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SNACK SHACK @ SANDY NECK - FOOD
Snack Shack @ f ZIo3 Sandy Neck 425 Sandy Neck Rd. a m a a , , FORMECK BAR DY NECK SNA 4 I Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. rn`sr�a F.P.(Thomas)Lee �$ +b 9 . 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. a Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 190 Issue Date: 01/01/2022 DBA: SNACK SHACK AT SANDY NECK OWNER: VAN COTT CON CESSIONS/PATRICK VANCOTT Location of Establishment: 425 (aka 590) SANDY NECK RD W. BARNSTABLE MA 02668 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: Z 0 Z 2 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: - - MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Well water analysis required regularly. rttt Qffice Initials: Im Town of Barnstable AR'iSTABLE. D.atc Pit[ Irtspectloni Services 19, MAE& Public Health Division Thomas McKean,Director 200 Malt `street; Hyannis,'N'LA 02601 Office: 508 86i2-464,1 F"IN: :iO -79O-6304 APPLICATION FOR.PERMIT TO OPERATE A FOOD ESTABLIS:HMF.NT DATE.._���� _ _�..... NE«-OWNERSHIP..................... RENEWAL.—X...... NAINIE;OF FOOD ESTABLISHMENT: 6+-)'3 x vat) ADDRESS OF FOOD 1�,STABLISICNIEN f ` ✓J'C n1 G (/ r }(r>t �'� ' I1tAlLING.:IDDRESS(IF:DIFFERENT Elt()1i .ABOVE): F3p Ge .� �'. : ,_ M. D 1 -tNIAlL.ADDRESS: TELEPHONE NUINIBER OF FOOD ESTABLISHMENT: ) - ` TOTAL NU\-IBER OF B,A'rl-II2-OOM;S: W EA-L WATE R: YFS,,.X NO ...(ANNUAL.,WA"E'ER,.1N:-�I.,1`SIS I2EQUIIIED) ANNUAL..: SEASONAL:,: �_DATES OF OPERA`I`ION:�i���� 10 �l i 301. NUMBER OF SEATS: INSIDE: OUTSIDE: f0 "TOTAL: SEATING, MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REVI:LNDER*** OUTSIDE DINING.MUST BE APPROVED BY THE HEALTH`DIV.AND LICENSING.AND MEET OUTSIDE DINING. REOU.IREIIENTS. IS NVAIT STAFF PROVIDED FOR OUTSIDE.DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOORS)".�4 TYPE O.F ESTABLISH lV1ENT: ('11L.F.ASF CEIECK A.LL THAT APPLY BE LOW) r 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 MACIIINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE, EVENT(SEE PAGE:#2) **� SEASONAL. NIOSILE S. NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION 11RIOR'TO PERMIT BEINt: ISSUED PLEASE CALL-508-862-4644` Q'A,A)iphcation Forms1`00DA11)' 020:dk OWNER INFORMATION: FULL`Ab1E OF Al'I'LICA1''T SOI-.F.(WNrR: Y T—I NO D.O.B 2 o tp� 04"�NER PHONE l;` ADDRESS 5w)tjlcq tv1 t CORPORATE Ott"\'F..R: CORPORATE ADDRESS: f. PERSON IN CI]A.RG E OI, nAILY.OPI:RATION.,s: List.(2) Certified.Food Protection. Managers AND at least(I) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I Certified Food Protection Manager PER SHIFT.. **ATTACH COPIES OF CERTIFICATES** The liealth 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 2. 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 oneninQl l :Please call Health Div.at 08-862-4644 to schedule your inspection. Please call at lust(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 thesuspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY:. Anyone who caters within the Town or Barnstable must notify the?own'hy fax or mail.prior to catering event. You must complete a catering notice found at http://www,towtiofbartista6le.us/liealthdivisionlapplications.ast). OUTDOOR COOKING- Outdoor cooking,preparation,or display of any foot)prod�ict by a (ood establishment is prohibited. NOTICE: Permits run annually lrom January I st to Dec. 31"each calendar year. IT 1S YOUR RESPONSIBILITY 1-0 RE"fUl2N 'I I1F COMPLETFJ)APPLICATION(S)AND Rr-,QUIR.F1D FFFIS BY l)FC lst. f :;r pplication Fonm'TOODAPPRFV3-2019.doc I NELTLLAB REPORT OF ANALYTICAL RESULTS PWS: 4020023 SANDY NECK BEACH Samples Received: 15-March-2022 Laboratory Case Number: 2C15061 Report Prepared for: Andrew Donnelly WhiteWater 253B Worcester Road Charlton, MA 01507 Director New England Testing Laboratory,Inc. Lab#: M-RI010 Date:2 1-March-2022 NEW ENGLAND TESTING LABORATORY,INC. 59 Greenhill Street,West Warwick,RI 02893 Total#of Pages:4 Samples Submitted: Sample Location Lab ID Type Code Sample Location 2C15061-01 RS 001 GUARD SHACK(PUBLIC BATHROOM) 2C15061 02- RW EP1 WELL#1 ENTRY POINT Request for Analysis 001 (RS) GUARD SHACK(PUBLIC BATHROOM) Total Coliform and E. coli bacteria SM9223B(04)(Colilert 18) EP1 (RW)WELL#1 ENTRY POINT Total Coliform and E. coli bacteria SM9223B(04)(Colilert 18) The analytical methods provided are documented in the following references: Standard Methods for the Examination of Water and Wastewater,20th Edition, 1998,APHA, AWWA-WPCF. Methods for the Determination of Organic Compounds in Finished Drinking Water and Raw Source Water, USEPA/EMSL. Page 2 of 4 '71 Massachusetts Department of Environmental Protection -Drinking Water Program g BACTERIOLOGICAL REPORT 11:.PWS INFORMATION:Referto your MassDEP Col[form Sam ]In_Plan to help completefhe PWS infbrmatlortend MassDEP Approved Sample Site Information sectttins PWS ID#: 4020023 PAS Name: SANDY NECK BEACH CitylTam: WEST BARNSTABLE Class:COM[J NTNC[] 7NC[X] IL ANALYTICAL INFORMATION:Refer to ourMaSsDEP state lab certiBeate for ro er Lab MA Ce #and 71 certified methotla; .- .- •,> rf `II,' `3s ." ; LY —....-.- _....�.. _._._.__.,.�,_P p R•- ____ - _� awl r Primary Lab MA Cert.#: M-RI010 Primary Lab Name: New England Testing Laboratory,Inc. Subcontracted?(Y/N): N Analysis Lab MA Cert.#: M-RI010 Analysis Lab: INew England Testing Laboratory,Inc. [X]Original Report []Resubmitted Report[J Confirmation Report (1)Reason for Resubmissien: []Resample[]Reanalysis[J Report Co (2)Collection Datecfcriginal sample: Total Col(form E.Co9 Enterocoecl �,- Fecal Cc lifolm �' HPC » n'" ;a®g orb sample Notes (TC)Method (EC}Method `° T° (ET}Method? �s (FC)M@(boa - �-� Methpp �. SM9223 SM9223 DEP APPROVED SAMPLE SITE INFORMATION[1] Rd`§" '^ ANALYSIS COLLECTION >+ ANALYSISa TC RES4,5]ULT ` R..Ij Eesult FC suit. Chlorine[2 HPC , LAB SAMPLE Sample Location RESDLT Result Result Result. ResultlYA] Result(2A] COLLECTED BY IDC Type[t,ll Code p 1 APProvad SAMPLE LOCATION(1j [] -mB/L 7kfuimL DATE TIME DATE TIME RS 001 GUARD SHACK(PUBLIC BATHROOM) A 03/15/22 13:30 03/15/22 17:15 BRIAN CONDREY 2C15061-01 RW EP1 WELL#1 ENTRY POINT A 03/15/22 13:45 03/15/22 17:15 BRIAN CONDREY 2C15061-02 iI)Sample Type,Location Code O,and Approved Sample Site location must correspond to the sample information on your MassDEP Total Coliferm Sampling Plan 2AI SWrR systems:HPC samples shall be taken at the same distribution sites and at the same time as total coliform,whenever chlorine residual IS not deteMd 9 the sample 4te.[2B)fecal Reporting Is for unfiltered SWTR sources only. [3)Sample Type:RS-Ro�bne Distribution Sample,RO.Onginal Site Repeat,UR-Upstream Repeat,DR-Downstream Repeat,AR-Additional Repeat,RW-Raw Water,PT-Plant Tap,SS-Special Sample 14)Report as S/100 mL,P(present),A(absent),or Too Numerous To Count:TNTC-I(invalid)or TNTC-P(present).Notify MassDEP of any E.collor enterococcl positive results by the end of the business day. [51 Collect appropnata numCer of re M samples within 24 hours of laboratorynudficstion for mtal coliform hive or invalid samples and E.ra'or enmmcacF 've n, valet scum les. In accordance with 10 CMR 22.15(2),if mailing paper reports,TWO copies of this report must be received by your MassOEP Regional Office no later than 10 days after the end of the month in which the results are received or no later than 10 days after the end of the monitoring period,whichever is sooner.Please note:Electronic reporting(eDEP)deadline is the same as above. I:certify under penaldes of law that I am the person authorized to fill out:t ris form and the r Laboratory Authorized Information contained herein is due,accurate and complete to the best extent of my knowledge. - Signature and Date: 3/21/2022 MassDEP Review Status: ❑ Accepted❑Disapproved Review Comments: Page 3 of 4 III IIIIIIIIII�"I�IIIII�IIII �/ ROUTINE SAMPLE SPECIAL SAMPLE 2 C 1 50613 REPEAT SAMPLE WAF SAMPLE 24 HR RUSH? PRESEASON SAMPLE 253E Worcester Road,Charlton MA 01507 Phone:(888)377-7678 Fax:(508)248-2895 SPECIAL NOTES: PWS ID#:4020023 PWS CLASS:TNC JOBAO#: Partial Seasonal System-WINTER PWS NAME:Sandy Neck Beach PWS ADDRESS:590 Sandy Neck Rd,W Barnstable MA 02668 METER READINGS: Cu Ft. or Gal PWS PHONE#: Is the source treated? YES NO DATE COLLECTED:3'J 5' Z Z Sample after treatment? YES LOCATION SAMPLE CHLORINE NOTES q ) CODE SAMPLE LOCATION TYPE TIME RESIDUAL TC ( oiBottles 001 Guard Shack(Public Bathroom) RS 1350 ✓ I EP1 Well#1 Entry Point Tap Guard Shack EP 13y✓` ✓ I Custody Transfer Name&Signature DATE TIME Sampler: Relinquished by: � $./5 1 n Received by: — / 2 2 . Relinquished by: ZC �i Received by: 3//Sf 2 5 5 PLEASE EMAIL THIS REPORT WITH RESULTS&INVOICE TO: ADonnelly@RHWhite.com and CAstephen@RHWhite.com 3 Page 4 0 °p�NE Tq TOWN OF BARNSTABLE:.. f .: HEALTH INSPECTORS Establishment Name: Date: __. ..._Page �. .of .OFFICE HOURS PUBLIC HEALTH DIVISION 800'-9:30XM. - BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A ayq: `0S HYANNIS,MA 02601 c sos ssz 4R644 No Reference R, Red item PLEASE PRINT CLEARLY:: rFD 10. -,.. - FOOD ESTABLISHMENT INSPECTION REPORT Name Date Z Ty be of Type of.Inspection g j Routine Address ��'t0�/�led,M Risk Re-ins ection Level Retail Previous Inspection' /l Telephone Residential Kitchen - Mobile Pre-operation Owner HACCP Y/N Temporary. Suspe Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP' In:- Other Inspector. � ' - Out: ?y 4 Each violation checked r quires 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) ❑ 3 ��� 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 D64-1--141 ❑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/TEMPERATUREOONTROLS(Potentially Hazardous Foods) [J ❑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 nk ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding -/ _ PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control. C ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HI GHLY.SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food.and Food Preparation for HSP )� ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 1V ❑ 11.Good Hygienic Practices ❑ 22.Posting of.Consumer Advisories 1 /� Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations v Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No �MYe 4 Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. . OveralLRating Y Y � ❑ Voluntary Compliance- ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled.- ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ 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 aboard of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations:9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an..F. B=One critical violation and less.than 4,non-critical violations 9 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in*suspension or,revocation of the food if no critical violations observed,4_to 6 non-critical violations=B. 26.Water,Plumbing and waste, (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. if no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8-non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 n` - ritical violations=C: 29.Special Requirements` (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's ign ur Pri t: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N v #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signa ure Print: Self Service Wait Service Provided Grease Trap Size Variance;Letter Posted -.. . Y N Dumpster Screen? Y N Violations.related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003 A Assi nment of Responsibility* 8 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours* ( ) g _ i� 14 Food or Color Additives 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each i 7-101.11 Identifying Information.-Original Containers* * 2 S90.003(C) _ Responsibility of the Person-in-Charge to. Other*,{,. <, - 3-501.16(A) Hot PHFs Maintained At or Above 140°F P y # 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F Storage- * Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as Public Health Control 590.003(F) 'Responsibility of A Food Employee or An 3-302.15 .Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.004(11) 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 Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP - 590.003(E) Removal of Exclusions and Restrictions 8 ( ) 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* Manual Wa ewa Temperatures* Raw Seed Sprouts Not Served* y pe 7-206.13 Tracking Powders,Pest Control and 201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* I Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY * Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* S90.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shelfsh 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. 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,Drinkin or Using Tobacco* * Requirements. 5 Receiving./Condition g• g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.11 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands _ 3�03.11 E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated O g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41'F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5. . .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 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. v rt Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BAR.`STABLE, Paul J.Canniff,D.M.D. 6 ♦ 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate bkA 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: 190 Issue Date: 01/01/2021 DBA: SNACK SHACK AT SANDY NECK OWNER: VAN COTT CON CESSIONS/PATRICK VANCOTT Location of Establishment: 425 (aka 590) SANDY NECK RD W. BARNSTABLE, MA 02668 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 . FEES - ---- — FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - --- ------- --- -- -- — MOBILE-FOOD: MOBILE-ICE CREAM: ` ( n FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Well water analysis required regularly. f Oq �FIKE i For Office Use Initials: do Town of Barnstable — Date Paid Amt Pal$ RUMSTAMILMBLE, : Inspectional Services 1 pD ' � Public Health Division Check# li QED MA'S A 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 a NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: 6' u) htCk , 5w, J eC'11 t/AN 00V C,07-JC646t1,-J 5 ADDRESS OF FOOD ESTABLISHMENT: � Aec k . • k7jY/ottbtc N w",V MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �o G ke,Y .6-nVe rco 94 r 0 5& 3 E-MAIL ADDRESS: J/4A)CO, G TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (�O ) 30 - 331-70 TOTAL NUMBER OF BATHROOMS: 1-:2 WELL WATER:YES X NO ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: '� DATES OF OPERATION: 5 A/al TO /30 / NUMBER OF SEATS: INSIDE: 0 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? AJD IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? YC-5 TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) _FOOD SERVICE _Y' 'dETAIL 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:Wpphcation FonnsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO((�� `D'.O.B /� (� OWNER gP�H`ONE#� ADDRESS J(� Z4ke-�/ l'r°W !/J�� � (iVryvl CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: &V�r6/4( Aj List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date I. Pf-r�je- V&f 31 �a 1. "J'- U a� A+ 2.- Molki A raker s i 17 i AD 3 a l 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/ai)plications.ast). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Application FormsT00DAPP REV3-2019.doc I 1 5 rw-r� NELTLLAB REPORT OF ANALYTICAL RESULTS PWS: 4020023 SANDY NECK BEACH Samples Received: 04-March-2021 Laboratory Case Number: 1C04054 Report Prepared for: WhiteWater 253B Worcester Road Charlton, MA 01507 Director New England Testing Laboratory,Inc. Lab#:M-RI010 Date: 10-March-2021 NEW ENGLAND TESTING LABORATORY,INC. 59 Greenhill Street,West Warwick,RI 02893 (401)353-3420 .0000, Total#of Pages:4 Samples Submitted: Sample Location Lab ID Type Code Sample Location 1C04054-01 RS 001 GUARD SHACK(PUBLIC BATHROOM) 1C04054-02 RW EP1 ENTRY POINT Request for Analysis 001 (RS) GUARD SHACK (PUBLIC BATHROOM) Total Coliform and E.coli bacteria SM9223B(04)(Colilert 18) EP1 (RW) ENTRY POINT' Total Coliform and E. coli bacteria SM9223B(04)(Colilert 18) The analytical methods provided are documented in the following references: Standard Methods for the Examination of Water and Wastewater, 20th Edition, 1998,APHA, AWWA-WPCF. Methods for the Determination of Organic Compounds in Finished Drinking Water and Raw Source Water, USEPA/EMSL. Page 2 of 4 Massachusetts Department of Environmental Protection - Drinking Water Program B BACTERIOLOGICAL REPORT PWS ID#: 4020023 PWS Name: ISANDY NECK BEACH City/Town: WEST BARNSTABLE Class:COM NTNC TNC[X] R s,P, Primary Lab MA Cert.#: IM-RIO10 Primary Lab Name: NewEngland Testing Laboratory, Inc. Subcontracted?(YIN): Analysis Lab MIA Cert.#: IM-RIO10 Analysis Lab: New England Testing Laboratory, Inc. [X]Original Report Resubmitted Report []Confirmation Report (1)Reason for Resubmission: F7esample[]Reanalysis Report Correction (2)Collection Date of original Sample: TC Method E.Coli Method Fecal Coliform HPC MethodLab Sample Notes: SM9223 SM9223 DEP APPROVED SAMPLE SITE INFORMATION[1] IJ Apt &&ffP1Q% 7@MN FORM.AGO W IRS 001 GUARD SHACK(PUBLIC BATHROOM) A 03/04121 14:05 03/04/21 16:55 MICHAEL NEE 1 C04054-01 RW EP1 ENTRY POINT A 03/04/21 13:55 03/04/21 16:55 MICHAEL NEE 1 C04054-02 [1]DEP Sample Type,Location Code#,and DEP Approved Sample Site Location must correspond to the sample information on your DEP Total Coliforrn Sampling Plan [2]Sv/TR systems;HPC samples shall be taken at the same distribution sites and at the same time as total ociliform,whenever chlorine residual is not detected at the sample site. 13)Sample Type:RS-Routine Distribution Sample,RO-Original Site Repeat,UR-Upstream Repeat,DR-Downstream Repeat,AR-Additional Repeat,RW-Raw Water,PT-Plant Tap,SS-Special Sample [4]Report as#/100 ml-,P(present) A(absent),or Too Numerous To Count:TNTC-1(invalid)or TNTC-P(present). [5]Collect appropriate number of repeat samples within 24 hours of laboratory notification for coirfom-positive or invalid samples.Notify DEP of any routine or repeat E.Coli or fecal positive results by the end of the business day. rti e nZoa '4 Laboratory Authorized Signature and, 4H Date: 3/10/2021 DEP Review Status: ❑ Accepted []Disapproved Review Comments: Page 3 of NEW ENGLAND TESTING LABORATORY, 1254 Douglas Avenue I �< . I II ____ 11 I I N orth Providence,RI 029Q¢ ,nc/ = _ 1f� •� 1-888-863-8522 I CHAIN OF CUSTODY RECOI 1 `FtJ.J�F PRO.L NO. PROJECTNAMFII_OC/UfON "' r•• CUENT 2G v eG�tl"/ P •rt R S REPORT TO :!. A E INVOICETO li U S O NO. V E O T A C R E DATE TIME O 3 R CONTAINERS V M A SAMPLE I.D. i� E rREmA c It .i. n 'sc Sampled by:(Signature) h, •ti: Datefllme Race ly @ithy(Signature) Datemme Laboratory Remarks: 'rl Specla)lnstruclions: <- • Temp.received: List Spedtic Detection Relinquished 6y:(Signature) DateTime RecaF iby-.(Signature) Cooled O Limit Requirements: Valerrane 3�y/.91 a 2 a ai 3 q_-Vl t ( < Relinqutshedby:(Sig n Daten-vne Receivgr�for Laborajoryby..((SSignatture) Daterrkne etlab Subcontracts the following tests:Radielogicais,Radon,Ash�stos,UCMRs,Perchlorate,Bromate,Bromide,Sieve,Salmonella,Carbamates 7Umaround(Business Days) t tom'1 O i! ni Massachusetts Department of Environmental Protection eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: WHITEWATERSBD Transaction ID: 1257880 Document: Public Water System Annual Statistical Report I Size of File: 1836.30K Status of Transaction: Submitted Date and Time Created: 4/7/2021:3:52:43 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. Massachusetts Department of Environmental Protection L� L� Bureau of Water Resources(BWR)—Drinking Water Program Public Water Supply Annual Statistical Report �' Reporting Year 2020 2020 Public Water Supply Verification Please verify the Information below and then click the Continue button. PWS ID: 4020023 PWS Name: SANDY NECK BEACH PWS Street Address Line 1: 590 SANDY NECK RD PWS Street Address Line 2: City/Town: WEST BARNSTABLE State: MA Zip Code: 02668-0000 Class: TNC Legal Information Book/Page: First Name NINA Middle Initial 1Z Last Name COLEMAN Company Name TOWN OF BARNSTABLE Phone Number 15087906272 Street Address 1 1189 PHINNErS LANE Street Address 2 City/Town CENTERVILLE State MA Zip Code JOHN Massachusetts Department of Environmental Protection PWSID#:4020023 Bureau of Water Resources(BWR)—Drinking Water Program Name:SANDY NECK BEACH Public Water Supply Annual Statistical Report City:WEST BARNSTABLE Reporting Year 2020 PWS Class:TNC S stem Information (TNC) _ 1.PWS Street Address DY NECK BEACH PWS Name 90 SANDY NECK RD PWS Street Address Line 1 PWS Street Address Line 2 WEST BARNSTABLE Massachusetts 02668 City/Town Pta e ip Code 508-362-8300 508-362-6517 _ Phone Number Fax Number(if available) eb Site Address of PWS(if available) 4Mailing ailing Address r Same as street address. ENVIRONMENTAL AFFAIRS DMSION ame NEY'S LANE TIN:NINA COLEMAN ddress Line 1 Mailing address Line 2 LIE Massachusetts 02632 Ptate Vip Code 3.Is this a Seasonal System f Yes r-No If Yes,List the dates. Opens: 101 Closes: 1231 MM/DD MM/DD 4.PWS Off Season Mailing Address(if applicable) Off Season Mailing Name Off Season Mailing address Line 1 loff Season Mailing address Line 2 City/Town Otate kip Code — I _. 33 I Off Season Phone Number loff Season Fax Number(if available) Off Season Address Starts: loff Season Address Ends: MM/DD I jMM/DD 5.Does your facility have tenants? 7,Yes !:No If Yes,please list each tenant(attach additional pages as needed)and their type of business: Business Name Type of Activity(e.g.caf6,day care,light industry) S.If you use a contract certified operator,does your system have a signed Public Water System Certified Operator Compliance Notice approved by the DEP °Yes �,"°No Owner Type: MUNICIPAL Federal Employment Identification Number(FEIN): (FEIN)-Do NOT provide SSN 1 Massachusetts Department of Environmental Protection PWSID#:4020023 Bureau of Water Resources(BWR)—Drinking Water Program Name: SANDY NECK BEACH Public Water Supply Annual Statistical Report City:WEST BARNSTABLE Reporting Year 2020 PWS Class:TNC .Is this system a not-for-profit organization f"-Yes { No If yes,indicate Tax Exempt code(e.g.,501C): 10.PopulationServed(DailyAverage): Winter Population(October March): 5 Summer Population(April September): 00 By what method was the population lCensus Type: Other figured Other Description: ESTIMATE 11.Distribution Meter information: a.Number of Service Connections: b.Percentage of service connections that are metered: 100 12.System Information a.Number of Distribution Systems: 1 b.Finished Water Storage Capacity in Million Gallons(11 0 [Conversion factor is(#of gallons)/(1,000,000)=MG] a Pumping Capacity(GPM): 5 13.Cross Connection Control Program Surveyor's FirstName Surveyor's LastName MassDEP Expiration Date Phone Number Certification ID Number CRT LAVERTUE � WS10-0004281 1/21/2024 781-878-sa70M� All testable devices are to be tested and inspected by a licensed tester(RPBP's semi-annually,DCVA's annually).If there are any RPBP's or DCVA's installed at this facility,list the testable device locations and 2020 test dates(use eDEP Attachment feature to submit this information). RPBP Devices I Device Location Test#1(for Reporting Year) Test#2(for Reporting Year) Delete DCVA Devices I Device Location Test Date(for Reporting' Delete 14.Emergency Response Actions: a.Has your system completed an Emergency Response Plan(ERP).(DO NOT submit your ERP to MassDEP.MassDEP will review the ERP during your next sanitary survey.) Yes C t— f�1 have made changes to the ERP(attach copies of all changes.) fo I have made no changes to the ERP. b.Does your system have an Emergency Response(ER)annual training plan as required per 310 CMR 22.04(13)(b)(10)? I f Yes r No Documentation of ER training must be kept onsite for state review,including at the next sanitary survey.This documentation should describe the training performed during the reporting period,including the types of training,the date(s)of training,and number of staff and local officials trained on each date and their job titles. Massachusetts Department of Environmental Protection PWS1D#:4020023 Bureau of Water Resources(BWR)—Drinking Water Program Name: SANDY NECK BEACH Public Water Supply Annual Statistical Report City:WEST BARNSTABLE 1` Reporting Year 2020 PWS Class:TNC c.Is your system registered for the Health and Homeland Alert Network(HHAN) d.Has your system signed the agreement and joined the Massachusetts Water and Wastewater Agency Response Network 7 e.How often does your system test the following Alarms: T_ Other Frequency: Interlocks: Other Frequency: __�� Back-uppower sources:p �..j Other Frequency: f.List and describe all Level 3 or higher ER incidents during the reporting period. Date of ER incident Level Description X.Comments or additional information regarding this section: Massachusetts Department of Environmental Protection PWSID#:4020023 Bureau of Water Resources(BWR)-Drinking Water Program Name:SANDY NECK BEACH Public Water Supply Annual Statistical Report City:WEST BARNSTABLE Reporting Year 2020 PWS Class:TNC Water Production & Consumption Information How to report in Gallons vs.Million Gallons When Converting gallons to Million gallons,decimal point moves 6 places to the left. If Reporting in Gallons(Gal)If Reporting in Million Gallons(MG) Example 1 45,562,100 45.5621 Example 2 340,21.2 0.340212 Example 3 631,020,000 631.02 Example 41 96,543 0.096543 Volume Units Ov Gallons(GAL) r Million Gallons(MG) (7 No Meter FINISHED Water Production and Consumption Summary for Reporting Year: Finished Water means water that is introduced into the distribution system of a public water system and is intended for distribution and consumption without further treatment,except as treatment necessary to maintain water quality in the distribution system(e.g.booster disinfection,addition of corrosion control chemicals). (4)Net finished Water Month (2)Amount of finished 3)Amount of finished that entered your (1)Amount of finished water from water purchased from water sold to other distribution system(1)+ own sources(GAL) other systems(GAL) systems(GAL) (2)-(3)=(4)(GAL) January 1,140 _ 0 0__..___ .__m__.�_�_1 1,140 s-® ®- February 1,110 0 0 1,110 March 750 0 0 750 April 2,030 0 0 2,030 May 6,830 0 0 6,830 June 16,270 0 0 16,270 July 26,620 0 0_ 26,620 August 35,440 0 0 35,440 September 4,200 0 0 4,200 October 1,390 0 0 1,390 November 1,030 0 0 1,030 December 800 0 0 800 TOTAL 97,610 10 0 97,610 Maximum Daily Finished Water Consumption: olume(GAL); 1,143....._..........._......_ Date: 8/11/2020� Massachusetts Department of Environmental Protection PWSID#:4020023 Bureau of Water Resources(BWR)—Drinking Water Program Name: SANDY NECK BEACH' p Public Rater Supply Annual Statistical Report City:WEST BARNSTABLE Reporting Year 2020 PWS Class:TNC RAW Water Production and Consumption Summary for Reporting Year: Raw Water means water in its natural state,prior to treatment and is usually the water entering the first treatment process of a water treatment plant. Same as finished water(it is not necessary to complete Table if same volume as above) Month (1)Amount of raw water (2)Amount of raw water (4)Net raw Water pumped from own sources purchased from other (3)Amount of raw water sold Consumption(1)+(2)-(3) (GAL) systems(GAL) o other systems(GAL) =(4)(GAL) __........_....._...._._..._...._._.__._.._.................. __..__........._._._.._.........._._.....__....... ..... January 0 � 0 0 0 February 0 0 0 0 March 0 0 0 0 April 0 0 0 0 May 0 0 0 0 June 0 0 0 0 July 0 0 0 0 ugust 0 0 0 0 September 0 0 0 0 October 0 0 0 .0 November 0 0 0 0 December 0 0 0 0 I TOTAL 0 0 f 0 1 0 Maximum Daily Raw Water Pumping: olume(GAL):I — —�I Date:C= Summary of Water Sold Sold Water System Name PWS ID# Total Volume Sold Water type �pfWF Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BAKNWAcue. + Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 190 Issue Date: 01/01/2020 DBA: SNACK SHACK AT SANDY NECK OWNER: VAN COTT CONCESSIONS/PATRICK VANCOTT Location of Establishment: 425 (aka 590) SANDY NECK RD W. BARNSTABLE, MA 02668 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Qn 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: Well water analysis required regularly. Jun 01 2020 07:32AM PPS Food Services 5088304448 page 1 Town of Barnstable Initials: •�UM�. Inspectional Services $ Public Health Division - I �2± Ig1D Thomas McKean, Director 200 Main Street,Hyannis,vMA 02601 Office: 503-862-4644 Fax: 509-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE U I-?.OIO NEW OWNERSHIP RENEWAL >'-- NAME OF FOOD ESTABLISHMENT: 5ofqe S �(,� ® ��,vr�••� 4 je"k- C3;%lt ADDRESS OF FOOD'ESTABLISHMENT: ��jrJeP,(� �,4.�, fA) &—as')4fole MAILING ADDRESS(IF DIFFERENT FROM ABOVE):_ ����`(,� 'yll/'c i ���� � ,)S— � E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES A NO_ ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: ld�l NUMBER OF SEATS: INSIDE: OUTSIDE:2 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. h� IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? t V IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? ' e5 TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) X 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 1l2) *** SEASONAL, MOBILE&NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-8624644 Q:1Application FormsTOODAPP 2020.doc Jun 01 2020 07:32AM PPS Food Services 5088304448 page 2 OWNER INFORMATION: LL FULL NAME OF APPLICANT_ Africk U,r SOLE OWNER: YE /NO D,0.11 OWNER PHONE#_ � ��S a (p�- ADDRESS 5Q 44-k° (It-C4-j f'/� k�� - � /`,c� CORPORATE OWNER: 1 CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: 1Aj List(2)Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I Certified Food Protection Manager PER SHIFT. "ATTACH COPIES OF CERTIFICATES** The Health Div,will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date I. �Wyo AM r6 ) tZk 2.—N6 Ll�j 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 openina!! 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(hereafter, 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 httn://www.townafbarnstable us/healthdivisiou/applications asn. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January lst to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:1kpplicalion Forms1F00DAPP REV3-2019.doc T NELTLLAB REPORT OF ANALYTICAL RESULTS PWS: 4020023 SANDY NECK BEACH Samples Received: 11-May-2020 Laboratory Case Number: OE11049 Report Prepared for: WhiteWater 253B Worcester Road Charlton, MA 01507 Director New England Testing Laboratory,Inc. Lab#:M-RI010 Date: 13-May-2020 NEW ENGLAND TESTING LABORATORY,INC. 59 Greenhill Street,West Warwick,RI 02893 (401)353-3420 I Total#of Pages:4 Samples Submitted: Sample Location Lab ID Type Code Sample Location OE11049-01 RS 001 GUARD SHACK OE11049-02 RW EP1 WELL 1 Request for Analysis 001 (RS) GUARD SHACK Total Coliform and E.coli bacteria SM922313(04)(Colilert 18) EP1 (RW)WELL 1 Total Coliform and E.coli bacteria SM9223B(04)(Colilert 18) The analytical methods provided a-e documented in the following references: Standard Methods for the Examination of Water and Wastewater, 20th Edition, 1998,APHA, AWWA-WPCF. Methods for the Determination of Organic Compounds in Finished Drinking Water and Raw Source Water, USEPA/EMSL. Page 2 of 4 Massachusetts Department of Environmental Protection -Drinking Water Program g BACTERIOLOGICAL REPORT , PWS iNFORMATIONtiofer toyourDEA Go�[fow rm Sampll�ng P�lan�toh alb omple the"�S Inf6rinatfion�anF,Adp�dved Samt51's Srfe Ittfofntoi�s4cfidrts elo � �' PWS ID#: 4OYOOZS PINS Name: SANDY NECK BEACH CitylTown: WEST BARNS TABLE Class:COM[] NTNC[] TNC[X] !1 BANAL :ICAL(NFORMA710N tRefer to your�MassDEP state lab�certiflcate for�proper Lab MA Cert#andycertlResF methods � �rr�' r ,, F Primary Lab MA Cert.#: M-RI010 Primary Lab Name: INew England Testing Laboratory,Inc. Subcontracted?(Y/N): Analysis Lab MA Cert.#: M-RI010 Analysis Lab: INew England Testing Laboratory,Inc. [X)Original Report[]Resubmitted Report[J Confirmation Report (1)R...on to,R—bmi.alon: (]Resample[J Reanalysis(]Report Correction (z)eonaetlen Dataof original sample: TC Method E.Ccll Method Fecal Coliform HPC Method Lab Sample Notes: SM9223 SM9223 ,,rrrr�� DEP APPROVED SAMPLE SITE INFORMATION(1) OW r y �'e ''r .GOLLEG21ON y$'1. 3 -ANALVB[8 -.: .TOTAL ' E.CUI or CNLAPoNE �f'IpCq - wF^ �-a t (ABSAMP DEP : OEPt - ro O FORM - FEGAL ' REBULT(41 °RE8{ILT�' ,"� ,e.iaa ''3 OO ECTE0,81 ,,..' tl i `a' - n// r 8ampl�e', 1'ocatloR OEPApp.wad BAMPLE LOCATIO (1t any RESULT( -61",i REBULT,1'}ij. mgRciuML DAt'Ei TIME .DATE t Tlg1E ' ' '.bTrPeU3t "(`'Codet11 r .,,. ,r,2'.ae ...�.//..?%� �_ .. RS 001 GUARD SHACK A 05/11/20 13:30 05/11/20 17:25 MICHAEL NEE OE11049-01 RW EPt WELL 1 A 05/11/20 13:45 05/11/20 17:25 MICHAEL NEE OE11049-02 [Ij DEP Sample Type,Location Code#,and DEPApproved Sample Site location must correspond to the sample Information on your DEP Total Coif..Sampling Plan [zj SWrR systems:HPC samples shall be taken at the same distribution sites and at the same time as total coliform,whenever chlorine residual Is not detected at the sample site. [31 Sample Type:FS-Routine Distribution Sample,RO-Original Site Repeat,uR-Upstream Repeat,DR-Downstream Repeat,AR-Additional Repeat,RW-Raw Water,Pr-Plant Tap,SS-Spedal Sample [9]Report as#1100 mL,P(present),A(absent),or Too Numerous To Count:TNTC-I(invalid)or TNTC-P(present). (5]Collect appropriate number of repeat samples wititln 24 hours of laboratory notification for coliform-positive or Invalid samples.Notify DEP of any routine or repeat E.Coli or fecal positive results by the end of the business day. 1 c peiial6espf�}ila vpthat IAmae,�inonedm�,Marc tN5/oml8nda - y i Laboratory Authorized Signature and „� ,t t l--\ inri,,orraoomm��''�'herem,sbevacarate artd tnp,Ftollte besi� uf Date: (,�1 � 5/13/2020 DEP Review Status: ❑ Accepted ❑Disapproved Review Comments: Page 3 of 4 I II I I it I II I I IIIif I I I _ _ -� Wh, vVAf r;R A WAMW (888) 377 7678 PWS WO PWS ID UODRMAnOW S-/ PWS W# Date Collected: M Name a QCI( a" PWS Class City/Town: G. 1 G Routine:Is the Source Treated? jam ; Was the sample collected after treatment? Manifolded: If applicable,list the connected sources: SMP e TOMI Cfrde# Source of Sample—_ e TIME Conform C?O Gu�� s�a�� ��' l ' 30 3�'S'"�'o / 4 CUSTODY TRANSFER DATE THOM Kenn ' hed By: Received By: - Relingadshed By _ - /63o Received By: . BOTTLES - -- TC = 1-4o HPC =1-46z Nurate,Nchft Sodium =I-250ml or 120ml non preserved(for all 3) VOC =2-40*1 VOA Vail HCL preserved SEC =1-1 liter non-preserved and I-250m1 Nitric preserved Of collecting a Nitrate,Nitrite,86dium at the same time as SEC a separate 2S0 or 120ml bottle is not needed) IOC =I L I liter non preserve4 I-1 liter Sodium Hydroxide preserved and 1-250ml Nitric Preserved SOC =Special made SOC Kit(in plastic bag) Lead&Copper =I-I liter non-preserved Rads = I literNitrid preserved for each Gross alpha,Radium 226,228&Uranium Page 4 of 4 f Bellaire, Dianna From: Miorandi, Donna Sent: Tuesday,June 09, 2020 12:07 PM To: Bellaire, Dianna Subject: RE: Sandy Neck Beach Test Results Dianna: All looks greatW Thanks so much-no need to flag anything here. All good. Now I guess the Snack Shack will contact me to do an inspection. 'Donna Z c/4/Gioranez, A. Town of Barnstable Health Inspector Public Health Division 200 Main Street, Hyannis, MA 02601 The information contained in this electronic transmission ("e-mail"), including any attachment(the "Information"), may be confidential or otherwise exempt from disclosure. It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.As such, it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable. If you have received this e-mail by mistake, please notify the sender and delete it from your system. Please do not copy or forward it.Thank you for your cooperation. From: Bellaire, Dianna Sent: Tuesday, June 9, 2020 11:59 AM To: Miorandi, Donna Cc: Bellaire, Dianna Subject: FW: Sandy Neck Beach Test Results Importance: High Donna; Here are the water quality results for Snack Shack at Sandy Neck requirement. Please let me know if you need to flag it for any reason. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us The information contained ui this electronic transmission("e-m,,l"),including any attachment(the"Information"),may be confidential or other%tnse exempt from disclosure.It is for the addressee onl}-.11iis Information may be pri-vileged and confidential work-product or a 1 BOARD OF HEALTH �YFt7 Town of Barnstable Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. DAWNSrABLE. John T.Norman MAS'S � 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, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 190 Issue Dater . 03/01/2019 DBA: SNACK SHACK AT SANDY NECK OWNER: RTPK ASSOCIATES/PATRICK VAN COTT Location of Establishment: 425 (aka 590) SANDY NECK RD W. BARNSTABLE, MA 02668 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: —_ ----- MOBILE-FOOD: MOBILE- ICE CREAM: -- Q.� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Must have water test before being issued a permit. f T s e �opt►+e royti Eo.t_oTff�e Use Only: Initials; o� Town of Barnstable (_ Die E Am 1 Lsl S x BARNSTABLE, Inspectional Services MASS• T �pTeoMA�a Public Health Division �nl Thomas McKean, Director ] 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 fJ. I �i APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT E C DATE l(� �� NEW OWNERSHIP RENEWAL Xi NAME OF FOOD ESTABLISHMENT: :jA),cy 6ffy— ` (9 kV' t ADDRESS OF FOOD ESTABLISHMENT; `J�(`j �y � jf, � 040, MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 36 t4kCiAN 41, 64t,�& Af dai63 4��`°8 E-MAIL ADDRESS; PI .CO-X4 " J TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (S*2 �'�q TOTAL NUMBER OF BATHROOMS: WELL WATER:YES X NO ... (ANNUAL WATER ANALYSIS REQUIRED) � G 2 ANNUAL: SEASONAL: DATES OF OPERATION: 1�glf l TO ct l J l NUMBER OF SEATS: INSIDE: OUTSIDE: 66 TOTAL: c SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. XY*OUTSIDE DINING REMINDER'** 4' OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV,AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. L IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? / v IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? l e TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BE, j I X FOOD SERVICE it 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 LA13 ANALYSIS REQUIRED) _ CATERING .- (CATERING NOTICE REQUIRED BEFORE EVENT(SEI�'PAGE#2) ^TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) fi i� I SEASONAL,MOBILE &NEW FOOD ONLY:><_Y REQUIRED TO CALL HEALTH DIV.FOR IiNSPECTJON PRIOR TO PERMIT BEING ISSUED E Q:\jlppfication Foini.v\[.00DAPPI Lf V2018.doc F a �1 ,; - PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT �1j�/6r y6J E OWNER: 5 tT] STSOL OWNER PHONE 5D� PT. � > ADDRESS ox) J Lt eyi-c r. G"wL64 5_(p 5 e c� CORPORATE OWNER:�� . C6 `,f� FEDERAL ED NO. : COR?ORATE ADDRESS. CI""t� PERSON IN CHARGE OF DAILY OPERATIONS: �C/E� `'�`✓ FE 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. r **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 F _ 3 2. Je vy 17Ice r SIGNATURE OF APPLICANT DATE 4 ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prio,•to openiriL!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROGIiN 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. I 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://wFvw,toNvnofbarristible,ns/liealtlidivision/applications.asp. E OUTDOOR COOKING: Outdoor cooling,preparation,or display of any food product by a food establishment is prohibited, t TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employe Signature Form. li NOTICI_',: Permits rum annually from January 1st to Dec.3 1"each calendar year. IT IS YOUR R ESP 0NSIBILITY TO [U-.TURN 'l'H.CO'viPLL 1'ED APPLICATION(S)AND REQUMED FF,I?S BY DEC 1st. r QAr\pplieat`.on Corms\POODAPPRLV2ol8.doc L 1 NELTLLAB L�- REPORT OF ANALYTICAL RESULTS PWS: 4020023 SANDY NECK BEACH Samples Received: 19-February-2019 Laboratory Case Number: 9B19053 Report Prepared for: WhiteWater 253B Worcester Road Charlton, MA 01507 Director New England Testing Laboratory,Inc. Lab#:M-RI010 Date: 25-February-2019 NEW ENGLAND TESTING LABORATORY,INC. 59 Greenhill Street,West Warwick,RI 02893 (401)353-3420 Total#of Pages:4 Samples Submitted: Sample Location Lab ID Type Code Sample Location 9B19053-01 IRS 001 GUARD SHACK(PUBLIC BATHROOM) Request for Analysis 001 (RS) GUARD SHACK (PUBLIC BATHROOM) Total Coliform and E. coli ba( SM9223B(Colilert 18) The analytical methods provided are documented in the following references: Standard Methods for the Examination of Water and Wastewater, 20th Edition, 1998,APHA, AWWA-WPCF. Methods for the Determination of Organic Compounds in Finished Drinking Water and Raw Source Water, USEPA/EMSL. Page 2 of 4 i Massachusetts Department of Environmental Protection -Drinking Water Program g BACTERIOLOGICAL REPORT II�PWWS1�FO�,R,MATt�QN�Ref�er�to your,D�EP.C�o(l�form Samp[i�nga�Plan tofielp complete the P„WS mformatton-and-DEpApproved Sample�Ite Informatwn sectloris below � ,- '' �� �'' PWS Will: 402OO2S PWS Name: SANDY NECK BEACH City/Town: WEST BARNSTABLE Class.COM[[ NTNC[] TNC[X] fw. „yr--• .. s+-�°rvanrAxf "T`- t" �, ll ANALYTICAL INfOR_MAT10 Refer to yaurMassDEP state labb certtflcate for proper Lab MA Cert#and Cert ed methods „ � Primary yLab MA Cert.#: M-RI010 Primary Lab Name: New England Testing Laboratory,Inc. Subcontracted?(YIN): Analysts Lab MA Cert.#: M-R1010 Analysis Lab: INew England Testing Laboratory,Inc. [X)Original Report [)Resubmitted Report O Confirmation Report ro R....n for Resubmi.sion: []Resample []Reanalysis [I Report Correction 12)camption oats of oriamm sample: TC,Method E.Coli Method Fecal Coliform HPC Method Lab Sample Notes: SM9223 SM9223 F7 DEP APPROVED SAMPLE SITE INFORMATION[1] .y ✓y; s.'?�` COILTbNN � 9lr?INALYa[Sfi}°% s �€?'q , s TOTALS3 E-Coor CHLORINE �� yy 2 `S7� 1#P t3 .,::. COLLECTEDf6V( jD# " x es ¢ `a� -.-COLIPORM 3'.,. FEC1�L REBlIl:7 4 RESULT � ,d f + BamPleloeatlog '(.`?'- OEPAypr ed BAMPLe LOCATItlN�tj f� i ..�y, a RESULT Ln,5)°, ftE$ULT�e(4�I "4/L �"#c[u/ml UA7 TIMES 'DATE t IRS 001 GUARD SHACK(PUBLIC BATHROOM) A 02/19/19 13:25 02/19/19 17:20 MICHAEL NEE 91319053-01 [1]DEP Sample Type,Location Code#,and DEP Approved Sample Sire Location must correspond to the sample information on your DEP Total Coliform sampling Plan (2]SWTR systems:HPC samples shall be taken at the same distribution sites and at the same time as total coliform,whenever chlorine residual Is not detected at the sample site, (3l Sample Type:RS-Routine Distribution Sample,RD-0dginal She Repeat,UR-Upstream Repeat,DR-Downstream Repeat,AR-Additional Repeat,RW-Raw Water,PT-Plant Tap,SS-Spedal Sample [4].Report as#/100 mL,P(present),A(absent),or Too Numerous To Count:TNTC-1(invalid)or TNTC-P(present). [5]Collect approprlate number of repeat samples Wthim 24 hours of laboratory notification for coliform-positNe or invalid samples.Notify DEP of any routine or repeat E.Coll or fecal positive resoles by the end of the business day. t rtlry pEnalUetfafl2w ttfatri al m meson of umniedrto fill out tlit dorm andztnaf '3 t'tt Laboratory Authorized Signature and Informadon'contame hertvn ssnhueysacwrate and anlo riae best'P.CitMknowletl err " i; Date: LJF�"—�� 2/22/2019 DEP Review Status: ❑ Accepted [Disapproved Review Comments: Page 3 of 4 ROUTINE SAMPLE O SPECIAL SAMPLE 9 B 1 9053 i 0 REPEATSAMPLE O OF 5 FOLLOW-UP AS SPECIAL NOTES: COC-Checked May 2018 7S38 Worcester Road,Chariton MA OM7 Phone:a88-377-767a/Faxsoa-za-2895 **Winter Plan;" IPWS ID#: 4020023 PWS CLASS TNC JOB/PO# 530 PWSNAME: Sandy Neck Beach ADDRESS 590 Sandy Neck Rd,W.Barnstable,MA 02668 PHONE: (SO8)790-6272 METER READINGS- Cu k o Ga DATE COLLECTED: ?//2'//q Meter: 9�7� 02`l 7/ Is the source treated? YES NO Sample after treatment? YES No LOCATIONICOOE SAMPLE LOCATION CHLORINE SAMPLE TIME TC OTHER RESIDUAL TYPE tl bottle;how many? 001 Guard Shack(Public Bathroom) — RS 1 of X • CUSTODY TRANSFER NAME DATE TIME sampten rRe%-#d0-d hy: -10 Recelved by: ReIlnquldxd by: Re Jved by: 0 DO NOT MAIL HARD COPY! Please Email this report with results AND invoice to: viainCilrhwhite.cam 5 S hack @ 3�d N QY ' Commonwealth of Massachusetts Executive Office of Energy &Environmental Affairs Department of Environmental Protection Southeast Regional Office•20 Riverside Orive, Lakeville MA 02347.508-946-2700 Charles D.Baker Kathleen A.Theoharides Governor Secretary Karyn E.Polito Martin Suuberg Lieutenant Governor Commissioner October 10,2019 Ms,Nina Coleman RE: BARNSTABLE—Public Water Supply Marine&Env.Affairs Division Sandy Neck Beach 1189 Phinney's Lane PWS ID#4020023 Centerville,MA 02632 Sanitary Survey Dear Ms.Coleman: Attached please find a sanitary survey report for a survey performed at Sandy Neck Beach on August 7,2019. Please sign and return the attached Sanitary Survey Compliance Plan within 30 days from the date of this letter. Please be advised,in accordance with 310 CMR 22.05(1)(d)3,the Department performed a special monitoring assessment of your Public Water Supply(PWS)as part of this sanitary survey. Based on criteria associated with this assessment,your facility has been put on monthly monitoring for bacteria beginning in November,2019. Please see the enclosed revised sampling schedule which reflects this increase from quarterly monitoring. The signature on this cover letter indicates formal issuance of the attached document. Please contact Allison Rescigno at(508)946-2763 or Allison.Rescignop_mass.gov if you have any questions concerning this document. Sincerely, Richard J.Ron eau,Chief Drinking Water Program Bureau of Water Resources CERTIFIED MAIL: 7018 1830 00013119 5772 r R/AR Enclosure Ecc: Russell Tierney,Operator,RTigmey@Rhwbite.com [for Roy Maher] Barnstable Board of Health,health@town.bamtable.ma.us DWP Archive\SERO\Bamstable-4020023-Sanitary Survey-2019-10-10 This Information is available In alternate format.Contact Michelle Waters-Ekenem,Director of Diverslty/Civil Rights at 617.292-5751. TTY#MassRelay Service 1.600-439.2370 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper SANDY NECK BEACH TOWN OF BARNSTABLE PWS ID#4020023 SURVEY DATE:8/7/2019 Public Water System Sanitary Survey TOWN: BARNSTABLE PWSID: PWS ID#4020023 PWS NAME: SANDY NECK BEACH Survey Date: AUGUST 7,2019 Report Date: OCTOBER 10 2019 Surveyor: , ALLISON RESCIGNO Affiliation: MASSDEP/DWP Person interviewed: ROY MAHER Title: OPERATOR SYSTEM DESCRIPTION: SANDY NECK BEACH IS A TRANSIENT NON-COMMUNITY WATER SYSTEM. IT UTILIZES A SINGLE 6-INCH STEEL-CASED WELL AND AN 85 GALLON HYDROPNEUMATIC TANK, THE WELL IS LOCATED AT THE SOUTHERN END OF THE UPPER BEACH PARKING LOT UNDER A LOOKOUT DECK, IT SERVES THE- FOOD SHACK/BATHHOUSE AND THE GATE HOUSE. THE FOOD SHACK /BATHHOUSE IS OPEN FROM MEMORIAL DAY WEEKEND TO COLUMBUS DAY WEEKEND. THE GATE HOUSE IS AVAILABLE FOR USE BY THE RANGERS ALL YEAR ROUND. THERE IS NO TREATMENT ON THE SYSTEM. ADMINISTRATION: General System Information PWSID CLASS SEASON START SEASON END SUMMER POP WINTER POP Last Annual Stat 4020023 TNC 01/01 12/31 300 5 2018 Facility Address PWS NAME ADDRESS TOWN ZIP PHONE# SANDY NECK BEACH 590 SANDY NECK ROAD BARNSTABLE 02668 508-362-8300 Mailing Address PWS NAME ADDRESS TOWN ZIP EMAIL MARINE&ENVIRONMENTAL 1189 PHINNEY'S LANE CENTERVILLE 02632 NINA.COLEMAN@TOWN. AFFAIRS DIVISION BARNSTABLE,MA.US Contact Information PWSID First Last ADDRESS TOWN ZIP WORK# PRIMARY 4020023 NINA COLEMAN 1189 PHINNEY'S LANE CENTERVILLE 02632 508-790.6272 YES 1 - SANDY NECK BEACH TOWN OF BARNSTABLE PWS ID#4020023 SURVEY DATE: 8n12019 Certified Operator Information PWSID First Last ADDRESS TOWN ZIP WORK# 4020023 ROY MAHER WHITEWATER,INC. SANDWICH 02563 508-888-3540 8 JAN SEBASTIAN_ROAD,UNIT 7 402GO23 . RUSSELL . TIERNEY SAME SAME SAME SAME PWSID First Last POSITION GRADE LICENSE# PRIMARY 4020023 ROY MAHER OPERATOR 3D/3T/4D 01T 23650/23819/23900 YES 4020023 RUSSELL TIERNEY OPERATOR 3T/4D 12407/7894 NO PWSID TREATMENT CLASS DISTRIBUTION CLASS POPULATION SERVED 4020023 N/A vss S-300/W-5 Does the PWS have a certified operator? Yes x No ❑ Are operator grades appropriate for system size and/or treatment type? Yes x No ❑ Does the system have the correct staffing levels for the system size and grade? Yes x No ❑ Is certified operator or a backup operator available for emergencies? Yes x No ❑ Comments: OPERATION AND MAINTENANCE: Is there an adequate spare parts inventory? Yes x No ❑ Is there an O &M Manual? Yes x No ❑ Is there a preventative maintenance program? Yes x No ❑ Are operational records collected appropriately? Yes x No ❑ Are records properly maintained and available for review? Yes x No ❑ Frequency of master meter readings? Daily ❑ Monthlyx Other ❑ Frequency of distribution meter readings N/A x How frequently are meters calibrated? ANNUALLY • The Department recommends that source meters be calibrated on an annual basis. Are emergency telephone numbers posted? Yes x No ❑ Is all critical infrastructure locked? Yes x No ❑ Does the PWS have available an emergency response plan prepared in El with the provisions of 310 CMR 22.04(13)? Yes x No Does the PWS conduct annual emergency response training in accordance with the provisions of 310 CMR 22.04(13)? TNC—N/A Yes ❑ NO ❑ Who performs emergency repairs? (Systems without dedicated staff) TOWN OF BARNSTABLE DPW STAFF 2 SANDY NECK BEACH TOWN OF BARNSTABLE PWS ID#4020023 SURVEY DATE: 8/7/2019 SOURCES: PWSID #Sources %Ground %Porch %Surface %Porch YEAR Avg Daily Max Daily Ground Surface Demand(GAL) _Demand(GAL) 4020023 1 100 0 0 0 2018 470 UNK Groundwater Sources Well Construction Information Source ID Source Name Location Availability Well TXpe Depth Pump Setting 4020023-OIG WELL#1 590 SANDY NECK ROAD, ACTIVE SGWNP UNK UNK BARNSTABLE _Well Inspection Source ID Casing height In Pit(Y/N)? Well House? Vent Screened? Seasonal? Condition?* 4020023-OIG 1 FT NO NO YES NO GOOD Are all wells in use approved and recorded in WQTS? Yes X No ❑ Are all of the wells listed on the sampling schedule? Yes X No ❑ Are manifolded wells reflected accurately on the schedule? Yes ❑ No ❑ N/A X *Is the wellhead damaged in a manner that would make the source susceptible to contamination Yes ❑ No X *Are there unprotected openings in the well cap or casing? Yes ❑ No X *Is the wellhead, cap, and/or vent subject to flooding? Yes ❑ No X Are all wells> 100 ft from the nearest surface water?(NC systems) Yes X No ❑ Is the quantity of water supply adequate? Yes X No ❑ Do any sources run dry? Yes ❑ No X If yes, during which periods and how is it handled? Source Protection i Source ID Approved Zone I Wellhead Zone I(ft) IWPA(ft) POLLUTION SOURCES Volume Controlled? Prot Plan IN ZONE I 4020023-OIG UNK YES NO 100 500 BUILDING,ROAD,PARKING Is there excessive use of fertilizers or chemicals in Zone I? Yes ❑ No X Are there any known or potential, sources of pollution observed in the Zone I or IWPA(other than those listed above)? Yes ❑ No X Is there an awareness of threats and an attempt to minimize them? Yes X No ❑ Is protection area posted? Yes X No ❑ Are source water protection measures adequate? Yes x No ❑ Comments: THE FOOD SHACK AND PUBLIC RESTROOMS ARE OPEN FROM MEMORIAL DAY WEEKEND TO COLUMBUS DAY WEEKEND.. AFTER COLUMBUS DAY WEEKEND, ONLY THE BATHROOM IN THE GATE HOUSE HAS AVAILABLE RUNNING WATER. 3 SANDY NECK BEACH TOWN OF BARNSTABLE PWS ID#4020023 SURVEY DATE: 8/7/2019 TREATMENT- GENERAL: Treatment listed Unapproved treatment No Treatment X . above is correct ❑ installed ❑ • Unapproved treatment is subject to MassDEP permit requirements SAMPLING: PWSID #Bacteria Samples Frequency Summer Winter 4020023 2 MONTH 2 1 Does the system have an approved Total Coliform Sampling Plan? Yes ❑ No X Have changes been made to the system(population,configuration, storage tanks, etc.) such that the coliform sample plan does not comply with 310 CMR 22.05? Yes ❑ No X Is the system taking the correct number of bacteria samples? Yes X No ❑ Is the system using appropriate coliform sample sites? Yes X No ❑ Is the system using appropriate source sample sites? Yes X No ❑ Are raw water sample taps available for all sources? Yes X No ❑ Comments: SEE TABLE B. STORAGE: Maintenance and Condition RWSID# ' Storage Tank Namp storage Tank .Capacity Last Inspection Las4:Cleaned.; Stni tural Integrity «1 Type, Materia( i (GAL)'; Date j DBte Contliton(1,} 4020023 TANK#1 HYDRO. 1STEEL 85 N/A N/A EXCELLENT MassDEP recommends storage tanks be inspected and cleaned every 5 years. Protection and Safety I Proptlr` I Covered fin¢ YQntgd/ $ampl® High LowJ ay pass'for ProteCSed frortj :,' ' PWSID#] $forage Tank Name `O�ferflow 1 Lgcked7(3j Screened?4 F Ta ?s, q ar`ms?,, len n*7o.r Runbl�s zft) FQnceti? ;.1 : r Structure?i ,. O 4020023 TANK#1 N/A YES N/A YES N/A YES YES . NO The storage tanks have nearby injection ports to allow emergency disinfection. Yes X No ❑ The storage tanks are adequately protected against vandalism, Yes X No ❑ (')Are there any holes or failures in the tank roof or structure? Yes ❑ No X 4 SANDY NECK BEACH TOWN OF BARNSTABLE PWS ID#4020023 SURVEY DATE: 8/7/2019 �2)Have any tanks been identified as subject to flooding or run-off? Yes ❑ No X (3)Are all the tanks protected from unauthorized entry? Yes X No ❑ (4)Is proper screening in place on all overflow pipes and vents? N/A Yes ❑ No ❑ Are monthly storage tank.inspection reports available for review? Yes ❑ No ❑ N/A X Are annual rooftop inspections conducted? Yes ❑ No ❑ N/A X Comments: PUMPING STATIONS: PWSID Number LOCATION AVAIL- WATER GPM EMERG MOTOR HP MOTOR TYPE ABILITY TYPE POWER? 4020023 01G FOOD SHACK ACTIVE SGWNP 6 NO 5 SUBMERSIBLE Are all pump stations recorded in WQTS? Yes X No ❑ Is there flooding or standing water in the pump house? Yes ❑ No X Does the air/water relief valve discharge have an air gap? Yes X No ❑ Are there any open floor drains in the facility? Yes ❑' No X Are pump stations adequately maintained? Yes X No ❑ Comments: DISTRIBUTIONURANSMISSION: Has the system submitted a distribution map to MassDEP Yes ❑ No X Are valve locations known or identified? Yes X No ❑ How many distribution systems are there? 1 Is adequate pressure being maintained? (26-60 psi) Yes X No ❑ The distribution system has 0 dead ends which are flushed As Needed List distribution system weaknesses or problems NONE Date of last leak detection survey: ON-GOING Percent of system surveyed?: 100 Are distribution valves exercised regularly? Yes ❑ Frequency? N/A No ❑ Is there a hydrant maintenance program? TNC—N/A Yes ❑ No ❑ Is there an adequate flushing program? TNC—N/A Yes ❑ No ❑ • The Department recommends that the distribution system be flushed twice a year. 5 SANDY NECK.BEACH TOWN OF BARNSTABLE PWS ID##4020023 SURVEY DATE: 8/7/2019 CROSS-CONNECTIONS/BACKFLOW PREVENTION: PWSID DEP APPROVED X-CONN PLAN? X-CONN SURVEY CONDUCTED? 4020023 CROSS-CONNECTION/BACKFLOW PREVENTION NTNC&TNC only: Was a cross-connection survey conducted by a Massachusetts Certified Cross-connection Surveyor? Yes ® No❑ NA❑ Surveyor Name: Certification#: Date of lasts stem-wide survey: Did the cross-connection survey reveal any unprotected cross-connection(s)? Yes Cl No 0 NA❑ If yes, have all cross-connections been eliminated or properly protected?Yes ❑ No ❑ Have testable backflow prevention devices, if present, been tested in accordance with the Yes® No El NA El frequencystated in 310 CMR 22.22 14 d ? Are there Hose Bib vacuum breakers on all threaded faucets? Yes 0 No ❑ NA❑ Comments: PLEASE SEE TABLE B. Statement of Zone I Compliance ❑ Your system is.currently in compliance with Zone I requirements for the following well: Please be advised that any modifications to the Zone I or activities within are subject to DEP approval. x Please note that you lack ownership or full control of the required [100 FT] Zone I protective radius around the following well: 4020023-01G If you plan to modify or expand this source or to replace any wells, you must notify DEP (in accordance with 310 CMR 22.21(3)(b), 310 CMR 22.04(1) and 22.21(10)(a)). At the time of such notification of a proposed modification or expansion,DEP may require you to comply with the Zone I requirement. x You are hereby notified that the following well: 4020023-01G is in non-conformance with the MassDEP's requirement (310 CMR 22.21(1)(b)(5)) that Zone I activities be limited to those directly related to the provision of public water or will have no significant adverse impact on water quality (as specified in Policy 94-03A). To the extent possible, efforts should be made to reduce or eliminate the impacts of non-conforming uses within the Zone 1. Pursuant to 310 CMR 22.04(1) and 22.21(a), you must notify the DEP if you plan to modify or expand your source or to replace any wells. At the time of such notification of a proposed modification, expansion, or replacement,DEP may require you to comply with the Zone I requirement that all Zone I activities be limited to those directly related to water supply or will have no significant impact on water quality. Non-Conforming activities documented within the Zone I: BUILDING, ROAD, PARKING 6 SANDY NECK BEACH TOWN OF BARNSTABLE i PWS ID#4020023 SURVEY DATE: 8nnoi9 SUMMARY OF FINDINGS Table B-Deficiencies MassDEP has made note of items that do not reflect good water system practice and,if left unresolved,could lead to problems that are more serious.Some of these items may be potential violations and are summarized below.Due to an item's severity or importance, MassDEP has included a required course of action with a compliance date. date';' Action Due T/F/M C6 A' T�611 B-CORR2 CTIVE ACTION Szgntficant CQmp7et4 by t s Deficienc • . bate> W_S 1. M 310 CMR COMPLETE AND SUBMIT A REVISED TOTAL COLIFORM NO 11/15/2019 22.05 1 a 3 RULE SAMPLING PLAN. 2. T/F/M 310 CMR COMPLETE A CROSS CONNECTION SURVEY NO 12/31/2019 22.22(3)c 3. Table C-Recommendations MassDEP has made note of items with a recommended course of action,summarized in Table C.It is strongly encouraged to follow the recommended actions in order to improve ability to provide a safe supply of drinking water.Failure to do so could eventually lead to violations of the regulations. 'TIM TABLE C=RECOMMENDATION$, 1: r» 2. 3. *Groundwater Rule Significant Deficiencies: The EPA, as part of the Groundwater Rule, required states to identify specific Significant Deficiencies that are related to the potential for fecal contamination of the water system. Significant deficiencies, when identified at a PWS that is subject to the Groundwater Rule, are regulated under the treatment technique requirements of the GWR. A PWS has 120 days to correct any significant deficiencies after notification from the state of their existence. If the deficiencies cannot be corrected within 90 days, then the PWS must enter into a MassDEP-approved correction action plan, with intermediate timelines for compliance. Failure to have an approved corrective action plan in place within 120 days or to comply with the timelines contained within the corrective action plan, constitutes a treatment technique violation,as detailed in 310 CMR 22.26(4). If a system fails to correct any identified significant deficiencies,then the PWS will be required to provide an alternate source of water,eliminate the source of contamination,or provide treatment that reliably achieves at least 4-log inactivation of viruses. - 7 I SA141DY NECK BEACH TOWN OF BARNSTABLE PWS ID#4020023 SURVEY DATE: 8/7/2019 SANITARY SURVEY COMPLIANCE PLAN RESPONSE FORM for TABLE A & B Within 30 days of receipt of this inspection report,you must complete and submit this response form if your system has TABLE A—Violations and/or TABLE B-Deficiencies.Attach a copy of the completed tables listing the date that the corrective action was or will be taken by your system and all other applicable documentation. (310 CMR 22.04(12)) Please note that violations listed in TABLE A of the Compliance Plan are also a Notice of Noncompliance(NON) pursuant to M.G.L. c.21A, §16 and 310 C.M.R. 5.00 and may require the submission of quarterly written progress reports on the identified violations. The following corrective actions listed in the Sanitary Survey Compliance Plan(s) TABLE A and/or B has been taken by the public water system.(Please check all that apply). ❑ My system has taken ALL of the corrective actions listed within the timeframes specified in the Sanitary Survey Compliance Plan(s). • For each item,I have listed the completion date of the corrective action within each table. • I have attached copies of supporting documentation as required. ❑ My system has taken SOME BUT NOT ALL of the corrective actions listed within the timeframes specified in the Sanitary Survey Compliance Plan(s). My system HAS NOT complied with ALL of the requirements set forth in the Sanitary Survey Compliance Plan(s). • For each item,I have listed the actual or anticipated completion date of the corrective action within each table. • I have attached copies of supporting documentation as required. • I have attached a revised corrective action schedule establishing timelines for my system to address outstanding items and I will submit a written progress report each quarter(every 3 months)until all items have been addressed, at which time written documentation of completion shall be submitted to the Department.I understand that my system may be subject to further enforcement action. ❑ My system is UNABLE to comply with some or all of the corrective actions within the timeframes specified in the Sanitary Survey Compliance Plan(s). I understand that my system may be subject to further enforcement action. • An explanation is attached. I hereby acknowledge receipt of the inspection findings and compliance plan table(s)of the sanitary survey conducted by the Department of Environmental Protection's Drinking Water Program. I certify that under penalty of law I am the person authorized to fill out this form and the information contained herein is true, accurate and complete to the best of my knowledge and belief. Water Commissioner,Owner,Owner Representative or Other Responsible Party: Signature: Date: Print Name: Title: Return this form,a copy of each Compliance Plan Table and all attachments to: DEP-BRP Drinking Water Program,20 Riverside Drive,Lakeville,MA 02347 Attn: Allison Rescigno 8 October 10, 2019 Required Water Quality Sampling Schedule Frequency For 2017 To 2019 Page 1 of 1 PWS ID 4020023 PWS Name .SANDY NECK BEACH Town: WEST BARNSTABLE Class: NC Apr-Sep: 2 per MONTH Season Start Date: 01101 Refer to your DEP Coliform Sampling Plan for approved BACTERIA SAMPLING coliform sample locations.Systems open before or beyond the Oct-Mar 1 per MONTH Season End Date: 12/31 start/end dates must collect samples during these extra months. Loc ID# SAMPLE LOCATION MULT/SIN R/F D/S WAIVER 2017 2018 2019 Y/N QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTRT QTR2 QTR3 QTR4 MANGANESE 10000 WELL#1 S F S [Next Sampling due in 2023] 4020023-01G WELL 1 NITRATE 10000 WELL#1 S F S 4020023-01 G WELL 1 NITRITE 10000 WELL#1 S F S 4020023-01G WELL 1 SECONDARY CONTAMINANTS 10000 WELL#1 S F S [DEP recommends annual testing] 4020023-MG WELL 1 SODIUM 10000 WELL#1 S F S 4020023-01G WELL 1 R/F=-RAW OR FINISHED WATER, D/S=DISTRIBUTION OR SOURCE SAMPLE Waiver.(Y)es,or(N)o MULT/SIN:(MULT)iple sources or a(SIN)gle source This monitoring schedule is based on the system's current inventory and is subject to change.Water systems are responsible for promptly reporting schedule errors or omissions. 'Errors or omissions on monitoring schedules do not prohibit the MassDEP from enforcing monitoring requirements set forth by the Regulations. i NELTLLAB REPORT OF ANALYTICAL RESULTS PWS: 4020023 SANDY NECK BEACH Samples Received: 29-April-2019 Laboratory Case Number: 9D29037 Report Prepared for: White Water 253B Worcester Road Charlton, MA 01507 Director New England Testing Laboratory,Inc. Lab#:M-RI010 Date: 02-May-2019 NEW ENGLAND TESTING LABORATORY,INC. 59 Greenhill Street,West Warwick,RI 02893 (401)353-3420 Total#of Pages:4 Samples Submitted: Sample Location Lab ID Type Code Sample Location 9D29037-01 RS 001 GUARD SHACK(PUBLIC BATHROOM) 9D29037-02 RS 002 SNACK BAR-LEFT SINK 9D29037-03 RW EP1 WELL#1 Request for Analysis 001 (RS) GUARD SHACK(PUBLIC BATHROOM) Total Coliform and E. coli bacteria SM9223B(Colilert 18) 002 (RS) SNACK BAR- LEFT SINK Total Coliform and E. coli bacteria SM9223B (Colilert 18) EP1 (RW) WELL#1 Total Coliform and E. coli bacteria SM9223B(Colilert 18) The analytical methods provided are documented in the following references: Standard Methods for the Examination of Water and Wastewater, 20th Edition, 1998,APHA, A'JWVA-WPC F. Methods for the Determination of Organic Compounds in Finished Drinking Water and Raw Source Water, USEPA/EMSL. Page 2 of 4 c Massachusetts Department of Environmental Protection -Drinking Water Program B L l BACTERIOLOGICAL REPORT . . ; ¢I P<WSdNFORMATtOtb Ref tto your DEP ColJform Sam ling Plan 4o fletp complete the PtiMSalnfo7rnatlon and$D,EPApprov-'6 IN"Psito lnformati�sectwns belaw� „ ' 3,;.,. ..,...,,,,....,,;..,,:.M,.«.,..,....,....:. .,zb, ,..:;-,,,,�_,.;.. P. .�.,w.;r..x. s....:, ..,....,,...�,,>;,,,-�ra�,..� ..:..�z„3,...:. aa..::,a.. PWS ID#: 402002$ PWS Name: SANDY NECK BEACH CitylTown: WEST BARNSTABLE Class:COM[] NTNC[J TNC[X] itl A_NALYTICA L INfO_RMATION Refer to your MassDEP"state tab certtflcate fo o er Lot MBA Cert#and cert[ftedsinethods r ' � w a, o.�,a„a��� _l.u,,w .,�,„»r� Primary Lab MA Cert-#: d_�....._.aM-R1010 a Primary Lab Name: New England Testing Laboratory,Inc. Subcontracted?(YIN): Analysis Lab MA Cert.#: M-RI010 Analysis Lab: New England Testing Laboratory,Inc. [X]Original Report []Resubmitted Report[]Confirmation Rep on (1)R...on for R—bml..lon: []Resample []Reanalysis (]Report Correction (2)C.11.ption D.t.of original sample: TC Method E.Coli Method Fecal Coliform HPC Method Lab Sample Notes: SM9223 SM9223 DEP APPROVED SAMPLE SITE INFORMATION[7] ,a. 7AL ' ��fi Coll oP a:Ir CHLORINE )(iFC -' COLIECTI0N8: ;qyv,} ANALVB[Hti' � ,v`�LµB`9AMPL Y „✓' -' ,Y,saN,l6ac , .:s. !q'.,°x''.. m` 'e^?' £'y..£% ::COLrORM � �FE"AL `� ; REBULT itJ y.�REr'•ULT ,�..� z $v; COLLECTED aVtOuuS". -8anrple�,�Loeatin 'y40EP Approved SAMPLE LOCA- TIDN z "z"�"` x�# � ' .�. �-� € _, �a,✓ ° Srx yPy 1a3� I REBULT[4,6] °�RE833LT(463 mglL #atu)mL �,DATE 17ME x DATE TIME 7 `� '"' RS 001 GUARD SHACK(PUBLIC BATHROOM) A 04/29/19 13:25 04/29/19 1700 MICHAEL NEE 9D29037-01 IRS 002 SNACK BAR-LEFT SINK A 04/29/19 1345 04/29/19 1700 MICHAEL NEE 9D29037-02 RW EP1 WELL#1 A 04/29/19 1340 04/29/19 1700 MICHAEL NEE 9D29037-03 (1]DEP Sample Type,Location Code#,and DEP Approved Sample Site Location must correspond to the sample information an your DEP Total Cdiform Sampling Plan [2]SWTR systems;HPC samples shall be taken at the same distribution sites and at the same time as total cpliform,whenever chlorine residual u trot o bated at Me sample site. [3]Sample Type:RS-Routine Distrbution Sample,RO-Original Site Repeat,UR-Upstream Repeat,DR-Downweem Repeat,AR-Additional Repeat,RW-Raw Water,PT-Plant Tap,SS-Spedal Sample [4]Report as#/lOD mL,P(present),A(absent),or Too Numerous To Count:TNTC-1(invalid)or TNTC-P(present). [S]Collect appropriate number of repeat samples within 24 trouts of laboratory notification for coliform.posltive or invalid samples.Notify DEP of any routine or repeat E.Coll or fecal positive results by the end of the business day. fkla(y�17fIdPYe#,MtovttatyartC'pesson avtlXxtied'to fdl out this:(ohn`endrdle :z ._ Laboratory Authorized Signature and �"IitF ma!m> tauled herein B true acOarete cgnpl :t9 ate,ttest extern oGmy Ykngwled90r't " p��/'� ez .,.,�.. .. �,.).,b. _. .. ., "''-.x a..*✓": Date: 9f `�—.� 5/02R019 DEP Review Status: ❑ Accepted ❑Disapproved Review Comments: Page 3 of 4 L ROUTINE SAMPLE O SPECIAL SAMPLE OREPEAT SAMPLE O OF 5 FOLLOW-UP , 9 D 2 7V37 w SPECIAL NOTES: COC-Checked May 2018 2536 WoKiStef Road,Qfadtan NIA 01507 Phone:aMS-377-7678/Fax mo-Z48-2895 ••Summer Plan" PWS ID#: 40200M PWS CLASS TNC loo/pO# 530 PWS NAME: Sandy Neck Beach ADDRESS 590 Sandy Neck Rd,W.Barnstable,MA 02668 PHONE: (508)790-6272 METER READINGS- Cu ft or DATE COLLECTED: Lly_o�r2cr//9 Meter._ 30/5--7� is the source treated? YES NO Sample after treatment? YES L/ LOCATION CODE SAMPLE LOCATION CHLORINE SAME TIME TC tt OTHER RESIDUAL TYPE 001 Guard Shack(Public Bathroom) RS 025 X •0 002 Snack Bar-Left Sink RS j:ys X ... EP1 Well#1 EP 1 ya X !� CUSTODY TRANSFER NAME DATE TIME S==Pkr eecelwdbr 9�� Regnquldwd a_ •fig_6 dyzi (FQ M� CD �zgt� �U � G O DO NOT MAIL HARD COPY! Please Email this report with results AND invoice to: viain@rhwhite.com Sandy Neck Beach Snack Shack Menu 2021 Appetizers Sandwiches w/chips Chicken Fingers $ 7.50 Served on choice of: Fries: $ 4.00 White, Wheat, Marble Rye or Bulkie Roll Onion Rings: $ 6.25 Tuna Salad $ 8.00 Wing Dings(7) $ 6.00 Chicken Salad $ 8.00 Mozzarella Sticks(5) $ 6.25 Turkey Sandwich $ 8.00 Chowder $ 4.00 Ham Sandwich $ 8.00 Club Sandwich (triple decker) $ 9.25 BLT $ 6.50 From the Grill w/Chips PB&Jelly or Fluff $ 3.50 add fries for$2.50 more Hamburger $ 6.00 Cheeseburger $ 6.50 Salad Plates Sweet Italian Sausage $ 7.75 Garden Salad $ 6.50 Fried or Grill Chix Sandwich $ 7.50 Garden salad add, Ham,Turkey,Tuna or $ 8.50 Grilled Cheese $ 3.95 Chicken Salad Grilled Cheese &Tomato $ 4.45 Hot Dog $ 3.75 Fresh Seafood (see board) Jumbo Dog (Pearl) $ 6.00 (Rolls or Plates) w/fries Turkey Reuben $ 8.00 Lobster Roll mkt Grilled Linguica $ 7.50 Fried Clams mkt Veggie Burger $ 7.50 Fish and Chips mkt Clam Roll mkt add fries for$2.50 more Fish Sandwich mkt Shrimp mkt Scallops mkt Beverages Assorted Coke and Polar $ 2.00 Snacks Products Chips $ 2.00 Milk, Chocolate Milk, Candy $ 2.00 Bottled Water $ 2.00 Ice Cream Novelties (see board) Hot Coffee or Tea $ 2.00 Milk Shakes(Vanilla, Chocolate or Coffee) $ 5.75 Iced Coffee $ 3.00 For the Beach Bagged Ice-5 Ibs $ 3.00 * Before placing your order, please inform your server if a person in your party has a food allergy. * Consuming raw or undercooked meats, poultry, seafood, shellfish or eggs may increase your risk of foodborne illness. OF,ME r _Y _ TOWN OF BARNSTABLE. ..HEALTH wsPECTOR s Establishment Name: Q S Date: 14 Page: of ' / - OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified :639- �0� - HYANNIS,MA 02601 MON.-FRi. No Reference R-:Red Item PLEASE PRINT CLEARLY D MPS° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Dat Type of Type of Inspection Routine AA CIPPL Address isk pod Se ice Re-inspection evel Re ai Previous Inspection Telephone Residential Kitchen Mobile <=Pre- eran Owner HACCP Y/N Temporary ess {► Caterer General Complaint Person in Charge(PIC) Tim Bed&Breakfast HACCP Other Inspector O 6 Out:();L(y- Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Inv, n Violations Related to Foodborne Illness Interventions and Risk Factors(Red Itemsl Anti-Choking 590.009(E) ❑ J 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) ❑ 00 FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS1✓��.Q ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives f''1-' `^'�� Cie :/ (`,_Iq p�„� ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals �M � -�/�'l*� FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ADJ ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures &kyA ❑ 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 (/ C.t✓CL PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) � -0> ❑ 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 I S Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations j ) Critical(C)violations marked must be corrected immediately. (blue&red items) CC DD 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 g ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations 26.Water�Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical iolat violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 9 within 10 days of receipt of this order. violation,4 to bnon-critical violations=C. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspecto' i nature Print: 31.Dumpster screened from public view w 7j{ Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N j/ #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's ig Qare^ Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N C�fi✓ 1 A16 Dumpster Screen o Y N Violations related to Foodborne Illness - - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* g Cooked and RTE.Foods.* - 19_ PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties- - 3-302.14 Protection•fiom Unapproved Additives P Contamination from Raw Ingredients Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15 i EMPLOYEE HEALTH 31302.11(A)(2) Raw Animal Foods Separated from Each ff * 590.004(F) - Y 7-101.11_.- Identifying Information-Original Containers * Other* 37501 16(A) Hot PHFs Maintained At or Above 140°F r 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Contain er`s*';' Require Reporting by Food Employees and Contamination from the Environment- * "'3>501 Y6(A) Roasts Held At or Above 130°F* 7-2�11.11 Separation-Storage ` -Applicants* - - 3 302 l (4 * P g 20 Time as a Public Health Control Food Protection 7-202.11 Restriction-Presence and µUse* 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* * 7.20112 Conditions of Use* 590.004 11 Variance Requirements - 3-304m Food Contact with Equipment and Utensils * ( ) 4 590.003(G) Reporting by Person in Charge* _ 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer d, 3 590.003(D) Exclusions and Restrictions* t 7-20411 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food _ 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and _( ) P _ 4-501.111 Manual Warewashing-Hot Water, 7.206.12 Rodent Bait Stations 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - - - Concentration and Hardness* 3-401.11A(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* Eggs 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* Ery°i-11112001 _ 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From 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 3-401.11(A)(2) Ratites,Injected Meats-155 155°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 ca[er- 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* t: . 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* ,rt,- 11 Good Hygienic Practices 1 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * - Requirements. $ Receiving/Condition g. g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140'F* (Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the Foodborne 12 Prevention of Contamination from Hands 3-403.11E 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 * 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 5-203.11 Numbers and Capacities* ! Within 4 Hours* 23.- Management and Personnel FG-2 .003 Tags/Records:Fish Products - 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 3402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance ! Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. physical Facility FC-6 .007 7 Conformance with Approved Procedures I 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 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:590Forrnback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �oF. row TOWN OF BARNSTABLE.. t l ICE Establishment Name VY Date: P/ Page:.of. W IL o V PUBLIC HEALTH N 0-9.30A.M. Pus H Dlvlslo BARMB7'ARLE. 200 MAIN STREET 3- 0-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN Of CORRECTION Date Verified HYANNIS,MA 02601. r f 50ON.-FRI. No Reference R-Red Item P SE P T R }. . rFD MP�p A . FOOD ESTABLISHMENT INSP C ION REPORT U_ Name Date a of Tyne of In pection Routine Address Risk Food S `e . Re-inspection Level a ail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary S Caterer General Complain Person in Charge(PIC) Time Bed&Breakfast 41 Other Inspector ' jut: 2mulg '0.0,r Each violation checked requires an explanation on the nar ative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ® �- ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives - ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS,FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) (9 ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY �1 ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violation Critical(C)violations marked must be corrected immediately. (blue&red items) vera Corrective Action Required: ❑ No ❑ Yes within 90 days as determined by the Board of Health. Non-critical(N)violations must be corrected immediately or qinspection 011 Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection ScheduledEmergency Suspension C N Official Order for Correction:Based on 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 re ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC 4 590.005 B=One critical violation and less than 4 non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food = 26. if no critical violations observed,4 to 6 Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If rion-critical violations B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critic (.violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590,00$) 9 V9lfffi0R,,4 to 8 non-critical violation =C ,1111 29.Special Requirements (590.009) within 10 days of receipt of this order. 36.Other DATE OF RE-INSPECTION: Ins a is Si nature t: 31.Dumpster screened from public view 4)5 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI s Sign ur Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N ` / / , uP0 Dumpster Screen? Y N l , j! Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 7-102.11 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* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* Y0 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) Repo 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 rting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions*590.003(E) Removal of Exclusions and Restrictions 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Reser of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP _7d Disposition of Adulterated or or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 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. 18 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* EB c& 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009 A 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( )-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority _ 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail - 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 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 Tune* 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 fuodborne 12 Prevention of Contamination from Hands 3-403.11 E 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 * 13N6-301.11 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 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.1I Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 special Requirements 009 3-502.11 SPecialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 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. oFIKE rok TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: ate: t Pager of v` do OFFICE HOURS iW�nNsrne�e. PUBLIC 0HEALTH RETSION \ 6:00-9:30A.M. MAIN 0 03:30-4:30 P.M. Item Code C-Critical Item. DESCRIPTION OF VIOLATI N/PLAN OF CORRECTION Date Verified ;'79: �0 HYANNIS,MA 02601 M -FRi. No Reference. R-Red Item PLEASE PRINT CLEARLY �1°lFo MPS° 508-8-862-4644 - FOOD ESTABLISHMENT INSPE TI • N REPORT Name q4Date e of Tyne of Inspection s Routine t Address Risk _ Food Ski a Re-inspection Level etaiil" Previous Inspection l Telephone Residential.Kitchen D Mobile re-oper Owner (� HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) VAN. Time Bed&Breakfast HACCP _ 1011An: Other Inspectorf / Out: f Each violation checked requires an explanation on then rative page(s)and a citation of specific provision(s)violated. c� Violations Related to Foodborne Illness Interventions and Risk Factors(Red Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ r,, Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ , Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned I 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) 1714.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7..Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding tA 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 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) aQj1 Corrective Action Required: ® No ❑ Yes Non-critical(N)violations must be corrected immediately or cx�u within 90 days as determined b the Board of Health. Overall Rating Voluntary Compliance y y ❑ ry p ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction Order for Correction:Based on an inspection today,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ Emergency Closure ❑ Voluntary Disposal Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.E -Equipment and Utensils (FC-4)(590.005 B=One critical violation and less than 4non-critical violations 9 q p ) cited in this report may result in suspension or revocation of the food 4 to 6von-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed, Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address vi I 4 to 8non-critical vi•atio 29.Special Requirements (590.009) within 10 days of receipt of this order. • =C. 3 I Other DATE OF RE-INSPECTION:OF RE-INSPECTION: Insp r' t t7 rintPi 31.Dumpster screened from public view ff/, Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N Frozen Dessert Machines: Outside Dining N Y PIC's Si ature Print: #Seats Observed e Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 1 q Food or Color Additives Law Cooled to 41'F/45'F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Chazge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F EMPLOYEE HEALTH 3-302.11 A 2 Raw Animal Foods Separated from 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 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)Resumed Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 183-401.11A(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 Utensils and Food ContactEggs 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* 3-401.1](A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155'17 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)(l)(2) Pork and Beef Roast-130'F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 8 590.009(A)-(D) Violations of Section temporary and - ide in cater- * Ratites-165°F 15 sec* in mobile food,tem o and residential Sources 10 Proper,Adequate Handwashing g' P mTY Game and Wild Mushrooms Approved B 3 401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Regulatory Authority y 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercial] Processed RTE Food-140'F* Blue Items non-critical 23-30) 3-202.15 Package Integrity Y Critical and non-critical violations,which do not relate to the foodbome 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 S Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 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 r..ritical item in the federal 1999 Food Code or 105 CMR 590.000. `Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �p tNF ro TOWN OF BARNSTABLE. _ .HEALTH INSFECTORs Establishment Name. Da e e4l / Page: of. OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. A 200 MAIN STREET 3:3o-a:3o F.M. - Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified JA a39: �0� HYANNIS,MA 02601 ( d' 508-862-4saa No Reference R-Red Item PLEASE PRINT C RLY prFD MP�a FO ES ABLIS MEN INSP TI N REPORT. .�/� i Name Date e o Tyoe of Inspection 1q] ( - O Routine Address isk o d,Serv' Re-inspection evel Previous Inspection Telephone Residential Kitchen n Mobile re-operaUo r Owner HACCP Y/N Temporary Sus 'ct Ilness �- Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP i Other Inspectorriv u /.. _ Each violation checked requires an explanation on the narrative page(s)and.a citation of specific provision(s)violated. lb 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) ❑ 0 FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities eo 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 V qq ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding f PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control I ❑ 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 LbEl11.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) 5 ( L Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or `I within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ 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 4nori-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(5901006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If If critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 no -critical iolations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. tion,4 to 8 non-critical v' lation -C. 30.Other DATE OF RE-INSPECTION: Ins cto' i• ature 0Print: r 31.Dumpster screened from public view / (O U Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si ure Print: Self Service Wart 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 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Anima]Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment * g 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* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) Variance Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Equipment 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg cmc mnooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009 A D m cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) ( ) Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 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, 8 g 3-403.11(A)&(D) PHFs 165'F 15 sec , 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the fvodborne 3-101.11 Food Safe and Unadulterated* 3403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 TagsiRecords: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 Handwashin Facilities 3-501.14 A Cooling C 3-202.18 Shellstock Identification* g ( ) g coked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures 1 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. gliq e5A pp THE rp TOWN OF BARNSTABLE f, - HEALTH INSPECTOR'S Establishment Name: I c to - Page:. of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARN ABLE. ` 200 MAIN STREET 3:30-4:30 F.M. Item Code C-Critical Item DESCRIPTION OF VIOLATIO /PLAN OF CORRECTION Date Verified �p 6 S.a.0 _ HYANNIS,MA 02601 MON.-FRI. No Reference .R-Red Item - PLEASE PRINT CLEARLY 'Fo N�PT 508-862-4644 FOOD E„ BLISHMENT IN TION REPORT Name 11:;AV),EA5HACADat e o Type of Inspection Operation(s) Routine Address Risk Re-inspection Food Service P �o Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector VT Out: Each violation checked requiresIV / I n explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 1 Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ c? FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities I V j _ "- EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals -- FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18..Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/"Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices" ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance Com F] Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-c•ical violations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector Sign tur 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 Signat e Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N 4: . Dumpster Screen? Y N Y } Violations related to Foodborne Illness � Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) ° FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45'F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140'F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P 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** 590.00411 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use * 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.004(11) 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 Reared or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( P 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* I� 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 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Fquipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg"nve rnnoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155' 15 sec* faces of Equipment* F Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- , Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 2-401.11 Eating,Drinking or Using Tobacco* * 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* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3 403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the . 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41'F/45'F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 I 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. Op 1HE r, TOWN OF BARNSTABLE HEALTH wSPECTOR's Establishment Name: Date: _ Page: of q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p Mp3 a 0� HYANNIS,MA 02601 -FRI. 08-862-4644 No Reference R Red Item PLEASE PRINT CLEARLY - rF0 M FOOD ESTABLISHMENT INSPECTION REPORT A'S 508-8 Name 64 Dat LL T e o T section O s outine Address Risk od Se - ection Level al Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) LAA Le Time Bed&Breakfast Other HACCP In: Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands �\J`� ° c�cl ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 11 t/ 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) c ❑ 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 CA- Critical C violations marked must be corrected immediately. blue&red items ( ) Y ( ) �� V` Corrects Action Re red: ,� N Non-critical'(N)violations must be corrected immediately or Overall Rating l within 90 days as determined by the Board of Health. ICg ❑ Voluntary Compliance ❑ Employee R I t n/ u e nspection Scheduled ❑ Emerg n Suspension C N Official Order for Correction:Based on an inspection toda ,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure oluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical-violations. F=3 or more critical violations.9 or more non-critical violations, 24'..Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scsred automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.'Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 9 violation,4 to 8 non-critical violations=C. 29.Special equirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signatu a Print: 31.Dum ter sgreened 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 P C's Sig a Print: /1 / Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N . 1 Dumpster Screen o Y N e /V Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* S Cross-contamination 14 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* g 2-103.11 Person-in-Charge Duties- - - Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19. PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or'Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F - 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each j 7-101.11 Identifying Information-Original Containers* 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 � 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* *Stora e- Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 7-202A 1 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employeeor 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 I 1 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q 590.003(G) Reporting by Person in Charge* _ _ 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)l Returned Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated Food' 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served 3-201.13 FluidMilk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 1 g Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eH-li"e 11112" 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Cayght Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Fisted Chemical* g g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 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 ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 1 T Reheating for Hot Holding Requirements.practices should be debited under tY29-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 1 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 3-403.11E 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 Cooling Cooked PHFs from 140°F to 70°F 3-501.14(A) g 3-203.12 „ Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices fF 590.000- Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel -2 .003 - 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection -3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils -4 .005 3-402.12 Records,Creation and Retention* ! 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste -5 .006 590.004(J) Labeling of Ingredients* P Supplied with Soap and hand Drying Devices i 27. Physical Facility -6 .007 7 Conformance with Approved Procedures/ 6-301:11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials -7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* +^ S:590Forrnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. f Op THE r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date:J rPage: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. i BARNSTABLE, • 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. A i639.p�0 HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY ,FOMP, FOOD ESTABLISHMENT INSPECTION REPORT �-LY Name Date APtm of Type of Inspection Routin Address Risk pod Sery e-Inspectio Level ction Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 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 00 ❑ 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 N� Critical(C)violations marked must be corrected immediately. (blue&red items) ' Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. = ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4npn-critical violations g )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up, infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to anon-cri 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8npn-critical violations=C. 29.Special Requirements (590.009 y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view / Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIV Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs * * 19 PHF Hot and Cold Holding Cooked and RTE Foods. 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F - 590.004(F)- * - - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* � g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.00411 Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) Variance Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and 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 Pesticiaes,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( P 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.1 IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11 A Cl Uild Food Ctt Surfaces of * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* ( ) ean tenss an onac Eggs-Immediate Service 145°F 15 sec -Equipment* Not Otherwise Processed to Eliminate. 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell 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* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )(b) 3-201.17 Game Animals* 11 Good Hygienic Practices Requirements.practices Id be debited under#29-Special 17 Reheating for Hot Holding j 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F[0 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* Supplied with Soap and hand Drying Devices Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 1 Conformance with Approved Procedures* S: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. `oFTNerok TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. ` 5vt 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 MON. No Reference R-.Red Item PLEASE PRINT CLEARLY `' �o .asq•n� 508-862-4644 rFDN1P' �. FOOD ESTABLISHMENT INSP CTION REPORT V-\ Grr\ Name / Dat Type of Type of Inspection �/ v O e s Routine cl- Address Risk od Se Re-inspection 5 Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile P -o eration Owner HACCP Y/N Temporary i� Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP �f In: Other L� Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. �--- Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands '-n � �( Ll ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 1/ S ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ©C✓'- ❑ ` C 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazard us Foods)1� ❑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 .(� �l PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control , v` ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPU TIONS(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 a �- Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations L Critical(C)violations marked must be corrected immediately. (blue&red items) �-' Corrective Action Required: 1❑ 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. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically lack of no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non critical. If no critical water,sewage back-up,infestation of rodents or insects,or la 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the abtve address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. f�nJ violation,4 to 8 non-critical violations=C. 29.Special.Requirements . (590.009) Y P y 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: G; 31.Dumpster screened from public view ,[l,LP \n Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered ��/ Y N iv #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sin ml -animin ia gna r 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) fi FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to' 1 590.003(A) jDern, ssignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) nstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils .7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(13) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14. Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( P 4-501.111 Manual Wazewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs- mme is sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg criw iiinoa 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 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* Other 590.009 violations relating to good retail 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* 3-201.17 Game Animals* 11 Good Hygienic Practices 1 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g• g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.12 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 5-20411 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 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. i.HE low TOWN OF BARNSTA.BLE_ HEALTH INSPECTORS Establishment Name: Date: Page: of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:MA.M. BARNSTABLE. • 200 MAIN STREET s:so-a:so P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. A .e39•A.0 HYANNIS,MA 02601 508-862-4644 No Reference R-.Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION EPORT ' l 5 �W Name Da T e o Type of Inspection U O Routine Address Risk Food Serv' Re-inspection Level a Previous Inspection Telephone Residential Kitchen ��Ss Mobile Owner HACCP Y/N Temporary Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. /1 n D Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ V Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS. ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No TO Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating ry p ❑ ❑ p ❑ y y ❑ Voluntary Compliance Employee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 Emergency Closure ❑ Voluntary Disposal Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 4 non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 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-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 anon-critical violations. If 1 critical refrigeration. _ violation,4 to A non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sign ur Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted -Y. N CA Y Dumpster Screen? 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.) o� FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According tb% 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 590.004(F) 590.003(C) Responsibility of the Person-in-Charge 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 * 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 Conditions of Use 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 720 .1 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions*590.003(E) Removal of Exclusions and Restriction 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)iB)Returned Food and Reted or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) s Disposition of or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( P 4-501.111 Manual Wazewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 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 Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* Eggs Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef lli e 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 Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and e ide in ca[er- Sources* Ratites-165'F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 3-202.18 3-202.18 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 Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-2041 t Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures 1 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 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. ,.o/o 6011 P�oFIKME Tom" Town of Barnstable Barnstable �,..1 WnWcaCity * BARNSCABLE, MASS. g Board of Health �O 039• �0 MAtR' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi September 8, 2010 Mr. F.P. Lee Horsley & Witten 90 Route 6A Sandwich, MA 02563 RE: Sandy Neck Beach, 425 Sandy Neck Road, W.B. A = 263 - 001 Dear Mr. Lee: You are granted variances on behalf of your client, Town of Barnstable, to construct an onsite sewage disposal system at Sandy Neck Beach, 425 Sandy Neck Road, West Barnstable. The variances granted are as follows: Section 360-2 of the Town of Barnstable Code: To place a soil absorption system within an area of shifting sands. 310 CNIR 15.211: To maintain existing grease trap 8.3 feet away from the foundation wall in lieu of the minimum ten (10) feet separation distance required. 310 CMR 15.221(7): To install a soil absorption system beneath 4.6 feet of soil cover, in lieu of the three (3) feet maximum depth of cover allowed. These variances are granted with the following conditions: (1) Outdoor Shower: There shall be no enclosure around the outdoor shower. The use of soap and shampoo at the outdoor shower is not authorized. (2) Restaurant: No more than 36 seats are authorized at the restaurant. (3) Function Hall: No more than 33 seats are authorized at the future function hall. Q:\WPFILES\Sandy Neck septic var2010.doc � S RE: Sandy Neck Beach, 42Y Sandv Neck Road, West Barnstable Horsley & Witten Page Two September 8, 2010 (4) The septic system shall be installed in substantial conformance with the revised engineered plans dated July 9, 2010. (5) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the revised plans dated July 9, 2010. These variances are granted because the physical constraints at the site severely restrict the location of the septic system components within shifting sands in order to maintain the required setbacks to the onsite community well. Since ly yours Wayne ill r, M.D. --- Chair n Cc: Nina Coleman, Sandy Neck Park Manager Marine and Environment Affairs Town of Barnstable 1189 Phinney's Lane Centerville, MA 02632 QAWPFILES\Sandy Deck septic var20IO.doc 'tten Group Hors ey Al Sustainai nvironmental Solutions 7�Z )Z �f-E.6A • Sandwich, MA • 02563 Phone-508-833-6600 Fax-508-833-3150 wwwhorsleywitten.com July 25, 2010 Mr. Thomas McKean, Director Barnstable Board of Health Town of Barnstable 200 Main Street Hyannis,MA 02601 Re: Variance Request—425 Sandy Neck Road,W. Barnstable Dear Mr. McKean: Please find enclosed the variance application for the septic system upgrade at the referenced location. The existing system will be upgraded"with a new,Title 5 compliant system for the batl-1house/concession building that incorporates capacity for future Coastal Interpretive Center. .We are submitting only wastewater design plans(Sheets C-10 and C-11) from the plan set for the project. A.new 7,000-gallon one-compartment septic tank, 3,500-gallon one-compartment septic tank,distribution box, and Presby Enviro-Septic leaching field are proposed to treat the 3,246 gallons per day(gpd) design flow. The existing 1,500-gallon-grease trap will remain. Anew recharge basin is`p'roposed for-the outdoor showers. Two variances are being requested from Title 5. A variance from the setback to the existing slab foundation for the bathhouse is being requested. The existing grease trap is 8.3 feet from the slab foundation: This variance will allow for the reuse of the existing grease trap. The second variance is for the depth of cover over the system. The proposed leaching facility is located underneath the existing parking lot. This variance will allow a gravity system be installed while maintaining the existing-grade of the parking lot. Enclosed please find the project plans and the Modified Certification for General Use for..the PresbyM —� - Enviro-Septic Leaching System, along with the Enviro-Septic Wastewater Treatment Operating-' Maintenance. All abutters have been notified in accordance with state and local statutes: Please,let me know if you have any:questions or comments. Thank-you very much for your consideration. We look forward to meeting with you on July 13, 2010. - Sincerely, , HORSLEY WITTEN.GROLP, INC. Mark E. Nelson. Principal Enclosures Sandwich Newburyport Providence Smart Growth • Integrated Water Management Wastewater Management • Stormwater Management Civil&Environmental Engineering Wetlands Assessment Hydrogeology&Water Supply Coastal Management Site Assessment&Remediation Land"Use Planning Graphic Services Education&Outreach COMPLETE • CO ON ON DELIVERY ■ Complete items 1;2,and 3:Also complete A. Sign ure item 4 If Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ❑ ddressee so that we can return the card to you. ived Wted Name)' to of Delive�■ Attach this card to the back of the.mailpiece, or on the front if space permits. D. Is elivery address 8ilAnt from it 1? ❑Yes J. Article Addressed to: If YES,enter delivery address below; ❑No I Prop ID:226171 BEAUCHAMP,ANNE M& 21 BLOSSOM ST 3. Se ice Type PORTSMOUTH,NH 03801 7certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise J ❑insured Mail ❑C.O.D. 4: Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7 010 0290 0 0 0 2- 1912 0312, (Frdnsfer from serve PS Form 3811,February 2004 Domestic-Return Receipt afl2ssa2 M�sa� i UNITED STATES POSTAL SERVICE First-Class Mail I Pqstage&Fees Paid LISPS Permit No.G-10 I M ' Sender: Please print your name, address, and ZIP+4 in this box • I I Engineering works, Inc. I 12 West Crossfield Road Forestdale, MA 02644 N I i I II �f�111E11a}11{}!}!lf�f�lsfll!l���!!}3il��i�ltEtf!l1�3}IFf1}f11I COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1 2,and 3:Also complete A. Sign item 4 if Restricted Delivery is desired. X went ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. ived by(P'dted , e) C. Date of De' ery • Attach this card to the back of the maiipiece, or on the front If space permits. D. Is delivery address d M from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑.No — Prop ID:226172` HOLCOMB,MICHAEL&ROBIN& AGLI,MICHAEL&CHRISTINE 115 GREYSTONE DR PLANTSVILLE,CT 06497 1 3. Se ice Type ICertified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2, Article Number 7010 _0290 0002 1912 0336 (Transfer from service labeo 4 ,i i - i; i i PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL_SERVICE - First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Engineering works, Inc. t12 West Crossfield Road 'Forestdale, MA 02644 I I I � illi fit i7llili till lFIli)7ifiitIIIfIIIIiiiifill Ili j COMPLETE .N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1;2,and 3:Also complete A S' at re Item 4 If Restricted Delivery is desired. ❑Agent I ■ Print your name and address on the reverse — ❑Addressee I so that we can return the card to you. g, ece;ved by(Printed Name) C.DatA of Delivery I ■ Attach this card to the back of the mailpiece, I or on the front If space permits. D. Is delivery address different from item 1? ❑Yes T. Article Addressed to: If YES,enter delivery address below: ❑No I I Prop ID:226166 CHUTTANI,RAM&ANJALI 40 DRAPER RD DOVER,MA 02030 3. Se ice Type Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise - J ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number _7012 - 0290 0002�;1912 0329 : s,l (Transfer from service label) , 1 OILa+ PS Form 3811,February 2004 Domestic Return Receipt`I ,�}102595-02-10-1540,1 UNITED STATES,P SERVL ;F 4 �,* gstaggk `F�ePeid I .'t'.w. .�'�i„rP X.. �b•1..{..�•h^� .4�Y ..- '• ��G1M t ;..ds y{iP• • Sender: Please print your name, address, and ZIP44 in this box • "H I Engineering works, Inc. 12 West crossfield Road Forestdale, MA 02644 I I 1 ii13il3213 .�1 ! SENDER: • •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1;2,and 3.'Also complete A. Signatu VIA item 4 If Restricted Delivery Is desired. X ��, ❑ASeressee ■ Print your name and address on the reverse so that we can return the card to you. B. Received by(Printed Name)' C.Datelof Wivery • Attach this card to the back of the mallpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to If YES,ngrw: I�o Prop ID:226173 RICCI,ELISABETH MARGARET 565 PLEASANT ST LEOMINSTER,MA 01453-6221 3. Service Type �f�� [B�Certifled Mail ins Mail ❑Registered 'Return Receipt for Merchandise 1 ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(6dra Fee) ❑Yes 2. Article Number 7 010 0290 0002 1912 0367 (Transfer from service labeQ 1 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-rut-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 ( • Sender: Please print your name, address, and ZIP+4 in this box • I I Engineering Works., Inc. 12 West Crossfleld Road j Forestdale, MA 02644 I I M I COMPLETETHIS SECTION • • ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature Item 4 if Restricted Delivery is desired. ` ❑Agent ■ Print your name and address on the reverse X °�'`� ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. �r wD. Is delivery address different from Rem 1? ❑Yes I T. Article Addressed to: ��Ol � If YES,enter delivery address below: ❑No � f finn• Prop ID:226174 MACARTHUR,ELIZABE P O BOX 871 / f` 3. Service Type HYANNISPORT,MA 02647 itCertified Mail ❑Express Mail [3 Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. M 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7010 0290 0002 1912 0350 I (transfer from service labeo PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 p UNITED STATES POSTAL SERVICE # First-Class Mail Postage&Fees Paid USPS Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4 in this box • I I I +Engineering works, Inc. 12 West Crossfield Road Forestdale, MA 02644 I` I I f��aiiii�s�l:��ili�{ililiSlarlalllFaFili�1�-1liiit7fltililliill� COMPLETE •N COMPLETE THIS SECTIONON DELIVERY a Complete items 1,2,and 3.Also complete A Signatu Item 4 If Restricted Delivery Is desired. . � ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. ecelved by(Pdriled Name)' at f.De'v ry ■ Attach this card to the back of the mailpiece, mil, l or on the front If space permits. , D. Is delivery address different from item t [3Y 1. Article Addressed to: If YES,enter delivery address below: ❑Ho I LOPATKA,PAULA ANN TR PAULA ANN LOPATKA LIVING TR 47 SOUTHWINDS CIR CENTERVILLE,MA 02632 1 3. Service Type lx Certified Mail ❑Express Mail ❑Registered [3 Return Receipt for Merohandise ❑Insured Mail ❑C.O.D. 4. .Restricted Delivery?(Extra Fee) ❑yes _ ----- —2: Article Number. :7 010s 0 2 9 0 i 0 0 0 2 1912 -0 3 4 3 = (transfer from service Iabeo r i; :a a r ! ;1 E ;1 1 • , PS Form 3811,February 2004 Domestic Return Receipt f02595-02-M-1540 UNITED STATFi�iAE� fl � e��: �.� �•. i .�a a eesP _.,: -t,•,M,.,.. aid I I .w'2•�n +»nry. ..n�`l..iv.let �..w,.®...� .h • Sender: Please print your name, address, and Z +4 in this box "" I I I Engineerin9 works, Inc. 12 West Crossfield Road Forestdale, MA 02644 I , I I I I I I M i I DATE: `'A v/20/ 6- FEE: �lJ * BARNSTABLE, # 9 MASS. �p 1639. REC. BY Town of Barnstable Vo SCHED. DATE: Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul J.Cariniff,D.M.D. VARIANCE REQUEST FORM LOCATION 425 Sandy Neck Road West Barnstable Property Address: Assessor's Map and Parcel Number: Map 263 Lot 1 Size of Lot: 1,188 acres Wetlands Within 300 Ft. Yes X Business Name: No Subdivision Name: APPLICANT'S NAME: Horsley Witten Group, Inc. Phone (508) 833-6600 Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Town of Barnstable F.P. Lee, P.E. Name: Name: Address: 367 Main Street Hyannis, MA 02601 Address: 90 Route 6A Sandwich,. MA 02563 Phone: (508) 862-4000 Phone: (508) 83376600 VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) 15.211 Distance to foundation wall Reuse existing Grease Trap r 15.221 (7) Depth of Cover Install gravity system and maintain�existing.parking lot grade. Bathhouse NATURE OF WORK: House Addition ❑ House Renovation ) Repair of Failed Septic System ❑'0 i Checklist (to be completed by office staff-person receiving variance request application) - Please submit copies in 4 separate completed sets. a Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) ' _ Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) _ Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.eanniff,D.M.D. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC 1 SFIE T®wn,of Barnstable Barnstable � Tp� �. Department of Public Works �► Administration&Technical Support Division All-Amedca ft ' 800 Pitcher's Way,Hyannis,MA 02601 D BAMSTABLE, w MAS& www.town.barnstable.ma.us s639• 2007 John W.Juros,AIA Rebecca Nickerson 508.790.6316 Owner's Project Manager Mark Marinaccio 508.790.6323 Voice 508.790.6324 NancyLee Cormier 508.790.6320 Fax 508.790.6344 June 22, 2010 Mr. Thomas McKean, Director Town of Barnstable Barnstable Board of Health 200 Main Street Hyannis, MA 02601 Re: 425 Sandy Neck Road —Variance Sandy Neck Beach Park Barnstable, MA Dear Mr. McKean: The Town of Barnstable has retained the firm of Horsley Witten Group, Inc. (HW) to design the septic system upgrade and represent the Town of Barnstable at the July 13, 2010, Board of Health hearing to request the following variances: 1. Variance of 1.7 feet from the required 10 foot foundation wall setback. 2. Variance of 1.6 feet from the required 3 foot maximum cover over the system. Please contact the Town's representative, Mark Nelson at (508) 833-6600 if you require additional information or have any questions. Very truly yours, I� J n W. Ju , AIA, Owner's Project Manager DEPARTMENT OF PUBLIC WORKS Administration &Technical Support Division C: Mr. Mark Nelson, Horsley Witten Group, Inc. Lynne Poyant ` Nina Coleman OWertical Construction\ACTIVE PROJECTS\SANDY NECK BEACH PARKWrchitectural-Beach House- Permitting\Permitting\Board of Health 062210(2).doc n Witten 7Z)2 Horsley GroupSustainable Environmental Solutions 90 Route 6A • Sandwich,MA • 02563 Te1:508-833-6600 • Fax:508-833-3150 • www.horstaywitten.com June 25, 2010 TO: Abutters of 425 Sandy Neck Road,W. Barnstable,Massachusetts SUBJECT: Notification of a Request for Variances In accordance with State Law, 310 CMR 15.00, The State Environmental Code, and the Town of Barnstable Board of Health, you are hereby notified that a Variance Request Form has been filed with the Barnstable Board of Health by the owners described above, regarding the subject septic system upgrade. Additional details follow: APPLICANT: Town of Barnstable ADDRESS: 367 Main Street Hyannis, MA 02601 PROJECT LOCATION: 425 Sandy Neck Road, W. Barnstable, MA 02668 Assessor's Map 263, Parcel 001 PROJECT DESCRIPTION: I The project includes the redevelopment of the existing beach facilities at Sandy Neck to renovate the bathhouse / concession building within the existing footprint and construction of a future Coastal Interpretive Center. Two variances from the State Environmental Code are being requested: a foundation setback(310 CMR 15.211), and a depth of cover over the system (310 CMR 15.221). APPLICANTS' AGENT: Horsley Witten Group, Inca PUBLIC HEARING: Tuesday Afternoon,July 13, 2010, at 3:00 PM LOCATION: Town Hall, Selectman's Conference Room, 367 Main Street, Hyannis, MA Plans for this project describing the proposed activity are on file with the Board of Health. Sincerely, HORSLEY WITTEN GROUP, INC. Gir �G� Mark E. Nelson, Principal HA\Projects\2006\6129 Fenuccio-Sandy Neck\Permitting\BOH\Abutter Notification LTR BOH.doc i Sustainable Environmental Solutions 90 Route 6A Sandwich,MA • 02563 Te1:508-833-6600 • Fax:508-833-3150 www.horsleywitten.com s Letter of Transmittal TO: Dave Stanton Date: 7/09/2010 JOB NO 6129, Board of Health RE : Variance Request 425 Sandy Neck Road 200 Main Street West Barnstable Hyannis, MA 02601 WE ARE SENDING YOU: HAND DELIVERY THE FOLLOWING: Report(Final) Prints X Plans _ Shop Drawings Specifications X Copies CD _ Contract Documents Dave, Enclosed please find four copies of revised plans for 425 Sandy Neck Road. a Based upon your comments,we have made the following revisions to the plans: 1. The 1979 Well Setback(160 feet)has been shown on the plan 2. A note has been added to the plan stating the outdoor shower shall not be enclosed and soap/shampoo shall not be allowed(General Notes 410) 3. The design flow table has been updated to reflect the number of seats instead of people/person. Please let us know if you have additional questions or comments. ' C Thank you. MAIL TO: SIGNED: Beth Kittila Jul. 9, 2010 3: 37PM OEP No. 4038 P. 1 �--\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENERGY&ENVIRONMENTAL AI'FAIRS DEPARTMENT OF ENWRONMENTAL PROTECTION CAPE COD OFFICE 973 Iyannough Road, Route 132, Hyannis.MA 02001 Phone;508-771-6003 PAIL:508-771-6166 MAL L PAMUCK MNA.BOWLS (Governor saeataly TWOTHYR MURRAY LAURIE BURG< Lieutenant Governor Commissioner FAX COVER SHEET FAX#(509)7714155 DATE: • .... .. . .. FROM.- TELEPHONE E 9(SOP M-M PLLASEDKZMTO: COMPANY NAME: - AD)DRM: FAXN'CJ I&- IWAL NUMBER OF PAGES: (INCLUDING TM9 COVER PAGE) PLEASE CALL IF YOUDO NOT-RECF.IVE A COMPLETE FAX REMARKS. This Warmallon fe amlloblela allervole fbmwL C411 Douald Af.ComP4 ADA Coardionfora1617•SS6-10A TDDI866-094622 or 617-MUM. GRAPH SH0WI NG RELATIONSHIP�EiN PUMP NG RATE- AND MINIMUM PROTECTIVE DISTANCE REQUIRED. o �-= MASS. D, E. Q. E. MAY - -1979 _"' . t - •al 81r V m1+ pa L• ' A V-m V , aoo , • � .�I_�: ! :.� � .,..... 'd ,I .I..li. .l { :�_'f. !t+ :,• ±;•.l` ip:: ;ji �`.�. _ -: %- - - . = "::i; .; .. . 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'—! m? ; '1.1 •I, 1. •.ji� 'tI,C,- (I�'i �•rl� ■I•; � ' I�Il�II G!i� 11,1 ;EI.I i - w 1�_ L!■ �� � �'1I/�• � ■"' 11.. .. I•. •:•. - F•.. m , 9 II i111 �` !.�I.i�■ .: �i I I II�I iili il�i i q -' 1• � ! I •! �irLill ir 7• V��- � _ ' -'• ..° i I 1 I� •� I1 i I i i1. •�•' �I1I! .. CV V - ' IIN III r.l 1 ''� '1�. 1�1'w �-r,l 1� Ipl ••�.' •'�1. • i• i'; • .. rn_ I I '1•!! 1I 1 HII j I�r � t t I, i:.• f I 1 1 �:'.(.� ^�i...,.. p . , I .• :1 _ - ;- L Ji1BIti tlll 'H , �. i�1 I 1Nf: nt1 . .. .. a 1 .s .•p r. J O 1 1000 - 10,000 '' �' �' �� �g ,004 I9000�000 � ,�. PRbJECTED MAXIMUM VA LY _ Interim Wellhead Protection Area OWPA)means that for public water systems using wells or wellfields that lack a Department approved Zone 11, the Department will apply an interim wellhead protection area. This interim wellhead protection area shall be a one-half mile radius measured from the well or wellfield for sources whose approved pumping rate is 100,000 gpd or greater. For wells or wellfields that pump less than 100,000 gpd, the IWPA radius is proportional to the approved pumping rate which may be calculated according to the:following equation: IWPA radius in feet=(32 x pumping rate in gallons per minute)+400. k\,_--7nef;ault IWPA radius or an IWPA radius otherwise computed and determined by the Department shall be applied to transient non-community(TNC)and non-transient non-community(NTNC)wells when there is no metered rate of withdrawal or no approved pumping rate. Public Water S-stem means a system for the provision to the public of water for human consumption, through pipes or other constructed conveyances, if such system has at least 15 service connections or regularly serves an average of at least 25 individuals daily at least 60 days of the year. Such term includes any collection, treatment, storage, and distribution facilities under control of the operator of such a system and used primarily in connection with such system,and any collection or pretreatment storage facilities not under such control which are used primarily in connection with such system.The Department may presume that a system is a public water system as defined herein based on the average number of persons using a facility served by the system or on the number of bedrooms in a residential home or facility. The Department reserves the right to evaluate and determine whether two or more wells located on commonly owned property,that individually may serve less than 25 people,but collectively serve more than 25 people for more than 60 days of the year should not be regulated as a public water system,taking into account the risk to public health.A public water system includes a"community water system"or a"non-community water system". (a) Community Water System means a public water system which serves at least 15 service connections used by year-round residents or regularly serves at least 25 year-round residents. (b) Non-community Water System means a public water system that is not a community water system: 1.Non-transient Non-community Water System or"NTNC"means a public water system that is not a community water system and that has at least 15 service connections or regularly serves at least 25 of the same persons or more approximately four or more hours per day, four or more days per week, more than six months or 180 days per year, such as a workplace providing water to its employees. 2. Transient Non-community Water System or TNC means a public water system that is not a community water system or a non-transient non-community water system but is a public water system which has at least 15 service connections or serves water to 25 different persons at least 60 days of the year. Some examples of these types of systems are: restaurants, motels, camp grounds, parks, golf courses, ski areas and community centers. h Horsley Witten Group p Sustainable Environmental solutions .,` 90 Route 6A Sandwich,MA • 02563 Tel:508-833-6600 • Fax:508-833-3150 wwwhorsleywitten.com v Letter of Transmittal TO: Town of Barnstable Date: 6/25/2010 JOB NO 6129 Board of Health RE : Variance Request 425 Sandy Neck Road 200 Main Street West Barnstable Hyannis, MA 02601 WE ARE SENDING YOU: HAND DELIVERY THE FOLLOWING: Report(Final) Prints X Plans Shop Drawings Specifications X Copies CD Contract Documents ENCLOSED PLEASE FIND 4 COPIES OF: Cover Letter Variance Request Form Checklist Property Owner Letter Authorization DEP Modified Certificate for General Use—Presby Enviro-Septic Enviro-Septic Wastewater Treatment System Operating Maintenance Abutter List for 425 Sandy Neck Road Abutter Notification Letter Application Fee(Check# 10374) Wastewater Design Plan and Details -24x36 (2 sheets)- Floor Plan MAIL TO: SIGNED: Beth Kittila yt �, APPLICATION FOR SITE PLAN REVIEW LOCATION Business Name: Sandy_ Neck Beach Subdivision Plan Assessor's Map# 263 Parcel # 001 ANR Plan AV Property Address: 425 Sandy Neck Rd Site Plan OWNER OF PROPERTY APPLICANT Name: Town of Barnstable Name: John Juros (Owner's Project Mcrr.) Address: Address: Town of Barnstable 800 Pitcher's Way, Hyannis Telephone: Telephone 508-790-6324 Fax Fax 508-790-6344 ARCHITECT/DEVELOPER/CONTRACTOR/ENGINEER AGENT/ATTORNEY Name: BLF&R Architects, Inc_ Name: N/A Address: 203 Willow St., Suite A Address: Yarmouthport, MA 02675 Telephone: 508-362-8382 Telephone Fax 508-362-2828 Fax STORAGE TANKS(HAZ MAT/FUEL OR WASTE OIL) ZONING DISTRICT CLASSIFICATION N/A District RF-1 Overlays) Resource-Protection Existing Proposed Lot Area Sq. Ft. 1 ,188.31 Ac. Number Number Fire District W. Barnstable Size Size Setbacks (ft.) (Actual) Above Ground Above Ground Front 108 + - Side 618 +/- Rear 300 +/- Underground Underground to water Contents Contents Number of BuildjM 1 new Existing 2 Proposed 1 r cons meted Demolition 1 bathhouse UTILITIES TOTAL FLOOR AREA BY USE Sewer- ❑Public [ZPrivate Size 9,900 gal Existing(sq.et.) Proposed (sq.ft.) Water- ❑Public ❑Private tank capacity Basement Electric - [VAerial [✓Q Underground Residential Gas - ❑Natural ❑ Propane Restaurant 425 Grease Trap - W Size 1 ,000 gal existing Retail Sewage Daily Flow * 3,246 gpd Office design flow Medical Office PARKING SPACES CURB CUTS Commercial (specify) 1 ,175 Required Existing Wholesale (specify) Provided 206 ex_ Proposed Institutional (specify) On-Site To Close Industrial (specify) Off-Site Totals All Other Uses On Site 500 gate- 896 2-bay garage Handicapped Gross Floor Area I house 2,496 (existing parking & drives to be unchanged) *GP or WP areas restrict wastewater discharge to 330 gallons per acre per day into on-site system. Q:SiteP1an:SPRPG3—02/20/2002 •!. n � Approved Old King's Highway Regional Historic District File# 4/14/2010 Approved? [► Yes ❑No Hyannis Main Street Waterfront Historic District File# N/A Approved? ❑ Yes ❑No Listed in National and/or State Register of Historic Places? ❑ Yes [;Tio Previous Site Plan Review File# N/A Approved? ❑Yes ❑No Previous Zoning Board of Appeals File# N/A Approved?. ❑ Yes ❑No Is the site located in a Flood Area(Section 3-5.1) Vyes ❑No In Area of Critical Environmental Concern? [oYes ❑No Is the Project within 100' of Wetland Resource Area_? ❑ Yes VN0 Site sketch—informal presentation [✓]Yes . ❑No. Site Plan prepared, wet stamped and signed by a Registered PE and/or PLS. ❑ Yes MNo Parking and Traffic Circulation Plan ❑ Yes ONO Landscape Plan and Lighting Plan GzYes ❑No Drainage Plan with calculations and Utility Plan [ Yes ❑No Building Plans, (all floor plans, elevations and cross sections) ( Yes ❑No Note that all si2na2e must be approved by Code Enforcement Officer at the Building Department Lot area in sq.ft. 51 ,749,280 sq.-ft Total Building(s) footprint 3,000 sq. ft. Maximum Lot Coverage as% of Lot Less than 1 GROUND WATER PROTECTION OVERLAY DISTRICT REQUIREMENTS: DISTRICT: Lot Coverage (%) Required Proposed Site Clearing (%) Required Proposed PRINCIPAL BUILDING ACCESSORY BUILDINGS) [ Yes ❑No Number of floors .1 Height: 17' ft. Number of floors 1 1/2 Height: 23 ft. FLOOR AREA: ridge FLOOR AREA: ridge Basement N/A sq. ft. Second N/A sq. ft. Basement N/A sq. ft. Second N/A sq. ft. First 1 ,600 sq. ft. Attic N A sq. ft. First 896 sq. ft. Attic 341 sq. ft Other(Specify) sq. ft. Please provide a brief narrative description of your proposed project: See attached I assert&at comp ted or.caused to becompleted)this page and the Site Plan Review Applicaat, st of my knIdgp,the information submitted here is rue. Signature of Applicant Date Richard P. Fenuccio. PRMTED NAME OF APPLICANT Q:SiteP1an:SPRPG4 02/20'2002 The propose work at Sandy Neck Beach is to raze the existing bathhouse except for its foundation. A new+/-1,600 sf bathhouse will be reconstructed on the existing foundation similar in size and form to the existing structure. The reconstructed bathhouse would similarly contain restroom facilities, lifeguard room, beach associated storage space,and a concessions area. A+/-900 sf accessory, 2 bay detached garage structure is proposed near the existing gatehouse building which is to remain. The garage would house 1 staff truck and 4 ATV's. No vehicle maintenance would take place at the facility. All on site, hand held fuel containers will be stored in an OSHA& NFPA approved safety cabinet. The attic will be used for off season light weight storage only. A 6'wide paved path is proposed to begin at the property line along Sandy Neck Road and continue out to the new bathhouse. The path will cross Sandy Neck Road at one location with a road hump crosswalk to calm traffic. No substantial change or improvements are planned for the existing parking and drive areas. The proposed new septic field will be located under a portion of the westerly parking lot and the pavement will be patched as necessary. l Monday,January 18,2010 !j 15:30 /u Massachusetts Department of Environmental Protection - Drinking Water Program Iir BACTERIOLOGICAL REPORT 1,Z, j D 3 PWS INFORMATION:`'Refer to'your_:DEP,Coliform�Sampling Planto;help.complete he�Pw!S'Inform'a'tion a.nd DEP A i-oyed°Sam le�Site,f�t -, ton,sections. -1 .�._«._..,,..�.�.n.�..-_....�.,.._ - _<�.........�_—.,�..•,..,.�_ .w..�.�.,w:.c.�. .,._..,:..r.�,_.�.:.�...a_...�a:...,�:,:�m..,...._,..�..:,:.�.,w.:,...w �.;�,.e.:.a:.�,.�a<,a:<,H.�.�P.:.... '�...�..:a...�..P.w. .�+r.:x...,,,..:�'°�:.=�_e.:.:�, ����f PWS ID#: 4020023 PWS Name: ISandy Neck Beach City/Town: West Barnstable MA CLASS: TNC ,.-�.•«+..r,.,.....w.+..++.c .+.x>a•w ^s, -.+e-..+w ..-rm^Y+-+._a-......mow+ - �'^..w�•-^.•-4 III. ANALYTICAL INFORMATION:, Refer'to:your;MassDEP'state:l_ab cerfificatefor ,ro er LabMA Cert:#'An�d•certifiedenethods. „u „; �. .,"� �: _ Primary Lab MA Cert.# M-MA063 Primary Lab Name: IFnvirotech Laboratories,Inc. Subcontracted? N Analysis Lab MA Cert.# M-MA063 Analysis Lab: lEnvirotech Laboratories,Inc. Resubmit Indicator: 10riginal Reason For Resubmission: I I Collection Date of Original Sample: TC Method E.Coli Method Fecal Coliform HPC Method BACKGROUND BACTERIA=2. MF-SM9222B Lab Sample Notes: DEP APPROVED SAMPLE SITE INFORMATION COT AL „EF OLIior c CHLORINE -- ':HP f ' ;'COLLECTED' L'AB ar - 'DEp ''� .. _- . .-IFO.,m:, .' FECAL ,, RESULT, f RESULT .:- ,, ,a BY :., SA[V1PL^E COLLECTION ANALYSIS} :' DEP Approved: `a., trr as; as .G ;.. z. x,; rDATE: tt 7TIME DATE FTI:Nth t{ ; 4 4 Sample ;w fLocahonf i sa SAMPLE LOCATION 1 RE �" t. �TYpe t 3z• . Code;l .i a'.._ LT - - -9 it - RESULT SU mg/L #cfu/ml RS 001 Guard Shack Men's Rm 0 1/15/2010 7:35 1/15/2010 16:00 Whitewater DEP-100094A`m, ¢a ' - I 1 DEP Sample Type,Location code#and DEP approved Sample Site Location must correspond to the sample information on your DEP Total Coliform Sampling Plan. 2 SWTR systems:HPC;samples shall be taken at the same distribution sites and at the same time as total coliform,whenever chlorine residual is not detected at the sample site. 3 Sample Type:RS-Routine Distribution Sample,RO-Original Site Repeat,UR-Upstream Repeat,DR-Downstream Repeat,AR-Additional Repeat,RW-Raw Water,PT-Plant Tap,SS-Special Sample. 4 Report as#/100mL,P(present),A(absent),or Too Numberous To Count:TNTC-I(invalid)or TNTC-P(present). 5 Collected appropriate number of repeat samples within 24 hours of laboratory notification for coliform-positive or invalid samples. Notify DEP of any routine or repeat E.Coli or fecal positive results by the end of the business day. I certlfiy underpenalities of law thatl am'tl;eperson authorized"to fill Laboratory zed Sign re Ronald Saari out this form.and the information.contained herein is true,.accurate and ' and Date complete to the best extent of my knowledge. .. - - DATE 1/16/2010 DEP Review Status: ❑Accepted ❑ Disapprove R iew C ments- Page I of I Massachusetts Department of Environmental Protection - Drinking W eam , . Secondary Contaminant Report I. PWS INFORMATION:Please refer to your DEP Water Quality Sampling Schedule(WQSS)to help complete this form PWS ID 14020023 City I Town West Barnstable By°----------------- -- PWSName Sandy Neck Beach f'�l►AIr.�;t. PWS Class: COM ElNTNC ElTNC ❑ DEP LOCATION Al Date DEP Location Name, aSample Information - Collected By (LOC)ID# • sa+ ' i Collected A 001 Guard Shack ❑ (M)ultiple ❑ (R aw 1/27/10 Whitewater Single W (F)inished B ❑ (M) ultiple ❑ (R aw ❑ (S)ingle ❑ (F)inished Routine or Original,Resubmitted or If Resubmitted Report,list below: Special Sample Confirmation Report J.(1)Reason for Resubmission (2)Collection Date of Original Sample A M RS ❑ SS Q Original❑Resubmitted❑Confirmation❑ Resample❑ Reanalysis[] Report Correction B ❑ RS ❑ SS ❑Original❑Resubmitted❑Confirmation❑ Resample❑ Reanalysis❑ Report Correction SAMPLE NOTES-(Such as if a Manifold/Multiple sample,list any sources that-were on-line during sample^collection):. A B II.ANALYTICAL LABORATORY INFORMATION: Primary Lab MA Cert.#: M-MA063 Primary Lab Name: Envirotech Laboratories,Inc. Subcontracted?YIN ❑ Analysis Lab MA Cert.#: Analysis Lab Name: Results MDL `'' Date Lab Sample ID'# Compound `SMCL Lab Method ; A B, Y-_ (mg/L) Analyzed A- B IRON(mg/L) 0.05 0.3 0.01 EPA 200.7 1/29/2010 DW-100154A MANGANESE(mg/L) 0.143 0.05— 0.008 EPA 200.7 1/29/2010 DW-100154A ALKALINITY(mg/L as CaCo3) None- CALCIUM(mg/L) None MAGNESIUM(mg/L) None A HARDNESS(mg/L as CaCO3 one,., POTASSIUM(mg/L) ;:None' TURBIDITY(mg/L) None ALUMINUM(mg/L) f 0.2 CHLORIDE(mg/L) 250 COLOR(C.U.) COPPER(mg/L) 1 ODOR(T.O.N) 3, pH SILVER(mg/L) 0.10 SULFATE(mg/L) ,250"- CONDUCTANCE(umhos/cm) 500. ZINC(mg/L) 5 EPA has established a lifetime health advisory(HA)for manganese at 0.3 mg/L and an acute at 1.0 mg/L. LAB SAMPLE NOTES';'Asterisk(*)"next to compound name indicates It was subcontracted A B I certify under penalties of law that I am the Primary Lab Director Signature: person authorized to rill out this form and the information contained herein is true,accurate and complete to the Date: %(, best extent of my knowledge. If not submitting these results electronically,mail TWO copies of this reportto your DEP Regional Office no later than 10 days after the end of the month in which you received this report or no later than 10 days after the end of the reporting period,whichever is sooner. DEP REVIEW STATUS(Initial Date) i Review ❑ WQTS Data ❑Accepted ❑ Disapproved Comments Entered t Premier Laboratory LLC iaannnrnar 61 Louisa Viens Drive Dayville,CT 06241 FAX:860-774-2689 860-774-6814 800-932-1150 ANALYTICAL DATA REPORT Report Number: E612F08 Project: Sandy Neck Beach prepared for: Whitewater, Inc. 253B Worcester Road Charlton, MA 01570 Attn: Russell Tierney Received Date: 12/28/2006 Report Date: 1/8/2007 Premier Laboratory, LLC Authorized Signature E��N ACCOgpq Certifications: a � CT(PH-0465),MA(M-CT008),ME(CT050),NH(2020),NJ(CT002),NY(11549),RI(RI246) 5068]A50 Premier Laboratory, LLC i nnonnmar 61 Louisa`✓iens Drive Dayville,CT 06241 FAX:860-774-2689 860-774-6814 800-932-1150 Report No: E612F08 Client: Whitewater Inc. Project: Sandy Neck Beach CASE NARRATIVE / METHOD CONFORMANCE SUMMARY Premier Laboratory received four samples from Whitewater Inc. on 12/28/2006. The samples were analyzed from the following list of analyses: Coliforms,Total(MF)by SM-9222B MA Volatile Organics by 524.2 Low DL in DW SM 922213[SM 922213] 524.2 Mass IOC in DW Mass Secondary Standards in DW 200.7[3000],200.8[3000] 150.1,200.7[3000],SM 2540C 245.2[245.1],300.0 SM2120B,SM2130B, SM2150B,SM2320B SM4500-CN-E[SM4500-CN-C] SM2340B[3000],SM4500-CL-D SM4500-SO4-E SM4500-SO4-E Variances: SDG: None reported. Method: None reported. QA/QC: None reported. sosezaw MASSACHUSETTS DEP/DIVISION OF WATER SUPPLY INORGANICS REPORT(FORM#1A.3) IOC I. FWS INFORMATION 1. PWS ID#: 4020023 2. City/Town: West Barnstable, MA 3. PWS Name: Sandy Neck Beach 4. PWS Class (bold) COM, NTNC, NC 5. DEP Source Code/Location ID 6. Sample Location 7. Date Collected 8. Collected By 4020023/002 POE 12/28/06 John Aprea 9. Is the Source Treated? No 10. Was the Sample Collected after Treatment? No 11. Manifolded: If applicable, list the connected sources: 12. Routine: ® Special: (explain below) Notes: Lab Name: Premier Laboratory, LLC. Lab Cert.#: M-CT008 Subcontracted? (Y,N) N Lab Sample ID#:E612F08-1 (use symbols to relate each analyte to a specific Lab) Sub. Lab Name: Cert. #: Lab Symbol: Composite ❑ If applicable, list the composited sources (DEP Source Code/Sample Location) Notes: Compound Lab Result MCL Detection Analytical Date Lab (regulated) Sample ID# mg/L mg/L Limit mg/L Method Analyzed Symbol Arsenic E612F08-1 ND 0.010 0.0050 200.8 01/03/07 Barium E612F08-1 ND 2.0 0.0050 200.8 01/03/07 Cadmium E612F08-1 ND 0.005 0.0010 200.8 01/03/07 Chromium E612F08-1 ND 0.1 0.0010 200.8 01/03/07 Fluoride* E612F08-1 ND 4.0 0.20 300.0 01/05/07 Mercury** E612F08-1 ND 0.002 0.00020 245.2 12/29/06 Selenium E612F08-1 ND 0.05 0.0050 200.8 01/03/07 Sodium E612F08-1 12 none 1.0 200.7 12/29/06 Antimony E612F08-1 ND 0.006 0.0010 200.8 01/03/07 Beryllium E612F08-1 ND 0.004 0.0010 200.8 01/03/07 Nickel E612F08-1 ND none 0.0010 200.8 01/03/07 Thallium E612F08-1 ND 0.002 0.0010 200.8 01/03/07 Cyanide E612F08-1 IND 10.2 0.010 SM4500-CN-E 01/03/07 Compound Lab Result MCL Detection Analytical Date Lab (unregulated) Sample ID# mg/L mg/L Limit mg/L Method Analyzed Symbol Sulfate E612F08-1 15 none 5.0 SM4500-504-E 01/02/07 II. LABORATORY ANALYTICAL INFORMATION: * There is also a secondary MCL for Fluoride which is 2.0 mg/L. **Please note that if method 245.1 is used for mercury,only method revision 3.00 will b P. ye accepted by DE Laboratory Director Signature and Date: %%err/il./� 1/8/2007 Attention:Mail TWO copies of this report to your DEP Regional Office within 30 days of receipt of results and no later than 10 days after the end of the reporting period. FOR DEP.IDWS USE ONLY:PLEASE MAIL&DATE AS COMPLETED Accepted: Disapproved: Data Entered into WQTS: Comments SDW0 W DEPARTMENT OF ENVIRONMENTAL PROTECTION B BACTERIOLOGICAL ANALYSIS REPORT- CONTAMINANT ID#3100 PWSID# PUBLIC WATER SYSTEM NAME TOWN/CITY LABORATORY NAME&ID#* 4020023 Sandy Neck Beach West Barnstable,MA Premier Laboratory,LLC. M-CT008 DEP APPROVED SAMPLE SITE SAMP LAB. COLLECTION COLLECTION ANALYSIS TCM TOT COLIFORMI FC/ECM FECAL-E.COLI/ CHLOR.RES. TYPE SAMP ID# CODE# LOCATION DATE TIME DATE CODE 100 ml** CODE# 100 ml** OR HPC/ml SAMPLE COLLECTED BY: IRS E612FO84 005 Bathroom Sink Office 12/28/06 09:10 12/28/06 303 0 John Aprea SAMPLE TYPE KEY TOTAL COLIFORM FECAL COLIFORMI REMARKS: RS-ROUTINE SAMPLE METHOD(TCM) E.COLI METHOD RO-ORIGINAL SITE REPEAT CODE# FC/ECM CODE# UR-UPSTREAM REPEAT MF 3 0 3 EC 4 0 0 DR-DOWNSTREAM REPEAT MTF 3 0 5 SWTR-MFC 4 0 1 SUBCONTRACTED LAB((II,F(APPLI L AR-ADD.REPEAT(DIST SYSTEM) P-A 3 0 7 raw water Q• b RW-RAW WATER ONPG 3 0 9 MMO-MUG 4 0 t ANALYZED BY l/ DATE:118/2007 SS-SPECIAL 3 1 1 EC-MUG 4 0 (LAB USE) PT-PLANT TAP SAMPLE NA-MUG 4 1 AUTHORIZED BY: DATE:1/8/2007 (LAB USE) LAB ID#ASSIGNED BY STATE CERTIFICATION PROGRAM "CAN BE EXPRESSED AS#/100ML,PRESENT(P),ABSENTIA),OR TOO NUMEROUS TO COUNT(TNTC) ***COLISURE METHOD-THIS CAN DO TOTAL COLIFORM and E.COLI SIMULTANEOUSLY,HOWEVER THE SAMPLE MUST BE INCUBATED 28 TO PAGE 1 OF 1 48 HOURS COPY1:COPY TO DEP REGIONAL OFFICE;COPY2:OWNER COPY;COPY3:LAB COPY 5ose245o MASSACHUSETTS DEP/DIVISION OF WATER SUPPLY SEC-CON page 1 of 2 SECONDARY CONTAMINANT REPORT (FORM#12.2) I PWS INFORMATION: 1. PWS. ID#: 4020023 2. City/Town: West Barnstable, MA 3. PWS Name: Sandy Neck Beach 4. PWS Class (bold) : COM, NTNC, NC 5. DEP Source Code/Location ID 6. Sample Location 7. Date Collected 8. Collected By A: 4020023/003 POE 12/28/2006 John Aprea B: C: D: 9. Is the Source Treated? No 10. Was the Sample Collected after Treatment? No 11. Manifolded: If applicable, list the connected sources: Notes: II. LABORATORY ANALYTICAL INFORMATION: Lab Name: Premier Laboratory, LLC. Lab Cert.4: M-CT008 Subcontracted? (Y,N) N Lab Sample ID#: E612F08 (use symbols to relate analyte to a specific lab) Sub. Lab Name: Cert #: Lab Symbol: Notes: Detection Results mg/L Analytical Limit Date Lab Method mg/L Analyzed A B C D Symbol Lab Sample ID ---------- --------- -------- 2 ------ Turbidity (NTU) SM2130B 0.10 12/28/06 0.28 TDS SM 2540C 1.0 01/03/07 100 Color (color units) SM2120B 12/28/06 0 Odor (TON) SM2150B 12/28/06 1 pH 150.1 12/28/06 7.6 Alkalinity- Total (CaCO3) SM2320B 1.0 01/02/07 59 Hardness (CaCO3) SM2340B 3.4 12/29/06 45 Calcium (Ca) 200.7 0.050 12/29/06 8.7 Magnesium (Mg) 200.7 0.050 12/29/06 5.5 Aluminum (Al) 200.7 0.050 12/29/06 ND Potassium (K) 200.7 2.0 12/29/06 ND Iron (Fe) 200.7 .0.050 12/29/06 ND Manganese (Mn) 200.7 0.010 12/29/06 0.14 Sulfate (SO4) SM4500-SO4-E 5.0 01/02/07 7.0 sosezam PWSID#: 4020023 (E612F08) (Form#12.2) Town: West Barnstable,MA SEC-CON page 2 of 2 Detection Results mg/L Analytical Limit Date Lab Method mg/L Analyzed A B C D Symbol Chloride (Cl) SM4500-CL-D 2.0 01/02/07 12 Silver (Ag) 200.7 0.0020 12/29/06 ND Copper (Cu) 200.7 0.010 12/29/06 ND Zinc (Zn) 200.7 0.010 1 12/29/06 0.013 Laboratory Director Signature and Date: 1/8/2007 Date Attention: Mail TWO copies of this report to your DEP Regional Office within 30 days of receipt of results and no later than 10 days after the end of the reporting period. FOR DEP/DWS USE ONLY: PLEASE INITIAL & DATE AS COMPLETED Accepted: Disapproved: Data Entered into WQTS: Comments SDMUz MASSACHUSETTS DEP/DIVISION OF WATER SUPPLY VOLATILE ORGANIC CONTAMINANT REPORT ` oc (FORM#7.3) page 1 of 3 I. PWS INFORMATION 1. PWS ID#: 4020023 2. City/Town: West Barnstable, MA 3. PWS Name: Sandy Neck Beach 4. PWS Class (bold) COM, NTNC, NC 5. DEP Source Code/Location ID 6. Sample Location 7. Date Collected 8. Collected By 4020023/004 POE 12/28/06 John Aprea 9. Is the Source Treated? No 10. Was the sample collected after treatment? No 11. Manifolded: ❑ If applicable, list the connected sources: 12. Routine: ® Special: R (explain below) Notes: II. LABORATORY ANALYTICAL INFORMATION Lab Name: Premier Laboratory, LLC Lab Cert.#: M-CT008 Subcontracted? (Y,N) r Lab Sample ID#: E612F08-3 Sub. Lab Name: Sub. Lab Cert.#: Composited If applicable, list the composited sources: Notes: Compound (Regulated - Result MCL Detection Analytical Date has MCL) ug/L ug/L Limit ug/L Method Analyzed Benzene ND 5.0 0.50 524.2 01/02/07 Carbon Tetrachloride ND 5.0 0.50 524.2 01/02/07 1,1-Dichloroethylene ND 7.0 0.50 524.2 01/02/07 1,2-Dichloroethane ND 5.0 0.50 524.2 01/02/07 para-Dichlorobenzene ND 5.0 0.50 524.2 01/02/07 Trichloroethylene ND 5.0 0.50 524.2 01/02/07 1,1, 1-Trichloroethane ND 200.0 0.50 524.2 01/02/07 Vinyl Chloride ND 2.0 0.50 524.2 01/02/07 Monochlorobenzene ND 100.0 0.50 524.2 01/02/07 o-Dichlorobenzene ND 600.0 0.50 524.2 01/02/07 trans-1,2-Dichloroethylene ND 100.0 0.50 524.2 01/02/07 cis-1,2-Dichloroethylene ND 70.0 0.50 524.2 01/02/07 1,2-Dichloropropane ND 5.0 0.50 524.2 01/02/07 Ethylbenzene ND 700.0 0.50 524.2 01/02/07 Styrene ND 100.0 0.50 524.2 01/02/07 Tetrachloroethylene ND 5.0 0.50 524.2 01/02/07 Toluene ND 1000.0 0.50 524.2 01/02/07 Xylene (total) ND 10000.0 0.50 524.2 01/02/07 Dichloromethane ND 5.0 0.50 524.2 01/02/07 1,2, 4-Trichlorobenzene ND 70.0 1 0.50 524.2 01/02/07 1, 1,2-Trichloroethane ND 5.0 0.50 524.2 01/02/07 50.21W PWS ID No: 4020023/004 (E612F08-3) (FORM#7.3) Town: West Barnstable, MA Compound (Unegulated - Result Detection Analytical Date voc no MCL) ug/L Limit ug/L Method Analyzed page 2 of 3 Chloroform ND 0.50 524.2 01/02/07 Bromodichloromethane ND 0.50 524.2 01/02/07 Chlorodibromomethane ND 0.50 524 .2 01/02/07 Bromoform ND 0.50 524.2 01/02/07 m-Dichlorobenzene ND 0.50 524.2 01/02/07 Dibromomethane ND 0.50 524.2 01/02/07 1,1-Dichloropropene ND 0.50 524 .2 01/02/07 1, 1-Dichloroethane ND 0.50 524.2 01/02/07 1, 1,2,2-Tetrachloroethane ND 0.50 524.2 01/02/07 1,3-Dichloropropane ND 0.50 524.2 01/02/07 Chloromethane ND 0.50 524.2 01/02/07 Bromomethane ND 0.50 524.2 01/02/07 1,2,3-Trichloropropane ND 0.50 524.2 01/02/07 1, 1, 1,2-Tetrachloroethane ND 0.50 524.2 01/02/07 Chloroethane ND 0.50 524.2 01/02/07 2,2-Dichloropropane ND 0.50 524.2 01/02/07 o-Chlorotoluene ND 0.50 524.2 01/02/07 p-Chlorotoluene ND 0.50 524.2 01/02/07 Bromobenzene ND 0.50 524.2 01/02/07 1,3-Dichloropropene ND 0.50 524.2 01/02/07 1,2,4-Trimethylbenzene ND 0.50 524.2 01/02/07 1,2,3-Trichlorobenzene ND 0.50 524.2 01/02/07 n-Propylbenzene ND 0.50 524 .2 01/02/07 n-Butylbenzene ND 0.50 524.2 01/02/07 Naphthalene ND 0.50 524.2 01/02/07 Hexachlorobutadiene ND 0.50 524.2 01/02/07 1,3,5-Trimethylbenzene ND 0.50 524.2 01/02/07 p-Isopropyltoluene ND 0.50 524.2 01/02/07 Isopropylbenzene ND 0.50 524.2 01/02/07 Tert-butylbenzene ND 1 0.50 1 524.2 01/02/07 M ID No: 4020023/004 (E612F08-3) (FORM#7.3) Town: West Barnstable, MA Voc Compound (Unegulated - Result Detection Analytical Date page 3of3 no MCL) ug/L Limit ug/L Method Analyzed Sec-butylbenzene ND 0.50 524.2 01/02/07 Fluorotrichloromethane ND 0.50 524.2 01/02/07 Dichlorodifluoromethane ND 0.50 524 .2 01/02/07 Bromochloromethane ND 10.50 524.2 01/02/07 Methyl Tertiary Butyl Ether* I ND 0.50 524.2 01/02/07 * optional Surrogate Recoveries (As required by EPA method 524.2) Compound % Recovered QC Limits (%) 4-aromofluorobenzene 106 80-120 1,2-dichlorobenzene-d4 109 80-120 The Q.k/QC required matrix spike sample information is on file at our office Laboratory Director Signature and Date: 1/8/2007 Date Atten-ion: Mail TWO copies of this report to your DEP Regional Office within 30 days of reciept of results and no later than 10 days after the end of the reporting period. FOR DEFYDWS USE ONLY:PLEASE MAIL&DATE AS COMPLETED Accepted: Disapproved: Data Entered into WQTS: Comments 5DW26W Sandy Deck Beach WHITEWATER, INC. A DIVISION OF R H WHITE COMPANIES,INC. West Barnstable MA 508-294-1390 PWS ID # 4020023 PO# PWS ID INFORMATION PWS ID# 4020023 Date Collected: PWS Name: Sandy Neck Beach PWS Class NC City/Town: West-Barnstable MA Routine: Yes Is the Source Treated? No Was the sample collected after treatment? No Manifolded: No If applicable, list the connected sources: SampleffTIMECol'i'for.. Total Gross pia,Radium Code 0 Source of Sam le Type VOC IOC SEC 221&221,Uranium —R 002 P.O.E. X 003 P.O.E. X 004 P.O.E. X 005 X CUSTODY TRANSFER DATE TIME Sampler: ~ -2 Relinquished B Received By: _ 9 Relinq 3�"uished 4l � i - ) Receive y: _0 2 ......... O• ES TC = 1 -4oz S C- HPC = 1 -4oz G Nitrate,Nitrite,Sodium =1-250rn1 or 120m1 non preserved(for a113) / ,`�� ' VOC =2-40m1 VOA Vial HCL preserved �d v SEC =I -I liter non preserved and I-250m1 Nitric preserved(if collecting a Nitrate,Nitrite,Sodium - at the same time as SEC a separate 250 or 120ml bottle is not needed) IOC =I-I liter non preserved, I - 1 liter Sodium Hydroxide preserved and I -250ml Nitric Preserved ` SOC =Special made SOC Kit(in plastic bag) Lead& Copper =1 -I liter non preserved Rads = 1 liter Nitric preserved for each Gross alpha, Radium 226,228& Uranium i PP D5 A L,, 11'e"EOUIRPED ___ BATHHOUSE MlD ORENCO CFI OR XPPR BovcD EawhJR. _ r _ - ��_ CONCESSION .._ ROVDE END CAP COASTAL .,.' STAND _ �• NCI PoSE z•. _ _ __ __ CENTER ,.�• ••:c - - c[uNour oOOD cuLo ,� _ - :• - W(IYPICN.... ECTIPARMEM I'SCH.b PVC VENTHEADE �.�- ems. '`� • •••�.� �'` TANK _ __r +` i• _ _.- x V' ROWS OF , " 30.ex iP RaO \�\\e• _1e.e •_'_0 I•^\�. _ i-�__w-_.,-_•" _. G . ... 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DIS $ I FLOOR PLAN PRWECTM M 10 DRAWING NO, � BIExeIR P1 .1 eem.e� aYrat� Bid S®t a= I • CRAN E Composites � � � 6743 Innovative Finishes Wall Panels STC, SSTC, LBCLN, FTBB Rev. 3 1 2.11 Class C Fire-Rating per ASTM E-84 Product Purpose The Innovative Finishes line combines the traditional benefits of Innovative Finishes panels are designed for interior wall finishes where a fiberglass reinforced plastic with linen and sandstone textures and Class C,sanitary,easy-to-clean panel is desired. tile-look and beaded finishes to provide a panel with presence and style that performs. It exhibits excellent resistance to mild chemicals and moisture. The panel has a Class C rating for flame spread and smoke development when tested per ASTM E-84. TableOne: Properties Typical Values n Property STC [SSTC] LBCLW , FTBB 4 t } , Nest Method: Flexural Strength 15 x 103 psi 14 x 10' psi ASTM-D790 103 MPa 97 MPa Flexural Modulus 0.5 x 106 psi 0.4 x 106 psi ASTM-D790 3447 MPa 2758 MPa Tensile Strength 8 x 10' psi 6 x 10, psi ASTM-D638 55 MPa 41 MPa Tensile Modulus 0.6 x 106 psi 0.6 x 106 psi ASTM-D638 4137 MPa 4137 MPa Barcol Hardness 40 40 ASTM-D2583 Izod Impact 5.0 ft-lb/in notched 4.0 ft-lb/in notched ASTM-D256 0.27 J/mm 0.21 J/mm Coefficient of Linear Thermal 0.20 x 10-5 in/in/'F 0.20 x 10-5 in/in/°F ASTM-D696 Expansion 36 pm/m/°C 36 Nm/m/°C 0.16%/24hrs@77°F 0.16%/24hrs@77°F Water Absorption 250C .250C ASTM-D570 Surface Burning Characteristics Class C Class C ASTM-E84 Taber Abrasion Resistance 0.015%Max W.Loss 0.015%Max Wt.Loss Taber Test (cs-17 wheels,1000g.Wt,25 cycles) TableTwo: Properties Nominal Product Code 4 ,Finish �t i�Color w., Available"Sizes Thickness � . Morning Mist Gray 1 636 STC Sandstone Fawn Brown 1 809 Almond Breeze 1 866 Cotton White 1 1130 Willow Green 1205 Sandstone Scored Red 1 731 SSTC 0.09"12.3 mm in 2",3",4",6",8",and 12"square tiles Blue 1 318 4'x 8' 4'x 10' Daisy Gold1111 1.2mx2.4m 1.2mx3.Om Morning Mist Gray 1 636 Call for stocking information Fawn Brown 1 809 LBCLN Linen Almond Breeze 1 866 Cotton White 11130 Willow Green 1205 FTBB 0.075"11.9 mm Beaded Cotton White 11130 Additional lengths,widths and colors available by quotation. 12,000 sq,ft.per product,weight and colors required to manufacture. Orders from different customers may be batched to obtain manufacturing minimums,however lead time may be affected. SPECIFICATIONS FABRICATING RECOMMENDATIONS Crane Composites panels are manufactured by a continuous laminating Note:Protect your eyes with goggles;cover your nose and mouth with process in lengths as required. a filter mask;cover exposed skin when cutting CCI panels. Hand Fabricating: Drilling—High speed drill bit(60°cutting angle,with COMPOSITION 12°-15°clearance)or hole saw. Reinforcement:Random chopped fiberglass. Cutting:Sheet metal shears or circular saw with reinforced Resin Mix:Modified polyester copolymer and inorganic fillers and carborundum or carbide-tipped blade. pigments. Production Fabricating:Use carbide-tipped tools. Straight cuts can be sheared(90°cutting edge with 0.002"[0.05 mm]clearance)or FINISHED PANEL QUALITY sawed. For irregular cuts,use die punch or band saw. 1. Panels shall have a wear side with a consistent pattern. Color Cleaning Instructions:Available from CCI. shall be uniform throughout,as specified. The backside shall be smooth. Backside imperfections which do not affect STORAGE functional properties are not cause for rejection. All Crane Composites FRP products should be stored indoors. 2. Physical properties shall be as set forth in Table 1. 3. Dimensions shall be as specified on purchase order,subject to SERVICEABLE TEMPERATURE RANGE the following tolerances: Panels will perform in temperatures from-40°F(-40°C)to 150°F(66°C). Width: t1/8"(t3.2 mm) For use in environments beyond this range contact Crane Composites Length: t1/8"(t3.2 mm),up to 12'(3.7 m) for recommendations. Squareness: ±1/8"(3.2 mm)in 48"(1.2 m)of width 4. Product quality standards and tolerances for panel weight and LIMITATIONS thickness shall be as set forth in Crane Composites'Quality Near Heat Source:Crane Composites panels may discolor when Control Procedures/Standards which are available on request. installed behind or near any heat source which radiates temperatures 5. Panels shall be installed in accordance with manufacturer's exceeding 130°F(55°C),such as cookers,ovens,and deep fryers. guidelines as set forth in the Crane Composites Installation Uneven Surface: Installation over uneven concrete block walls may Guide(Form#6876). result in areas of delamination and bulging. CERTIFICATIONS NOTICE 1. Meets USDA/FSIS requirements Panels will provide a clean,aesthetically-pleasing finished installation. 2. Meets FMVSS 302 Requirements However,by nature,fiberglass reinforced plastic paneling may 3. FRP does not support mold or mildew(per ASTM D3273 and occasionally have small areas that are aesthetically unacceptable ASTM D3274) for use. Panels should be inspected on-site prior to installation. If 4. Meets minimum requirements of major model building codes any portion of material does not provide an acceptable appearance, for Class C interior wall and ceiling finishes of flame spread Crane Composites should be notified at once. Upon verification of 5 200,smoke developed 450 or less(per ASTM E-84) unacceptability,that portion of material will be replaced by Crane 5. Crane Composites certifies that Innovative Finishes(STC, Composites. Crane Composites'sole responsibility is for the SSTC,LBCLN,FTBB)meets the requirements of ASTM replacement of defective materials but not for labor or other handling or D5319. installation expenses. Classification Class C- Flame spread 76 to 200,smoke development index of 450 or less per ASTM E 84. Grade 6: o.081 to 0.099 n.(2.06 to 2.51 mm);0.090 in.nominal(2.29mm). Tolerances: Width and Length: +.125 in(3.175mm)up to and including 12 ft. Squareness:+,125 in(3.175mm) Thickness:+10%Camber:+.25 in(6.35mm) FLAME SPREAD AND SMOKE DEVELOPMENT RATINGS The numerical flame spread and smoke development ratings are not intended to reflect alleged hazards presented by Crane Composites products under actual fire conditions and this product has not been tested by Crane Composites except as set forth below. These ratings are determined by small-scale tests conducted by Underwriters Laboratories and other independent testing facilities using the American Society for Testing and Materials E-84 test standard(commonly referred to as the"Tunnel Test"), CRANE COMPOSITES PROVIDES THESE RATINGS FOR MATERIAL COMPARISON PURPOSES ONLY. Like other organic building materials(e.g.wood),panels made of fiberglass reinforced plastic resins will bum.When ignited,FRP may produce dense smoke very rapidly.All smoke is toxic. Fire safety requires proper design of facilities and fire suppression systems,as well as precautions dring construction and occupancy. Local codes,insurance requirements and any special needs of the product user will determine the correct fire-rated interior finish and fire suppression system necessary for a specific installation.We believe all information given is accurate,without guarantee. Since conditions of use are beyond our control,all risks are assumed by the user, Nothing herein shall be construed as a recommendation for uses which infringe on valid patents or as extending a license under valid patents. www.astm.org/Standards/E84.htm. www.FRP.com 1 1.800.435.0080 1 1.815.467.8666(fax) I salesbp@cranecomposites.com Crane Composites is the manufacturer of Glasbord,Sequentia,Sanigrid II and a variety of other fiberglass reinforced plastic(FRP)composite wall panels CRAN E Composites Inspired by the Kemlite tradition,Crane Composites has over 55 years of experience in Commercial Building Products and is a recognized industry leader in FRP applications. We believe all information given is accurate. It is offered in good faith,but without guarantee. Since conditions of use are beyond our control,all risks are assumed by the user. Nothing herein shall be construed as a recommendation for uses which infringe on valid patents or as extending a license under valid patents. Form 67431 Rev.3 12.11 1(5688) PAGE NO. / is `— DATE: I J I o 6�5 ASSESSOR'S MAP & PARCEL: COMPLAINT LOCATION: �' I UHM LQ_ � n COMPLAINT DESCRIPTION: rr No u BLS O Z_S!_ r d b ORIGINATOR PHONE: DATE: INSPECTOR: _ INSPECTOR'S ACTIONS/COMMENTS: T e The Town of Barnstable = Health Department { 161 ' 367 Main Street, Hyannis, MA 02601 ■AY�' Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health January 12, 1995 r Mr. David Curley, Director Recreation Department Town of Barnstable Dear Mr. Curley: .The attached complaint regarding filth at the Sandy Neck bathhouse every year was received at the Health Division office on January 10, 1995. Please advise what actions will be taken .prior to re-opening the bath house this spring. Sincerely yours, Thomas McKean, CHO Director of Public Health June 1, 1981 Mr. Jack Heher Director, Recreation 367 .Main St. Hyannis, Ma. Dear Mr. Heher: It is highly recommended that Mr. Gary A. Johnson not be awarded the Sand Neck Food concession next year because of an apparent y ulation 595.032 � of 105 CMR 595.Oa0, Minimum violation of Reg arenti Sanitation Standards for Food Service Establishments , app y operating without a permit. i Mrs, Johnson came to our office on Friday, May 22, 1981, at 4 P.M. and requested a food service permit. She was informed that an, application had not been filed nor had an inspection been requested by them. She became agitated, and stated it was the era of the for DTown's responsibility to infiorm th told of thisedure procedure,btainingl a permit and that they had r ion Monday, May 25, 1981, Mr. Johnson applied for his permit and was then inspected by the Health Department. He was told to ob- tain the permit at the Health Department office before selling , food to the public. June 1 l9 8l he has still not picked up his permit. On Fr of Ju Health Inspector John Jacobi that Friday, May 29, he was told by p he must obtain a food service permit or cease operation. The Health Department made several visits to his establishment last yea r before he could be convinced to obtain a permit. Iti view of this non-cooperative attitude,, it is recommended that he not be considered for any future Town concession, very truly yours, John M. Kelly Director of Public Health - JMRjmm cc: ;Zr. Thomsa Geiler 11 I Health Complaints 29-Jul-02 Time: 10:37:00 AM Date: 7/23/02 Complaint Number: 3560 Referred To: Sam White Taken By: THOMAS MCKEAN Complaint Type: ARTICLE X- FOOD Article X Detail: EMPLOYEE HYGIENE Business Name: Sandy Neck Concession Number: Street: Sandy Neck Village: WEST BARNSTABLE Assessors Map Parcel: Complainant's Name: Address: Complaint Description: Employees are not washing hands after using the restroom. Employees are smoking while serving food to customers. No gloves worn as required. Actions Taken/Results: LM and SW inspected Sandy Neck Snack Bar to find no hot water, no ServSafe certified food handlers on site, and fridge temps approximately 10 degrees over the maximum. Snack Bar was immediately shut down for all food prep sales. Were kept open only for pre- packaged foods and soda. Recreation on site to repair hot water problem. Return visit by SW on 7/24/2002-- hot water reading 150 degrees, fridge temps 38 degrees, and Gerolisa Assis on site as the ServSafe certified food handler-- re- opened for business. Investigation Date: 7/23/02 Investigation Time: 11:00:00 AM i NEXYLLAB Certificate of Analysis To: WhiteWater, Inc. Date Reported: June 28, 2018 253 B Worcester Rd Charlton, MA 01507 Date Received: June 25, 2018 PWS: Sandy Neck Beach 4020023 Case No. 8F25065 Submitted samples from: DEP Sample Type I DEP Location Code I DEP Sample Location RS 1 002 Snack Bar SUBJECT: Total Coliform Bacteria METHOD: Standard Methods for the Examination of Water and Wastewater, 201h Edition, 1998, APHA, AWWA-WPCF. Total Coliform: SM 9223B New England Testing Laboratory is certified in the Commonwealth of Massachusetts(Lab ID M-RI010)for all tests performed on the premises. This report shall not be reproduced,except in full,without written approval of the laboratory. New England Testing certifies that the test results contained within this report meet all method and certification requirements except as detailed in the Case Narrative section of this report. NEW ENGLAND TESTING LABORATORY, INC. 59 Green Hill Street,West Warwick,RI 02893 (401)353-3420 Total#of Pages: 3 Massachusetts Department of Environmental Protection - Drinking Water Program B BACTERIOLOGICAL REPORT I:P,yY$INFORMATI N:Refer,to your EP Coh orm Samp ing Plan fo help complete tFie PW5 informatio"ri and UEY Appr'dViSd Sample bite,Wormatlon sections!below. PWS ID#: 4020023 PWS Name: SANDY NECK BEACH City/Town: WEST BARNSTABLE Class:COM[] NTNC[] TNC(X] IL ANALYTICAL,INFCRMATIONtRefer to your MasSDEIP state lab certificate for proper Lab MA Cert#and certified methods. rY M-RIO10 Primary Lab Name: New England Testing Laboratory,Inc. ( ) Prima Lab MA Cert.#: Subcontracted? Y/N Analysis Lab MA Cert.#: M-RIO10 Analysis Lab: New England Testing Laboratory,Inc. [� [X]Original Report []Resubmitted Report []Confirmation Report (1)Reason for Resubmission: []Resample (]Reanalysis []Report Correction 12)Collection Date of original Sample: 1 TC Method E.Coli Method Fecal Coliforrn HP C Method l- Lab Sample Notes: SM9223 SM9223 DEP APPROVED SAMPLE SITE INFORMATION[11 '. - ... " - qua s COLIT . , - : ] COLLECTION .ANALYSIS 1 LAB SAMPLE DEP" . `' ;DEP r�,.. a .. 1.11, �y ,- E NPC m, - IU# .._. .. Sample, location - DEP Approved SAMPLE LOCATION y TOTAL_._, FECAL r RESULTIN2 RESULT "" COLLECTED BY i K p a pP [1* RESULT[4,5]" =RESULT[4,5] ,�"IL[ #cfu/mL a :DATE 71ME kDATE TIME '' �-4. �q, k- TYpe[1,3] �.Code(17 .. . RS 002 SNACK BAR A 06/25/18 15:00 06/25/18 17:55 TOM WALKER 8F25065-01 [11 DEP Sample Type,Location Code#,and DEP Approved Sample Site Location must correspond to the sample information on your DEP Total Coliform Sampling Plan [21 SWiR systems:HPC samples shall be taken at the same distribution sites and at the same time as total coliform,whenever chlorine residual is not detected at the sample site. [31 Sample Type:RS-Routine Distribution Sample,RO-Original Site Repeat,UR-Upstream Repeat,DR-Downstream Repeat,AR-Additional Repeat,RW-Raw Water,PT-Plant Tap,SS-Special Sample [4]Report as#/100 mL,P(present),A(absent),or Too Numerous To Count TNTC-1(invalid)or TNTC-P(present). [51 Collect appropriate number of repeat samples within 24 hours of laboratory notification for coliform-positive or invalid samples.Notify DEP of any routine or repeat EColi or fecal positive results by the end of the business day. certify under penalties of law that I am the person authorized to fill out this form and the - I ILaboratory Authorized Signature and n""'fd°rmatlon contained he'Fem is lniffi',°ac�tirate'end complete to the best extent of my knowledge Date: 6/27/2nt R DEP Review Status: ❑ Accepted ❑disapproved Review Comments: Page 2 of 3 NEW ENGL•AND TESTING LABORATORY, 1254 Douglas Avenue orth RI 1-888 863 8522e, 02904 1� CHAIN OF CUSTODY RECOR 8 F Z 5�5 Z ( :s; PR NO. PRQtECT NAMFJLOCATION / / `n.�,.,,,. •� a A.: CLIENT 'A 1 lvECG '--Cam•(-{- :tI P f ' r• 4' 1 S A E iII. REPORT TO: O O R g 5 ai.• .� INVOICE TO: :I U SO T NO. A ,�u ` {'''• " C.t E I H OF T O E I DATE TIME )'r -i O R U R CONTAINERS V REMAR KS RKS M A SAMPLE .�_� E '1i1L { P B 6 z Is�oa aOZ 25 SNack �) M9'S 27o � • •;: '•li ,;1 ,t - �f• t .rr rid 4 U4 .� d ,t'iI i 14 t •�'` r Sampled by(Sfgnatura) Daternma RaceH J I tty-.(Signature) Date/nme Laborat Remarks- ' r r G^ZS" °f)' Spacial instructions: 1 S': Tenq>.received. Ust Specific Detection AL& 2el k �i Coded D Umit Requirements: Relinquished bY-(Stgnep+re) Datefnma tieceN ,Ity:(Signature) atelykne L9 ,i aY'Z 1�/1a1.4�2 �t� c Relinquished by:(Signature) Date lima Rarely .or •4 �:�' :¢, l Laboratory by:(Signature) Datafthm —Netlab subcontracts the following tests:Radiologicals,Radon,As Sto ,UCMRs,Perchlorate,Bromate,Bromide,Sieve,Salmonella,Carbamates Turnaround(Business Daysj w 7 s 0 NEXTUAB Certificate of Analysis To: WhiteWater, Inc. Date Reported: May 14, 2018 253 B Worcester Rd Charlton, MA 01507 Date Received: May 7, 2018 PWS: Sandy Neck Beach 4020023 Case No. 8EO7049 Submitted samples from: DEP Sample Type DEP Location Code DEP Sample Location RS 001 Guard Shack Public Bathroom RS 002 Snack Bar—Left Sink RW EP1 Well#1 SUBJECT: Total Coliform Bacteria METHOD: Standard Methohds for the Examination of Water and Wastewater, 20 Edition, 1998, APHA, AWWA-WPCF. Total Coliform: SM 9223B New England Testing Laboratory is certified in the Commonwealth of Massachusetts(Lab 1D M-RI010)for all tests performed on the premises. This report shall not be reproduced,except in full,without written approval of the laboratory. New England Testing certifies that the test results contained within this report meet all method and certification requirements except as detailed in the Case Narrative section of this report. NEW ENGLAND TESTING LABORATORY, INC. 59 Greenhill St.,West Warwick,R102893 (401)353-3420 Total#of Pages: 3 Massachusetts Department of Environmental Protection - Drinking Water Program B I BACTERIOLOGICAL REPORT y � p_ the PWS Information and DEP Approved Sample Site Information sections below. WS INFORMA ON: Refer to .our DAP Ooliform SamplingPlan to help complete � _ � �y PWS ID#: 1 4020023 PWS Name: I SANDY NECK BEACH City/Town: WEST BARNSTABLE Class: COM ❑ NTNC ❑TNC 11.ANALYTICAL INFORMATION Referto your MassC�EP st�atte lab cart ate for proper Lab MA Gertz#and c methods. I Primary Lab MA Cert.#: M-RI010 Primary Lab Name: FNew England Testing Laboratory Subcontracted?(Y/N): Analysis Lab MA Cert.#: Analysis Lab: IN Original Report❑ Resubmitted Report❑Confirmation Report (1)Reason for Resubmission: ❑Resample❑Reanalysis❑Report Correction (2)Collection Date of Original Sample: -� TC Method E.Coli Method Fecal Coliform HPC Method -- ---------------- ..._..-- ---- ------ ---.._..................................................._...._......_.............._...... --- ------- - _-- Lab Sample Notes: SM 9223 INFORMATION' TOTAL E.COLI or CHLORINE HPC ANALYSIS ,,,,C1FP�DEPI'A FPROVED SAMPLE SITE INF" f;01 IF,("iRM PECAN. RESULT` ' RE3ULTz COLLECTION ANALr COLLE!TED BY " . LAB SAMPLE _a DEP Approved SAMPLE LOCATION" RESULT'' a RESULT'' mg/L #c DATE '"I ..TIME j1' ' "UA 16 "" i UMt'°"o wrml ILA fl Sample Location s e fu/mL ev .Awv N,VnxI,Ii,Y , d, x , ' ,q,,:,-. _. ,A VI {A lAP rp41'Vl,. . a. 1 .NINNY n f'..' rt' NAI Np.�, IION{I)N,V LL011 .,N. 1 n �V� " n am �' ,qw ':rtznNa,�wu , i r .,m o� ..�, ..... YPe a Dode N " A__ w fu ol,ni ourtaoiuliiiorol�(h lmn"W"ro dYili,ai,,,,�aom uon., . n nNil„" . nn,'rmto mmr mm"ou �s ! # ,,� vlwa,mm Nam. � RS 001 Guard Shack(Public Bathroom) A 5/7/2018 13:55 5/7/2018 16:55 Tom Walker 8E07049-01 RS 002 Snack Bar-Left Sink A 5/7/2018 14:09 5/7/2018 16:55 Tom Walker 8EO7049-02 EP EP1 Well#1 A 5/7/2018 14:00 j 5/7/2018 16:55 Tom Walker 8EO7049-03 'DEP Sample Type,Location Code#,and DEP Approved Sample Site Location must correspond to the sample information on your DEP Total Coliform Sampling Plan 2SWTR systems:HPC samples shall be taken at the same distribution sites and at the same time as total coliform,whenever chlorine residual is not detected at the sample site. 3 Sample Type:RS-Routine Distribution Sample,RO-Original Site Repeat,UR-Upstream Repeat,DR-Downstream Repeat,AR-Additional Repeat,RW-Raw Water,PT-Plant Tap,SS-Special Sample "Report as#/100 mL,P(present),A(absent),or Too Numerous To Count:TNTC-I(invalid)or TNTC-P(present). s Collect appropriate number of repeat samples within 24 hours of laboratory notification for coliform-positive or invalid samples.Notify DEP of any routine or repeat E.Coli or fecal positive results by the end of the business day. contained herein rs#rue accur p� xtefo rand the Laboratory Authorized Signature and rnformf action underPar ,e' n afe and comp need to filb out this form a y knowledge. u y enalhes of law that!am fhe rson complete So the best e iN,N�yrra yto,arN 5/14/7019 DEP Review Status: ❑Accepted ❑Disapproved Review Comments: Page 2 of 3 01, ROUTINE S WhwiteWater O REPEAT SA , 8 E 79 V WATER S WASTEWATER SOLUTIONS SPECIAL NOT . "Summer Plans" 2538 Worcester Road,Charlton MA 01S07 Phone:888-377-7678/Fax SOB-248-ZMS PWS 1D#: 4020023 PWS CLASS TNC 10B/PO# 530 PWS NAME: Sandy Neck Beach ADDRESS 590 Sandy Neck Rd,W.Bamstable,MA 0260 PHONE: (508)790-6272 METER READINGS- Cu ft o Ga DATE COLLECTED: S-�-I� Meter. I)S I gOOQ Is the source treated? YEs aN Sample after treatment? YEs u� LOCATION CODE SAMPLE LOCATION CHLORINE SAMPLE TIME TC OTHER RESWUAL TYPE Mbottie;,lwer many? 001 Guard Shack(Public Bathroom) RS 13;SS X • 002 Snack Bar-Left Sink RS • EP1 Well#1 i EP CUSTODY TRANSFER NAME DATE TIME sm"Pleron-r .9LkE� 5--7,1� Owl jW Lk[, BUJ RemNed br. �-� < RettnWsMdbr- J S Reid br• . DO NOT MAIL HARD COPY! Please Email this report with results AND invoice to: viaintmrhwhite.com a G� NEUIUB 73 Certificate of Analysis To: WhiteWater, Inc. Date Reported: July 28, 2017 253 B Worcester Rd Charlton, MA 01507 Date Received: July 20, 2017 i PWS: Sandy Neck Beach 4020023 Case No. 7G20062 Submitted samples from: DEP Sample Type DEP Location Code DEP Sample Location RS 001 Guard Shack Public Bathroom RS 002 Snack Bar-Left Sink EP EP1 Well#1 SUBJECT: Total Coliform Bacteria METHOD: Standard Methohds for the Examination of Water and Wastewater, 20 Edition, 1998, APHA, AWWA-WPCF. Total Coliform: SM 9223B i DEP Sample Type I DEP Location Code DEP Sample Location F 1 10000 Well#1 SUBJECT: Nitrate METHOD: Standard Methohds for the Examination of Water and Wastewater, 20 Edition, 1998, APHA, AWWA-WPCF. Nitrate: SM 4500-NO3-E New England Testing Laboratory is certified in the Commonwealth of Massachusetts(Lab ID M-RI010)for all tests performed on the premises. This report shall not be reproduced,except in full,without written approval of the laboratory. New England Testing certifies that the test results contained within this report meet all method and certification requirements except as detailed in the Case Narrative section of this report. NEW ENGLAND TESTING LABORATORY, INC. 59 Greenhill St.,West Warwick,R102893 (401)353-3420 .00) Total#of Pages:4 Massachusetts Department of Environmental Protection - Drinking Water Program B BACTERIOLOGICAL REPORT I.PWS INFORMATION: Refer to yourDEP Coiiform Sampling Plan'to help complete the PWS Information and DEP Approved Sample Site lnfuiriiation sections below. PWS ID#: 1 4020023 PWS Name: F SANDY NECK BEACH City/Town: r WEST BARNSTABLE Class:COM ❑ NTNC ❑ TNC II.ANALYTICgL INFORMATION Refer_to your MassDEP state lab certlfcate for: ro er Lab MA Cert.#and certified_metlluds Primary Lab MA Cert.#: M-RI010 Primary Lab Name: New England Testing Laboratory Subcontracted?(Y/N): �� Analysis Lab MA Cert.#: Analysis Lab: ®Original Report❑ Resubmitted Report❑Confirmation Report (1)Reason for Resubmission: ❑Resample❑Reanalysis❑Report Correction (2)Collection Date of Original Sample: TC Method E.Coli Method Fecal Coliform — HPC Method 9223 SM 223 — ------- —.__—_------.....__.._._.___._...._._......._._..._.._........__...........__.. Lab Sample Notes: DEP APPROVED SAMPLE SITE INFORMATION' COLLECTION ANALYSIS TOTAL E.COLt or ',CHLORINE HPC LAB SAMPLE DEP DEP COLIFORM FECAL RESULT' RESULT' COLLECTED BY inT m RESULTS mg/L � ME DATE TIME * ID# i 3 v LE LOCATION' a RESULT"' #cfu/mL DATE �..�.._ T' Type Sample Code#n DEP Approved SAMPLE RS 001 Guard Shack(Public Bathroom) A 7/20/2017 13:30 7/20/2017 16:30 Tom Walker 7G20062-01 RS 01 G Snack Bar-Left Sink A 7/20/2017 14:15 7/20/2017 16:30 Tom Walker 7G20062-02 EP EP1 Well#1 A 7/20/2017 14:22 7/20/2017 16:30 Tom Walker 7G20062-03 'DEP Sample Type,Location Code#,and DEP Approved Sample Site Location must correspond to the sample information on your DEP Total Coliform Sampling Plan 'SWTR systems:HPC samples shall be taken at the same distribution sites and at the same time as total coliform,whenever chlorine residual is not detected at the sample site. 3 Sample Type:RS-Routine Distribution Sample,RO-Original Site Repeat,UR-Upstream Repeat,DR-Downstream Repeat,AR-Additional Repeat,RW-Raw Water,PT-Plant Tap,SS-Special Sample "Report as#/100 mL,P(present),A(absent),or Too Numerous To Count:TNTC-I(invalid)or TNTC-P(present). 5 Collect appropriate number of repeat samples within 24 hours of laboratory notification for coliform-positive or invalid samples.Notify DEP of any routine or repeat E.Coli or fecal positive results by the end of the business day. l certify under penalties of law that 1 am the person authorized to till out this formand the Laboratory Authorized Signature and j„ rue accurate and complete to' extent of'my knowledge. Dater 7/2$/2017 riformatiod'conmtained wherein rs t, a Y the best a wy DEP Review Status: ❑Accepted ❑Disapproved Review Comments: Page 2 of 4 f Massachusetts Department of Environmental Protection - Drinking Water Program N Nitrate Report I. PWS INFORMATION: Please refer toSour DEP Water Quality Sam"Fling Sctiedule WQSS)to help`complete this form PWS ID 14020023 City/Town: FWEST BARNSTABLE PWS Name: Sandy Neck Beach PWS Class: COM ❑ NTNC ❑ TNC DEP LOCATION - Sample Date DEP Location Name Sample Information Collected By (LOC)ID# Acidified?`` ;Collected A 10000 Well#1 ❑(M)ultiple ❑(R)aw Yes❑ 7/20/2017 Tom Walker ®(S)ingle ®(F)inished El(M)ultiple El(R)aw B El(S)ingle El(F)inished Yes El C ❑(M)ultiple ❑(R)aw ❑Mingle ❑(F)inished Yes El D ❑(M)ultiple ❑(R)aw Yes El (S)ingle El(F)inished Routine or Original,Resubmitted or If Resubmitted Report,list below: Special Sample Confirmation Report (1)Reason for Resubmission (2),Collection Date of Original Sample A ®RS ❑SS ®Original❑Resubmitted❑Confirmation ❑Resample❑Reanalysis❑Report Correction B ❑RS ❑SS ❑Original❑Resubmitted❑Confirmation ❑Resample❑Reanalysis❑Report Correction C [:IRS ❑SS ❑Original❑Resubmitted❑Confirmation ❑Resample❑Reanalysis❑Report Correction D ❑RS ❑SS ❑Original❑Resubmitted❑Confirmation ❑Resample❑Reanalysis❑Report Correction SAMPLE NOTES—(Such as,if a Manifold/Multiple sample,list the sources that were on-line during sample collection). A B C D II.ANALYTICAL LABORATORY INFORMATION: & Primary Lab MA Cert.#: M•R1010 Primary Lab Name: New England Testing Lab Subcontracted?(YIN) Analysis Lab MA Cert.#: Analysis Lab Name: NITRATE MCL MDL 5 Lab Lab Method Date Analyzed Result(mg/L) (mg/L) (mglL) Sample ID# A 0.04 10 0.03 4500-NO3-E 7/21/2017 7G20062-04 B 10 C 10 D 10 Finished water results equal to or exceeding'/z of the MCL(5 mg/L)triggers quarterly monitoring. Finished water results exceeding the MCL of 10 mg/L requires confirmation sampling within 24 hours. Notify MassDEP of any MCL exceedances. LAB SAMPLE NOTES A B C 'D''�' i I certify under penalties of law that I am the person Primary Lab Director Signature: p� authorized to fill out this form and the information contained herein{is true,accurate and complete to the best extent of my knowledge. Date: 7/28/201 7 If not submitting these results electronically,mail TWO copies of this report to your DEP Regional Office no later than 10 days after the end of the month in which you received this report or no later than 10 days after the end of the reporting period, whichever is sooner. DEP REVIEW STATUS(Initial&Date) Review ❑WQTS ❑Accepted ❑ Disapproved Comments Data Entered Page 3 of 4 ---- - - -- � ROUTINE SAMPLE -- - - - - - WhiteM&ter C7 0 REPEAT SAMPLE 7 2 vW�2 WATER & WASTEWATER SOLUTIONS SPECIAL NOTES: 2538 Worcester Road,Chadton MA 01507 Phone:888-377-7678/Fax SOB-Z48-2895 ••Summer Nan" PWS 1D#: 4020023 PWS CLASS TNC 10B/PO# 530 PWS NAME: Sandy Neck Beach ADDRESS 590 Sandy Neck Rd,W.Barnstable,MA 02668 PHONE: (508)790-6272 METER READINGS- 'Cu or Gal DATE COLLECTED: `7-20'I7 Meter. p 5s�SDo 2 3`t'7 2 Is the source treated? YES NO Sample after treatment? YES OO LOCATION CODE SAMPLE LOCATION CHLORINE SAMPLE TRNE TC NO3 OTHER RESIDUAL TVFE Rhonka.�nmrl 001 Guard Shack(Public Bathroom) — RS 131,36 X L 002 Snack Bar-Leh Sink — RS 04'15 1 EP1 Well ttl EP )4 22 X 10000 Well#1 — FS 13:Zo X t CUSTODY TRANSFER NAME DATE TIME RturpYished6r: 0!'� �J�1l1C� �6V'�7 RKelve4lllr; ReunpuW-ed W. _ I RKl1YtA6y' �— �jl g UQ go- UQ oDO NOT MAIL.HARD COPY! Please Email this report with results AND invoice to: viain0rhwhite.com 3 , TO„ Massachusetts Department of Environmental Protection - Drinking Water Program B BACTERIOLOGICAL REPORT Q0 ,.,°,;I�,,.,,... .n.1ORM. ATION: .Reterto•youc D EP Coliform:SablPItn 'PIarto hetP complete the PW 5 Intarmatianand DEP Sample Site Information sections-below.,9 PWsID#: 4020023 PWS Name: SANDY NECK 13EACH Citylrown: WEST 13ARNSTA13LE Class:COM❑NTNC TNC ,f��; Y G �NFCjRMi►'1IQIy i' oyou�M�ssDE Ss te;lab,cA c�iteafgirpwope t�ab.� "art;#and cer4lfled methods. Primary Lab MA Ceti.#: M-RlotO Primary Lab Name: New England Testing Laboratory Subcontracted?(YIN): ON o Analysis Lab MA Cart.#: Analysis Lab: 19 Original Report 1]Resubmitted Report❑Confirmation Report (1)Reason for Resubmission:O Resampte❑Reanalysis 1]Report Correction (2)Collection Date of Original Sample: 7C Method E.Coll Moth Fecal Coliform HIS Method SM 9223 - �_ Lab Sample Notes: ::.: .. t , . DEP APPROVED SAMPLE SITE'INFORMATION ...; ;, • -:<•.+',' :: _•:>; ,...;,: -. � COLLECTioN.::.°..: . �ANAL•Y8t8:;:.::: . :: . . ;.TO'TAL`is:,,�COUor,:: :CHLORINE';; , _ DEP . ..D ...... ... .... .. ... , . , ; ,::. .. !COLLECTED' ,: ..:..,....EP::.:... .:... :.. .....•:�::,.....s• ..•.,.......•........,,........._.._.:.: .COLIFORM.: ::,FECj1L .. .RESULT'.,. RESUL`I� : : `. : ;:.:...:,.; ,. :.;..::;. ::: .::-: ::::...:..:::..::: .. :.. 41':•.:::•:': . . : . $ample toctatlon:; •;' :OEP/►PproyadaAMPLE.LCCATION�'•..;; :RE9UL7 .:;RESUI:T'�. ingfl f"Ch�ImL .:. DATE: TIME DATE: ?�ME W RS 002 Snack Bar-Left Sink A 5/10/2016 14:00 5/10/2016 17:45 Tom Walker C0510-W1e : 0 0 vi i 'DEP Sample Type,Location Code#,and DEP Approved Sample Site Location must correspond to the sample Information an your DEP Total ColHonn Sampling Plan N rn 'SWTR systems:HPC samples shall be taken at the same distribution eltes and at the same time as total coliform,whenever chlorine residual Is no detected at the sample site. N °Sample Type:RS-Routine Distribution Sample,RO-Odglnal Site Repast,UR-Upstream Repeat,OR-Downstream Repeal,AR-Addlilonai Repeat,RW-Row Water,PT Plent Tap,SS-Special Sample � 4 Report as#/100 mL,P(present)A(absent),orToo Numerous To Count:TNTC-1(Invalid)or TNTC-P(present). °Collect appropriate number of repeat samples within 24 hours of laboratory notification for col form-positive or Invalid samples.Notify DEP of any roullne or repeat E.Coil or local positive results by the and of the business day. i.lce/lHy.turder' ` `` �law'eh�temlhe� : • 'a�tia>:e;lad.�oi.t:pila�lo�in'siddie;:'::.'''.".'.�' Laboratory Authorized Signature and peon IR 6!!.oanteh�ed:/te�la"brre;:aodketaarrdoomlpf�leYotfie'AM, xfefd R1Y ! Da Date: , t 5/1 ZIZ016 Ij DEP Review Status: ❑Accepted 0 Disapproved Review Comments: �, 12345678 v N5078 09:35:08 05-26-2016 2/18 Nt.LJ LJ AI5 # �� Certificate of Analysis To: WhiteWater,Inc. Date Reported: May 16,2016 253 B Worcester Rd 10 Charlton,MA 01507 Date Received: May 10,2016 PWS: Sandy Neck Beach 4020023 Case No. C0510-W 16 Submitted samples from: DEP Sample Type I DEP Location Code I DEP Sample ocation RS 1002 Snack Bar-Left Sink SUBJECT: Total Coliform Bacteria METHOD: Standard Methods 2r the Examination of Water and Wastewater,20 dition, 1998,APHA,AWWA-WPCF. Total Colifotm: SM 9223B New England Testing Laboratory is certified in the Commonwealth of Massachusetts(Lab ID M RI010) for all tests performed on the premises. This report shall not be reproduced,except in full,without written approval of the laboratory. New England Testing certifies that the test results contained within this report meet all method and certification requirements except as detailed in the Case Narrative section of this report. NEW ENGLAND TESTING LABORATORY,INC. 59 Greenhill St.,West Warwick,RI 02893 (401)353-3420 .00000 Total#of Pages:3 1�a� tN�n Cow�C rv4�`o�► ` ; 1 ; i 4 _ r 0-0-0 v V' o ❑ BENCHMARK V TOP OF SPIKE — — — — — — — — 275'f TO ELEV.=25.63' WATER (SEE NOTE 9). REPAVE PARKING— — — LOT MATCH i — ° ❑ OBSERVATION EXISTING GRADE PORT (TYP. 2) / LOW VENT-r pGE OF EXISTING CATCHBASIN —`_ ❑� (TYP. 2) /� � � � 57.0 PAV ME TO REMAIN (TYP) � EDGE OF PAVEMENT LOCATE y BEHIND FENCE \ �Il 15' 1 1 —OUTLET DISTRIBUTION BOX / 5.5 0 7 LONG RARIUS PAVED / SWEEPING ELBOW PARKING / / / 1 1 / N LOT / 2 6" SCH 40 PVC / 10.0 57.0' 6" SCH 40 PVC \ 77.0 3.0'�31 8 —�_ �k �L=3.0, S=1% i \ / \ / NEW DECK AREA \ / PAVED 25.5' PALOKTG ' O // EXISTING DISTRIBUTION BOX TO BE REMOVED (SEE NOTE 14) TITLE 5 SAW CUT AND PATCH ` �� 4 SCH 40 PVC s RESERVE{ �� O _ = LEACHING / L=5.9 , S 1 EXISTING PAVEMENT / AREA TITLE 5 LEACHING — ! O REUSE EXISTING 1 ,500 \ GALLON GREASE TRAP 57 AREA REQUIRED, \ .NEW 3,500 � � \� \ \ , , TP 3 ( X77 )5 —GALLON SEPTIC , \ \ 6" SCH 40 PVC .0' TYP. TANK O -- L=85', S=2% TP#4 PAVED PRESBY ENVIRO—SEPTIC �—�r PARKING LEACHING. FIELD NEW 7,000. GALLON \ 4" SCH 40 PVC (MATCH EXISTING GREASE LOT - SEPTIC TANK- \ ;` _ TRAP INLET PIPE SIZE AND ELEVATION) � 6 Q L=8.3, S=6.14% (CONTRACTOR TO : . CONFIRM ELEVATION) CONCRETE WALKWAY / EXISTING LEACHING / FIELD TO BE ABANDONED IN PLACE ;1<< , ABA 1- 5 Ea• X 8.3 / / B S / SEE NOTE 14 / "/ ` �� ATHNO T//�G ,' / INSPECTOR: E. KITTILA INSPECTOR: E.KrrnLA INSPECTOR: !E.KITTILA INSPECTOR:_ E.KrFnLA SOIL EVALUATOR: D.STANTON SOIL EVALUATOR: D.STANTON SOIL EVALUATOR�ID.STANTON _ 'SOIL EVALUATOR: D.STANTON I I 5/26/2010 ._.__ DATE: 5/26/2010 DATE: 15/26/2010 ; DATE 5/26/2010� .. __ - 12956 ;PERC#: 12956 � O�� I L S PERC#: ' 12956 PERC# -12956 PERC#: �� � I TP-4 I AI TP-1 -'�- TP-2 i -- rk 0.0 ' 25.7 0.0 25.5 0.0 20.3 0.0 20.5 41 - -- (_ ° F A A A A awl15 --: `---_❑ {, PAVEMENT PAVEMENT PAVEMENT PAVEMENT , - « v,' 4 ', _ I�,; , �� E o "'- 0.3 i 25.4 0.6 24.9 0.3, 20.0 0.5 - 20.0 AW.. tj� - ,i..,. c� o. _ -.. --.... .�_. Ss. . N Cr1xx ,._ : 3.1t• a ` _ S::" _ 9-1 P� ; uVi 0 4 �y60`�i.. '. .. ■ ,Cf1• F� .'• I') i ,K.�du t. `�'„ �, 1_ � CD LOAMY SAND I LOAMY SAND LOAMY SAND LOAMY SAND ` :. r �t 10 YR 5/6 j. 10 YR 5/6 10 YR 5/6 10 YR 516 CL LL CL a 13� 244 15 240 17 186 18 1 BENCHMARK -f -=- _ , 8.7 � lF z, a TOP OF SPIKE .. C - - C --- C + C _ •, _ <- 4 yF cn W q ' ELEV -25 63' ---j--- ; -.. _ �.:�,•. -_ -�• 275 t TO I O o i f WATER (SEE NOTE 9 I - - CIO ) M-F SAND i M-F SAND REPAVE PARKING I- --< - -- 4 }, 1 ; .� �� µ > LOT MATCH 2.5 Y 72 2.5 Y 72 r .` � � - _� s •�.�- '�_ _. N 1� OBSERVATION 46"DEPTH OF � M-F SAND , 48"DEPTH OF M-F SAND •, :., t-•-, - � `T�_A '�-�-: � Q Q®a® � EXISTING GRADE - - - /J PORT TYP 2 PERC � ! 2.5 Y 72 PERC 2.5 Y 72 � �''-- `� '�'i�x;;•` , � o ,-E_ .. � -- _ -- ( ) { - - -`-- - - - - 2 MIN.ANCH I I < , �'.. ° p < 2 MIN.ANCH , `g -. � r+, _�. *! ,., ���. -.; _ ,•� LOW VENT �% DGE _'� - EXISTING CATCHBASIN PERC RATE i PERC RATE " " ` L �..,Y; - _ m (TYP. 2) F PAV E TO REMAIN (TYP) ED p �-p IY , x �+ _4CD LOCATE -,- GE BEHIND FENCE _ 57 OF P ENT 12.0 ' 13.7 12.0 13.5 10.0 10.3 10.0 10.5 ��� CD ' 1 cJ = NO GROUNDWATER OBSERVED NO GROUNDWATER OBSERVED NO GROUNDWATER OBSERVED NO GROUNDWATER OBSERVED .; r` ` _ k. )i . I , U =� �- 7 _ = _ 1 1-OUTLET DISTRIBUTION BOX 5.5 1 / ,p i ,dt •ate v�r, •: 't� ,, % .T _ _ LONG ' _ o 7.1�1 - - _ -- - NG RARIUS PAVED / ; � r` �: � , fay o• t" ' � i! •; � .- V C .. SWEEPING ELBOW PARKING / ''� � `, °<, - o� "���3' t , ; � k�� � - w Z LOT s i 2 _ 6" SCH 40 PVC �r✓� a� 3.0 - L=9 , S=1% �''•: ,.} �` rfi c , i a + ;.j 1 i tp �\ 57.0' 6" SCH 40 PVC x , c ,� z � . �� .�1 s «►Y m m L=3.0, S=1% DESIGN CRITERIA - t ; � • °'` `` "�= = C4 " k a \ \ O JEM _ / �� USE PUBLIC PARK, TOILET WASTE ONLY c ' a ,� rr �. �`' _ _ O 8 I 0 \ \ QP PAVED _ NEW DECK AREA I FLOW PER PERSON 5 GPD/PERSONLN III i e 1 W Q PARKING 25.5 -1-. ' ' / NUMBER OF PEOPLE 400 PEOPLE q, �, �r o 0 LOT / EXISTING DISTRIBUTION BOX TO / (BASED ON 200 PARKING SPACES @ 2 PEOPLE PER CAR) 4) i y a � �'? N ° VICINITY MAP ° � = V) 2 l FLOW 2,000 GPD C BE REMOVED (SEE NOTE 14) TITLE 5 a Go co w IA •C c 3 rs M N » USE LIFEGUARD ROOM, MULTI-PURPOSE OFFICE GENERAL NOTES Graphic Scale a o O O Z) CUT AND PATCH �` ---- 4 SCH 40 PVC RESERVE ' FLOW PER 1,000,SF 75 GPD/1,000 SF 1. 425 SANDY NECK ROAD, ASSESSORS MAP 263 LOT 1. 1-inch - 3,000 feet = y y to EXISTING PAVEMENT ° j \ L=5.9 , S=1% LEACHING OFFICE AREA 413 SF 2. THE PROJECT IS LOCATED , \ 1 AREA / FLOW 31 GPD WITHIN THE SANDY NECK / BARNSTABLE HARBOR AREA ZONING DISTRICT: RF-1. TITLE 5 LEACHING -� � ----_ � ```- � O REUSE EXISTING 1,500/ AREA REQUIRED _ \ \ 3. THE FEMA FLOOD INSURANCE RATE MAP (COMMUNITY PANEL NO. 250001001D; DATED JULY 2, 1992) IDENTIFIES THE GALLON GREASE TRAP 57.0 USE RESTAURANT FAST FOOD MAJORITY OF SANDY NECK ROAD, THE PARKING LOTS, THE BATH HOUSE AND CONCESSION STAND, AND THE PRIMARY (57 X77 _ NEW 3,500- \ I # T P 3 FLOW PER SEAT 20 GPD/SEA T DUNE AREAS ALL WITHIN ZONE C. (^ / GALLON SEPTIC 6" SCH 40 PVC NUMBER OFSETAS 3s sEArs [[" ! / 5.0=P. TANK O - \ L=85', S=2% TP#4 I' (BASED ON 6 PICNIC TABLES @ 6 SEATS PER TABLE) 4. THE PROPERTY IS LOCATED WITHIN THE RESOURCE PROTECTION OVERLAY DISTRICT. l� PAVED FLOW 720 GPD PRESBY ENVIRO-SEPTIC- \ � Nq 5. THE EXISTING TOPOGRAPHY AND LOCATION SURVEY DATA AS SHOWN ON THIS PLAN WAS TAKEN FROM A PARTIAL FIELD PARKING LEACHING FIELD NEW 7,000 GALLON \ NEW 4" SCH 40 PVC MATCH EXISTING l USE FUNCTION HALL /� _ ( SURVEY CONDUCTED BY THE TOWN OF BARNSTABLE AND TAKEN FROM THE PLAN ENTITLED "TOPOGRAPHIC PLAN OF LAND SEPTIC TANK• • _ GREASE TRAP INLET PIPE SIZE AND ELEVATION) FLOW PER SEAT 15 GPD/SEAT IN BARNSTABLE (W. BARNSTABLE) MA FOR THE TOWN OF BARNSTABLE D.P.W. - SURVEY SECTION" REVISED JANUARY 5, NUMBER OF SEATS 33 SEATS L=8.3, S=6.14% (CONTRACTOR TO CONFIRM J zo1o. (BASED ON 500 SF AREA @ 15 SF PER SEAT) (, / ` .,� ELEVATION) ____ FLOW 495 GPD 6. THE WETLAND DELINEATION SHOWN HEREON WAS CONDUCTED BY SANDY NECK PARK IN JUNE 2007. �1 �t -._ r � ,.. CONCRETE WALKWAY' �- � � rJ--- ` •�`II / j61 � TOTAL DESIGN FLOW 3,246 GPD 7. CONTOURS AND WETLANDS BOUNDARIES BEYOND THE SURVEY LIMITS AS SHOWN ON THIS PLAN HAVE BEEN TAKEN FROM q w q EXISTING LEACHING --� - f '�c-� GIS DATA PROVIDED BY THE TOWN OF BARNSTABLE. rn / FIELD TO BE Q' SEPTIC TANK "�111000, ABANDONED IN PLACE SEPTIC TANK(200%DESIGN FLOW): 6,600 GAL. 8. ON JUNE 29, 2006 THROUGH AN ADMINISTRATIVE CONSENT ORDER WITH DEP, ON THE EXISTING WELL SERVICING THE (SEE NOTE 14) /J/ 8'3 rNN61i r vG ,�+ SITE WAS MADE A PUBLIC WATER SUPPLY PWS WITH PWS ID 4020023. "5 �- i � SEPTIC TANK(100%DESIGN FLOW): 3,300 GAL. ( ) # ECONsr E roe TOTAL TANK CAPACITY: 9,900 GAL. 9, A BENCHMARK, LOCATED 50 TO 75 FEET FROM THE NEW SYSTEM, SHALL BE SET BY THE TOWN PRIOR TO f / I E n USE 7,000 GALLON AND 3,500 GALLON SEPTIC TANKS �'^ 166.1' / CLEANOUT .;� Ec25 rED ;/' CONSTRUCTION. v z 150' WELL SETBA J J TO GRADE OU(SSA 65� H U RE GREASE TRAP 10. THERE SHALL BE NO ENCLOSURE AROUND THE OUTDOOR SHOWER. THE USE OF SOAP AND SHAMPOO IN THE OUTDOOR TU B L1�JRAL RESTAURANT FLOW PER SEAT 15 GPD/SEAT SHOWER WILL NOT BE ALLOWED. O QU ZONE I / / \ \ \i ' ;`,' NDAT/ .,;I INTEIRPRETIVE NUMBER OF SEATS 36 SEATS o WELL SETBACK ////J J 6 \� ON CENTER MIN: GRASE TRAP VOLUME 540 GAL ^y WASTEWATER NOTES FFE=25.1 USE EXISTING 1,500 GALLON GREASE TRAP 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS SHALL BE IN ACCORDANCE WITH M THE STATE ENVIRONMENTAL CODE AND THE RULES AND REGULATIONS OF THE LOCAL BOARD OF HEALTH (BOH). w / / / ` +' + \ �� / 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE ENGINEER AND/OR THE LOCAL BOARD OF HEALTH (BOH) VARIANCES STAFF. ABANDON EXISTING �- WATER SERVICE / 14 3. FAILING TO PROPERLY INSPECT OR PUMP THE SEPTIC TANKS AND GREASE TRAP OR CHANGES TO EFFLUENT FLOW, � C - - / TOWN OF BARNSTABLE BOH LOCAL CODE WAIVERS GRADING, OR LANDSCAPING, EITHER ON-SITE OR ADJACENT TO THE SITE, MAY RESULT IN IMPROPER FUNCTIONING OF NEW THE SEPTIC AND LEACHING SYSTEM. \ - W -` . /// j INFILTRATION REGULATION N \ \ ,� '" 7-__ / / / BASIN E-Code 360-2. Shifting Sand Regulation 4. THIS ON-SITE WASTEWATER TREATMENT SYSTEM IS NOT DESIGNED FOR USE WITH A GARBAGE GRINDER. �- 160 / y _ /j /i //// / 9 g IWPA - ,1/. 5. THE OWNER SHALL INSPECT AND PUMP THE SEPTIC TANK ONCE EVERY 2 YEARS. 1 1 / SETBACK - ` ° EXISTING 8,000 GALLON \ \ \ LOCAL UPGRADE PROVISIONS N_ �/ - - 6. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT AT ALL POINTS WHERE PIPES ENTER OR LEAVE ANY 1 \ (1979) i - _ SEPTIC TANK TO BE % \ \ \ \ \� JJ - B / / REMOVED SEE NOTE 14 ? \ REGULATION REQUIRED PROPOSED CONCRETE STRUCTURES. CID i ) \ \\ NONE 7. USE SCH. 40 PVC PIPING WITH WATERTIGHT JOINTS UNLESS OTHERWISE NOTED ON PLAN. ALL PIPE SHALL BE PLACED ON A COMPACTED FIRM BASE. 9 , ' / r � C TITLE 5 VARIANCES / J 8t \ - - - - \`� // - /11-V / \ REGULATION REQUIRED PROPOSED 8. THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING OPERATIONS AND MAINTENANCE INFORMATION FOR THE SEPTIC CLI ( / \ NEW 2 HDPE _ SYSTEM TO THE ENGINEER, AS REQUIRED. // \ 100' /` _WATER SERVICE 2� / Z� - Q Y 9. THE CONTRACTOR SHALL PROVIDE A DEWATERING PROTOCOL PRIOR TO CONSTRUCTION IF GROUNDWATER IS ANTICIPATED C) U / WELL / /// / - B?` ` _ 310 CMR 15.211 Minimum Setback distance to foundation wall 10 feet 8.3 fleet DURING CONSTRUCTION. C N - - - - '' z / SETBACK / // ///i _ - ' \ / NEW A�riance of 1.7 feet is being requested(Grease Trap Only). C M / - - BIORETENTION _ _ 10. AREAS UNDER THE LEACHING FIELD FOUND TO HAVE UNSUITABLE SOIL MUST BE REPLACED WITH TITLE 5 SAND AS E `� A / / NEW 1�0 _ _ _ �--'� 310 CMR 15.221(7)Depth of corer over system 3 feet max 4.6 feet max � o � / /// / / ' OUTDOOR _ _ / AREA - / SPECIFIED IN 310 CMR 15.255(3). ANY AREAS THAT ARE FOUND TO HAVE UNSUITABLE MATERIAL SHALL BE REPORTED `d N a _ A variance of 1.6 foot is being requested. pq IZP / SHOWER_ - - - \ -�J/ 1 - = - _ TO THE ENGINEER. 0 3 J !': •. o U / \ \ / / / / / / _ - 20 - ' ! 11. ALL SEPTIC COMPONENTS SHALL BE INSTALLED WITH MAGNETIC WARNING TAPE. _0 -� o / L/ / / �/ /%/ ' - - - \��/ ''-- - . - PRESBY SYSTEM 2 / /�// RECHARGE BASIN-- - \ - '�- `c /' - - - J i Design Flow 3,246 12. ALL SEPTIC TANKS SHALL BE APPLIED WITH 2 COATS OF DAMP PROOFING OR BITUMINOUS MATERIAL. a S FOR OUTDOOR - - - - - - ` \ \ a x a w / / / � - - - - - - -- _ - - - a No. Beds 2 U / \ / / J / / /// /�/ SHOWER ? - - - TITLE 5 REQUIREMENTS 13. A LEAKAGE TEST WITNESSED BY THE ENGINEER ON ALL NEWLY INSTALLED COMPONENTS IS REQUIRED PRIOR TO SYSTEM / / _ -TITLE _ Flow per bed 1,623 START-UP. A TESTING CERTFICATE SHALL BE SIGNED AND SUBMITTED TO THE ENGINEER. / \ / i /j/ / //j/ i _ - - - � � ` � ` - - - -, - - � � _ i max flow per section 500 LL / / / �/ �_ - - - - - - - - ��� _SOIL ABSOI�TION SYSTEM (RESERVE AREA ONLY) #Sections 4 14. HALL BE ABANDONED OR REMOVED IN ACCORDANCE WITH TITLE 5, 310 CMR ALL EXISTING SEPTIC COMPONENTS S I Table A Presby Guide 15.354(3). C\I / \\ ( J / �~ I (/ / / /// ///�/%,j -- - - - - \ \ I `, - - - - / LEACHING SYSTEM USED: BED Commercial per 100 gpd 50 �/ - - / \Q _ ! �/ DESIGN PERCOLATION RATE: �- 2 WMAN. ! Total L.F. Required 1,623 WASTEWATER INSTALLATION INSPECTION NOTES J J l J ( / l / I/ /�� - \ \ \ \ \\ \\ I / SOIL CLASS: I L.F. per section 203 1. THE CONTRACTOR SHALL PROVIDE A MINIMUM OF 24 HOURS ADVANCE NOTICE TO THE ENGINEER, LOCAL BOARD OF C:)C:) EXISTING WELL - - - - - - _ LONG TERM ACCEPTANCE RATE(LTAR): -- 0.74 GPD/S.F BUILDING _' L.F. per bed 811 HEALTH FOR ANY INSPECTION. '� / / // // / / / \ / / TOTAL AREA REQUIRED: 4,386 S.F. _ Table C Presby Guide 2. ALL WASTEWATER SYSTEMS, INCLUDING THE LEACHING SYSTEM, SHALL BE INSPECTED BY THE ENGINEER AND DEP, OR / -i L.F. per section 220 THE LOCAL BOH REPRESENTATIVE PRIOR TO BACKFILLING. AT A MINIMUM THE FOLLOWING ITEMS SHALL BE INSPECTED: U Q ( I / / / / / / / / / / / / / \ \ \ \ - - - f - - / --- - - 2.1. EXCAVATION OF LEACHING FIELD PRIOR TO PLACING SYSTEM STONE/COMPONETS \ / TOTAL AREA PROPOSED: L.F. per bed 880 Total L.F. 1,760 2.2• LEACHING FIELD COMPLETE INSTALLATION PRIOR TO BACKFILL 2.3. ALL SYSTEM COMPONENTS BASE AND INSTALLATION PRIOR TO BACKFILL It 5T L X 7T W 4,389 �S.F. 2.4. START UP TEST OF SYSTEM WITH ALL COMPONENTS INSTALLED AND FUNCTIONING AS DESIGNED Q- I � 1 j//�/ // // / �/ / / / ,� / / / ,✓ _ \ \ - __ __ __ _N._._ ,. - / _ __ _ _ l ~ TOTAL ALLOWABLE FLOW. 3,248 GPD Area provided 2.5. FINAL INSPECTION OF BACKFILLED SYSTEM 5`�` \ - - -- - - center to center spacing 5.5 Z 3. THE CONTRACTOR SHALL BE RESPONSIBLE TO MAINTAIN UP-TO-DATE AS-BUILT DRAWINGS AND NOTES INDICATING THE HORIZONTAL c� spacing between pipes 0.5 USE 1 57'X 77'LEACHING BED(RESERVE AREA ONL17 length AND VERTICAL LOCATION WITH TWO TIES OF ALL SYSTEM COMPONENTS INSTALLED. THESE AS-BUILT DRAWINGS AND NOTES WILL v, t- Line len h 55 UTILIZED BY THE ENGINEER FOR THE PREPARATION OF RECORD PLANS. a o a o Min. Area required(Table D Presby Guide) m kn lop.._, / \ Ir \ \ \ \ Commercial per 100 gpd 81 PRESBY SYSTEM NOTES � pq o 0 ^ / I ` min area req. 2,629 1. SYSTEM TO BE INSTALLED IN ACCORDANCE WITH ENVIRO-SEPTIC WASTEWATER TREATMENT SYSTEM MASSACHUSETTS > ``'' Q � °O O / \ \ - -/ / / / / ( ( I ' ( I / 7� \ �1 I \ area provided Z907 DESIGN AND INSTALLATION MANUAL, STATE AND LOCAL REGULATIONS. FOR PRODUCT INFORMATION OR THE NEAREST n2 / C I \ I I DEALER CONTACT PRESBY ENVIRONMENTAL, INC. 143 AIRPORT ROAD, WHITEFIELD, NH 03598 PHONE 1-800-473-5298 a 3 z; � \ / / - WWW.PRESBYENVIRONMENTAL.COM R, g O / /' / / / / �/ / ' I I I I I / I l \\ \ II I , _ '� c 1 - \ \ \ \ \ II SCHEDULE OF ELEVATIONS / 1NV.EL. 2. MINIMUM OF 6" OF MEDIUM TO COARSE SAND WITH LESS THAN 2% PASSING A # 200 SIEVE (ASTM C-33) REQUIRED Registration: I I 20 / / / I / l \ /� C:) � I ` / / / / / / / I / ( j i \ �- / \ \ \ \ 1. I ` AROUND CIRCUMFERENCE OF ENVIRO-SEPTIC PIPES. (SEE DESIGN AND INSTALLATION MANUAL FOR COMPLETE SAND AND � TOP OF FOUNDATION 25.65 FILL SPECIFICATIONS.) BUILDING SERVICE 22.58 // / 3. INSTALLER ADVISED TO CONTACT DIG SAFE PRIOR TO CONSTRUCTION. l '/h // / / �' _..r70 J J / / J / \ \ / \ \ \ \ \ / I GREASE TRAP SERVICE 22.65 r',g FAT PIU G 3 Q. ` / / / / rj \ / \ \ ` 4. DO NOT INSTALL SYSTEM ON WET OR FROZEN GROUND OR LEAVE SYSTEM UNCOVERED FOR EXTENDED PERIODS OF .+ \ / \ \ EXISTING 1,500 GALLON GREASE TRAP-INLET 22.14 TIME. Ka LEE a.. 1r �. CIVIL . � EXISTING 1,500 GALLON GREASE TRAP-OUTLET 21.94 5. NO DRAINS, HOT TUBS, SAUNAS, GARBAGE DISPOSALS ETC. SHALL BE INCORPORATED INTO THIS SYSTEM UNLESS GIsrr /\ / / / OTHERWISE SPECIFIED. TEE WYE AT BUILDING SEWER 21.88 No. 42324 / � \ \ ~ 7,000 GALLON SEPTIC TANK-INLET 20.88 7,000 GALLON SEPTIC TANK-OUTLET 20.63 O / / / / / / - \ \ \ 6. PRIOR TO BACKFILL OR PAVING OVER THE SYSTEM, THE DRAFT AT THE DISTRIBUTION BOX FROM THE BUILDING ROOF ' - - - ti ! I / / / / // STACK VENT SHALL BE TESTED TO ENSURE ADEQUATE AIR FLOW. 9 - -\ 3,500 GALLON SEPTIC TANK-INLET 20.60 3,500 GALLON SEPTIC TANK-OUTLET 20.35 \\ \ \\ PRESBY MAINTENANCE SCHEDULE Project Number: Sheet: GRAPHIC SCALE / \ \ ` 1. THE DEPARTMENT OF ENVIRONMENTAL PROTECTION'S TECHNOLOGY APPROVAL REQUIRES ALL ENVIRO-SEPTIC SYSTEMS TO 61'29 10 of 15 � �� / D-BOX-INLET 20.26 D-BOX-OUTLET 20.09 BE INSPECTED ANNUALLY. ;6 20 0 10 20 40 80 o / / 5 \ �� \ \ \ BREAKOUT 20.39 2. PRESBY ENVIRONMENTAL INC. REQUIRES THE ANNUAL INSPECTION TO BE COMPLETED BY AN OPERATOR TRAINED BY Drawing Number: E / // \ \ TOP OF SYSTEM 20.39 PRESBY ENVIRONMENTAL, INC. TO INSPECT ENVIRO-SEPTIC WASTEWATER TREATMENT SYSTEMS. / \ \ \ PRESBY INVERT IN 19.47 _ 0 ' - ' 52 �, \ BOTTOM OF SYSTEM 18-39 3. A PERPETUAL MAINTENANCE AGREEMENT IS REQUIRED. Co (1 IN = 20 FEET) ESHGW(TP-3) 10.30 CONNECT TO EXISTING 6" SCH. 40 PVC FROM BUILDING SERVICE CENTER COVER 7,000 GAL. SEPTIC TANK CENTER COVER FLEXIBLE COUPLING (TYP.) WITHIN 6" OF FLEXIBLE COUPLING (TYP.) WITHIN 6" OF ROVIDE WATER PROOF PAVED AREA LANDSCAPED AREA FINISHED GRADE FINISHED GRADE RISER, FRAME AND PROVIDE 24" DIA. WATER 6" SCH 40 PVC TO 3,50 PROVIDE 24" DIA. WATER 6" SCH 40 PVC SECURE COVER TO PROOF FRAME AND SECURE GAL. SEPTIC TANK PROOF FRAME AND SECURE TO D. BOX EL. 25.3 GRADE COMMON FILL/ ORDINARY BORROW COVER TO GRADE (TYP.) COVER TO GRADE (TYP.) _ _ _ COMPACTED GRANULAR FILL o EL 25.3 EL. 25.5 PAVED PARKING 0 i o E 23.72 _III' DEPTH AND SURFACE 3 y TREATMENT VARIES o 24. -III—i _ . :I I—I I, • I—III- FLOW FLOW —I I(—I iiCL LL A l l—I I -� I I MI I I Y III, ,III-► i=1 i- / / / / / / w °° { T— ,; 20.5 - 4" SCH 40 PVC TO '\�\/\/\ /\/\/\/� C o 29" MIN 4 SCH 40 PVC . _ PRESBY LEACHING FIELD VARIES VARIES a ° /\\/\\/\\/� VARIES 0 kFROM 3,500 GAL _ \\//\\//\\ > a i /\\//\\//\\/� 10" MIN. ` 10" MIN. A10012X28VC EFFLUENT SEPTIC TANK -III— ( — II I I� II I—I I—I —� �" \ \\ \\/ ° ° a, 1899 \ \\ \ 3" MIN. 200% OF DESIGN FLOW-6,600 GAL. FILTER (ZABEL OR I I I I_I I I I I i_I I ,I I= `/\/\/\ /\/\/ 3 MIN. / 3" MIN. 7,000 GAL. PROVIDED 3" MIN. APPROVED EQUAL) Fl/ GAS BAFFLE 6 OF 3/4 \/\\/\ a ° � 100% OF DESIGN FLOW-MIN. 3,300 GAL UNDISTURBED COMPACTED CRUSHED \\\�\\�/\ a ° /\\�/\N dark. a 3,500 GAL. PROVIDED EARTH STONE BASE \\// // \//\\/\ Y W 1 DE 11 OUTLET DISTRIBUTION BOX INSTALLED ON LEVEL STABLE G a VARIES • --- .. - ET DISTR °. .. , TRACER TAPE . . EL. 15.1 ::,..: . ..-. .. � >• . . . -,.,-. .- EL. 15.7 BASE. � a PROVI � REEN METALLIC ARI 9" CRUSHED STONE BASE'{ 2. INSTALL FIRST 2 FEET OF OUTLET PIPES LEVEL. EIGHT OUTLETS USED, 3 /\\/\ /\\% 9 CRUSHED STONE BASE ° ° // OUTLETS CAPPED j\\j\ 3. PROVIDE SPEED LEVELERS ON ALL OUTLET PIPES. VARIES /\ ° ° C w NEW 7,000 GALLON SEPTIC TANK (H_ 20) NEW 3,500 GALLON SEPTIC TANK (,H2O) NEW 11 OUTLET DISTRIBUTION BOX DETAIL (H /\\/ \/\\/\ o y o NOT TO SCALE NOT TO SCALE NOT TO SCALE 6" (MIN.) ��%\\%\ \ \\\\ INSTALL NON-WOVEN L w ROTONDO PRECAST OR APPROVED EQUAL ROTONDO PRECAST OR APPROVED EQUAL %\//\// \ \\ FILTER FABRIC IF C� m E m Y GROUNDWATER IS C E c°, �,, 4 m PE PRESBY ENVIRONMENTAL, INC. PI E j�j \ PRESENT o o '� 4- Q i INNOVATIVE SEPTIC TECHNOLOGIES DIA TER \\/\\/\ /\ \ ` COMPACTED PEA c � „� o Route 117 • PO Box 617 • Sugar Hill,NH 03585 \// // \ \j GRAVEL (SEE NOTES) W _ Q � Tel 1-800-473-5298 • Fax: (603)823-8114 „ \ \ \ / ,Q y 1z _ Z N www.Presbvenvironmental.com • info cQPresbyeco.com 6 (MIN.) \ �� 4"0 PERFORATED INSPECTION PORT TO BOTTOM OF /\/\ / 2 THICK POLYURETHANE o °' ; � �; L6 9" MIN PROVIDE NEW WATER / / N _ 3 Cn M N 3' MAX TIGHT RISER, SYSTEM SAND AND THREADED CAP WITH CURB BOX 2 MIN OVER i�\/\ \ \ \ \ \ \ \ \ \ \\�INSULATION WITH PVC >` o a a? w FRAME AND � / // // // / // // // // // // O y � cacao biz COVER TO GRADE (TYP.) TO GRADE. WRAP PIPE WITH PERMEABLE GEOTEXTILE \\,/ �\j\\jam\j/ �\jam\jX\\/\\jam\j�\j�\/�JACKET PLACED AROUND = y y o FABRIC TO ELIMINATE SAND INFILTRATION. (SEE SITE / / / PIPE WHERE REQUIRED .:.; -LOAM AND SEED = = PLAN FOR LOCATION) ENVIRO-SEPTIC CORE NEW HOLE PAVED PARKING T Z PIPE 12 (MIN.) COMPACTED SUBGRADE - - - _- BACKFILL =_ - - - - - - -- - j NOTES: - - - - - __- _ �j CLEAN BACKFILL 2• 1. GRAVITY SEWER AND FORCE MAIN SHALL BE INSULATED WHEN VERTICAL OR HORIZONTAL ;.. _ _ AND PROVIDE _ ` -NEW SCH 40 - - - i y= �` SOIL COVER IS LESS THAN 4 FEET AND WHERE SHOWN ON PLANS. - - - 9" - - - - - PVC OUTLET PIPE MIN o P� �: �; 2. BACKFILL PLACED IN UTILITY TRENCHES INCLUDING DISTURBED AREAS SURROUNDING EXISTING MID DEPTH UTILITY TRENCHES SHALL BE PLACED AND COMPACTED IN 12" (MAX.) VERTICAL LIFTS. KITCHEN 3. TRACER TAPE FOR NON-FERROUS PIPE SHALL BE CONSTRUCTED OF A METALLIC CORE ��^I SERVICE i ( ( I I (__ 1 OF TANK -=—PROVIDE NEW SCH s" - SYSTEM SAND OPE BONDED TO PLASTIC LAYERS. THE METALLIC TRACER TAPE SHALL BE A MINIMUM 5mm Q; ►� i—= PLACE WASHED THICK AND MUST BE LOCATABLE AT A DEPTH OF 18 INCHES WITH ORDINARY PIPE 40 PVC INLET AND _ STONE AROUND ENVIRO-SEPTIC LOCATORS. OUTLET TEES WITH - 12" =-_SUPPORTS AS III—III I I ` ELBOW PIPE 4. PEA GRAVEL SHALL CONSIST OF CLEAN, HARD, ROUND PARTICLES OF GRAVEL MEETING -III III _ _ _ ' - • - ` � ' - "- ' - " —NECESSARY NATURALLY OCCURRING PERVIOUS THE FOLLOWING: � CE� MATERIAL OR TITLE 5 SAND FILL SIEVE SIZE PERCENT PASSING �^ "y EXISTING BAF�F[ DRILL SEVERAL 1/4"0 HOLES AT LOW POINT OF 3/8" 85-95 �I," ") q WALL TO BE - ( '__'_ — — ELBOW TO DRAIN CONDENSATION. LOW POINT MUST NO. 4 5-15 ( UNDISTURBED EARTH ! I I CONFIRMED DURING BE ABOVE SEASONAL HIGH WATER TABLE. NO. 8 0-2 CONSTRUCTION) NOTE: THE CONTRACTOR IS RESPONSIBLE 5. CONTRACTOR SHALL ACHIEVE 95% COMPACTION FOR THE BEDDING. TRENCH BACKFILL C,, w FOR PUMPING THE EXISTING GREASE TRAP PRIOR TO CONSTRUCTION ENVIRO-SEPTIC LOW VENT UNDER ROADWAYS SHALL BE COMPACTED TO 95�. EXISTING 1 .500 GALLON GREASE TRAP DETAIL ENVIRO-SEPTIC EFFLUENT DISPOSAL AREA OBSERVATION PORT NOT SCALE SEWER TRENCH DETAIL O w^ NOT TO SCALE NOT SCALE NOT TO SCALE ►� ,�.� ►� MIN. 1 5.5 MIN. 1 OFFSET ADAPTOR (TYP.) PAVED PARKING �+ N RAISED CONNECTION (TYP.) COUPLING (TYP.) - co SYSTEM SAND PROVIDE 6" CURB BOX MOUNTED 4-INCH PVC FLUSH WITH GROUND " THREADED CAP n 6' 1 ,1' -. 2 C16� ENVIRO-SEPTIC PIPE 4 ii ii N y 6 LOW VENT MANIFOLD (TYP.) Z 1 T I 0. v 25.5' N ` 1—)i I�) II i� PROVIDE ADAPTER TO 45 AT EDNGREED OF PVC BEND BEND 0 N i JOIN SEWER OR LATERAL WYE CONNECTION FOR Z TO 4-INCH ELBOW o 6" LOW VENT (SEE g NATURALLY OCCURRING PERVIOUS IN LINE = a WASTEWATER PLAN _ MATERIAL OR TITLE 5 SAND FILL U_ 0 3 o ca FOR LOCATION) ,r U U) _ 0 3 a Cz O - _ NUMBER OF ENVIRO-SEPTIC LINES: 2 BEDS: EACH 16 a g >> U PROVIDE SPEED LEVELERS AT LINES: CENTER TO CENTER SPACING :5.50 FEET: 4 = I ALL DISTRIBUTION BOX OUTLETS SECTIONS PER BED EACH WITH 220 L.F. ENVIRO SEPTIC N 57.0' PIPE U_ �' I 57.0' ENVIRO-SEPTIC EFFLUENT DISPOSAL AREA CROSS SECTION TYPICAL CLEANOUT DETAIL � NOT SCALE NOT TO SCALE C O NEW 3,500 GALLON 0 CN Z SEPTIC TANK CL O L z 25.5' rnn I O Y CIO NEW 7,000 GALLON o SEPTIC TANK 0 ono y N N O pp (V O 0 O z ❑ 9 O d v rn p 4.6' TYP. M � ar� 4 ti o PROVIDE SYSTEM SAND 1' BEYOND ENVIRO-SEPTIC PIPE AROUND ENTIRE SYSTEM (TYP.) OBSERVATION Registration: NVIRO SEPTIC SYSTEM NOTES N0. 2 I PORT (TYP.) I O h ��`.Y Of Mass 4- (SEE PRESBY E ) °y G �r AT f'IU Q LEE v CIVIL O 1 S No.47O24 9 9 O \ Project Number: Sheet: O �(� BUILDING SERVICE (SEE s a) WASTEWATER PLAN) \ 61,29 11 of 15 0ENVIRO—SEPTIC EFFLUENT DISPOSAL AREA Drawing Number: NOT SCALE - 11 I STAMP; 31'-t0" 12'-0" 00 Co 3'-4" 3'-4" 4'-B" 10'-2" 12'-10" B'-0 12'-0" m Co Co C 10 10 ROOF EDGE ABOVE ,�1 66 o 0 Lo � B"xB" PVC WRAPPE COLUMNS, TYP. 7 w LL WRAPPED BEAM, ABOVE ROOF EDGE = 0 ABOVE z Lo J wN DUTY BOARD W t— o _ 1 z _ UCn v C C B A c A3.t I A3.1 in Q A3.1 A3.1 (n 4 a LIFEGUARD ROOM O6x6 WOOD A A ■� <t 103 POST Up — — — — — — -- ■ 1 Hm C7 _.. �� o } FLOOR I DRAIN WH ® ® B I ® LOCKERS C C �JANITO 06= I 104 107 Co C L A7.1 F BENCH E E C I � K I t BASE CAB. w/ SINK of UNDER COUNTER REFl i C 2 W t UPPER CAB. -i A&.1 �. I I MEN RESCUE I Q t \N IF - - - - - -I ( E IOtb RACKS I < W F II I ( FLOOR FLOOR DRAIN H DRAIN p I Q00 m TYP. n ® ® A FLOOR® v Q I 3 I i CUPOLA I = p G 1 E = C I A _ _ DRAIN_ _ _ _ _ I Q W A1.0 ABOVE ( -1c�, U A7.1 U A7.1 ( \ ' v ILR(LoF - - 4 —J � w w I LIFEGUARD t I I z z Co W I w o I m F m B ( GENERAL BEACH ( J 1 I m m _ LM 4'_HQ0D ABOVE _ to I STORAGE i r II \ / YF Lu v- Z II II On W FloqQ Bw CONCESSIONS Yu LL LL zz D I--- HAND FLOOR FOOD PREP AREA A MECHANICAL Om 1 O O z Q 0 SINK DRAIN 101 WOMEN 108 I Q L- D i 05 1 N ? BABY—' WBP B rBABY�11 �HANGINC CHANGING, 00 Y o Z (ox6 WOOD F— POST UP 0 04 I— — mRINK = W m FOUNTAIN I Co 0 1 Z r O Co -, - - -- 3 F ROOF--EDG—E B"x8" PVC WRAPPED A1.0 I N m ( I (LABOVE WRAPPED BEAM, TITLE: r I I COLUMNS, TYP. ABOVE TYP. ' In- FLOOR , A I DRAIN OA 3 o L FLOOR PLAN n o CONCESSIONS,r 11 1-011 p SERVICE AREA:.. �4 A3.1 7'-4" 102 A3J 4'0" WIDE x 4-0" 14EIGHT SERVICE + OPENING W/ SLIDING SCR EN _ __ COUNTERS_ COIL DOOR ENCLOSURE ABOVE - _ _—— 10 — _ — — 7'-4" DATE ISSUED: STAINLE55 STEEL SHELF I I Ob . 18 , 2010 E I E REVISIONS: ; A3.1 A3.1 ROOF EDGE ABOVE WxW PVC WRAPPED — COLUMNS, TYP. — — — — — N 2'-II " 6,_1" 2'-112" q'-7" 15'-0" 6'-Ilu 5,_q" 6'-3n Id lid 12'-0" 2'-011 31'-0 12'-0" C DRAWN BY; S. Khalil Lo PROJECT #: M - 10 - ,� � DRAWING NO.: a� 3 I D PLAN 1 FLOOD 11- I 11 1= Scale : 114 = 1 - 0 J 1 SOILTEST, PIT DATA. INDICATES INDICATES PERC: = OBSERVED TEST GROUNDWATER TP. I NAND AUGER #I HAND AUGER ' I TR. GIRD. EL. IDJ GRD. EL. 13'Z4 GRD. EL. 13-7-4 GRD. EL. GW. EL. 5.7 GW. EL. 5.9 _, GW. EL. 5.8 GW. EL. U I' 2' 3' 4' 5' 6' r& A 2, 3� 4' 5' 6' 7' 8� 9' 10 11, 12' v 2' 3' 4� 5' 6'. 7'. 8� 9' 10 II' 12' 0 -a 2� 3' 4� 5� 6' 7� 9� 10, II, 12' DATE: DATE: DATE: DATE- 8- ?-14 - 801 2- ZZ- 90 4-zi-CI TEST BY: TEST BY: TEST BY: TEST BY: T. MRRCELLO THE 135C GROUP - NOIZWELL3 INL. WITNESSED BY: WITNESSED BY: WITNESSED BY: WITNESSED BY: S. DUNN I)J(, E. EARR`I - BARNS. EAH PERC. RATE: PERC. RATE: PERC. RATE: PERC. RATE: 4 Z- MIN./INCH - MIN./INCH - MIN./INCH MINdINC -;4 ... ;�,I_ p; ('. iV. 1•' .£i.. d.....:p .,.. ,.t•I,,.:-.jj .MS,. s,.. f# A'dY,';,,_ .., M,... .. -; .,. .. DATUM VERTICAL DATUM: ELEV. - 13.Z4 BENCH MARK: USED NAIL AT TRAVERSE POINT #-7 SEPTIC TANK DETAIL: ' I DAD &ALLOnI DISTRIBUTION BOX DETAIL: �g - s LEACHING TRENCH DETAIL: NOT TO SCALE NOT TO SCALE � NOT. TO SCALE ' NOTES: I. SEPTIC TANK SHALL BE STEEL 4. INLET AND OUTLET TEES TO BE CAST IRON, 301 " NO. OF OUTLETS: 5 FINISHED G DE REINFORCED CONCRETE. SCHED. 40 PVC OR CAST -IN -PLACE CONCRETE. TEES .� / FILL AND LOAM 2 SEPTIC TANK TO WITHSTAND H-2.Q LOADING TO BE CENTERED UNDER MANHOLE COVER. �--�- J_--, NOTES r.-:.'.... - • •, ` . .:. :.. -..--• :: -,`:. ,:.. - 3 RECOMMENDED MANUFACTURER-ROTONDO OR L DIST. BOX TO WITHSTAND H-m LOADING • - VENT' APPROVED EQUAL. I 1 s<N 40 4 "PERFORATED PVC , S =0005 JI PRECAST 1 - - - - 1420 - - - - -- G 3. ALL PIPE CONNECTIONS AND CONCRETE MANHOLE eovER E.L. Le6AapN CAT AID. LTW3 IS1k -II I • DIST I '- LEVEL b, BOTTOM DEPTH EFFECTIVE 51 CONSTRUCTION TO BE WATERTIGHT. DROUGHT TO FINISH GRADE (u1Ar�xr,c#rr) 1 BOX I 2• PROVIDE INLET TEE OR BAFFLE WHERE SLOPE Of I i INLET PIPE EXCEEDS 0.00 FT/FT. OR IN ' \ PUMPED SYSTEM. 6,, L LOVER t°►,c. 3 4 L---r-�---J 3. FIRST TWO FEET OF PIPE OUT OF DIST 41' BOX TO BE LAID LEVEL. • PLAN VIEW PROFILE ' 11 E.L. Ln6AKbM cOW1R 4. RECOMMENDED MANUFACTURER- ROTONDO MEASURE SLOPE AT THIS POINT 6-0 �� NORMAL WATER LEVEL t0 OR APPROVED EQUAL. CAT. n10. LVC 13'LS It �•- 2 It DIST.=I50zSLOPE --------------------n 3 (PLAIKI ViMTEDfGASKETED) -i I_�Z ' NOTE: I.L.' DEEP CONL. I 20 LOAM 8 SEED 2°/ MIN. FINISH GRADE 1 �ALAST REQUIRED 1 INLET TEE I�'-IO PROVIDE . • • •. ,� , I . WATERTIGHT .. - - II JOINTS(IpD) ,1 I• •i I!' z ------ 12° _ MIN. TO KEEP TANK 4'-O'YIN. OUTLET S"(o I 1�• , it �I -IL LIOINO DEPTH TIE ` r NOT 2 I .� �') i., I • Y e . '.. •%f 4 -10 INLET _ „I I � 1•01 2 MIN. OF 1/8' TO FROM FLOATING - yL}� , �- l5 �T I . SGH O S,�� TONE 1I. 4 OUT WASHED 3 L.. a ..: '• v:,' ,: •:: r•.. a . i... ► 3/4 TO I-V2 DOUBLE ... • . .. .: , . ,. •.:... ..:�• >, : • .: •. -BOTTOM OIN t pl CLEAR ay� EOTTOM ON LEVEL STABILE EASE 0." ,,s -� a "�,' o-o SLOPE = Y WASHED STONE(no tins) t}" L 2 �o� LEVEL STABLE z _ (tYp) rrr,a r•{� CROSS-SECTION „ » BASE PLAN VIEW CROSS-SECTION VIEW a��II. 3A"TO 6'MIN.3/4 TO CROSS-SECTION 11/2" STORE 1 STONE , INVERT ELEVATIONS NOTE' TOPOGRAPHIC SU RVE`I WAS PROVIDED B`! THE' BARNSTABL E D P �tJ 4 INVERT AT BUILDING a� SEE PUMP L.I.O _ DETAILS 4' INVERT AT SEPTIC TANK0n) j. j&c1+aFMgf��� SHEETZ OF2-4' INVERT AT SEPTIC TANK(out) 11.3S ^ ► �'� CRISPIN y�� 4' INVERT AT DIST. BOX(in) IZ.28 H 1 �j t cry � ' No 371I2 4' -INVERT AT DIST. BOX(out) I . , . �• ` � '�,��'cf Eat �! '� . , 'es/At 3 ISOLATED WETLANDS W ITI-IIN INVERTS AT LEACHING FACILITY: �I ZONE C rHE DUOX NE CID �:fl 0 4 INVERT AT BEGINNING rloNUrIEMT OF LEACHING TRENCH 12.09 Q F60ND (T`IP.) _ 4' ANVERT AT END ti00� i ZONE. AlEL= 11� PRO PO' ED Z" � SDR- Z,1 OF LEACHING TRENCH � S T PI Is , WAiEf� SERVICE FORCE MAI FEMA C IMMONIT�I PANEL ELEVATION AT BOTTOM \ i '� Z50001 0011C FROM PUMP HOUSE TO OF LEACHING TRENCH I I. 4- PROPOSED �I REVISED 5-19-e,5 NOTE : GMUNDINIC, WIRE MAy GATE HOUSE. 6ATEHDUSE EXIST f3ELD� POLE5 OBSERVED GROUNDWATER ELEVATION 5.9 . �� 9�► � Ile ZONE q3 .�.� v► Is 20�E C ,� ADSUSTED GROUNDWATER, c¢ ELEVATION USING WELL 0SDW LSZ • I �2�1!j` tIL1T`I PALE (T` \ �f E.L. Le BAKON CAT. td0. LTW 3D0 SEE PUMP DETAIL _ PUMP HOUSE MANHOLE B,CCVEF AS REQUIRED rpenF) F( SHEET Z_ OF 2-) I.C. C INC. BRLrl51 (PLAIN GGx x ... r.r e ...,» - E EL: I EL_ . FIRST PIPE LENGTH �,+ r ,\ ,. ,. ZONE A- 3 GRrc H0UsE To BE SE LEVEL T ED /- ,• r, FIN MIN. 2' EL' 13.a-` NE C ISH FIOR _ \ 2 .. �� LEALNIIJG AREA o `f �a s f i,. .r y $ 1 `i• r,. A N"PVCERFr 'TWORI MIN Qv� _ ,� " - vEMT ZONE A) E ,q3 �'_=-:.-- � DESIGN FLOW. i4" PVC SCH 40 4"PVC SCH 40 2'- I/d� 3/8'h)UBLE 1e § ED STONE]` ISOLATED W ETLA N D� �a- I' (.•$ r"I i-(,.35�_ AU DITORIU M . ZO PEOPLE E -_5 LECTURES PLAN VI W 3/4I/2 DOUBLE WASHED STONE 3 GAL/ PERSON EM PLO`( EES -- 10 PEOPLE x 15 GAL I P = I506 I L _ j - S OUTLET \1= IZ_I l SC.AL.E: I„ t00' =dtA API '< LAST BOX zBOT EL I - " 1000 GALLON ADSUSTE b HIGH WATER EL. = �.1 NOTE . WITHIN HE LIMITS sHOWIJ \� .\ PRECAS' C ,NCRETE AID „ REMOVE EXISTING BIT. LONG. •^ SEPTIC TANK PRDFI LE nl - GROUNQWATER ObSERVE� EL. = S-9 REGMADE AND REPAVE' WITH IZit DF GRAVEL AND 3" OF T`IPE NOT To SC.A, LE _ I - I STATE bIT. CONC. SPEC. LIMIT OF REPAVING ID- - I .� H. A .' Z l .� 1 I 0 _ 4 Y A9 f •� / PRpPOSED 2 m FDpRC>?{MAIN 2� ' �._.� WAT ER .;f r:9- ► I ii .r ii !'. ,p �,, t\d ,f. •f, 1• ttn>W ::# F.'� A4'. :`;.. `.,. \, ( , i..•. fi, f G: i H ` I a PUMP oUSE TO GATEHOUSE 01 GJ, O 4 L SDR - Z I _'---I 12" GRAVEL 4 5EWER FORCE z: , � ri y� Z 3U BIT. 1`ONC, T`(PE I-) VEM 41, 41 3' LS \ NT , (DOD GALLON LEAcAm6 RAW DtAUGEK O p Pl II HALE I 12 O SEPTIC TANK ,;_ �0. / i �� (T`I O� \ .p N6 t. 9� . L Z O _ r / e-PU M P m m r_HA'tN\ESER �n D0 12 v ` _DUA�p l4-1 r' _ IQ SrRVICF Vr c 0% 0.!+ ,'d, ` 7f s,..... i�+' ,d r9 A+. i' j # ."•+f' 1 _y.•i! 1 \_^` `��h%1 F II DLD RGLESS I PLAN VIEW S g Romeo _ I : . SCALE: I" aO' GgrE I - PLAN VIEW SCALE: I = 2 0' T)" DOCUMENT NA,. SEEN PWAFN BY W_ WNGI / VOID{ A COrt NIOMY T11EItElAL'*' O' ANY �U► STAN1Nt MMVN O� A C T 1Y�I MR11K' I1 ►ERWSSION OF THE COP"IOM OANWA M MAAKL REQUIRED SEPTIC TANK: 450 x I.5 = 675 GAL. SEPTIC TANK PROVIDED: = I DOO GAL. SIZE OF LEACHING FACILITY REQUIRED: DESK3N PERC. RATE Z 2 MINJNCH SIDEWALLS = Z.S GAL. / S.F. BOTTOM I. 0 GAL. / S.P. A55UME : to'IDEEP x 3" WIDE TRENCH. S. S GAL. /.L_ F. _ 450 GAL. - S. 5 = 8l. 8 L. F, SIZE OF LEACHING FACILITY PROVIDED: USE Z . TRENCHES W' DEEP X 3' WIDE x 4I ' LONG TOTAL LEACHING = 328 S. F. LOCUS PLAN: " . tiF CURaENr LATE HOUSE LDCArIO m S,9 tiF A,a y Ro 9� N 5 /JD'I FULLEKS1-11 GKEA MAI POINT LOCUS k REVISIONS NO I)A'F 4-30.9D REVISED -M SRb\tl COKKECT GROONDWATEf\ ELEV. BASED ON TOWN OF RARKISTALLE D.P.W. ENGINEEKIM6 UPDATED 5DKVEY. Al -(E'�T Plr -W- I GENERAL NOTES' I. THIS PLAN IS FOR DESIGN AND CONSTRUCTION OF THE SEWAGE DISPOSAL FACILITY ONLY. 2. ALL CONSTRUCTION METHODS AND MATERIALS SHALL CONFORM TO MASS. D.E 0 E. TITLE 5 AND LOCAL BOARD OF HEALTH REGULATIONS. 3. ALL PIPES LOCATED UNDER PAVEMENT OR TRAVELED SHALL BE SCHEDULE 40 OR EQUAL. 4. THERE ARE NO KNOWN WELLS LOCATED WITHIN 100 FT. OF THE PROPOSED LEACHING FACILITY NOR ANY WELLS PROPOSED WITHIN 100 FT. OF ANY:KNOWN LEACHING FACILITY. B. THIS SYSTEM IS NOT DESIGNED FOR THE USE OF A GARNWE GRINDER G. SEE SHEET L OF Z FOR LANDSCA AND PLANT LISTS. 1 CONSTRUCTION NOTES. I- EXISTING UTILITIES WHERE SHOWN 'N THE DRAWINGS ARE APPROXIMATE. THE CONTRACTOR SHALL BE RESPON- SIBLE FOR PROPERLY LOCATING AND COORDINATING THE PROPOSED CON- STRUCTION ACTIVITY. WITH DIG -SAFE AND THE APPLICABLE UTILITY COMPANY AND MAINTAINING THE EXISTING UTILITY SYSTEM IN SERVICE. DIG SAFE SHALL BE NOTIFIED PER THE STATE OF MASSACHUSETTS STATUE CHAPTER 82, SECTION 409 AT TEL 1-800-322-4844 THE ENGINEER DOES NOT GUARANTEE THEIR ACCURACY OR THAT ALL UTILITIES AND SUBSURFACE STRUCTURES ARE SHOWN LUCATIONS AND ELEVATIONS OF UNDERGROUND UTILITIES TAKEN FROM RECORD PLANS. THE CONTRACTOR SHALL VERIFY SIZE, LOCATION AND INVERTS OF UTILITIES AND STRUCTURES AS REQUIRED PRIOR 'To -THE -START, OF CONSTRUCTION. ED The BSC Group The BSC Group- Norwell Inc 293 Washington Street PO Box 185 Norwell MA 02061 617 659 7981 PROJECT TITLE SITE PLAN GATEHOUSE SANb\I NELK ROAD W.6ARNSTASLE, MA PREPARED FOR: TOWN OF BARN5TA6LE DATE FEaRU_AR`I 2C) _1990 - COMP- DESIGN_ G_RU55EL L CHECK R. CHAPMAN DRAWN. D. LEARNED FIELD. FILE NO DWG. NO 3839 -01 SHEET JOB NO 4-4L93.6Di I OF _. ... .-+... .... .. ., •r-=' ,-. m...... 1R-'h a.,y s!: �1 .)'..� .-v`.•'F".. "Lt:. <:,-1.tr.+.._-�•. ....,r..-R.i+.+•Y+�M►[NIRni _-___ __- _._- __. -_.-. _. __ -_.. _-__ _. - ..,�_,:.. �.._.�. ... _.. _ _.___.._._-.:�.._......�_..+.�._...ru_-+�:u... n_a- •..Tar.-•+ _.•., r.-..� i.-..a�.nY.. •t�.w.uws.aFn.^wr•s..•nx:r: � .r �..w- ...•.._ � � �, ;E, j f ........ ..... . . . . . . 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