ p outine Address �6_�`n�� C> Risk �ood Se e-mspection h` Level ee aiR� l Previous Inspection Telephone Residential Kitchen Date: f Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP &f 'T Iee/A In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ r j �- � ►'dam'-� FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands (I ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 44 EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color AdditivesajocQ1 0-e- kQ U, ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals Y r FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) L�yTJ. 17714.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 re ardless of the number of critical,results in an F. B=One critical violation and less than 4 non-critical violations 9 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 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 back-up, l iti water,sewage If l no critical iti 9 h d l violations l vi and than non-critical. critical o a 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 c 9 p,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&non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008) = 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations C. 30.Other DATE OF RE-INSPECTION: Inspector's Sig, ture Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness _ Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 1 q Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12-• Additives* 3-501.15 Cooling Methods for PHFs E * I *. 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and.RT Foods. 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. 590.004(F) 11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-.in-Charge-to. __ Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reate for of Food* 7-204.12 Chemicals for Washin 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 g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-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* I 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* Fffecore 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155' 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* F Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical Ratites-165`F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165`F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )O ' 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding R radices 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 * N5-203.11 Preventing Contamination When Tasting* 3 403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13Handwashing 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* * 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products Numbers and Capacities* Within 4 Hours 9 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 * 5-205.11 Accessibility,Operation and Maintenance 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:59017ormback6-2doc *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.rK► TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: I ( �J Da CJ` Page: of OFFICE HOURS BARN E. PU62 0 MAN STREEET C HEALTH SION - 3::30-0-4:30 P.M.:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �A ,639.n 0 508-862-4644 'FDN1P' FOOD ESTAB SHMENT INSPFIEVION REPORT Q Name Dat i Type of Type of Inspection t i e Routine Address ° Risk Food Service P Re-ins ectio Level a Previous)ts,,ei Telephone Residential Kitchen Date:Mobile Pre-opeo Owner HACCP Y/N Temporary S Caterer < General Complain Person in Charge(PIC Time Bed&Breakfast ? Other Inspector I 'a, LV Zj Each viola Ion checked requires an exp anation on t e narrat e(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ i 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) ❑ y d / v FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands Al ❑ 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) �Z I Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating V V f-v 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 to o 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 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 Y tY (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials FC-7(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 no critical iolations. If 1 critical refrigeration. ( ) v' lion,4 to 8rion-critical atio -C. 29.Special Requirements (590.009) within 10 days of receipt of this order. %71ZOA 30.Other DATE OF RE-INSPECTION: I ecto atu 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 Sig 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 L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to * Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 ' Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 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* * 7.203.11 590.004(11)Conditions of Use 3-304.11 Food Contact with Equipment and Utensils 7-20 .1 Toxic Containers-Prohibitions* Variance Requirements 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 Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources F 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of 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* EJ/crrve 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 3-01.l l(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* P 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A D Violations of Section 590.009 A D in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) ( )-( ) * Ratites-165°F 15 sec* in mobile food,temporary and residential I Sources g, P aT>' 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* 3AOl.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( ) 11 Good Hygienic Practices practices should be debited under#29-Special 3-201.17 Game Animals* 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-201.11 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands 3403.11E 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 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 * 5-205.11 Accessibility,Operation and Maintenance 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. 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:59OFormback6-2doc *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. 'AboFae ro TOWN OF BARNSTABLE. HEALTH INSPECTOR'S Establishment Name: ( � Date: Page: of �( OFFICE HOURS BARNSTABLE.O` PU62 0 MAN STREEETLIC HEALTH SION okiov-1n 3::30-0-4:3:30 P.M.A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MON.-FRI. `lEnMa+"a HYANNIS, MA 02601 sos-862-a6aa No Reference R-Red Item PLEASE PRINT CLEARLY FO D ESTABLISHMENT INSP C ION REPORT Name Date D° e of voe of Ins ep ction _ p s Routine Address ' Risk ood ice- Re ins n Level Prev p l� Telephone I '7 Residential Kitchen Date: 41I Mobile Pre-opera i Owner HACCP Y/N Temporary Suspect I nss Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HAr. P Inspector u Each violation c ecked requires an explanation on the narrativ (s and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Rig Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ IV Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ Pl FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5:Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) 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 checked indicate violations of 105 CMR 590.000/Federal ❑ Embargo ❑ Emergency Closure C] Voluntary Disposal ❑ Other: 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 4 non-n-crib al-violations 9 if no critical violations observed,4 to boon-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-cn" al violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 vio 4 to Snon-Critical violat` ns= 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Ins ;Print: �ry r' : \ 31.Dumpster screened from public view C Is Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N rig 1� #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Waft Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH - 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 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 Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR . 3-306.14(A)(B)Returned Food and 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 Hermeticall Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and - 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-40L11A(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* EfI=cti-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-1 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-0Ol.l1(A)(2) 155 Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Chemical Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed * g g �' S90.009(A)-(D) Violations of Section 590.009(A)-(D)in caYer- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* 3-401.11(A)(I)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements.practices Id 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(13) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 Commercially Processed RTE Food-1 °F* Blue Items 23-30) g (C) Co y s d o 40 3-202.15 Package Integrity* Critical and non-critical violations which d not relate to the * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* o o n the me 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 * 3-501.14 3-202.18 Shellstock Identification 13 Handwashing Facilities A( ) Cooling Cooked Fr from 140°F to Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and id From 70°F to 41°F/45/45°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* t Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand m Provision Drying 29. 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. CkUP'le oF�NE r TOWN OF BARNSTABLE HEALTH iNSPECTORs Establishment Name: Date: Page: of , ti OFFICE HOURS P ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ' 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MON,639.°�0j' HYANNIS,MA 02601 508-8 -FRI.62-4644 No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPCTON REPORT Ma+ 08� G Name Dat Type of T e f In ction era i n s outi Address O isk a nspec on, 0 eve) ietail Previou I s ti 9Telephone sidential Kitchen Date: I Mobile Pre-ope a on Owner HACCP Y/N Temporary Suspec III ess IN Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other sue' , Inspector ut: Each violation checked requires an explanatio on the narrativ�iisk age(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals 3: 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 f ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control 8.Separation/Segregation/Protection. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HS ) 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP�V/ �� I('/ 10.Proper Adequate Handwashing CONSUMER ADVISORY �/' C] 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories U 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, ems ❑ 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 B=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 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- itical. 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- ritical lations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) g vi n,4 to 8non-critical vio tion 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Ins is i ure Q 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 PI(A s SignaturePrint: 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.) i. FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 590.004(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 * 7-102.11 Common Name-Working Containers* 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 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(1)) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* q Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* rv, Sanitization Temperatures* TWEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef five 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 3-401.11(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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g' Stuffing Containing Fish,Meat,Poultry or 590.009(A)-�) Violations of ( )-( )in S 590.009 A D cater- Sources * Proper,Adequate Handwashing 10 Ratites-165°F 15 sec* in mobile food,temporaryand 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 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 3-202.15 Package Integrity* ( ) Y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the g 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 1.003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41`F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 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 "I' 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements 1 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 federal1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. figOF IME r 4 TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: .� Date: ' i Page: Tf ti 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 Mesq: `0� HYANNIS,MA 026 1 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY prFD MPS A 508-862 4644 FOOD ESTABLISHMENT INSP C ON REPORT- Name Da Type of Type of Inspection Operation(s) Routine Address Risk Food Service Re-inspection 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 /. Inspector Out: Each violation checked requires in explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 8L 16; ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic ChemicalsIN FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) , ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ' ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories &- - Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No 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 ❑ VOlurilary 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 4 non-critical violations if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must •C=2 critical violations and less than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials - (FC-7)(590.008) 9 viol 4 to 8 In n-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Ins c is Si u 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 Signat re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N f n e } 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 signment of Responsibility* 8 Cross-contamination 14 Food or Color Additives 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.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-102.11 Common Name-Working Containers 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to �1 Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge* 3-304.1 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 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 y Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg criw 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 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* Shellfish* 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* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g� g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES C * 3-301.12 Preventing Contamination When Tasting* 3-403.11 (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F* Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* L18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.1 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ) 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F[0 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. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1 1.009 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. .f e�. Al Iq Win' BLE HEALTH INSPECTOR'S Establishment Name: / �. Date: Page: of . � 4OWN OF BARNSTA OFFICE HOURS v IC HEALTH DIVISION 8:00-9:30 A.M. TABLE. W 11 00 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MA • ARNS ` f�" CfIYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item . PL SE PRIM CLEAR Y .°39• �0 % 508-862-4644 n F OD TA LISHMENT INS C ION REPORT /' Name Dat Type of jype of Inspection Routine Address Risk 'Food Sery Re-inspection _ ® Level `Retait� Previous Inspectio -� Telephone Residential Kitchen D IV Mobile re-operation Owner o HACCP YIN Temporary ess Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other r / Inspector i Each violation checked requires an explanation on he narr iv pages)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and isk Factors(Red Items) Anti-Choking 590.009(E) ❑ ' Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ' ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating d ❑ 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 or 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 q ❑ within 90 days as determined by the Board of Health. I ❑ 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 4npn-critical violations re 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 i no violations. If 1 critical refrigeration. 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 28.Poisonous or Toxic Materials. (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address - tical 29.Special Requirements_ (590.009) within 10 days of receipt of this order. i vi 4 to 8npn-critical v tion C *�Z 30.Other DATE OF RE-INSPECTION: In c n t re rint: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC s Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N rY Dumpster Screen? Y N Violations relatettto Foodborne Illness Violations Related to Foodborne Illness Interventions f 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 _ y 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* PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge Common Name-Working Containers ge to- Other* _ * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.I1' Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for 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 Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of 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* Ef/twe 11112001 4-602.11 Cleaning Frequency of Utensils and Food. Animals-155'F 15 sec* 590.006(B) I 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)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* * Ratites-165'F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing g' P m*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* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms 3-401.11( )( )ro) 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#29-Special Requirements. $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* :: 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23-30) 3-202.15 Package.Integrity ( ) Commercially Processed RTE Food-140`F Critical and non-critical violations,which do not relate to the foodbore 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`17 to 70'17 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 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41`F/45'F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. t tw,.r j t 7 � F Y j w Y I F i r ` t I /' r `OptME►°� TOWN OF BARNSTABLE .. HEALTH INSPECTOR'S Establishment Name- Date: Page:.. of 1. PUBLIC HEALTH DIVISION OFFICE HOURS 8:00-9:30A.M. BARNS'1'ABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MAC. MON.-FRI. HYANNIS,MA 02601 No Reference R-Red Item PLEASE PRINT CLEARLY A ,619..go f,, 508-862 4644 rFD MPS FOOD FeTABLISHMENT INSPECTION REPORT Name LiV Date 20Tyne o lygiiZEInspection pRffatin�4s� Routi Address Risk S ection n7YLevel Re ai Previous Inspection Telephone b Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N, Temporary Suspect Illness Caterer General Complaint Person in_Charge(PIC) Time Bed 8 Breakfast HACCP Other IV In: Inspector Out: r Each violation checked requires.an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ c. Ua FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑_1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS c.\ (.► ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP), ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Serious) Critical Violation s scored =F is automaticallyif: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If y 1 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 infestation of rodents or insects,or lack of back-up, 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view V Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N v #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 6 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11 A 2 Raw Animal Foods Separated from Each * 590.004(F) ( )O P 7-101.11 Identifying Information-Original Containers * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food 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 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition of Adulterated or Contamr�iated, 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 Fgod* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual.Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 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* Eg give 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 aces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 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 Anus* 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. ;r 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated B) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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 P 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[o 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures 1, 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 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. TW D V ` _ 3,� r 5� •-� III V\ � Fee i THE COMMONWEALTH�OF p'XA,SSACHUSETTS Entered in computer: tYe-�✓ P BLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS e� �,,a, ppli>cation for Zi�po�a.r *pgtem �lCon!6truction Permit \�,*pplicatio or a Permit to Constnic )Repair( )Upgrade )Abandon( ) ❑Complete System ❑Individual Components ` 3o ;Ton Address or Lot No. q�n Sk. 0Skervi l\P Owner's Name,Address and Tel.No. Assessor's Map/Parcel 11-7 —7(0 Ik0. Sox Cj7 Z OST��R V IU,I�, r1r1 t� OZ(oS S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. H%ckky 7TP - ?Atom suMocv , i?C l 3'5 IRW-alf LAn2 Pgq�rr.,s ozbo► cash, 7 P4� .e,, (kk dSkervlIle, ► c, / Vnt C�vi'Wr Type of Building: N-0 wrd e re� t v F5- 4 Dwelling No.of Bedrooms Lot Size Co,9-10%- sq.ft. Garbage Grinder(PO �" I Other Type of Building kE' WI No.of Persons Showers( ) Cafeteria( to 1 Other Fixtures Design Flow ZOO gallons per day. Calculated daily flow Cog Zgallons.Plan Date r-cbb Z8. Z.o n 1 Number of sheets Z RevisionDateTitle 5[TG tFL-A IJ pRopoSE� SohL S ,STE U?akbb .SSize of Septic Tank 1000 (-K. (CxkSTXA/r. Type of S.A.S. � x �1/y) Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees o ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provis' Title 5 of the Enviro tal Code and not to place the system in operation until a Certifi- cate of Compliance has bee i ue s Bo H Signed - ea ® * � Date Ug o D I Application Approved by Date Application Disapproved for the following reasons Permit No. � Date Issued THE COMMONWEALTH OP MASSACHUSETTS BARNSTABLE, MASSACHUSETTS �+ ' Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded) Abandoned( )by at F, i�� ��\G 1 �� �J`� �V \SZ has been constructed in ccordance with the pr visions of Till 5 andVo r Disposal System Construction Permit No.F ��- �dJ�dated U Installer ow . �A---No Designer i The issuance of this jermit shall not be construed as a guarantee that the s�stem will functipn a] desig ed. Date I f`r C`) Inspector c C - "4 No. ✓�� —����-------------------------------------------- — -Fee w � —THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE., MASSACHUSETTS Miopo.5ar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade )Abandon( ) System located at i( 1 -\c,, i-, 1 ���.t V(\\•P 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: Construc on must be completed within three years of the date of this p }rnit. Date: I i I l ` Approved by 1 l 1 #870 t j Design Flow ' Retail:gallons per square foot= 0.05 (50/1000) { Office:gallons per square foot= 0.075 (75/1000) Finish Wede Retail space= 1370 sf 69 gpd i Office Space= 0 sf 0 gpd minimum allowable gallons per day 200 gpdFilter Total 200.0 gpd =Fobrie Compacted Fill Septic Tank 'eu Ile—Ile Sized @ 200°b of design flow for retail= 400 gallons Pea Stone Reuse Existing 1000 gallon tank e Leaching Leach Field N Chamber 3/40-11/1 Double Waned'' Required Area=GPDl0.74 270 sf Stone Field Size=13'Width x Length Length= 21.0 If I 9' I Use 9 x21'field with 1 (one)500 gallon leaching drywells Area Provided= 309 sf All Components To Be H-20 CROSS SECTION OF CHAMBER NOT TO SCALE, 4'O Sch.40 PVC Finished f From Septic Tank Grade - Conduit Thru Chamber !^ For Power 6 Float Gal°' .' To D-Box Emergency SIC Cables. Chain o: Vol. 2G (.AL ° o.° Min.2 Cover � -.W.;�R 1'•� Afarm — o on El. 'S7 -° 2"0 Sch.40 PVC ccl. y ri�+j P 1 Pump cnEl.3�-S' Mercury Float d P Threaded Pipe Switchs-3Req'd c-I ` ®,4,•, ,,;' _.p Pump off El 35.5 Check Valve C° °� .(� •pA F Secure Pipeat Toga ee Bottom of Chamber ' Bottom El3`L5 , "-� !`, •- I _ 6"Washed a :;s no:. 'e r one Min. ' e�Y SECTION �— j MIN*hp Vl1MP PUMP CHAMBER DETAIL To 3CA4PRavM 24"0 Opening Above For M.H. Not to Scale ley ENwi1Et:R 1/2'0 Galy.Pipe For Frame a Cover. Float Support ots •. Pump Power Float Control To D-Box Cables Installed in Accordance ff With Local Bldg.6 Elec.Codes. 1 NOTE: Engineer to Field Confirm Elevations -19 At Time of Installation. a 4"0 From.Septic Precast Pump Tank.Sch.40 PVC Chamber 0 26 PLAN M1N F1-•3fl.y FG. 40' cc.3 -a o a v Ivoo 1000 GIRL loon oAt. j 6R6ASE i E�.3fi.6 TRAP SEVTtC putt? o' c +I rANK cNAMt�BR s�38:4 L 3 retN �'� E1.-3 t ! Ct• .•L, I DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale 5,HGGT Z/-z McKenzie, Marybeth From: Stanton, David Sent: Tuesday, May 02, 2017 8:08 AM To: Hartsgrove, Elizabeth Cc: McKenzie, Marybeth; Flynn, Margaret; McKean, Thomas; Gallant,Therese Subject: Gone Chocolate Attachments: 100px-Barnstable,_MA_Seal.png Just to follow up on Gone Chocolate seating, the Health Division is still ok t,r�have6 seat (possibly more should they request more and a thorough review of the septic capacity is reviewed in conjunction with th� abutting establishment on the same septic system.) They have had the seating there for ages, see a-maid. b`es low.. , i Thanks, Dave -----Original Message----- From: Stanton, David Sent: Friday, December 19, 2014 8:53 AM To: Flynn, Margaret; Scali, Richard; Hartsgrove, Elizabeth Subject: RE: Common Victualer Just an FYI, I will be on Vacation for a little while and the owner of Gone Chocolate is about to give birth (I think within the next 2 weeks) and also they are going to close down the shop for most of January and February, so if possible maybe we can hold off a little bit on making the decision, which ever way it goes, so we don't put her into labor early. Thanks, Dave -----Original Message----- From: Flynn, Margaret Sent: Thursday, December 18, 2014 8:55 AM To: Scali, Richard; Hartsgrove, Elizabeth; Stanton, David Subject: RE: Common Victualer I worked next to this ice cream shop for 10 years, they have always had seats Maggie Flynn Administrative Assistant Licensing Authority 200 Main Street Hyannis,MA.02601 508-862-4614 _ 518-118-2412(fax) -----Original Message----- From: Scali, Richard Sent: Thursday, December 18, 2014 8:49 AM To: Hartsgrove, Elizabeth; Stanton, David Cc: Flynn, Margaret Subject: RE: Common Victualer 1 You are correct. But there is a long history here.....lets chat. R- Richard V. Scali, Esq. Director of Regulatory Services 200 Main St. Hyannis, MA 02601 508-862-4778 508-778 2412 fax -----Original Message----- From: Hartsgrove, Elizabeth Sent: Thursday, December 18, 2014 8:35 AM To: Stanton, David Cc: Scali, Richard; Flynn, Margaret Subject: RE: Common Victualer Because they have been in existence for a decade or even two, they might not have been required to get a common vic because they are not technically a "restaurant"... however you are correct, a food establishment WITH seats= common vic license. I can talk to Richard and Maggie about the history with this property. This cross referencing is EXACTLY the type of team work we need! Thanks Dave for your help and keen eyes!!!! -Liz Elizabeth G. Hartsgrove Town of Barnstable Consumer Affairs Supervisor 200 Main Street Hyannis, MA 02601 508-862-4670 unxsr,RL& pTEO MAC A -----Original Message----- From: Stanton, David Sent: Thursday, December 18, 2014 7:54 AM To: Hartsgrove, Elizabeth Cc: Scali, Richard Subject: Common Victualer Good morning, Quick question, we have begun to address the seating issues at food establishments during our food establishment inspections. The first one I have counted since the meeting was Gone Chocolate in Osterville. They have chocolates and ice cream. Their food permit has always said 0 seats, even though they have had a few seats in the establishment for ages (well over a decade or two.) The currently have 6 seats and 3 small tables. They are ok with Health to have the 6 seats, however we realize this may trigger a common victualer(sorry, I am not familiar with the license and or when it is\is 2 not required as we had been told conflicting things about it over the years by several different former employees.) What is the next step, would they need a common victualer license as the do have a couple of seats? I can give you more info about the type of use if you need, but mostly take out retail of chocolates and ice cream. I have seen over the years a couple of people sitting down having their ice cream in their if it makes a difference, but again, very few at most. Thanks, David 3 Holbrook R. Davis P. 0. Box 572 _ - Osterville, MA 02655' July 28, 1987 Town of .Barnstable Board of Health c/o ..Mr. John M. Kelly 367 Main Street Hyannis, MA 02601 Dear Mr. Kelly: I am in. receipt of your letter of July 24 concerning sewage disposal at the property I own at 870 Main Street here in Osterville. At the present time and, indeed, . for the past two or three, months, I have had .an engineer, builder, and an architect working on the "development" of my property here. Specifically, Baxter & Nye, Rogers & Marney, Inc. , and R. L. Seaberg Associates are involved in this effort. I trust that you agree with me that it would be unwise to approach this question of sewage disposal on a piecemeal and unintegrated basis. On the other hand, the job is a fairly extensive and complicated one and it would be practically impossible to submit plans within ten days from the date of your letter. Accordingly, I would appreciate your granting a 90 day extension to the permit now held by Gone Chocolate (Mrs. Sheila Burchell ) and also give me permission to submit engineered plans within this period of time. As a matter of fact, the plans. should be ready well before the end of 90 days and I am ,quite sure the work on the system in question can be completed at an early date, but I would like first to make sure that its removal or replacement. ties in with an overall plan. T I would also inform you that the system in question. receives very little use and almost no use as a consequence of the presence of the aforementioned permit holder. Looking forward to hearing from you. Very truly yours, Holbrook R. Davis HRD/jl oFTxE�o TOWN OF BARNSTABLE OFFICE OF BAnaSTAME, a BOARD OF HEALTH q MA06. �p 1639' 0M00"\.� 367 MAIN STREET A HYANNIS, MASS. 02601 April 6, 1989 Ms. Sheila Burchell 858 Main Street Osterville, MA 02655 Dear Ms. Burchell: You are granted a variance from the Board of Health Regulation #10 - Plumbing requiring inground grease interceptors at all food service establishments, at 858 Main Street, Osterville, d/b/a "Gone Chocolates," listed as parcel 75 on Assessor's map 117. The variance is granted with the following conditions: 1) Cooking, preparing, microwaving, and steaming of food is not authorized at this establishment. 2) You must install an under-sink grease interceptor under the double compartment sink approved by the town plumbing inspector. 3) This grease interceptor shall be cleaned monthly (instructions enclosed.) 4) You must submit floor plans of the food establishment and receive approval from the Health Department prior to any reconstruction of the establishment. 5) All other regulations contained in 105 CMR 590.000: State Sanitary Code, Chapter X - Minimum Sanitation Standards for Food Establishments and of Town of Barnstable Board of Health Sanitation regulations shall be strictly adhered to. This variance is granted because there will be no food preparation at this site. This variance is not transferable, and will be voided if the establishment has a change in use, change of ownership, or leased to a party other than an applicant. Very ly yours, Gr r C. M. Farris , M.D. Chairman BOARD OF HEALTH TOWN OF BARNSTABLE GF/bs i . ee 1 TOWN OF BARNSTABLE r OFFICE OF t ' s2e119rnari t30 . .__ OF J aer MAIN STREET �OM11YM HYANNIS. MASS.02601 VARIANCE REQUEST FORM All variance requests must be submitted fifteen (15) days prior to the scheduled Board. of Health Meeting. NAME OF APPLICANT �-^ `'�' ��' TEL. NO. ADDRESS OF APPLICANT NAME OF OWNER OF. PROPERTY �--- DATE APPROVED / SUBDIVISION NAME ' ASSESSORS MAP AND PARCEL NUMBER ��7 - O 75 LOT SIZE 2 Z . LOCATION OF REQUEST VARIANCE FROM REGULATION (List Regulation) � 0g c � �. - . , ,-- - r,_ r v REASON FOR VARIANCE (May attach letter if more space is needed) .S�'✓►2c�- !'Lp Ire 5:��?F;e.r�c �r�"�-�-�•,� - .�.-��. /�.G�� �• G_r,, .�-mot`' �'-���cp_l/1.�- PLAN '- TWO COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANdE APPROVED NOT APPROVED REASON FOR DISAPROVAL O !AM DEBT. • iAE11E D Grover C.M. Farrish, M.D. Chairman Ann Jane Eshbaugh Ak. 3' 1. 1989 James H. Crocker, Sr. _ BOARD OF HEALTH TOWN OF BARNSTABLE (. p�.e.�N CW -c66�i� : i i r _ � kQ'LLf C r - l I I I , LF- I , Fo- t 77-7 i I : V F - Wb (f7 S/ m -06 1 Ic CA Veir _ y !14 , y No. i.a�.� ...... FEs............L.a.00 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town Barnstable ..........................................O F........................ Appliration for Disposal Works Tonotrurtion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: 858 Main St. . Osterville_,_.-Ml�_•_••026 - ............ __..... 6555--••--.T }aan..Ca rd i-p-s....--•...................•---................-•----------..........--•--------- Location-Address or Lot No. Holbrook Davis....................... -... . ................ ----------------------------- 8,5$.,Mn..St,.s Q;a �xxa11�,_.1�A....D2b5.......-- ... l --o Davis Owner Address aA &-B_Cesspool_S:ervi__ce ......................................•._ 12$.31shaps_..Termcp-,...Iiyannas:►...VA......02-60j..... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria a Other fixtures ----------------------------•--• - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date......................................... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.._._..--_--_.__..-_---. Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------------------------------------------------------------•-••-•.........-•-•......................................................... ODescription of SoitS.and...............................................•--•------------------------------------------------•---------------------------------------------.......------• W V ........••-••-•-----•••--•--•-----•--•.....................•-•-•............-••--...•••-••......-•-•-••-••••-•--••-•--•-••-••---•-•-......-•••--•-••••......•........................................... W UNature of Repairs or Alterations—Answer when applicable_---installation of._a 1t000 gallon,___pre_-cast, leach..pzt...(-aYeXf10X.�--stnne--Packed...ta--replace- _--Eav&-. n---------------------------------------------------------------------------• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1Z 5 of the State Sanitary Code— The undersigned further Agrees not to place the system in operation until a Certificate of Compliance has issued by the oar ' f61alth. ei �J .- 3/27/�---------------- 3�2,-��te Application Approved BY -•..------- Date Application Disapproved f ereasons-----------------------•--------.....-----------------.....--------------------•-----------------•---••----..... Date Permit No..�.--•--••--------•--•--•--------•----•----•-....... Issued-.............3/27/84......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Fa:rnstable .....................OF............ Appilrta#ion for Dispnsttf Works Tnn5trnrtion amit Application is hereby made for a Permit to Construct ( ) or Repair (a ) an Individual Sewage Disposal System at: 85'-- •' =-??.... ........==fedrill..... _-•-••---•----5.5........ ................................... - - - ..__........_.... Location-Address or No Lot Nolbrooli Davis •-•-•-......_ _5_ . ;.,air. S ......C)s.tervd lje s..'!.A---_-4..65.�................ Owner Address W A P CessD ool_�e -v__jce.............................•-----------•-•-_-•- ,-a -• -• - Installer Address Type of Building Size Lot............................Sq. feet U� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------------------------------•-----••----•-•-----•--- -------------- w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.........._.......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) � Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------_................ --------------------------------------------------------------------------------------------•---------•.... .--------------------------------------------•.... D Description of SoiSi.and-------------------------------------------------------•-•----------------------------------------------------------•------------•------------------------------ x w UNature of Repairs or Alterations—Answer when applicable_..1Y1s�alletion of 1,000 Uallon, pre—Cast, leac�z--•gi-E---�ovex .¢��__3,::Gor.e_.I c�ea_.1sz_x+eplace_a._�caue--3n.--------------•------------ - -- ----- -- ------.. . ...__. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I TiE 5 of the State Sanitary Code—The undersigned further,agrees not to place the system in operation until a Certificate of Compliance has -issued_by the_boa of Iiealth. 3/27/N= ..........-•-.... - Application Approved B _,..-... 3/2 7/FA.t-e ._ ._ _..._ Date Application Disapproved f he l wing reasons----------------------------------------'g -------------------•---------------------------------------•----•---- ...................................................... ---.......---•--•------•-------...---------•--....-----------••--------------•---••---------------•----------•--......-•-- .........--•--- Date Permit No------................................................._ Issued.......... 3127/ . Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town OF....T;a.rnstabl. . . .e ........... .. ................................................................ f9rdifirat a ,af Mantlrfiattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired b�_. .... Cesspool _3ervice,___128 Iisho�s err.ace, r:;annia:---rA.....02601 ..................................................... 'atn St. , Gsterville, FA02655 -Inilral= Candies - Hobrook Lavi_s has been installed in accordance with the provisions of TU LE oj�j� e State Sanitary Codf as described in the application for Disposal Works Construction Permit No....... __ __f__I ------_•.----. dated.__.._37------- ----------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST D AS A GUARANTEE THAT THE SYSTEM WI F CTION SATISFACTORY. DATE..) ..l .. _.6-.-!.._....••--••.......••-••••-•..............••-•._._.. Inspector... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............T own...............OF..............Faxnstable .............................. FEE.•-.....:.............. � 15.00 Bispos tf Vorks TlInstrnrtinn ramit Permission is hereby granted..A._e ��_.Cesspool Service, 128 Fi_sbovs Terrace Hyannis Hyannis 02601 to Cons }rtt�t ( ) or\Repair (X ) an Individual Sewage e Disposal System gain St. , Csterville, 1,.A 0265jg- Trahan Candies - Holbrook Davis at No.-- = ................-••--•-•-•`-..................................5.......................................... ) Street �( - 3/ �7`r� as shown/theplicati for Disposal Works Construction Permit-No. ............... Dated......._...._/__.......................... ...................•-_ •-- ...----•----------•-------------•----•----••----•..........•.....-•-•-••. Board of Health DATE•--- ........................................................ FORM 1255 A. M. SULKIN, INC., BOSTON �; jell-p LI& Vj WT ,y cJl V' - a� U0. �ONc Cr �Y AAI -z� -\ Previous owners from 1987-2013 In Attic LOCATION �`�+'A�' A' � SEWAGE PERMIT NO. RAI-02/ VILLAGE 11r A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED - / � Lolvc- H 2 N T z � LOCATION41� �,, SEWAGE P'ELRMIT NO. 8y` Q O f y/I LjJ/)(.. ts' - VILLAGE A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER 14,0 LLhoo '7 N /• Icyok y 7cX � 4h1,( I I �C► U[.lp�� DATE PERMIT ISSUED `3/,29 DATE COMPLIANCE ISSUE 3/a zz 6 N G -S o2 f NOTES \ V I.Water Supply For" \ / 2 Location of Ufilitil Desigft Fiow At Least 72 Hou Retail: -,lions r square foot= 0.05 (50/1000) Project The Cant � per s4 Office:gallons per square foot= 0.075 (75/1000) Not+f+cat+on to D Retail space= 10020 sf 501 gpd 3 The Contractor i b� Office Space= 630 sf gI gpd Permits From Tc minimum allowable gallons per day= 200 gpd Defined byThis I Total 548.3 gpd 4 Install Risers as Septic Tank Finished Grade. l �s 5.All Structures 8 Sized(0,200%of design flow for retail= 1097 gallons to Vehicular Trc 47 Existing 1500 gallon tank 6. Septic System t4 310 CMR 15.0( Leach Pit Barnstable Boar. Existing 1000 Gallon Leach Pit T. All Pipinq tobe f 8X8 with 2'Crushed Stone Sidewall Area= 188 SF Capacity= 470 gpd `..,` Bottom Area■ 79 SF Capacity= 79 gpd Total= 267 SF 549 gpd All Components To Be H-20 ,. Design FI*W +' ' Retail:gallons per sqi J� 5 LY t Office:gallons per sqi Retail space= + S �• � � Office Space= minimum allows Septic Tank Sized Q 200%of des f ,t ''"k Leach Field \ r * Required Area=GPC ` Field Size=13'Widtt Length= 13.0 Use 13'x13'field with 1 r=7 W t CK t�t15 ` Area Provided= All Components' i �Y 40 �. � �`, �",: .. I fir` ��� �•I �%�S'�1Mb�l �'roBEREM j P2 t �• ���� I � o� Design Flow �un11 Retail:gallons per W �}�'Ce� o'^. ._..4 ._._.. �°f? -" :�, ❑-. .,_,,;�`—...,, .. ,- _ Office:gallons per Retail space ! + �t(C, office Space 0-0r -7 f �42' - - minimum all( Septic Tank • l ` " \ Sized C 200%of r t rr \ SLAG r T: ` Leach Field Required Area=G Field Size=IT W t APPR�X+MATE t�CATioM, Length■ 2 'of SEP`1C TANK r 000 ' I Use 13'x27'field v ' } Area Provided■ i All Component i1( R,E rh°vFo Design Flow k Retail:gallons I Office:gallons I Retail spa r APPRoXIMA-'E `OCAT10N of Stir, Office Sp - �•„ d„ tk.. ate"• �' ��,,, ..to•,` .� Septic Tank SLAB HYD ! Sized Q 200% - 444 Leach Field It I3 Required Area Field Size=1( 0�1 Length= l Use 10'x55'fig 4 Z r F1E1..D AD3USTED . Q ` ` Area Provided r APMNO WATER L\NE- All Col$�eor _ Y•r - 1 )5Y: � v ` SCALE: V = 30' 1. Thi ma: pro 2. All For property line information see Plan of Land in Barnstable,MA Prepared for Holbrook con Davis dated August 4,2000 By Canal Land Surveying in Plan Book 561 Page 68. 310 NOTES finish Greds#8461.Water Supply FrThis Lot is Municipal Water 2 Location of UWiies Shown on This Plan Are Approx M, Fab is Compacted Fll l - w Design Flow At Least 72 hours Prior to Any Excavation For This LOCUS Retaik gallons per square foot= 0.05 (SOH 000) Project The Cc ntroctor Shall Make The Required Notif ication to Dig Sate(I-888-344-7233) Office?:gallons per square foot= 0.075 p5/1000) 1/8=l/2" ' ��•. ` 3 The Controctcr is Required to Secure A Pse Sforw - =L -F Base B Retail space= 10020 sf 501 gpd q ppropriate� 1e00 Office Space= 630 sf SI gag Permits From Town Agencies For Construction Minimum allowable gallons per day= ZOQ gpd Defined byThi. Plan Total 548.3 gpd 4 Install Risen is Requiredto Within leaf s Leaching y w e a {, Septic Tank Finished Grads. 3/4 —1 1/2 N Chamber y t 5.All Structures B Double Wad a dried Forr Feet or More or Subject Stone * . n f Sized Q 200%of design flow for retail= 1097 gallons to Vehicular 1'ratfic to be H-20 Loading. •-" .f' Z [�l Existing 1500 gallon tank 6 Septic System fobs Installed in Accordance With r _INN I1 310 C M R 15.i)O Latest Revision And The Town of Leach Pit Barnstable Soird of Health Regulations L Existing 1000 Gallon Leach Pit T. All Piping too•Sch.40 PVC. LOCUS PLAN ,( CROSS SECTION OF CHAMBERS s�ie: 1:i2,000 */' \ 8X8 with 117 Sidewal Area Crushed ASSeSSOrS Stone 188 SF Capacity= 470 gpd NOT TO SCALE Parcel 075-1 &077 Bottom Area■ 79 SF capacity= 79 gpd ZONING-GROUNDWATER PROTECTION r Total= 267 SF 549 gpd #862 8� All Components To Be H-20 OVERLAY DISTRICT qN� y Design Flaw IF.G.9� F,G.91 . .• �)a �01 Retail:gallons per sq i!;ro foot= 0.05 (5011000) ST�,� If�p Office:gallons per sluare foot= 0.075 (75/1000) Ift \J U `fir �OPop Retail spece= 0 sf 0 gpd Office Space= 24M sf �0939, Top El. y0_ minimum allowaNe gallons per obi W0 gpd 1500 Gallon Q.b , o Septic Tank 200.o g� 39.g Spptit Tank 3 c :y 39.Z Bot.El. 37 39.4'. y� Sized C 200%of de-*n flow for recall= 400 gallons Bedding as R6Z 07 <<✓/ ~ ' `%;� Jae 1500 gallon tank • PaTitle S d 0 S \� /5", Leach Field �4.. ell \ '-': ,, • „ Required Area■GPDIh.74 270 sf DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Field Size=13'V t7 x Length cx�c?rNciSE�'�K \ � ■ e Not to Scale \ f Length Use 13'xlT field we,t (one)500 gallon leaching drywells T-T wlzK CAAA OIAS Area Provided■ 273 sf Field adjust inverts as required to meet min. pitch requirements. l , ,o--_�' _ _ _ _ O p All Components To Be H-20 Per Town of Barnstable Groundwater Map groundwater elevation is approximately 5.0 ,; t0°°�'�`� Therefore there is approximately 35 to 39 feet to groundwater from existingde. VENT��M IF REQUIRED PER T O s � f VENT TO BE LOCATED SO AS NOT TO P)Mr 01AWOrzk / CREATE A VISUAL IMPAIRMENT ► , , �.;�_�•� .„,__.: o _ 40 #856 &858 7 i„ I 1 r,S�to*e kG.42' Design Flow F6. 42 1 I /'Tim Retall:gallons persquaraF�-„= 0.05 (50/1000) ft b-I j '�I_ offlae: ii'vis per 3quarr- t= 0.075 (7611000) 1000 C.,.. t _ Wwt I Mail space= $000 sf 3W gpd nn c d s CiMce Span,= 900 sf aQQ If c TE►Se�� c:, `42 minimum allowable allons per day= 2N gpd 3�. 7.` Total 22L7 g,M i$vvwas Wo Septic T:mk 313.( Septic Tank `— Bol.El. ` i t• I clued®200%of(esign,ljw for retail• 738 gallons Us:1500 gallon tank �� !i f Bedding os 1 SLAB Per Title 5 . t i Leach Field Required Area a Goo/0.74, 497 sf ?�, DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Field Sized 13 Wiifth x Length Not to Scale li APPROXIMATE 1 ot.AZi Length■ 27.0 If 'OF SEPTIC'TANv, ) 000 Use IT.x2r field v'th 2(two`,•500 gallon leaching drywells Field adjust inverts as required to meet min. pitch requirements. !I Area Provided■ 511 sf Per Town of Barnstable Groundwater Map groundwater elevation is approximately 5.0 All Components To Be H-20 'Therefore there is approximately 35 to 39 feet to groundwater from existing grade. ' EXISTING SEt'71C #832 �; i SYS�i=M TO E5E K?MOvEO Design Flow --- yy' Retail:gallons p.r square foot= 0.05 (50/1000) F.G.y 1 Office:gallons p:.square foot= 0.075 (75/1000) FG•4 ; 1 Retail spar-'a 855?sf 328 gpd 1 C O \ ., Office Spe = 3528 sf W gad e • I r,,M �'` `` �,JI� ' -1 Total 021 gpd y'S' H 22 1500 Gallon Top El. 4 3' Hr0 Septic Tank y - 42.8' �pyic Tdnk 42.6 SLAB 1� 1 ` Sized Q 200%ii design flow for retail= 1184 gallons BOt.EI: Ii0' ' Use 1500 gallon tank y2•4', 42 2 y ._4 � Bedding as t ; .,�`• .�4 ��4� .� 2b Leach Field Per Title 5 J r ►�` -0 Required Area=hPD/0.74 $00 Sf ,� Field Slzb■117 64k th k Length i ` '� Length 3;.0 n DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Use^0'x55'fiel uRh 5(free)500 gallon leaching drywells 4�, ♦ Scale --- ,Area Provided 810 sf Not to F1ELp At OUSTEO I b.,`. :b3 r r'. AROVINO WATER L1Nt All Cornpone rrs T� Be H-20 4 u, 4 Field adjust inverts as required to meet min. pitch requirements. 0` .-• 1 1 Per Town of Barnstable Groundwater Map groundwater elevation is approximately 5.0 L ,ram° Therefore there is approximately 35 to 39 feet to groundwater from existing grade. "� O 17 SITE PLAN SCALE: 1" — 30' Proposed Septic System Upbrades 8329 8469 8569 8589 & 862 MAIN ST 1. This pFan is for the repair/upgrade of the existing septic systems to OSTERVILLE, MA max,;Ium feasible compliance. There is no proposed increase in flow or a FOR tT pro[,)sed change in use. MR. HOLBROOK DAVIS 1 2. All iorkmanship and materials not specifically mentioned on this plan shall By For property line information see Plan of Land in Barnstable,MA Prepared for Holbrook comet,with the provisions and specifications contained within _ - .__ SULLIVAN ENGINEERING Davis dated August 4,2000 By Canal Land Surveying in Plan Book 561 Page 68. 31OCF'IR15.00 latest addition Relocated Septic System for 856&858 Main Date: 09/06/01 OSTERVILLE, MA St&Added Upgrade for 870 Main St. DATE: FEBRUARY 28, 2001 Revision Modifications to System Based on Additional Date:03/22/01 `x As Built Information N �- {