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HomeMy WebLinkAboutCVS PHARMACY #2200 - RETAIL FOOD G5-A=p03 -©al CVS PHARMACY #2'200 1030 PUTNAM AVE. ,COT. oFrt►± r Town of Barnstable BOARD OF HEALTH ' John T.Norman Board of Health Donald A.Gaudagnoli,M.D. QAIRNSTABLL F.P.(Thomas)Lee,. MASS Daniel Luczkow,M.D. Alt. 1639• ,� 200 Main Street, Hyannis, MA 02601 ro-wta'�a 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: 524 Issue Date: 01/01/2022 DBA: CVS PHARMACY #2200 OWNER: CVS PHARMACY INC. Location of Establishment: 1030 PUTNAM AVENUE MARSTONS MILLS„ MA 02648 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2022 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: GQ� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: rq� Initials: � � Town of Barnstable Amt pd$ BAENSPABM : Inspectional Services Date Paid En +''0� Public Health DivisionMASS, I , 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 9 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: �l l/� Y,7 e_ CVS/pharmacy MAILING ADDRESS(IF DIFFERENT FROM ABOVE): One CVS Drive i0flpharlrlaCypermltS@cvs.ea •CO man Code 1166 Woonsocket, RI 02895 E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: �j( �G -)qdy- TOTAL NUMBER OF BATHROOMS: WELL WATER:YES " NO ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: ;/ SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE:d TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FQOD SERVICE TAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:Wpplication Forms�F00DAPP 2020.doc OWNER INFORMATION: Stepnanle c:adorette FULL NAME OF APPLICANT 1-icpnsina Coordinator SOLE OWNER: YES/NO r OWNER PHONE# L-f G 1,- 4-ADDRESS n / CORPORATE OWNER: CVS/Pharmacy CORPORATE ADDRESS: One CVS Dri In ve Mail o RI 02S95 � PERSON IN CHARGE OF DAILY OPERATIONS: t �.( b7 rd t Woonsocket, List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div.will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1 2. A4" � M/ 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/at)plications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q:\Application Forms\FOODAPP REV3-2019.doc I Town of Barnstable BOARD OF HEALTH l John T.Norman Board of Health Donald A.Gaudagnoli,M.D. =' UARNsra►BM Paul J.Canniff,D.M.D. MASM 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, 30513, 146, 189 and .189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 524 Issue Date: 01/01/2021 DBA: CVS PHARMACY #2200 OWNER: C.V.S. CORP./ LICENSING DEPT Location of Establishment: 1030 PUTNAM AVENUE MARSTONS MILLS„ MA 02648 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2021 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: � k VKWEt For Offi • Initials: ti Town of Barnstable Date Paid (1 � Amt Pd$ � bO— BAMSTABLE, ; Inspectional Services 9�pr p`�� Public Health Division Check#5o'�6 En wte+ 1—,S r - 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 �ZI NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Ws Y CVS/pharmacy CV ADDRESS OF FOOD ESTABLISHMENT: U One kUU 1 ive VIdIl 1160 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Woonsocket, RI 02895 E-MAIL ADDRESS: nonpharmacypermlts@cvshealth-com �d TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (w 0 TOTAL NUMBER OF BATHROOMS: WELL WATER NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) F D SERVICE ETAIL 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:Wppl ication FormsTOODAPP 2020.doc f 1 Rt 4 h OWNER INFORMATION: Stephanie Cadorette FULL NAME OF APPLICANT L!€ensing Coordinator SOLE OWNER: YES/NO OWNER PHONE ADDRESS CVS/pharmacy CORPORATE OWNER: Mail Code 1160 2895 CUS r vim'L CVS/pharmacy CORPORATE ADDRESS: C)mo CVS Drive Mail Code 1160 PERSON IN CHARGE OF DAILY OPERATIONS: kNoonsocket, RI 02895 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 2. H / 12-/ 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 openin¢!! 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 httt)://www.townofbarnstable.us/healthdivision/applications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc a ` IHFr Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. i DAiaNSH'ABLL John T. Norman MA 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate M }g•b A 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: 524 Issue Date: 12/20/18 DBA: CVS PHARMACY #2200 OWNER: C.V.S. CORP./ LICENSING DEPT Location of Establishment: 1030 PUTNAM AVENUE MARSTONS MILLS, MA 02648 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 . OutdoorSeating: 0 Total Seating: 0 _ FEES -------- -- -- — FOOD SERVICE ESTABLISHMENT: YEAR: 2019 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: ---------- ----- r- - - MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: i PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: I 0 OFTNE b1yr For Ofa Initials: * o� Town of Barnstable Date Paid Amt I'd$ 9 MAR& Inspectional Services c� �ptEG�a`0 Check# 5 6q Public Health Division ALM k4lf Thomas McKean,Director j']j ' 200 Main Street,Hyannis,MA 02601 � t Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 1 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: er- K1\ ADDRESS OF FOOD ESTABLISHMENT: ) ?jQ "WZ 40t!! 1 0 jf j CVS/pharmacy MAILING ADDRESS(IF DIFFERENT FROM ABOVE): One CVS Drive Mail Code 1160 E-MAIL ADDRESS: `c L� �Con,.G(/l' Woonsocket, RI 02895 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (6a) 1441- 96BY/ TOTAL NUMBER OF BATHROOMS: WELL WATER:YES dESS NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: I/ SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REOLUREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHIVIENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE TAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:Wpplication FormsTOODAPPREV2018.doc S PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT C A� SOLE OWNER: YES/NO OWNER PHONE # C/G) 7'7G J�1 p armacy ADDRESS One CVS Drive Woonsocket, R 02895 CORPORATE OWNER:a/�✓/�a A,-„a .. WDERAL ID NO. : o5— CVS/pharmacy CORPORATE ADDRESS: One CVS Drive Mail 6ede 1169 Woonsocket, RI 02895 PERSON IN CHARGE OF DAILY OPERATIONS: 6 Ie4e 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 r 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 opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1 st to Dec.3 I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application Forms\FOODAPPREV2018.doc Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNsrABLK Paul J.Canniff,D.M.D. .6s9. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L.Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 524 Issue Date: 12/10/2019 DBA: CVS PHARMACY #2200 OWNER: C.V.S. CORP./ LICENSING DEPT Location of Establishment: 1030 PUTNAM AVENUE MARSTONS MILLS, MA 02648 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: YEAR. 2020 RETAIL FOOD: $100.00 COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q/ FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Y For Office Us%Only, Initials: `( Town of Barnstable ,Date Paid 3W1 BAR KAM.� Inspectional Services 34�a316 �5a ' '6 • Public Health Division Check# r f �fD MPy !f 5 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 _. Office: 508-862-4644 Fax: 508-790-6304 i-J APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE q NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: CVS/pharmacy MAILING ADDRESS(IF DIFFERENT FROM ABOVE): One CVS Drive Mai o e E-MAIL ADDRESS: nonpharmacypermits@cvshealth.Com Woonsocket, RI 02895 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: /J bq WELL WATER:YES NO V.. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:_f� SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE �R-ETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: tepreanie Cadorette FULL NAME OF APPLICANT Licensing Coordinator yy� SOLE OWNER: YES/NO VS/ � OWNER PHONE # `ZG��OcV A� Dre ADDRESS One CVS 1160 CORPORATE OWNER: Woonsocket, RI vn, CVS p armacy CORPORATE ADDRESS: One��rt Drive i 0 � alai woonsocket, RI 02895 PERSON IN CHARGE OF DAILY OPERATIONS: Gafo� e-(L 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 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 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/bealthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsWOODAPP REV3-2019.doc oF, rok TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Page: ( Of . 40 OFFICE HOURS PUBLIC HEALTH DIVISION e:00-6:30A.M. eAansrAeLe. = 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. SA MON.-FRI. ,639.p.0 HYANNIS, MA 02601 sos-ssz 464a No Reference R-Red Item PLEASE PRINT CLEARLY 'fOM FOOD ESTABLISHMENT INSPECTION REPORT Name 2,2-0-Z) Date Type of Type of Inspection 1 ; n Operation(s) Routine C� l U/ c1�! (�vCt Address l d 3 0 (,f� .IA. M Risk Egad Service Re-inspection Level Reta I Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP O In: Other Inspector Out: rle Each violation checked req Tres an explanation on the narrative page(s)and a citation of specific provision(s)violated. . Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 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 Y� EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations \ Critical(C)violations marked must be corrected immediately. (blue&red items) \ Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating 111 within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 9 violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspect gnatur PPn :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 nature : Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8' Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from ' 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each i 7-101.11 Identifying Information-Original Containers* 590.004(�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 t * 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(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR3-306.14(A)(B)Returned Food and ReserAdulterated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition ofAdulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces r 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* TIMEITEMPERATURE 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 -601.11 A Clean Utensils and Food Contact Surfaces of * Animal Foods That are Raw,Undercooked or 4 5-101.11 Drinking Water from an Approved System* ( ) Eggs-Immediate Service 145°F 15 sec Equipment* Not Otherwise Processed to Eliminate' 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Elf d-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* ' Shellfish* • 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and r' StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing i; * g' P �' Game and Wild Mushrooms Approved By * 1 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F kitchen operations should be debited under 2-301.11 Clean Condition-Hands and Arms the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 2-301.14 When to Wash* k * Other 590.009 violations relating to good retail 590.004 C Wild Mushrooms* 3-401.11(A)(1)(b):All Other PHFs-145°F 15 sec ( ) 11 Good Hygienic Practices practices should be debited under#29-Special 3-201.17 Game Animals* Y9 � 17 ['�,, Reheating for Hot Holding Requirements. $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity { ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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 Cooling Cooked PHFs from 140°F to 70°F (A) g Convenientl Located and Accessible S` 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* y Tags/Records:Fish Products 5-203.11 Numbers and Capacities* n 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* i Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004 Labeling of Ingredients- Supplied with Soap and hand Drying Devices i (J) 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability t 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. OWN _ 7 OF wo- Pk d 41 P x. 7101 a z - v r a x f s t a a L son fang t 70 J - ;. * a ATT - - x- - a . . 404- i o t t , all 1 ^ to t ^x Y no s d 6 vgal. r y°FTNE►o TOWN OF BARNSTABLE HEALTH.INSPECTOR'S Establishment Name: Date: Page: ( , of / OFFICE HOURS PUBLIC HEALTH DIVISION boo-saoA.M. BARNSTABLE. ` 200 MAIN STREET s.3o-a:ao F.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. 0g•� HYANNIS, MA 02601 - MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY p t639•a 508-862-4644 .. 'ED1AP" FOOD ESTABLISHMENT INSPECTION REPORT Name S ?,GU Date Tyoe of lyoe Inspection I�_ ^ 1. Operation(s) e / �f.✓ Address 1 b Q� &t , W Risk Food Service ection / Level a ai Previous Inspection Telephone esidential Kitchen Date: Mobile Pre-operation ` Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) YA / Time Bed&Breakfast HACCP In: �l Other Inspector �dD Out: /�' Each violation checked re Tres an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ / Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ I Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ �,� p��/� FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS /� u Q ❑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 3 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 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 4 non-critical violations 9 2 .Water,Plumbing and Waste (FC-5)(590.00 ) establishment permit and cessation of food establishment operations. if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 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 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to Snon-critic vi lations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Sign ure Print 31.Dumpster reened 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 t Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 15 Cooling 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501. g Methods for PHFs Cooked and RTE Foods' Additives*' 19 PHF Hot and Cold Holding 2-103.11 Person-in-Chazge Duties 3-302.14 _ Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-]02.11 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* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(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* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(1--)) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y * P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products 4-501.112 Mechanical Warewashing-Hot Water Monitoring 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* 163-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef cme 11112001 4-602.11 Cleaning Frequency of Utcnsils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* -- 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 1 p Proper,Adequate Handwashing * g' P �' Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 1 Reheating for Hot Holding practiceRequirements.sshould be debited under#29-Special $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification* ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F[0 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* s 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. P`oF,aE row~o TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: C V Date: Zr3 7-4 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 Mbsv: �e� HYANNIS, MA 02601 MON.-FRI No Reference R-Red Item PLEASE PRINT CLEARLY °lFo MPS° 508-862-4644 FOOD ESTABLISHMENT INSPECT)ON REPORT Name 7iZ Dat � Type of Type of Inspection DVk R tine Address �/^ C Risk oo a-ins ection V Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness w Caterer General Complaint C�✓eC Person in Charge(PIC) Time Bed&Breakfast HACCP VGC�f✓l�_ In: 'Z.'S-bee,\ Other Inspector 0ut:3; Io(r-% Each violation checked re Tres an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 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 HSP1 ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ) p ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories vv Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) checked indicate violations of 105 CMR 590.000/Federal Food Code. 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 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpste creened from public view A?- Permit Posted? y _ N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N P s Signature �r Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N ' 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* 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003 C Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F ( ) P Y7-102.11 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 Time as a Public Health Control Applicants 3-302.11(A) Food Protection* * 20 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) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions*590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 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 Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 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 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 Not Otherwise Processed to Eliminate I Equipment* ( )( ) Pathogens # 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game * s"e"11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155`F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipmcnt* * 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 8 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodbome illness interventions and risk factors. 3-202.1 3-202.1 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 3-201.4( ) 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* 3-403.11 A& PHFs 165`F 15 sec* $ Receiving/Condition ( ) (D) 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 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk actors listed above,can be found in the 3-101.11 Food Safe and Unadulterated* f f g Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility 6 007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .006 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 106 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °f tNF To., TOWN OF BARNSTABLE; ' .HEALTH INSPECTOR,s Establishment Name: Date: Page: of Y OFFICE HOURS PUBLIC HEALTH DIVISION O 8,00-9:30A.M. BAR-srAB�e. 200 MAIN STREET o 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified - mAss. m� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �p 639•s� v 508-862-4644 h FOOD ESTABLISHMENT INSPE TI N REPORT Name Date pe of I TvDe Insoection 311ker io s utine' Address Risk Food Service ecti n _ i evel etwl Previo i Telephone ential Kitchen Date: Mobile Pre-ope at Owner HACCP Y/N Temporary Suspe Illness Caterer General Complaint Person in ge(PIC) Time Bed&Breakfast HACCP IrM Other / Inspector , I 'I Z:51ij LD 16 1 Z2�� Ir- Each violation checked requires an explanation on the na rative ages)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 ff ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities A -Net EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals 0. r-. FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures 1 ❑ 5.Receiving/Condition ❑ 17.Reheating kr 1 ❑ 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 Violation (�)i(� 'J1 Critical(C)violations marked must be corrected immediately. (blue&red items) ' I IQ Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating l within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 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 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 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 9 violations observed,7 to 8 non-crit al viol tions. If 1 critical refrigeration. )( ) be in writing and submitted to the Board of Health at the above address � 29.Special Requirements (590.009) within 10 days of receipt of this order. 4 tion,4 to 8 non-critical viola y o s= 30.Other DATE OF RE-INSPECTION: I s ctor' Si at --� 31.Dumpster screened from public view xx Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's Sig 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) Assignment of Responsibility* 8 Cross-contamination 1q Food or Color Additives,. Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202:12 Additives* ! 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods;* - 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients F 15, Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to - - Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 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 Separation20 Time as a Public Health Control ` 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 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* Eg ctsw 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or - 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* 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* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3A.03.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures F* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) - Microwave-165' 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 HandsRemaining * Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) 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 70'17 * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient. 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45'F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 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. oFaE ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: CJV. l Date: V l I I"( Page: _of Xp� o. OFFICE HOURS BARNSTABLE. PUB2 0 MAIN STRELIC DETSION '• 3:30-4:30 A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS, MA 02601 M 5088- -FRI.62-4644 No Reference R-Red Item PLEASE PRINT CLEARLY � FOOD ESTABLISHMENT INSPECTION REPORT. Name Date f/��`G( a of f Inspection Lysd I Operation(s) Q ci foOrn 3 MA Address I0 3Q R/' Risk Food Service pection _ L d f�k on Level eta Previous Inspection 'I 7�1 rr Telephone dential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness --� V" J Caterer General Complaint / Person in Charge(PIC) Time Bed&Breakfast HACCP ttj-0 1010 In: Other Inspector Q qn ���5 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 ❑ 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 i - ❑ 11.Good Hygienic Practices ❑22.Posting of ConsumerAdvisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No - ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005in- 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 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 iolatnviolations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8non-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 PIC's Signatur I1 ^ Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted .Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to * Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage*g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* 590.003(G) Repo Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.00 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* � ) � rting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and 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 7204.14 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 F9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(1)) 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 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products 4-501.112 Mechanical Warewashing-Hot Water Monitoring 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 5-101.11 Drinking Water from an Approved System* Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 7/72001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces ofP Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-_130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 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- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing g' P �Y Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail practices 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requ rem nos 1d be debited under Jt29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3403.11(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* 3403.11(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* 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 Handwashin Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification* g ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 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 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Fonnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °p THE ro TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of W OFFICE HOURS PUBLIC HEALTH DIVISION 8:00=9:30A.M. BARNSTABLE. ' 200 MAIN STREET 3:3o-a:3o P. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS, MA 02601 MON.-FIR No Reference R-Red Item PLEASE PRINT CLEARLY rE0 MPS 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name D ype of T s ectio Ooeration(s) Address 3 Ris • Food rvice spection ,)/` Level Previous Inspection vw 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 Other 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 / ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating L ❑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 f❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories L�0 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating I� l G 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 a insp tion today,the items ❑ Embargo ❑ Emergency Closure F] Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation - (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 4non-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 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 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 obsery non-critical violations C. ed,7 to anon-critical violations. If 1 critical refrigeration. violation,4 to a 29.Special Requirements (590.009) within 10 days of receipt of this order. = 30.0ther DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Du Aster 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 ature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N J Dumpster Screen? y N , Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives _ Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.*2-103.11 Person-in-Chazge Duties 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control* * 3-302.15 Washing Fruits and Vegetables .202.12Conditionsf Applicant To Report To The Person In Charge * 7 o Use 590.004 11 Variance Requirements 3 304.11 Food Contact with Equipment and Utensils ( ) 9 * 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 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* F�o 6.13 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. 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 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Equipment 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 crave 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR'2'2.0* 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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g frY 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 9 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practiceess s shohould be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed R E Food-140°F Critical and non-critical violations,which do not relate to the foodbome Prevention of Contamination from Hands 3-101.11 Food Safe and Unadulterated* 12 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* Lu 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 Produc 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 Rete 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004 Labeling of Ingredients* Supplied with Soap and hand Drying Devices (J) 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approv 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 .0093-502.11 Specialized Processing Me 30. Other 3-502.12 Reduced-Oxygen Packagi8-103.12 Conformance with Approv S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105-CMR 590.000. �p THE row TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of . do OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A ,6;q,p.� HYANNIS,MA 02601 M-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY FFO MPS 508-862 4644 FOOD ESTABLISHMENT INSPECTION REPORT Name ^ Date #-7 etyllaguoj Type of Inspection Operations) �-Fe4v�lousn u Address a Risk Food Service Level ail . spection Telephone ential 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 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 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.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) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating �p �Q within 90 days as determined by the Board of Health. I rl tU ❑ Voluntary Compliance ❑ 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 ❑ 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 B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical -up,infestation 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 i 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 anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to anon-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 C 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 to Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen o Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C)_ PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F7-8- 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* 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 1S 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-OriginalContai * - 590.004(F) ners 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hat PHFs Maintained At or Above 140°F* 7-102.1 I Common Name-Working Containers* 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* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 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* * Proper,Adequate Handwashing Ratites-165°F 15 sec* g Sources ' in mobile food,temporaryand residential 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 10 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 3-202.19 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 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g. g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 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 1 Handwashing Cleanser;Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ _ 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. i pp THE ror, TOWN OF BARNSTABLE, HEALTH INSPECTOR'S Establishment Name: Date: Page: of . do OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mAss. g MO -FRI. � ,a HYANNIS,MA 02601 soa-8sz-asaa No Reference R-Red Item - PLEASE PRINT CLEARLY A ss,a m tED MAC FOOD ESTABLISHMENT INSPECTION REPORT Name L✓ l) Date e of Type of Ins ep ction .:'Operation(s) Routi Address AA. Risk O Service ins e n Level etai r ction Telephone ential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Y, 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) ❑ �l 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 S> /j ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisoriesn/� Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations �� Critical(C)violations marked must be corrected immediately. (blue&red items) � Li �Q Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating 1(� 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 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 B=One critical violation and less than 4 non-critical violations regardless of the number,of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation 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 i cal violations. 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 non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. w 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 PIC's Signat re 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 Foodbome Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) 'I FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16A 7-102.11 Common Name-Working Containers* ( ) Hot PHFs Maintained At or Above 140°F*Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* _ 7-201.11 Se azation-Stora e* 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 * ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer - 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for 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* l� 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg cmc uuzoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of.Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155'F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 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- Proper,Ad Sources* 10 equate Handwashing Ratites-165°F 15 sec* ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 - Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ 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 * (Blue Items 23-30) [33-202.18 202.15 Package Integrity (C) Commercially Processed RTE Food-140°F 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodbome 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* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Shellstock Identification g Item Good Retail Practices FC 590.000203.12 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 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand 'in Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000: ofTHE rope�,, TOWN OF BARNSTABLE _ HEALTH INSPECTOR'S Establishment Name: Date Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. 3:3o-a:3o P.M. BARNSfARLE. 200 MAIN STREET Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p a3q.s�0 HYANNIS,MA 02601 M-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY tED Mai 508-862-4644 FOOD ESTABLISHMENT INSPECTIO REPORT Name Date Type of ns ec ion 00 Ooeration(s1 Routin F } Address Risk rvice ction 1 C&WLevel Retail Previous Inspection Telephone ential 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 Y� 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) ❑ 117 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 ❑ 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 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 violations observed,7 to Snon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address 29.Special quirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: In ector'Nnw�,�� Print: 31.Dum ter screened from public view L Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 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 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 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F 15 Poisonous or Toxic Substances - 590.004(F)- EMPLOYEE HEALTH 3-302.l l(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* - Applicants* - - - - 3-302.11(P,) Food Protection* 7-201.11 Separation-Storage*g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits 7-202.11 Restriction-Presence and Use*and Vegetables * - 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 _ I 3-304.11 Food Contact with Equipment and Utensils ) - Variance Requirements 590.003(G) Reporting by Person in Charge*J Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* ( 3 590.003(D) Exclusions and Restrictions*590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or g 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reted of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 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 Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* - 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155"F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.1](A) Clean Utensils and Food Contact Surfaces of Eggs-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* E//'i"11112001 590.006(B) Water Meets Standards in 310 CMR 22.0* * - -4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* - 3-302.13 Pasteurized Eggs Cnhstrtnte for Raw Shell Contact Surfaces of Equipment gg 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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By' 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145`F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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-145'17 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 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands ( ) g * Critical and non-critical violations,which do not relate to the foodborne 3-403.11E 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 70'17 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 1.003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41'F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records;Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 1 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_CfvIR-590.000. "Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °p THE roy TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: t Date: Page: . of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. 3:30-4:30 P.M. BARNSTABLE. • 200 MAIN STREET Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY. HYANNIS,MA 02601 508-862-4644 'E0N1P' FOOD ESTABLISHMENT INSP CTIONREPORT Name V S Date e o T sec ion �eration(s) outine r E ' Address Risk F rvice ection Level etail Previous Inspection Telephone ntial Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness 1p Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast O HACherCP / 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) ❑ i AA 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 Ll✓ ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations t Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo Emergency Closure Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005 6=One critical violation and less than o 6 non-critical violations g ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage i 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must back-up,infestation of rodents or insects,or lack of t 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 within 10 days of receipt of this order. violation,4 to 8nori-critical violations=C. 29.Special Requirements (590.009) 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N 1601 #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si nature Print: Self Service Wait Service Provided Grease Trap Size . Variance Letter Posted Y. N Dumpster Screen? y N Violations related to Foodborne Illness - - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) I Assignment of Responsibility* 8 Cross-contamination L 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* 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* � 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 3-304.11 Food Contact with Equipment and Utensils* - 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* - 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washin Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid-Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* _ __ Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System*_ __ _ gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* e1/-"°e i°rz°°i 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved_Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 1 p Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 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�01.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g. g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3=403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Lu Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 g 3-202.18 Shellstock Identification (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 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007. 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 _ HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. i Town of Barnstable �, Op tHE T Regulatory Services B"Nsrna , Thomas F. Geiler, Director b9. ,0� Public Health Division lFD MP'�A Thomas McKean, Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 6, 2001 Deitland Smith,'Manager CVS Pharmacy#2200 1030 Putnam Avenue Cotuit, MA 02635 Order To Appear At The Board Of Health Meeting on March 20, 2001, 7:00 pm On March 1, 2001, cigarettes were sold to a minor (a person under the age of 18 years) by Dennis Frawley, who is employed at the CVS Pharmacy located at 1030 Putnam Avenue, Cotuit, Massachusetts. Mr. Frawley received a Warning Notice at the time of the violation. ]According to Chapter 270, Section 6 of the Massachusetts General Laws "whoever sells a cigarette, chewing tobacco, snuff, or any tobacco in any of its forms to any person under the age of eighteen (18) or, not being his parent or guardian, gives cigarettes, chewing tobacco, snuff, or tobacco in any of its forms to any person under the age of eighteen (18), shall be punished by a fine of not less than one hundred dollars ($100) for the first offense, not less than two hundred dollars ($200) for the second offense, and not less than three hundred dollars ($300) for any third or subsequent offense. Also, Board of Health Regulation Part IX, Section VII specifically states "Persons, firms, corporations, or agencies selling tobacco products to minors (or selling tobacco products without a Tobacco Sales Permit) shall be punished by a fine of not more than $300 per day for each day of such violation and/or suspension of the tobacco sales permit. This letter shall serve as a Warning Notice to you, as you are the manager of this establishment: At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules, and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. You are directed to appear before the Board of Health at the Tuesday, March 20, 2001 meeting at 7:00pm. The meeting will be held at the Barnstable Town Hall, 367 Main Street, Hyannis, MA, in the 2nd floor Hearing Room. The reason for the meeting is to provide you an opportunity to present your action plan to prevent sales to minors in the future. PER ORDER OF TH BOARD OF HEALTH omas A. McKean, RS, CHO Agent of the Board of Health ...- .. .- ..,..._..+'-. r �-+ _, _�.,,..r-.......,i.��:t".•_.'`..-.nt'-^''"',."'Y'""Ft..��....y,,,n..,.,.�'F�.-...r'a.4'..-..-k,.t...-^''.w.v^^"L.ti,--•'++,.-..,,,r.,.r'*'a.... ti • TOWN OF BARNSTABLE Ordinance or Regulation WARNING NOTICE Name of Offender/Manager enn t-r c. c `,r' Address of Offender''"' / 14cN,/ crr\,,j rR My/MB Reg.AA Village/State/Zip s .. . - Business Name `�..1, lr;T 1 S� s am/tp on 20 0/ Business Address ! r� K w 1"l /V\�' Signature .of Enforcing Officer Village/State/Zip ` ; _ . r R Location of Offense Enforcing Dept/Division Offense This will serve onlylas a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. f • _ _--- The ( ionwealth ofMassuchusetts _ Department of Industrial Accidents Office 01fnFeSMff2 iuns 600 Washington Street Boston,Mass. 02111 Workers'Compensation Insurance Affidavit ttsatt: n tutma a gnr�- , name: i l L-yn Lmac, location: -� city m� C'� \V �1", s m b� c }} C phone# �-L'� ❑ I am a homeowner performing all work myself. ❑ [am a sole proprietor and have no one working in any capacity I am an employer providing workers compensation for my employees working on this job. 3Y" 4 Fs'Fry 3 i n.7- comnanyname , ZY :a dd i - M. `W a n...-� Clty i, ) , 'z!'rr3 `tz�-4 qvMi't , f v^•t'� �C'�i'" En�"� �3•• ir'",��F:� ahone�f —l� SS S fka++HJ�4 4T�«ST'�t�{��F � insurance ohc ❑ I am a.sole proprietor,general contractor,or homeowner circle one)and have hired the contractors listed below who have the following workers' compensation polices: k.. coin anvaiame address " rm� ' p 77777777� City: phone## 7777 insurance co' e*fi ? , r ohc"".. «..,�. .. to .a... 121111 coin an name r , i 5.g t : MS F5 tr r add ress x �F�� £ , ,t a , urz . tr ¢ IR city hone#rA ova ,a r insurance co• ct € it A7tac ..dih0.nalir ��(tie(essvti �y:�} yynx +�mw�wwu �aw��v.G1���'Yr I � 4 tlt�F����.X•:. � .' •• - Failure to secure coverage as required under Section 25A of i17GL 152 can lead to the imposition of criminal penalties of a fine up to S1 500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP\4'ORK ORDER and a fine of$100.00 a day aainst me I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. g t do hereby certifji under the pains and penalhe of perjury[liar the information provided above is true and correct Signature r r Date V Print name a`Zc_�b-Q1 Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# I Building Department check if immediate response is required ❑Licensing Board ❑Selectmen's office ❑health Department contact person: phone#; —Other (revised 9195 PJA) • - • Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire,express or implied,oral or written. An employer is defined as an individual,partnership,association, corporation or other legal'entity,or any two or,more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the, performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. ` �" .mf&..I�... :.t,csafbt �iW.S,UY: Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit.' The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the,number listed:below.. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number:. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigation-2 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone 9: (617) 727-4900 ext. 406 � �,�Ct � 5 �-. �U�� ����1 � �r�c��� c v Sf-�ter- �c�� ����� �+ (v,c.��Ui�C�-� �(v i C� ���-i�1,��U�-s � .. ..,, »- - ,.. _.•,.. ...,:.-._.:.,:__•_�••I +rxry ,. v� .r.c+.. - ,y+'+,Y+T T-rraF—�.. a `"v..w .f-� �•-'--.•,r,y.+,. TOWN OF BARNSTABLE BAR_W 4126 Ordinance or Regulation WARNING -NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# �C Village/State/Zip ,,, -� m/Business Name , �} a ' p02" on It 20A 6 Business Address 10__W WINN]) AK w �� Y If) eM OAP � r Signature of En- fdre fig" Officer Village/State/Zip 2AJ' a)/U'5; 1 � QA 4FU / lei Location of Offense S/n r r f Enforcing Dept R)i,"vision Offense Facts J M iL/c 1 of n woom w om Pos-rV W,-15o c,=a 0k_1 '!�_H6LVM90 1A1PR&3Q1(1V1q ' This will serve only as a warning. At this time no legal ictio,,n has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-w 4126 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# ,Vi llage/State/Zip Business Name L Business Address o ad/p`mj on 6 2 0- 1,7,�*4 4:5;' V !119,20 1-� Signature of Enforcing Offices Village/State/Zip Location of Offense Y lcyCt1G = 7 �J{Ir�+L Enforcing I Offense Facts r'V wl�0` 5aMrk' 4 V This will serve only as a warning. At this time no legal Action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR_W 12r) Ordinance or Regulation WARNING. NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# ,Village/State/Zip Business Name t1 _ � am/pm; on �t'.T 201 ' P. Business Address t / Signature .of Enforcing Officer Village/State/Zip r t Location of Offense Enforcing Dept/Division Offense Facts - f �r I This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORDJREG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR_w 4127 Ordinance or ,,Regulation WARNING NOTICE Name of Offender/Manager J Address of Offender MV/MB Reg.# Village/State/Zip— ,* ,, Business' Name � am/pm, on ///—"20_ Business Address /0, WNW AV5 f)V YA6 Signa't`ur'le .of E,,fiforcihg- Officer Village/State/Zip7 Location of Offense 1A / r Vw Enforc"nnjg'Dept0ivision Offense Facts ,LJ tJ/llR *,e _,�10r"r"� r ' ! lfh9�� �"(1� Vh�zko 1�01_s/,/11VA& 06 CsePkk At This'*1' 1'V Cse"=ve only as a-warning. "At this time' no legal action has been atak"ern. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-w 412 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip-, Business Name `"'` _ am7p-m ,*/on 20_ Aj Business Address A S1gnature .of Eilforc q' OfficeVillage/State/Ziptl . ll . - MA P-fJ Location of OffenseL t r Enforcing p De t:kOivision Offense (?J1 t1ft fair=� Facts -� ' y-. , �e This "will )i;dirve only as a "warning: At this"time r o legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-w 1027 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip r am/pm;. on 20 .` r Business Name t .� _ Business Address Signature -of Enforcing Officer Village/State/Zip Location of Offensef Enforcing, Dept/Division Offense r j. ' I ,1 Facts f {� This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. i i �__ � � �y � , 1 �«�,. I I Barnstable Weights and Measures Program Civil Complaint No.BAR E558469 200 Main Street THE NONCRIMINAL FINE FOR THIS OFFENSE IS$ 100.00 HYANNIS, MA 02601 NAME OF OFFENDER: CVS#10852 ADDRESS OF OFFENDER: 411 Barnstable Road CITY/TOWN Barnstable STATE MA zip 02601 IF MARKED THIS WILL SERVE AS PERSON IN CHARGE: Mike Sims INSPECTOR OF RECORD: Jaime Cabot A WARNING DATE OF VIOLATION: 4/4/2019 TIME 3:05 PM LOCATION HOWEVER ANY ❑ OFFENSE: Item Pricing (Chap 94 Sect 184D), Simple Cleansing Wipes (No Clue of Price) FUTURE VIOLATIONS ENFORCING INSPECTOR: .Jane Zulkiewicz I ACKNOWLEDGE RECEIPT OF CITATION: MAY RESULT IN ISSUANCE OF A NOTE:YOU HAVE THE FOLLOWING ALTERNATIVES REGARDING THE DISPOSITION OF THIS MATTER:READ BELOW CIVIL PENALTY OR CRIMINAL (1) You may elect to pay the above fine to the Enforcing Agency at the above address either in person during normal business PROSECUTION hours or by mailing a check,money order,or postal note to the Enforcing Agency within twenty-one(21)days after receipt of this notice. (2) If you desire to contest this matter in a non-criminal proceeding,you may do so by submitting a written request within 7 days after receipt of this notice to Division of Standards,One Ashburton Place,Boston,MA 02108,Attn:Non-Criminal Hearing. Please include a copy of this citation. (3) If you fail to pay the above offense within 21 days after receipt of this notice,or If you fail to appear for the hearing,or to pay any fines determined at the hearing to be due,a criminal complaint may be issued against you. I hereby elect option one. Payment enclosed in amount of$ Signature Date 5/3/2019 Citizen Web Request owe �. a s �Friday, May 3 2019 Application Center Request Inforniation Request ID: 59988 Created: 4/18/2019 11:54:41 AM Status: Assigned To Staff Assigned To: Miorandi, Donna Health Office Anonymous: No Request Category: Chapter 54-5 : Rubbish and Garbage edit Routine work: No Estimate: No edit Date scheduled: edit Estimated 5/2/2019 Change Estimated _Apr May 2019 Jun Completion Completion Date: -- — - Date: Sun Mon Tue Wed Thu Fri Sat 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 Created By: Crocker, Sharon Priority: Medium edit Health Office Citation Numbers: edit Requestor Information Requestor Request Parcel Number Map: i057 Block: 003 Lot: 001 Requestor asked to check into --- commercial dumpster regulation covering CVS. They do not think there are any Parcel Lookup doors on the enclosure because they are never closed. Usually, the lids of . Email: dumpsters are open when driving past. "There are always crates and debris next https:Hitsgldb.town.barnstable.ma.us/CitizenRequest/WRequest.aspx?ID=59988 1/3 5/3/2019 Citizen Web Request to the dumpster. It is unsanitary and unsightly." Edit Requestor Information Track Request Progress Request Work History: Internal Note History: Entered on 5/3/2019 8:10:20 AM System entry on 4/18/2019 11:54:41 by Miorandi, Donna AM: DZM investigated and took pictures on 4/18/2019. DZM Assigned to Miorandi, Donna left them a warning and shall follow-up after vacation., DZM also called complainant from FIRE dept. regarding this matter. update delete Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) I i i Spell Check,, Spell Check Add document or image link: Choose File No file chosen * You can also type in a folder name to see everything in the folder Current Links: ------------------ Time worked on request: 1.00 Response time: 2.00 *Time entries are in hours. Examples of time entries: 1.25, 0.5, 0.75, 1, 3.5, 0.25, 0.10 * Response time: Measured from the creation date to your first actions on the request. * Do not include nights, weekends, and holidays in response time for most departments. 0 Save changes O Check to notify town employee below to review this request. 0 Save changes and notify Health office V citizen* Health • Close request Brief message to reviewer: https://itsgldb.town.barnstable.ma.us/CitizenRequest/WRequest.aspx?ID=59988 2/3 TOWN OF BARNSTABLE SITE PLAN REVIEW LTt DATE: December 27, 1996 FC �f0 TO: TomMcKean 1996 FROM: Anna Brigham, Site Plan Review Coordinator RE: SPR-114-96 CVS, 0 Route 28 (Putnam Ave&Route 28), Marstons Mills, (057/003.001) Proposal: To construct a 8775 sq.ft. masonry building, required parking, utilities and landscaping. Building will be used as a CVS Pharmacy and retail store. *REVISED PLANS* Please submit this form,with any comments or additional requirements you may have regarding the above referenced application, to the Building Commissioner's office by January�1997. I have the following/attached comments/requirements regarding this application for Site Plan Review . I do not have any comments/requirements regarding this application for Site Plan Review at this time. (Signature) Centerville-Osterville-Marstons Mills E Water Department P.O. BOX 369 - 1138 MAIN STREET OSTERVILLE, MASSACHUSETTS 02655 `�%�EoSr�pc t �� F OFFICE OF u R BOARD OF WATER COMMISSIONERS WATER 3 ATE WATER SUPERINTENDENT 9 TEL.No. 508-428-6691 �SToNS FAX No. 508-428-3508 August 8. 1997 13 lg Mamouth LTD. Partnership r yc4�Tti' >> 9T c/o Coffman Realty ` 1301 Belmont Street Brockton. MA 02401 Z 1 Re: Cross Connection Survey Fire Service-CVS Store Route 28, Marstons Mills Gentlemen: In July; 1997 a cross connection survey was conducted at the CVS store at the corner of Route 28 and Putnam Avenue, Marstons Mills. This survey was conducted in accordance with the Drinking Water Regulations of the Commonwealth of Massachusetts, 310 C.M.R. 22.22. As a result of the survey. it is recommended that t testable and D.E.P. approved double check valve assembly by installed on the fire service. Before installation of a device may be installed, a design data sheet should be submitted to this Department for approval. After the plans are submitted. reviewed and approved. installation of the device may proceed in accordance with 310 C.M.R. 22.22 guidelines. If you have any questions regarding the survey, please contact me at (508)428-6691. Very truly yours. Herbert L. McSorley Temporary Superintendent H,MCS/1w cc: Town of Barnstable,Board of Health Plumbing Inspector Norwood Fire Protection, Inc. Centet-ville-Osterville-Marstons Mills Water Department P.O. BOX 369 - 1138 MAIN STREET OSTERVILLE, MASSACHUSETTS 02655 OFFICE OF u WATER M' BOARD OF WATER COMMISSIONERS ?s DEPT. WATER SUPERINTENDENT �STOIs TEL.No. 508-428-6691 FAX No. 508-428-3508 '. August 8, 1997 1E AUG 1 3 1997 ::1,FHARrd;rgB Mamouth Ltd. Partnership � f ,"HnFPT lE c/o Coffman Realty 1301 Belmont Street £ Z, Brockton,MA 02404 Re: Cross Connection Proposal Backflow Device-Fire Sprinkler System "CVS Store',Marstons Mills,MA Gentlemen: The C-O-MM Water Department has reviewed the plans of a proposal for a backfloN-, device at the location mentioned above. The plans call for installation of one (1) 4" Ames Model 2000ss. double check valve assembly on the fire sprinkler system equipped with a Siamese connection. These plans are hereby approved with the following provisions: 1) The fire lines affected may be shut down during normal business hours after reasonable notice to permit necessary testing and maintenance. If it is not possible to meet this requirement. it will be necessary to provide a by-pass equipped with an approved type backflow prevention device. 2) The installation must be readily accessible for testing and maintenance and also be in full compliance with 310 C.M.R. 22.22. 3) A complete set of spare parts must be available for future maintenance and be on hand for the first inspection. 4) The fire sprinkler system will not be treated with any chemicals, including anti-freeze. After the installation is completed, please notify this office so that arrangements can be made for an inspection, testing and registration of the device by a representative of this Department. Very truly yours, krb McSorley Temporary Superintendent cc: Town of Barnstable,Board of Health Plumbing Inspector Norwood Fire Protection, Inc. WN OF BARNSTABLE LOCATION 030 PC,4r/"4A) Ve *�— SEWAGE # �L -191 S VILLAGE i ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �; pttV 14;�L'Oa 0 ( 8 a3 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) - , �1L7e/¢L�2S� (size) W-3 NO.OF BEDROOMS BUILDER OR OWNER Q PERMTTDATE: L ? COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility d 6-1 et Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by A -c : ay ' / - Cl �ivFILi�A dA-5 INPCTPA70-0 �^E =�Si No. � Fee I L5 D THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Migozal *pgtem Construction Permit Application for a Permit to Construct(/)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �� �(f j fV1l�.N/ (� Owner's Name,Address and Tel.r4�ro. mitit�uL L4-d Assessor's Map/Parcel 1 f ,p -sy- �' �'�✓U�4 r Installer's Name,Address, and �Tel. No. Designer's Name,Address and Tel.No. too i1 A-I N S7RB cT A*A o.z +- Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder 40) Other Type of Building iRE:.r-4 a/:MQ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4,i?5 gallons per day. Calculated daily flow 4 3 ! gallons. Plan Date 1 i ld 6 /9A Number of sheets Revision Date I/ 47 TitleF o!_ Pk�,o�j� l�; MA� �' I(j V f AY,-- Size of Septic Tank 1�299 6&L Type of S.A.S. G 14 Description.,of Soil D—\3�� yu A se3 L Ll S: 1'/ Nature of Repairs or Alterations(Answer when applicable) .1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions-of Title 5 of t'e Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss Mthis d of alth. Signed "C Date Application Approved b� Date Application Disapproved for the ollowing reasons Permit No. j ? Date Issued - ___��, / No. 'Wt f Ke_ hi 0 .✓` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes f ; PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZIppYication for Mizpozal *p.5tem Construction Permit Application fora;Permit to Construct W)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. NQ,10 PUTAA4N Vs Owner's Name,Address and Tel.No. S�t Assessor's Map/Parcel ae W-Ob*� S710 C5 �G�C'lb( .' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. DES 4 t4C6,R A 1 r f , 1AC_ Type of Building: Dwelling No.of Bedrooms._--` Lot Size sq.ft. Garbage Grinder 40) Other Type of Building R�F_r-at L!'r� c No. of Persons " Showers( ) Cafeteria( ) M1 Other Fixtures { � o l Design Flow gallons per day. Calculated daily flow4 3 !? gallons. jr Plan Date 1/ 1026 l Number of sheets Revision Date 313/f gz Title S Tk { C6ZF- -/AA) REAL;L- /4)4 Size of Septic Tank 1420 4L. Type of S.A.S. -.io L44'3>1,�6 Description.of Soil(2_3 r 42A6r;z A r r, a r�-aL`�r =Pd e<n, t -� 24 'iA 6<1'3 r l Nature of-Repairs or Alterations(Answer when applicable) - Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued y this ward of ealth.: __. Signed"" �n Date G tw Application Approved b � ? " ;- Date 'L1�—I&_/ 7 Application Disapproved for the ollowmg reasons . ` Permit No. /- -7- /g �. Date Issued --------------------------------------- II THE COMMONWEALTH OF.MASSACHUSETTS BARNSTABLE, MASSACHUSETTS imp a. F Certificate of (Compliance ; THIS IS TO CERTIF ,1that the On-site Sewage Disposal System Constructed(\-,e)Repaired( )Upgraded( ) Abandoned( )by at has been constructed in accordance I' _ with the provisions of Title 5 and the for Disposal System Construction Permit No. 1 /�_ dated i Installer Designer i The issuance of this permit s all not be construed as a guarantee that the system will function as designed. Date r � - C? Inspector I i' No. Fee ( in C7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS &5po5af *pgtem Construction Permit j Permission is hereby granted to Construct Repair( )Upgrade( )Abandon( ) O'System located at�/ n 0 -- and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to j comply with Title 5 and the following local provisions or special conditions. I` Provided: Construction -must tbbee completed within three years of the date of this tit. it. Date: " l� ' A loved b. r G'`i WN OF BARNSTABLE LOCA1.TION Z_:c{r ,�JAL SEWAGE # 92-1?A VlI IAGE �� ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. �, ,( A.) IgVi6 ' P ca S4 p-- SEPTIC:.TANK CAPACITY _ /SOo 4 a L S88"'�L023 L _ LEACHING FACILITY: (type) 7-e470 (size) NO.OF,BEDROOMS BUILDER OR OWNER 60rlc ► ,4,U PERMI'TDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of.Wedand and Leaching Facility(If any wetlands exist /Y� within.300 feet of leaching facility) Feet Furnished by /� �11,. —.Si` {� ..J ------------ i AL .40 ti .d ,76 VO-Lbla10��N S2Q1d���l�Ny �s - - ­', I� , ,1,,,, ;_­ � '­ � � I- I . I I .1 I � I I1. ., - I-_� ­ , . -1 I--�11__�­,_"_� ---�� � I � I -1. .- . I � , , - I I I I I I 11 - I 1, " � I . -11 �', ,,,, 'ci I. . 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' -, � . I �, I � _' ' � � I 11 I . I - 1. I I � I �, I I I I I I . 01::I I'S I I '" � - ,,,A . � � I I I . I I , I I - I I I 11 I ". k. ,­,,�7� " ", ,%_,", ` "- I - � ,� I; " I � I .� I . I I I I I � I I !, ­ , 11% , . I I �:, ,!'L � . I I � I . I I � � : ,� � " r � I I I � I I I I L I I I � I I � I - I I ,� � I I �I . . ".1 I - I I � I I I I 1, I I . I I I I -, , , " .11 j I- �,I - . - ,:'. '�"'r �­�­ I , , � :z I 1�11 :,, .� I ," , I I I I . I I . . I I I I .I'll.1�1_V�,'', 11, , " ,� . ,�, � ;U., :­UTIL1TY:'_.POLE � � : ,' � � I r . ' 'I : I � I , ,. �,""ill ';j i" , " , "�'o , ,t ­­� I ­14��t - r i-,", ­­�, I . I I 1. I � � I L I , i�,_',,,1r,,',_1_j�',`;4 �,"j,'!rr� '��' " �,Z,�'­ -1 ' .,-,, �- ,-� 1, ) - , ;., � - ! , - I I " I . I I - I � I � ,z,�C,._,,,._P . � e, ,,, , ,;, - � - I I I - ,t�,;� d'e". .,',�, ,.,­_� " , _ , ? 1.z1f-, �" , "A',� I " , � � ,��',,",�I - I I ,� '. I �, � I . I I � �, , � � I I I . . I . � ZONING DISTRICT: VB-A I I 1 12/12/96 ADD. 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BORNSTEIN, TRUSTEE "k 411.o NOTICE WINDMILL SQUARE REALTY TRUST Unless and until such time as the original (red) stamp of the responsible Professional Engineer, or Professional Land Surveyor /V appears on this plan: (A) no person or-persons, including any municipal or other public officials, may rely upon the information contained herein; and (B) this plan remains the property of Holmes McGrath, Inc. 12/26/96 LEGEND REVISE SEP MAH I)(15TINO OA 5 AND WA 7FR LIA(,F5 7W CONTRACAOR SHAll 0CWRRM 12/12/96 ADD SIAMESE TON MAH MBM ACAYAZ L 00A PONS //V Fl,Z D. - 'UTILITY- POLE,'- 12/7/96 ADD ROOF DRAIN M AH M8M _�D_r a w n�' h e c k e-d DATE DESCRIPTI*ON 0 4 0 LEPHONE H.H.,- R E V I S 1 0 N S TRA T, FFI C 11:64 GRADING/DRAINAGE/UTILITY PLAN �'A I 11 TcH BAS N S1 TE PLAN HYDRANT:' EX �G, OT, GRADE ,' 1' . 'SP Z COFFMAN REALTY, INC. _GR '75 '�­ ,'PROP�08ED'��SP ADC QT IN PROPOSED WALL, PA:CK LIGHT COTUIT MA %W4 GRAPHIC SCALE -LI �-PROPOSED POLE GH T' Z 20 10 0 20 60 �0 F SCALE: 1 20' DATE: NOV. 27, 1996 BAR' holmes and mcgrath, inc. MICHAEL J BORSE0 f""".4 civil -engineers an, land surveyors d EXLI�STI­�6�'jc6NTOUR_ , IN FEET 1 inc h 20 ft. N 200 main street 4 PRO 0$ 'Q U 7 E .4i 1 11 , , lod R falmouth,­ma� 02540 P b :' '6NT T MAL DRAWN: ' MAH, MJB CHECKED: M Sfy"- -D WG AN\COTUIT\96182SP. \COFFM DWG. NO.: 64 SHEET .3 OF 4 JOB NO: 96182 41. 3, ;77;,7* -7' ------II7,s'4 7----------- DEEP OBSERVATION HOLE LOG NO. 1 imis �rode,o ow an certU 6,syt 01-0 m d,adjar t t -sh�li iiap e n' of, 2'%.'Im sOTHER s�t1r6n-;-blr,'Schedut1e'40 pf '(t ht.."Joirits SOIL PV& p SOIL TEXTURE SOIL COLOR SOIL DEPTH ELEV. HORIZON (USDA) (Munsell) MOTTLING STONES,BOIJUDERS, c '_disto6ce; b I o,,ed S��stern 0. 49.9 01 min,,distaric'e s49.7 0 GENERAL NOTES DESIGN CRITERIA: 5� 49.5 A SANDY L OAM rst­, Jbor emovo �Ihin Z R­ ble'�6velrs; %vi SIL FY SANDY LOAM 49.4§:' 1) No change to this syste -15"�,'of finished gr�de m shall be made unless�,�Ac6esq Holett 'in ank o-� approved in writing by holmes and mcgrath, Inc. PACE x 50 GPD/1000 S.F. 439 GPD 2i 47.9 8,775 S.F. OF RETAIL S Subject to-Irispection during construction by the GARBAGE DISPOSAL: NO 54" 45.4 C1 MEDIUM SAND��,-be :20 ,,.,in Diometer 2 Board of Health and holmes and mcgrath, Inc. SOME GRA VE Dist 'box�r LEACHING. AREA CAPACITY REQUIRED 39 GPD 3) Heavy construction equipment shall not travel 120 39.9 C2 MED FINE SA NO IS 0.01 SIDE AREA PROPOSED 191 S.F.on. over dispoc.ol system during or after constructi VARIES 0 eon-'Bock fill S=Z=io�02 2" loyer of 1/8 to , 4) Disposal system to be constructed in accordance BOTTON AREA PROPOSED 422 S.F. lb level: with Title 5 of the State Environmental Code. 61 S,F.0.01 MN." MAX. ,,1101UICI evel 1/2" washed stone 5) A copy of these plans must be kept on the site U_ PROPOSED LEACHING CAPACITY 453 GPD during the lirne of construction. WATER SUPPLY: COTUIT WATER DISTRICT 4 ft. of 3/4" to. 1/2" washed 6) A copy of these plans must be furnished to the SEPTIC -T NK Icontractor construi PRECAST CONCRETE UNITS: H-10 LOAD)ING(o , co stone all around'infiltrator and C4 ctin-g the disposal system.__00 '_G co 1 ft.,below. ev'.=44.64 DEEP OBSERVATION HOLE LOG NO. 2 i 7) Before backfilling, the contractor shall notify esign-,. I0" holmes and mcgroth, inc., or the Board of Health 0 SOIL IL COLOR (STRUCTUKS, y,",sothers,' Agent toinspect the system as constructed. U 4,) 5.5'± STONES,DW-DERS,UO) (Munsell) MOTTLING I8) f the controstor encounters any variation between DEPTH ELEV. HORIZON (USDA) CONSISTWY,X GRAVEL)he existing tonditions shown'on, the plan and the- 20> H > conditions encountered on the site, or ony'soil> O" 49.0 Bottom of Test Hole Elev.=39.0 C 7 sff condition different than shown on the soil log, or J" 48.7 0 6 '1A�ER',OF tPUSHIED_Ci*1PACTED '$TON E any adverse soil, the contractor shall immediately contact holmes and mcgrath. inc. Holmes and-STONE LAYER OF .CRUSHED COMPACTED SANDY LOAM to 'Scale SOIL TEST nLE mcgrcth, inc.i will examine the soil condition 5 48.5 A C d report to the owner any suggested revisions. Dcte of s6il test: JUNE 25,1996 24" 47.0 SILrYSANDYLOAM an -CAULEY Test token by: JACK LANDER'S C1 GRA VEt MEDIUM SAND SOME Results witnessed by- ED BARRY 42 45.5 Percolation rate: <2 min./inch MED. FINE SAND 720' 39.0 C2 Ground water NONE -ENCOUN'TERED. 4 �PVC.,VENT'PIPE PERC, TEST #3728 s2 INFILTRATORS (INFILTRATOR rAIR) WITH I 2' OF 4' PERFORATED PVC IF- INS PlNltH' ED ,GRAIDE INSP�CtION HO PECTION HOLE 4" PERFORATED PVC PIPE BETWEEN AS PER MANUFACTURER'S SPECIFICATIONS BITUMINOUS CONCRETE BERM I 'PAVEMENT PERIMETER 4" SEEDED LOAM 6" 1" FINISH COURSE PITCH,::, BITUMINOUS CONCRETE t 12" H L PIPE'� I2" BINDER COURSE�34". 6'-3"6 73'�P -AIL 'IN T P I E-�' DE�T�,i.-,NOT TQ :SCALE, 8" COMPACTED GRAVEL'rypICAL 1(;H —2 PACITY INFILTRATOR PAIR (H 0 LOA CALE NOT TO st BER M DETAIL sNOT TO SCALE IIINSTALL"TUFMTE'�S PEED 'LEVELERS IE31TUMINOOS ON ALL OU MET,,PIPES 4" SEEDEDIOAM CONCRETE SIDEWALK CON RETE DISTRI[BUTION COVER"AT_LEA"LEVEL, -OR R CURBING U T 2% PITCH KNOC FINISH COURSE 2% PITCH, 3"BINDER C 7 6" GRAVEL 6" GRANTE CURB TYPE VA1 INLET 28" (D OU LET BITUMINOUS CONCRETE FINISH COURSE.,4. GRAVEL 7" 2" BITUMINOUS CONCRETE BINDER� COURSE LOAN AND SEED 12" REVEAL�7 1:1 2 2500 PSI CONCRETE REPLACE WITHEQUILALENT BEHIND EACH JOINT 4" sOF WHAT 'EXISTS (11 1/2 CUBIC FEET�ACH JOINT)S��SFr S I TAPER CU VATH BIT.CONC.!0_PAN ECTI T N RB A CURB 01f O" 3' 4 8" GRAVEL BASE IPORTLAND CEMENT CONCRETE ILJ-.M C!"M CURBING ZSIDEWALK ' DETAIL H , NOT TO SCALE C'NO PLAWOF SIDEWALK. RAMP SCA 4* ; LD EXISTING SUBBASE LE. 1 MASSACHUSETTS STANDARD LEBARON 4 FLANGE LF ALL ACCESS. MANHOLE,�COVERS'FOR ADJUST GRADE WITH BRICK OVE AND GRATE OR EQUAL DETAIL 0 F GRANI TE CURB'H e'S r 0 eS SEPTIC ITANK, DISTRIBUTION BOX,�f7,3, io" ialmets A�c' 1, �AND .LEACHING STRUCTURE SET MORE SCALE: 1" 1 ' FILTER CLOTH:r! HAN s6, BELOW FINISHED ,-GRA T DE 5"I LET OUTLET. SHALL r BE RAISED 'TO MIN.IN WITHIN 6" OF BRICKS MAY BE USED FOR NOTICE Unless and until such time as the original (red) stomp of the 24*FINISHED GRADE.* PRECAST CONCRETE RISER-L;rA. GRADE ADJUSTMENTS. DIA. 2 LAYER OF 1/8" TO 1/4 responsible Professional Engineer, or Professional Land Surveyor FRAME TO BE SET IN A CRUSHED STONE appears on this plan: 2 4"±1 FULL BED OF MORTAR. pu tic officials, may rely upon the information contained herein; and 0 0 (A) no person or persons, including any municipal or other 000 0 0 �6 010 (8) this plan remains the property of Holmes McGrath, Inc. 48"±l" DIA. NON-SHRiNK GROUT 0 0 0 c IFRAME', COVER , o0oo DRAIN PIPE OVER 'T'S" WHERE REQUIRED. 0 CHAIN OR APPROVED 0 (0)0C, - � U()0- - 12/26/96 REVISE INVERTS EQUIVALENT C rn T 000C)o 00 MAH -RIINFORCED 'CRE -STEEL ON TE 3/4' TO 1-1/2"I0000 0 L -N 0 —SHRINK 000 C 0 GAS TRAP 0 00 00 00, 12/12/96 ADD SIDEWALK AND HANDICAPPED RAMP DETAILS Mem N ON4 0 NCRETE MAH PRECAST CO 0 C MORTAR 000 HEIGHT, OF RISER 0 0 0 000 RE STONE 000'REMOV to\ OUTSI E DIA. OF TANK RISER WHE �ItR SECTIONS. VARY REQUIRED 0 0 00,-, 0 0 0 DESCRIPTION Drown A 000 00 DATE 00oc' .FROM PIP 1' TO 4' 0 0o 0 0 0000 0 0 C, 0000 00( 0 0 0 )00 U C)0 0 0 0 000 U000 I 0 N S PILLOW d�, 0 C)0.3" min'acteoraiiite t�qOire MIN 0 C) 0 C,o 0 0 0 00 () o IN LET UOO Q 0 0 STANDARD AND SEPTIC , DETAILS 0 et to PROVIDE "V" OPENINGS 00- 1 2" UOO OUTLE )oo 0 T 3-C: 00c) V 0 0000 000 0 0 0000 r)E 000 iqu level 0 0oci 0 0 o 0 0 c )000000 BITUMINOUS JOINT SEALANT (TYP.) 0 C) 0000 PL OOC 0 oo(-) , - 0o 0 r 000 0 0 0 Oar E VARIES 6' DIA. 4-0-0-VARIES 0 0 0 C, 00 0 0 I0 ov ()()C,0 0 0 0 MONOLITHIC BASE 0 0 00 0 0 00000000 COFFMAN REALTY NC.0 0 0 0 000 00 0 sSTEEL sREINFORCED 000 UOOO I00 00 0 1 N ) 00 U PSI 28 DAYS !2 0 I0 CONCRETE 4000 0 SET ON t COTUIT MA UNDISTUR13ED BASE UNDISTURBED BASE BARNSTABLE IDATE: NOV. 26,11 S E C RO" SECTION; ND �SE SCALE: AS SHOWN 996 C TANK LLON SEP, TYP I C A L SOU D �'CATCH BASIN TYPICAL LEACHING PIT holmes and me rath, inc. H LL(H-20 LOADING) civil engineers and Ian? surve rs YO L TO SCALE 2 0,10 A I NOT j3C R EL IIL I200 main street CIVI NOT NOT TO SCALE falmouth, ma. 02540 No. 35054 G I S1 DRAWN: MJB CHECKED M E)nA, npi r,, 96182DT.DWO —1 �1 1 SHEET JOB NO: 96182 DWG. NO.: 64 Ur 4 INSP11 Ill7 Is J