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Home My WebLink AboutCHEF SIGMUNDS CHOWDER COMPANY - FOOD - CLOSED 40 Tr)cllkSJ-I j B c&J anif S l ar5--Dhs h'1 i 1 s- 06$-0-,W--e0t - — - - OgSli� Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BAR NSTAO «- Paul J.Canniff,D.M.D. MIAK F.P. Thomas Lee Alternate 9. 200 Main Street, Hyannis, MA 02601 #' Phone: 508 862-4644 Fax: 508 790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 406 Issue Date: 01/01/2021 DBA: CHEF SIGMUND'S CHOWDER CO. INC. OWNER: JAN KAROLCZAK Location of Establishment: 40 INDUSTRY ROAD/UNIT 5 MARSTONS MILLS„ MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: MUST POST VARIANCE LETTER. NON-TRANSFERABLE conditional variance granted to use a grease recovery device in lieu of the required in-ground grease trap with the conditions: (1) GRD shall be maintained onsite in good operating condition, cleaned and emptied daily if necessary. (2) Seats are NOT ALLOWED at this food establishment. (3) Menu restricted to clam chowder and other chowders/soups. of • Initials: ti Town of Barnstable For 0 Use Only. : . M. Date Paid (( �Amt Pd$ Inspectional Services ,' `0� Chk# '�fDrAP+p ec Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE Abr,2ar::REW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: k 8 S MAILING ADDRESS(IF DIFFERENT FROM ABOVE): ^^ E-MAIL ADDRESS: �'r I TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO_/.. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: 0 TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,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 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:\Application FormsTOODAPP 2020.doc r OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES D.O.B L-1 OWNER PHONE# 5� —�j�a5r-1 f,0*1 ADDRESS CORPORATE OWNER: `I� C CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. O� / / 1. I 2._V IGN OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FonnsTOODAPP REV3-2019.doc S Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. RARNSrAOM John T.Norman A F.P. Thomas Lee Alternate 36 1k 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 .www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 406 Issue Date: 09/01/2019 DBA: CHEF SIGMUND'S CHOWDER CO. INC. OWNER: JAN KAROLCZAK Location of Establishment: 40 INDUSTRY ROAD/UNIT 5 MARSTONS MILLS, MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: .0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD.OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: ` Qn 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: MUST POST VARIANCE LETTER. NON-TRANSFERABLE conditional variance granted to use a grease recovery device in lieu of the required in-ground grease trap with the conditions: (1) GRID shall be maintained onsite in good operating condition, cleaned and emptied daily if necessary. (2) Seats are NOT ALLOWED at this food establishment. (3) Menu restricted to clam chowder and other chowders/soups. Town-of Barnstable IME yP "� Regulatory Services t Q << BABC'SSTABLE BLAB . # Public Health Division - - _ ._ ,�/ c Mu:e ue•�n W::M 16.5 1639-2034 �'"ren Mai a Thomas McKean,Director. 575 200 Main Street,Hyannis;MA 02601 : Fax: 508-790-6304 Office: 508-862-4644 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISffi HINT DATE: NA ME OF FOOD ESTABLISHMENT: �,e'� S �,,��(,{'s C �swoLe L®rr n -►�C', ADDRESS OF FOOD ESTABLISHMENT: b ho� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS*:. 'INSIDE: d OUTSIDE: TOTAL: O * Note:If indoor seating provided, see Licensing regarding Common.Victuallers License` TOTAL NUMBER OF-BATHROOMS: ANNUAL OR SEASONAL,OPERATION: TYPI CAL HOURS OF OPERATION MON-FRI: o : °AM TO ; O P DAYS CLOS ED HOLIDAYS (I.E.MONDAYS) o IF SEASONAL: APPROXIMATE DATES:OF OPERATION _%_/_ TO ***RENIINDER** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING PLEASE CHECK ALL THAT APPLY TYPE OF ESTABLISHMENT FOOD SERVICE RETAIL FOOD . BED &&BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO,MUST OBTAIN A COMMON VICTUALLER'S LICENSE RESIDENTIAL KITCHEN MOBILE FOOD FROM DIVISION TOBACCO SALES FROZEN DAIRY DESSERT MACHINES- CATERING (OVER). OUTSIDE DINING Q.\AppI ication formMoodappIdoc ***RETVI11VDER** IF OUTSIDE DINING YOU MUST BE APPROVED BY THE HEALTH DIVISION AND LICENSING AND MEET:ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? URTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?/V n •IS AN AIR C. CONTACT INFORMATION:._, / b a s+o� �o� - 1 FULL NAME OF APPLICANT �. SOLE OWNER: NO D O.B PHONE# l � ADDRESS 'S�^ otu y f IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL.,,r. PARTNERS:: , IF APPLICANT IS A CORPORATION: STATE OF INCORPORATION:_ FEDERAL IDENTIFICATION NO::, Y • FOOD` SERVICE. ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD:ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST). EFFECTIVE JANUARY 1, 2004, EACH .FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO. BE ONSITE DURING ALL HOURS OF OPERATION.*** PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*.** ,LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I:E. SERVSAFE.) EXPIRATION DATE: 2. EXPIRATION.DATE: `EFFECTIVE FEBRUARY 1, 2011E EACH FOOD ESTABLISHMENT_THAT.COOKS) PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON-OR OFF THE PREMISES. SHALL HAVE AT 'LEAST ONE CERTIFIED FOOD' ALLERGEN AWARENESS ***. PLEASE` PUT THE NAME OF THE ESTABLIS11MENT ON TRAINED STAFF MEMBER: THE CERTIFICATE*** ALLERGEN AWARENESS TRAINED STAFF. LIST THE NAME OF YOUR ERTIFED FOOD AL !l jj EXPIRATION DATE; NA OF APPLICANT : DATE . Q:\Application Forms\Fo6dapp3.d9c M i' i j For Office UsC Only. Initials: Town of Barnstable Date Paid �Amt Id$ d anRvsrnstie, Inspectional Serviced 6 MASS.9 Public Health Division che`'`# n RFD MA'S A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A KOOD ESTABLISHMENT DATE iLla_tf� NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: A ADDRESS OF FOOD ESTABLISHMENT: � f• �i ��S MAILING ADDRESS(IF DIFFERENT FROM ABOVE): `vl� E-MAIL ADDRESS: G A S C-ory-> TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NOZ.. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: NZ - 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) &OOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc r i OWNER INFORMATION: FULL NAME OF AfRLICANT I SOLE OWNER: Y /NO D.O.B 1.4 6 OWNER PHONE # ADDRESS nib l CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. SIG O PPLICANT DATE ' ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openine!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/ai)plications.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. I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:Wpplication FormsTOODAPP REV3-2019.doc MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include copies of your employees' food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, please include the required fee amount (see fees at bottom of this page). Make check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax copies of your employees' food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, you must mail the required fee amount(see box below). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. FEES: Bed &Breakfast Permit= $55; Food Service Permit 0-49 seats=$250; 50 or more seats$300; Continental Breakfast=$30; Retail Food (only TCS Foods) = $20; Retail Food Store—Less than 8,000 S.F. _ $100, more than 8,000 S.F. =$285; less than 1,000 S.F.; Retail Food Combo/Limited Prep. - $200.00; Cottage Food Industry=$75; Mobile Truck=$50; Mobile Ice Cream Truck=$35; Frozen Dessert License= $30; Additional non-refundable Fee for New Establishment or New Ownership=$100-$500(see staff), Late Fee= $10 Q:\Application FormsTOODAPP REV3-2019.doc 12/25/2019 Imaging-View Transaction ..,rr.,ariw cr ,. r. u.ww+.:.. ... +. ...:_r•..�:.,ww. ....�m� . ,� wr`r.r. ar-.. .+..,....:o.orw..m..sr,_.mw.m.�+.:.e:.r.rx..,.w,.w.M.wy ' x CHEF SIGMUNDS CHOWDER CO INC. 260 r 262 COTUTf BAY DRIVE `` 53=116417113 CO'TUR,MA 02635 03 UAL ,/n�CHECK fl jr \p1 UapYW{Crurn • �e«s Tay m tfre -' b f�Q _. p • Pleow r-,;" The Cooperative Ban j C jYjy, FBRENT For 1: 2 L L 3 7 Lrzt. it: 9 L901?0479119 0 AV ...r...-....,.........-•--.....+-...v.+,.,......�.r..�,...rr.....e. ...,. .-o...o.r..-r.,�...�......+.r•.......,e......��s........r.r .s,..v. I r • . - ��. , -- - 1026/l 9 0188730 MS0 0 1 1304476- 0920385816 2019-10-28 - O 0 to to 0 Fs* - o https://web l 3.secureintemetbank.com/PB I_PI3 11151/Account/Detail/f42c6960-7f6b-413e-8966-e876d42863d3?Token=Dyq EfNvfk6RGeBvQReKj W6o... 1/1 Town of Barnstable BA"STABLF, MA—S& 039. Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Paul J.Canniff,D.M.D FAX: 508-790-6304 John Norman Donald A.Guadagnoli,M.D. January 10, 2019 Mr. Mark Boudreau, Esq. Boudreau and Boudreau 396 North Street Hyannis, MA 02601 RE 'C ' " V 'ces G.06�Q;C hbf�.,�iigmunIndustry,Rd lan 4,qMp?!ny o _ Dear Mr. Boudreau, You are granted a conditional variance, on behalf of your client Rebecca George, from Section 322-3 of the town of Barnstable Code which requires minimum 1,000 gallon capacity grease traps at all food establishments. This variance will allow you to operate a food establishment utilizing a grease recovery device at 40 Industry Road, Marstons Mills with the following conditions: (1) The menu is restricted to clam chowder and other chowders/soups. (2) Seats are not authorized at this food establishment. (3) The grease recovery device shall be maintained in good operating condition, cleaned and emptied daily if necessary. (4) This variance is not transferable to another owner or leasee of this establishment. You are also granted a variance to operate a food service establishment with one certified food protection manager. This variance is granted because only one person will be employed at this food establishment. Si erely yours 'P%N&V%&J��nff,-Itff.6. WP/ChefS igmundChowderVariances20l 8.docx `oFt"�'owti TOWN OF BARNSTABLE , �, HEALTH INSPECTOR�s Establishment Name: C S/_6/No ate: '(/ iPal e: of `GYP o� OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. EARN ABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Ve fied +'63q .•� - HYANNIS, MA 02601 - M-8 -FRI. No Reference- R-..Red Item - PLEASE PRINT CLEARLY . 508-862-4644 - FOOD ESTABLISHMENT INSPE T N REPORT Name. / An ate a of Inspection �! O g Rouf / Address C od Sery e-inspection R1 / Jr Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness i- Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP n: Other Inspector Each violation c ecked requires a explanation on the narrative ge(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) ❑ 22 FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands 0 ❑ 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 d ❑ 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 I ❑ 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) n 9.Food Contact Surfaces Cleaning and Sanitizin❑ g g ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY I �a��!� �s' ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories IT 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 corre cted immediately or .within 90 days as determined b the Board of Health. Overall Rating y y ❑ Voluntary Compliance. ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the a 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 o 6 non-critical violations . 26.Water,Plumbing and Waste (FC-5)(596.006) 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 aright to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-crit. al violations. If 1 critical refrigeration. viola on,4 to 8 non-critical viol ns= .29.Special Requirements (590.009) within 10 days of receipt of this order. a 30.Other DATE OF RE-INSPECTION: In p tor's i t reI a - 31.Dumpster screened from public view & Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's Si ure Print: Self Service Wait Service Provided Grease Trap.Size Variance Letter Posted Y N Dumpster Screen? Y N 67 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) i Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12-° Additives* 1. 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* *- - 19 PHF Hot and Cold Holding 2-103.11 Person-in=Chazge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11 A 2 Raw Animal Foods Separated from Each * ' S90.004(F) ( )O P 7-101.11 Identifying Information-Original Containers * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 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 3-302.15 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 Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable DrinkingWater* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E//&B 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitiza[on-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 carer- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g. P arY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wl/d 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 Requirements.practices ld be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* _ 3-403.11(A)&(D) PHFs 165'F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the )Wdborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands i 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F[0 70°17 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I 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. i oFT"E Loy TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: -Page: of a p o� OFFICEHOURS ' PUBLIC HEALTH DIVISION " s:oo-s:sOA.M. BARNSTABLE. ' 200 MAIN STREET 330-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MA55. g. MON.-FRI. i639•a,0 HYANNIS,MA 02601 508-862-4644 No Reference .R-Red Item PLEASE PRINT CLEARLY rFDM FOOD ESTABLIS MENT INSPE�T, N REPORT in, Name Date, e o Type of Inspection i O era i Routine Address Risk ood Service Re-inspection el t ' Previous Inspection I in Telephone 4 ✓ /J, Residential Kitchen Dates Mobile `Pre-operatio i Owner HACCP Y/N Temporary -Suspe ness Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP A ON Inspector _ &// /0 / Each violation eked requires an explanation on the narrative pag (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 (yam EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives A ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals r1 WTI f 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 l,�r I ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 1 s/ -❑ 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: W t L I❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ 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 6=One critical violation and less than 4 non-critical violations if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 C=2 critical violations and less than 9non-critical. 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 v'blations. If 1 critical refrigeration. 29.Special Requirements (590.009 within 10 days of receipt of this order. violation;4'to 8 violation C.nora-critical 30.Other DATE OF RE-INSPECTION: Inspe s Sig t Z 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 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 Law Cooled to 41°F/45°F Within 4 Hours* ( ) g 14 Food or Color Additives , r 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* - a g Cooked and RTE Foods.* Protection-from * 1.9 _ PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 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-I01.I l Identifying Information-Original Containers* 590.004(F) � * 2 590.003(C) Responsibility of the Person-in-Charge 3-501.16(A) Hot PHFs Maintained At or Above 140°Fge[o - - 7-10211 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* P g 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* 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 Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) I Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and * 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 1 g Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness*- - 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Wa[er.from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of ' Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg cave 11112001 4-602.11 Cleaning Frequency of Utensils and Food. Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 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 g P arY 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By - 3401.11(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* 3-441.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail * 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 3-201.17 Game Animals Requirements. 5 Receiving/Condition, 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23.30) 3-202.15 Package Integrity* g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 in 3-203.12 Shellstock Identification Maintaed* Conveniently Located and Accessible Within 2 Hours and From 70°F[0 41°F/45°F 5203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 - Tags/Records:Fish Products P 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 I 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 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ' p INE r HEALTH INSPECTOR'S Establishment Name: ' Date: (' _ Page: of � °''ti TOWN OF BARNSTABLE, 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 'b a3y: .•� HYANNIS,MA 02601 sos N.-FFRI. No Reference R-Red Item. PLEASE PRINT CLEARLY ,FOMP,e FOOD EST BLISHMENT INSPE I0 REPORT ® (� Name ate De of Type of Inspection _> s Routine Address R- C/F.c#Serwc Re-inspection Previous�nsection Telephone Residential Kitchen Mobile Pre-operaOwner HACCP YIN Temporary Caterer General Complaint o`er Person in Charge(PIC) Time Bed&Breakfast HACCP_ Other J Inspector Each violation c cked requires an explanation on t e narrative page and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk F ctors(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) ❑ 99 d d 0 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 TIMElrEMPERATURE 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 r}I 4 ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time Asa Public Health Control I All ❑ 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 y- r 0-14-_jgg�ad Hygienic Practices ❑ 22.Posting of Consumer Advisories / p Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations i Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating. within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction-Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than.3.non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or-revocation of the food B-One critical violation and less than 4 non-critical violations 26.Water,Plumbingand Waste if no critical violations observed,4 to 6ron-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up, 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must g p;infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. viola!' 4 to 8 non-critical violations=C. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspe is Sig ature P��r 31.Dumpster screened from public view, r ✓t✓ i Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N R C's Sig t e Pn t: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y- N Dumpster Screen? Y IN // 'c a.. i 41 I Wolations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 1g 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) 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 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Se azation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(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 Wazewashing-Hot Water Monitoring* 3-801.1](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 dness* 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* g PP Y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ery'i-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-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 m 590.009(A)-(D) Violations of Section temporary and - ide in cater- , Ratites-165°F 15 sec* in mobile food,tern or and residential Sources g, P �' 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved B 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F kitchen operations should be debited under Regulatory Authority y 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* Requirements. 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1g 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 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. 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* I 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. a W ��,5 E c` c oe �� a 0 ter 1.14 bIS '�1 � ago° opS'• 3c� �¢�J�J2 �� phi ok EnginsOlIng 167 8 aeh.Street Dennis,MA 02638 508-385-8682 1� 31'-6r4" W�PANEIS.T�L ` f OO I ZVENIT� � f H2V*A QI 0Q L_ — -- 1 FOUR BURNER I 1 O GAS RANGE i A/C UNIT—�{ 1 ANSUL SYSy�TdI ABOVE L I HOOD ADO v � I f 'kALK-IN. I I FREEZER CEILING HFJGHT I � FLOOR-AREA m 628.6 S.F. I .; COUNTERTOP f r I ENTRY � � � i;• 9 O ® i yEsnsuUE. I U BELGREASE TRAP '� C ® ICE _ �0 I BATHROOY SINK sw �. HVAC I10 I uNiT � it'-33/4 iU 1 cD Z 1. Replace existing ExiULite pack. Unit non operational 2.-Add Employees Only signage to restroom door i U' f l t��g 3.-Verify/Operational 50 CFM ventilating fan » I FAT OF&fq 4.-Sprinkler system needs drop pendants thru the ceiling W C &Hood Fire Suppression Gas Valves J_f 5.-CO Detector EXISTING CONDITIONS PLAN s SCALE _ � = 1 _p ;U9. T VARNUM 6.-Rate of Rize/Heat Detector wl Sounder Base. This MECHANICAL unit connects to the building fire detection system o, No.30690 .. 7.-Illuminated Exit sign g.-Emergency Lite pack �,ress oath<100 ft for sprinkled building q Town ®f Barnstable 4. Building Department Services oF1r�royti Brian Florence, CBO BARNSTABLE +�cc�s H�w.s®o�sratu�iue�°w Building Commissioner 1639-2014 * Bs 200 Main Street, Hyannis, MA 02601 MASS. 9Q� 163;9. � www.town.barnstable.ma.us , Office: 508-862-4038 Fax: 508-790-6230 October 5,2018 Mr. Jan Z. Karolczak c/o Attorney Mark Boudreau 396 North Street :Hyannis,MA 02601 RE: Site Plan Review#073-18 Chef Sigmund's Chowder Co,Inc. 40 Industry Road,Unit 5,Marston Mills Map 058,Parcel 028 Proposal: Applicant proposes to conduct a food preparation business for the retail sale and delivery of clam chowder and similar products to individuals. There will be no seats and none of the food will be sold for immediate consumption. It is anticipated that there will no more than two employees. Prior use of the premises was a take-out pizza business with no seats. Dear Attorney Boudreau: At the formal site plan review meeting held October 4,2018,the Site Plan Review Committee found the above-referenced application to be approvable subject to the following: • Approval is based upon site plan of existing condition entitled"Existing Parking Space Layout at 40 Industry Road, Marstons Mills,MA", dated January 3, 1995 depicting location of six existing customer parking spaces plus 2 HC parking spaces available for Unit 5 within the condominium parking lot. • Chef Sigmund's Chowder Co., Inc. Business Plan explaining the operation of the business: prepared food to be cooled and packaged in quart containers for retail sales and delivery to individual customers;food is to be brought off site,heated and consumed; no seats will be provided; no food to be consumed on site. e A Conditional Use Special Permit from the Zoning Board of Appeals for retail use in the SD-1 District is required. i 2 Board of Health variances may be required: o Variance for an under sink grease recovery device where an in-ground grease trap is not present. o Variance for one certified food protection manager,where 2 are required. It is required that when two employees are present, both will need to be certified for food safety. I s i` f • Floor plans depicting the number/type of sinks, prep tables etc., cut sheets; a schedule of surface materials in the kitchen and food preparation area; and, specs for new equipment (NSF, UL listed) will need to be provided and approved by the Health Inspector at the building permit stage. Marybeth McKenzie, Health Inspector Tel: 508-862-4649. • Consultation with a hood specialist to determine appropriate hood and design for the type of cooking proposed is strongly suggested prior to the building permit stage. • Existing sprinkler heads are reported to have been covered by the installation of a suspended ceiling. A proposal for making the sprinkler heads functional will be required at the building permit stage. .,Applicant must obtain all other applicable permits, licenses and approvals required. Upon completion of all work, a registered engineer or land surveyor shall submit a certified"as built" site plan and a letter of certification, made upon knowledge and belief in accordance with professional standards that all work has been done in substantial compliance with the approved site plan(Zoning Section 240-105 (G). This document shall be submitted prior to the issuance of the final certificate of occupancy. Sincerely, Ellen M. Swiniarski Site Plan Review Coordinator CC: Brian Florence, Building Commissioner, SPR Chairman Fire Protection Officer Martin MacNeeley, COMM FD Health Department ZBA Town of Barnstable _ � Building ? Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and:this Card Must be Kept � ;Posted .bs9. -Until.Final Inspection Has..Been Made. `Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Finaflnspection has been made. 1. � Permit Permit No. B-19-580 Applicant Name: Approvals Date Issued: 04/26/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 10/26/2019 Foundation: Commercial Map/Lot: 058-028-OOE Zoning District: SPLIT Sheathing: Location: 40 UNIT 5 INDUSTRY ROAD, MARSTONS MILLS Contractor Name: Framing: 1 Owner on Record: GEORGE,THOMAS A& REBECCA A Contractor License: 2 Address: 48 CYPRESS POINT Est. Project Cost: $3,500.00 Chimney: YARMOUTHPORT, MA 02675 Permit Fee: $160.00 Description: INSTALLATION OF WET CHEMICAL FIRE SUPPRESSION SYSTEM ,Fee Paid: $ 160.00 Insulation: INSTALL(1) U.L. 300 WET CHEMICAL FIRE SUPPRESSION SYSTEM IN Date: 4/26/2019 Final: 6' HOOD. SYSTEM IS TO MEET MANUFACUTRES SPECIFICATIONS AS WELL AS NFPA 17AP SYSTEM WILL COVER 6' PLENUM, 12X12 DUCT ` Plumbing/Gas C_ ' AND ALSO RANGE UNDER HOOD !!! Rough Plumbing: Project Review Req: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application andthe approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT w�/�,�L Final: S�j'� Town of Barnstable Board of Health i6 79 �f0 MA'1 a 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Paul J.Canniff,D.M.D FAX: 508-790-6304 John Norman Donald A.Guadagnoli,M.D. January 10, 2019 Mr. Mark Boudreau, Esq. Boudreau and Boudreau 396 North Street Hyannis, MA 02601 c, F� Y'e '; fi ^v"L`G �' 3*d4`�st',4�,'�"ni''`ws' u` 1is'„`'�'y��`, ' t-�,T..$�+.`.5 y�✓ � n7V �u`3�;'�� , ` ""� `'�M�% }RE = VanancesGrantedChefSigmundsaCiowderCompany�40llndustryRd Dear Mr. Boudreau, You are granted a conditional variance, on behalf of your client Rebecca George, from Section 322-3 of the town of Barnstable Code which requires minimum 1,000 gallon capacity grease traps at all food establishments. This variance will allow you to operate a food establishment utilizing a grease recovery device at 40 Industry Road, Marstons Mills with the following conditions: (1) The menu is restricted to clam chowder and other chowders/soups. ---- - (2) Seats are not authorized at this food establishment. (3) The grease recovery device shall be maintained in good operating condition, cleaned and emptied daily if necessary. (4) This variance is not transferable to another owner or leasee of this establishment. You are also granted a variance to operate a food service establishment with one certified food protection manager. This variance is granted because only one person will be employed at this food establishment. Si cerely yours P n ff, 1, Q:WP/ChefSigmundChowderVariances2018.docx �el,2— DATE .yOF IKE �5, 9 BARMABSA$LE:RFD MA'1A REC.BY: q•i6 blT® 1 .o Ba ste �y a •i BCHED.DATE: 41 . Board of Health NO Main Street,Hyannis MA'02601 ' ..; Office: 508-8624644 Paul,J.Cannifl;D.M.D. FAX: 508-.790-6304 Donald A.Guadagnoli,M.D. Junichi Sawayanagi CE RE UE S T FORM . VA.RIAN Q . . .LOCATION Property Address: 40 Indus Assessor's Map and Parcel Number.: 058/028 Size of Lot: 1.08 acres : Wetlands Within 300 Ft: Yes Bus'messName:Chef Sigmund. Chowder Company, Inc. No x SubdivisionName:; .= Inc:: APPLICANT'S NAME:Chef Sigmuncrs Chowder Company, Phone 508. 775-1085 Did the"owner of the property authorize you to.represent him or her? Yes x No �y 7 PROPERTYOWNER'SLAAME CONTACT PERSON .Ai��- "''."�►��•�'-� Name: Rebecca A. George Name: Rebecca A. George Address: 48 Cypress Point Address: 49 Cypress Point . Yarmouthport, MA 02675 Yarmouthport, ,MA 02675" Phone: Phone: EMAIL: VARIANCE FROM RE GULATION:(Incl.Reg Code 4)-REASON FOR VARIANCE(May attach separate.sheet if morespace needed) _Grease trap " Proposed use will produce very little grease No more than twom 1 nvPPs takes rn,t only Number of rewired bathroomG p--�--� N„mh`Pr of cPrt ;f;P�` f._ n�� Rr� Only one employee for initial operation of tection managers business NATURE OF WORK: 'House Addition U House Renovation Repair of Failed Septic System," Checklist-.(to be completed by.office stc&erson receiving variance request application) Please submit first four on list as-5 collated packets. A. Five(5)copies of the completed variance request form _ O p PP 'ng an I/A system or P y ( proposing B. Five 5 copies of MA DEP approval letters for, se tics stem when ro osi secondary,treatment unit(S T.U;), C. Five;(5)hard copies of eng. red,plar submitted(e.g.septic system plans)and one(1)electronic version submitted to email: health@town.barnstable.ma.us D:.Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)and one(1)electronic version. , A completed seven(7)page checklist confirming review of engineered.septic ystem.plan by submitting engineer or RS. _ or business-owner authorized you to represent him/her for this request Signed letter stating that the property _ Applicant must notify abutters by certified mail at least ten days.prior to meeting date.at applicant's expense(for Title Vand/or. local`sewage regulation variances only)., Full menu Five(5)copies of.full menu submitted(for grease trap variance requests only). . _ Fee Submitted*$95;00 for the,following variances: 1)New construction,:2) Septic.repairs with inciease'iri flows, and 3),New ` owner/new lessee applying for food, pool or body,art variances. Exemptions from Variance Fee: l) Septic repair without an 12 increase in flow and variances granted at.the counter,2).Monitoring Plans,and 3)Temporary Food"(not a"variance). _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROV Paul J.Canniff,Chairman ED NOT APPROVED Donald A.Guadagnoli,M.D. Junichi Sawayanagi REASON.FORDISAPPROVAL Q;\Application Forms\VARIREQ Rev APR 4=2018.docx ' 1_h �� f �� i. �� - �4 --.�� L� #tv ��J �I � 7 V � �ti � �� . E- ��/�• 20 f/r►1/� CHEF SIGMUND'S CHOWDER CO., INC. BUSINESS PLAN The Applicant, Chef Sigmund's Chowder Co., Inc. proposes to conduct a.food"preparation business for the retail sale.and delivery of clam chowder and similar products. 'There will be.no seating and none of the.food will-be sold hot or ready to'be"immediately consumed. The chowder is intended to be brought off site, heated, and then consumed. The chowders will be prepared on a stove with an approved hood, brought to a boil and then cooled and packaged in quart containers. The product will be sold as a base as-well. 2 _' Clam Chowder Fish Chowder. 4 Soups du Jo ur Lobster Bisque : . Corn Chowder G 1° y � . McKenzie, Marybeth From: McKenzie, Marybeth Sent: Tuesday, November 13, 2018 9:57 AM To: Swiniarski, Ellen Cc: McKean,Thomas Subject: 40 Industry Rd, Cotuit Hello Ellen, Hope all is well. Richard Guarino 508-428-1522 called this morning. He is quite upset about someone making chowder in the old Domino's unit. He said that he spoke to Robin in zoning about the conditional use letter that was sent out and the newspaper advertisement. His complaint was that the letter and advertisement in the newspaper did not mention that the new owner will be manufacturing chowder on site, I guess that verbiage was not in the letter. He is concerned about manufacturing at this site (the trash/dumpster, septic, traffic and other issues)You should give him a call to help answer some questions that I could not answer since I was not at the formal site plan review. I did try to explain if a facility is looking to receive a food establishment permit then they usually are making product on site. Thanks Marybeth! BOUDREAU& BOUDREAU,LLP 396 NORTH STREET � HYANNIS, MASSACHUSETTS 02601 r� ek �_t Telephone:(508)775-1085 Telefax:(508)771-0722 X: pMa. Philip M. Boudreau w;7 Philip Michael Boudreau Mark H. Boudreau December 17, 2018 Board of Health Town of Barnstable 200 Main Street Hyannis, MA 02601 ATTENTION: Mary Beth McKenzie RE: Chef Sigmund's Chowder Company, Inc. 40 Industry Road, Marstons Mills Dear Ms. MacKenzie, I am writing in response to your telephone call last Thursday concerning the variances that I applied for on behalf of Chef Sigmund's Chowder Company, Inc. The business will dispose of their garbage into plastic bags to be placed in an outdoor dumpster. It is anticipated that the vast majority of the items to be disposed will consist of onion skins and celery heels. The clams arrive outside of the shell in one-gallon plastic buckets. The bucket are rinsed and cleaned before being disposed of. The fish for the fish chowder arrives already filleted with no bones on other parts of the fish. The cooking of the chowder Will occur mostly in the morning. Any strong odors dissipate in the first two hours of cooking. The business anticipates using the Big Dipper W- 250-IS GPM unit which is the same unit used by the Domino's Pizza business at this site. My client is not in possession of any maintenance records for this unit but believes it was regularly inspected by the Town of Barnstable. I have attached specifications for the Big Dipper. Thank you for kind attention to this matter. Sincerely, 4ark H. Boudreau MHB I` IS Unit Ope. U56-81 Skimming Wheel, Programmable .Timer Solids.Collection Field Reversible Top - Basket Cover Clean Water Outlet Inlet from Sink Outlet Baffle " Grease Collection 1� 1.'?� Container . Cutaway Drawing of Big Dipper® -200--IS SIG DIPPER@ Product Features and Benefit Big Dipper units separate fats,.,dils.and'grease with a proven,efficiency of up to 98.6%. Automatic removal of grease retains unit separation efficiency. Fully automatic self cleaning cycle with 24-hour programmable titer.. Removes_collected grease&oils from tank.without.any operator assistance. Constructed of corrosion resistant.materials. Suitable for installation in; virtually any location. Integrated Motor/Grease Oufet/Beater/1_id on the,IS Series, Enables fast, do-ivyourself`unit.operation reversal. � incidental solids automa-ticaliy removed in ASS"-Series, No strainer basket to manually empty ® Easy lift grease cc�6ie �r ii tl�e IS Sep ies� Simplifies grease collection container emptying: Coma footprint. Makes installation possible in tight spaces. ' -di er.com 1 8 Do-633-420 4 Copyright©2003 Thermaco,Inc. 5 'Inc www.bi ermaco PP(h 9 1 _ y , Big Dipper, internal Sh-a}ne;- (IS) series units:utilize an internal strainer basket to capture.incidental solids in kitchen wastewater flows. A skimming wheel system inside.the unit skims the grease &;oils out of the retention area when activated by an integral programmable timer.IS units work well inside fast food-type restaurants;or,food preparation facilities where grease removal directly at the source is paramount.. Big Dipper.IS unit sizes.handle kitchen flows of 20 to.50 gallons per minute. -Poi t Source Grease Removal Unit Units in the 20-30 GPM(1.2&1151/s)range typically service:a single fixture such as a pot sink or pre-rinse'station,and are installed;as close as.possible to the device being serviced: IN-200-IS 20 GPI' (.1.26 I/sy Exterior Construction:304 Stainless Steel,Bright Finish Skimming Rate:351b./hr.(15.9 kg/hr) Solids Strainer Capacity:1.16 gallons(4.41) ; 2"Inlet/Outlet(50 mm) _ 350W/115V/6OHz* W-250-15 25 Uvi t(1.58 i/s) Exterior Construction:304 Stainless Steel,Bright Finish SkhTmingRate:35lb./hr.(15.9 kg/hr) Solids Strainer Capacity.1.16 gallons(4.41) 2"Inlet/Outlet(50 mm) , 350W 115V 60Hz* ': I&'-350-I.5 35 GNA (2.21 I/s) Exterior Construction:304 Stainless Steel;Bright Finish Skimming Rate:35 1b./hr.(15.9 kg/hr) Solids Strainer Capacity:.2.5 gallons(9.51) ^- 3"Inlet/Outlet(75 mm) IV ' F yr 350W/115V/60Hz* W-500-15 50 GPM (3a15 1/s) Exterior Construction:304 Stainless'Steel,Bright Finish Skimming Rate:35 lb./hr.(15.9.kg/hr) Solids Strainer Ca aci :2.5 gallons(9.5`-l) `� p �' a 3"Inlet/Outlet(75 mm) 350W/115V/601iz* ant, w � - WI-300-AST 30 -PM (1 a8c, 1/5) , Exterior Construction:304 Stainless Steel;Bright Finish Skimming:Rate:,52.5 lb:/hr.(23.9 k ./hr) SIG DiPPERO %L200'-11 , Automatic-Solids Transfer Feature 3"Inlet/Outlet(75 mr)' 150OW/115V/60Hz* *220-240V/50hz models available "Big Dipper Model W-300-AST requires a separate facility-supplied 5 GPM(.3151/s)water supply for operation. 'Thermaco,Inc.provides a 0.5"`(13 mm)male connector to accommodate this connection.`Minimum water supply; pressure should be 40 PSI (2.76 Bar); maximum water supply pressure should be 70 PSI (4.83.Bar). Note.'lftstEk 'a>1lorM,. U:St:0?nPJY With"All'applicabge local, state and na iollal'cwdes f®r oyoOr area. 6 Thermaco,Inc.www.big�dippencom.1-800-633-4204 Copyright 912,003 Thermaco,Inc 1L L ago go a of 8 .., t��i � �f'x .�, C c ., tb �'�. � M' � r�''-"^•�V.+ .s-+n•�5•�"' �,,dj� i�'afi�,,�.,L�M-4-��'r�=w �6 - �"r-�n.�v `��` I'E� ,�?h4 �y`i.��y-"'-;,y�t'�l�� v.C�T ��'g �"`• i�~x` ^4� -- ./�� - �I ass �1r``,r^°' •, . gig- f.i2 'h"-18 s, S � • MEN xGt }O MEN IL4 MY, tu �wr a�z� � t}i � •'"T.�� ",z z, { r�r r:mr��'.�`�°,s - h ".�-`"r 6 i`�iL�4k:J• t '"'• �•'r�'? � `��... ��Y'' ��, :a tom' i S C� �?`�+3�'�,tea t'"[ W� =c''�`• i.�;.�r},�.a �y �"t-.� 'c��s��.h:{� F t j, r � y "ems' - o .o:' a - � -•• ' 33 e tea, c de Ir co S/ysr --� January 19, 1995 Calvin Punzalan 23T Whites Path South Yarmouth,MA 02664 RE: 40 Industry Road, Cotuit Dear Mr.Punzalan: Your request for a variance from the Board of Health Regulation #10 (Part II: Section 1.00) which requires the installation of a grease trap,is not granted. You may, however, install a grease recovery device in addition to an under-the-sink grease interceptor . You are granted a variance from the Board of Health Regulation #11, (Part II Section 1.00) which requires separate toilet facilities for male and female employees which are conveniently located. This variance is granted with the following conditions: (1) Seating for patrons is not authorized. (2) No more than 12 employees are authorized within this food service establishment at one time. (3) This variance decision letter shall be posted on the wall adjacent to the food service permit in an easily accessible location for viewing by a health inspector anytime inspections are condGcted at this establishment. (4) The applicant shall obtain permission from the Plumbing Inspector who enforces the Massachusetts plumbing Code. (5) This variance is not transferable to anyone other than the applicant,Calvin Punzalan. (6) This variance may be revoked anytime unsanitary conditions are observed. Calvin This variance is granted because one bathroom will be provided within the same area(Unit#5)as the food service establishment. The second bathroom will be located on the second floor above the business. It is the opinion of the Board that the second bathroom will be convenient to the employees. Very truly yours, Brian R. Grady,R.S.,Chairman Susan G.Rask,R.S. Board of Health Town of Barnstable . BRG/bcs cc: Edward Jenkins Ralph Crossen Zoning Board of Appeals calvin McKean Thomas To: Ritchie Carol-Ann Subject: SITE PLAN REVIEW#62-94/DOMINO'S PIZZA I am in receipt of the site plan review application to change the use of an office into a pizza shop at 40 Industrial Road Cotuit. I offer the following comments: *The State Sanitary Code, Article X, requires a three compartment sink which is not shown on the submitted floor plan. *Separate male and female bathrooms are required by the Board of Health. Only one bathroom (with one toilet) is shown on the submitted floor plan. *There is no in-ground grease trap plan shown on the submitted septic system plan. The Town of Barnstable Board of Health requires the installation of inground grease traps at all food service establishments. *The dumpster location is not shown on the site plan. Page 1 i r McKean Thomas - To: Ritchie Carol-Ann Subject: SP#62-94 and#03-95/Domino's Pizza and Box Car Willys SP#62-94/Domino's Pizza r Revised plans were received on January 24, 1995 showing a grease recovery device. The applicant also obtained a variance for placement of the second bathroom in the second floor unit area above Unit#5. Therefore, I have no objection to site plan review approval at this time. SP#03-95/Box Car Willys A Board of Health meeting is scheduled to be held on February 7, 1995 at which time Mr. Plannishek will request a variance to expand the outside dining area (for additional seating). I reviewed the submitted plans received on January 23, 199.5; 1 have no objection to moving forward at site plan review contingent upon the applicant receiving a Board of Health variance for additional seating in the outside dining area. Page 1 hum.- GOWN OF BARNSTABLE SITE PLAN REVIEW DATE: December 30, 1994 TO: Tom McKean FROM: Carol Ann Ritchie, Site Plan Review Coordinator RE: Site Plan Review#: 62-94 Domino's Pizza, 40 Industrial Road, Cotuit Map/Parcel: 58-28 Proposal: Change of use, office space to pizza shop. 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 10, 1995. I<havethe 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. 4 (Signature) r ry 7 A 4 qqr,r DORMER4*a8a 10'-0" I 2+d FIDOR:MCYttOOOI< 80'-O' 10'-0' a o'•O" FLOOR T yam, 0" 39'•O' -- ( . .s _ . — .� Q'CONCRETE�IOCI(f fiSF 1 UNIT#13 - LOWER UNIT A 12 - LOWER ro•-o- I WAREHOUSE WAREHOUSE I ( I 1 OVERHEAD at•`.;:,•' ;i DOOR I Is'-7—^ ►— 13• CONCRETE FLOOIt,::�1 . rr�cAc I _m 3'tf a'-o', s'•o" s'•o-1 4'•0'3••Or i UMT 013 - UPPER L"T 0 12 - UPPER STORAGE 32•-a. « STORAGE Fw- I12'-o T. i I2'-o' 11.pI CONCRETE� O I o ' ' a efoilfy c n c :h.Ys r � t eyTd ',. 0 0 O stairs TYPICAL SE m I do" e e 'fors o ( NO WALE �, I n'- I n' '1- .... 4'-d, 3'0" 5.0 4'0 _ e U ( I UNIT#11 - LOWER UNIT 0 10 - LOWER I I U 7• m UOWT 0 11'- UPPER _w --wr!10 - UPPER Gt Z WAREHOUSE WAREHOUSE i - c� • L—_— Z Q a S70RAGE STORAGE ELEVATIONS :mac-ts' s ' _7. _ ( ( CL 38'-9' I 38,_9- a I 32'--4° 32,_2. _.... 1 ,. - . tid•dl Q I , FRONT SECI'ICM'""� El. O I W I I w ,. I Z W CELlr10 OLi. E,p O I 38'-9" 38'-9° aNN. iv m Z UNIT#9 - LOWER UNIT AI B - LOWER r—— 2 I � m ; a2'-2' 3 t'-t' T: ' 2nd FLOOR'-e32 w:4 +- I o I v.; I 2ndCELllG.90.4 -Per WAREHOUSE WAREHOUSE u O I ;, ; I r•t- T LNT/9 - UPPER UNIT 0 B - UPPER REAR 3=0N 3=d a'-d' s-o" STORAGE : STORAGE 4 I _ t a � 1.r FLOOR.c9a 10 I I I JI'•p• R'-O' - Iz'- r1'•O' 1 M CELM.eLc +11 iP9 Y' v I o I I + stairs shis 2nd FLOOR.83.4 I " darn - e �'da� I 2nd CEILAW 90.3... s/oir� darn. 'v- dmMs 1� T 3'•d d•O" 3'-d 5•-O" a'• 3 OVERHEAD b,. m UNIT�Y 7 - LOWER UNIT 6 - LOWER I TYPICAL I 7'•z• a UMT 0 7 - UPPER + -LAWT 0 6 - UPPER ITT WAREHOUSE I WAREHOUSE I--—— ( : u STORAGE I ;, r'b STORAGE a. 38 9" I 38 11' I I 'i 3t'..!• !!'-2' I � .. •. -:`.. \unurms o - 4 CD coroN'sPACE i ,10A-.eosn m ''��— COMMON AREA - O O m m O COMFION SPACE a �► slsfs Born ar e'•I- e I aa• UNIT#I - RETAIL UNIT A 2 - RETAIL UNIT A 3 - RETAIL 1 UNIT AI 4 - RETAIL UNIT 0 5 - RETAIL i m T 1 UNIT%14 UMT 116 " OFFICE UNIT 0 16 IB•-8.1/2" 19'-7- IV-6* re'-6' le'-9•vz' g UNIT 015 OFFICE UNIT /17 OFffCE a t v � 'in OFFICE OFFICE v ID v � � '� ^ v ! 16'-d Id'•I' 19'-8• la'•1' '" le'•0• ' FI ..,�'}�'�ht:' 12 m a M c 4'•f•1�2 13 • • j¢� 3�0' 4'•IO•v2' a'•9-v2' • ' a'•f-1/2- - . 7••d• .:11• A A N N 1 « L I5 w w w w w 111 16 - .aKW CONCRETE APRON ---- ----- ------ ----- __ 17 ---------- —) is COMMON SPACE----------- I rw_^ 100'-0• I CERTFY TNAT TH13 R.AXPULCr 1st FLOOR PLAN AND ACCURATELY CEI'ICii u Lo rour, crRraN,aw tom" OF THE UPM 11 JM8EIIEt rTN OU3K: 2nd FLOOR PLAN 18,As DUU. - 'y,a,,... DaTE� 7v cc SHEEP I OF W•• ,i , 'Y'��y.I�.,L!+�yL4�d►••: +`��.jtiy ! .rid INDUSTRY, 2e. ' aN�•��(;,'s. t ROAD `� t;,,�C�' +�; t �;•;w�•��, C 1Nf' I.•�IF» 10 LOCUS MAP - y, • .. i'a i .. „ 1 y Z ..:. .. . + a• .. r r. •„►', :f••�.�•C•' .4tS .. 4 't. 1:25 000 - x _.ONE: S 8 D MAP 58 - PCL. 28 ZOE F. 1'4RNEP ,y 20 . 10 d�'.- �l '••r' 20 ai N 5 1 06 3 9 E --r C.S. FND. 57. 35 p/S STF it �0�, 1 edg of po e t 6 20 F P� VED PARKING L 0 T I I .a;r. i \ e , ' I 80. 00 1' BUILDING �•. ±. 1 � / v(�` 1 -':�r.•�f , . ..:, ,. o.. w •;�'.t ��.�:Y»_ 't-y',-'•�-++."Rs.�;in�'i-+l!•e'• .p f'ix, _,v. ' I A co r� K. - - • Apron • 1 � r c� (((tlYYy j UN1 TS #6 to 1 ,F SECTION . HIS SEC 7 co 11 ' O WAREHOUSES - LOWER GE - UPPER - S TORA O LLJ ._ (''onC. �,� I /0. 00 THIS SEC TION /0.00 ' .�..ZCOnC. - S/ep , Step / RETAIL UNITS #1 to, #5 - LOWER ti o Z T I \ A I Conc. I O - Conc. 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