Loading...
HomeMy WebLinkAboutCAPE COD CHOCOLATIER - FOOD (2) Cape Cod Choclatier 1600 Falmouth Rd. Unts.7&81 Centerville Olq A J CASUALe ' Town of Barnstable Bo nRTD. OFHEALTH Norman Board of Health Donald A.Gaudagnoli,M.D. '� FlAlititiTA1SLE. F.P.(Thomas)Lee,. ��+39• �� 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. Ito m 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: 286 Issue Date: 01/01/2022 DBA: CAPE COD CHOCOLATIER OWNER: CAPE COD CHOCOLATIER INC Y Location of Establishment: 1600 FALMOUTH ROAD, UNIT 12 CENTERVILLE„ MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: 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 I Restrictions: Variance wsa granted for one toilet. For OfficnI ' Initials• Town Of Barnstable Dates aid �a — B, „B Inspectional Services MASS.. public Health Division Cheek ', l fO MAC i Ti�pmas McKean;Director 200 t'blarn Street, Hyannis,MA.02601 Offi e: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP ..,,,,,,,,, R.ENEWAL NAME OF FOOD ESTABLISHMENT: '&"oc c. k mn(G.�i``Q R. F ADDRESS OF FOOD ESTABLISHiNIENT: �U0,C0 4- J vylC-)i j C e c MAILING ADDRESS(IF DIFFERENT FROM ABOVE)- E-MAIL ADDRESS: 1 e C t1 �✓i ' t r lV�✓"1 kA TELEPHONE NUMBER OF FOOD ESTABLISHMENT: �) - � TOTAL NUMBER OF BATHROOMS: _ r' , r •C Z ya 4c } WELL WATER: YES_..... NO_.__ Z..(A.NNL3Ai.WATER ANALYSIS REQUIRED) AN,NUA.L. ✓ SEASONAL; DATES OF OPERATION: l Ifs i I TO�! 31 /ra NUMBER OF SEATS. INSIDE: OUTSIDE: TOTAL: r SEATENG: MUST OBTAIN A COMMON VI.CTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE:DINING REMINDER*,** OUTSIDE DINING MUST BE APP OVED BY THE HEALTH DIV.AN.D LICFNSINICC,AND.MEET OUTSIDE DINING REO UIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR.CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY requir d for TCS'foods(foods requiring refrigerationlfreezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT 1V XCHINES ... (MONTHLY LAB ANALYSIS REQUIRED) ->-CATERING.... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) ( ** SEASONAL; MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALT H DIV. FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q\Appiicasion FormsTOODAPP 2020.doe 3 l OWNER INFORMATION:, FULL NAME OF APPIACANT 1�i SOLE OWNER: YES 1. (.)_ D t :ll 0G-2— OWNER PHONE# `tea -7 3 7— 135 l ADDRESS i 2 ,fir L. CORPORATE OWNER- ��- X C L i CORPORATE ADDRESS: c c �a . ; r� ll M�� c� z_ PERSON IN CHARGE OF DAILY C,PERATJONS: 1 CIO Lisa(2) Certified Food Protection Managers AND at least(I) Allergen Awareness Certified Staff All FOOD ESTABLISHME T$ must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTlFICAATES** The Health Div. will NOT use past years'records. You niust provide new copies and PEST THE CERTIFICATES at your food.establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 5qj J �3 r = ~1,..34 AY rt 9/L 1 f-,d .E♦ f- Sl F & �ll ( ;7'�"' /✓ .✓ 2. d�- f1 1 ' 1 U SIG `ATU i,, F.APPLICANT" DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including ntobile trucks most be inspected by the Realth Div. prior to Opening'I Please call Health) iv, at 08-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: FrozV desserts must be tested by a State Certified lab prior to oPeni.ng and monthly thereafter, with sample results.subrnitted to the I161th Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Perniit until the above terins are niet. l - t CATERING POLICY: Anyone.who�atcrs within the Town of Barnstable must notify thcTown by fax or mail prior to catering . event. You ntust complete a catering n tice found at httn:,tr m- vvvw.tonofbarnstable.uslhealthdivision/apulications.asy. OUTDOOR COOKING: Outdoor cooking.preparation„or display of any food product by a food establishn-tent is prohibited. NOTICE: Permits run annually from January l st to Dec.3l y`each calendar year. IT. IS YOUR RESPONSIBILITY TO RETURN T14E COMPLETED APPLIC:r TIO7 (Si AND R:EQWIR.ED FEES.BY DEC Ist. I t i t I 4 QA,Appiication FarrinsWOODARP REV3-2019.d 6z TOWN OF BARNSTABLE. _ HEALTH INSPECTOR'S Establishment Name: Date: Page: 1 Of ( ^. OFFICE HOURS --Y-- P PUBLIC HEALTH DIVISION 8:00-,9:30A.M. BARNSTABLE, • 200 MAIN STREET 3:30-4:30 RM. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified A 63q. �0� - HYANNIS,MA 02601 sos-asz-4R644 No Reference R-Red.Item - - PLEASE PRINT CLEARLY 'FON1P�p FOOD ESTABLISHMENT INSPECTION REPORT I, Name DAX t? Date L/ Tvoe of Tjaq of Insipection O ✓ G �Sr vu 1Opegatipn outin Address ` d-D��L&_yLA ` Risk Food Service Re-inspection O T Level Retail Previous Inspection d h Telephone Residential Kitchen Date: Mobile Pre-operation S b � Owner HACCP Y/N Temporary Suspect Illness �� A n Caterer General Complaint121' 1.S �I /vI Person in Charge(PIC) �� ( n Time Bed&Breakfast HACCP In: Oth 1. t 4y � � l/livt I.✓I l�l Inspector S'�7 Out: (�` t 36t- - Each violation checked r quires an explanation on the narrative page(s)and a citation of specific provision(s)violated. 8 Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009 E �-3 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) /W1 i 0\"\ V-a GL 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) l9 ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ��✓ ��Gl/l ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ��'12 ��a� OJ c� U ❑ 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) r Q ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP G / +e c� Oa + ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 'Xinsp; ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Base today,the items ❑ go Embar checked indicate violations of 105 CMR 590.000/Federal Food Code. Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 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 , 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 no -critical violations=C. :Inspector's Signatu a Pri30.Other DATE OF RE-INSPECTION: 31.Dump er screened from public view Permit Posted? �Y N Grease Trap Previous Pumping Date Grease Rendered Y N / #Seats Observed Frozen Dessert Machines: N PIC's Sigpatufe Print: Outside Dining Y v Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N ,.-'..-- ...-'"'s .... .P6.�^y.l✓.;,'7K-.�....--.r- rvN•...r...+^F� -.�-..;�,.v Y-..�.. -f. ..-,r".-.as-,-r^-,,.--�..e--�--���cs..-...��...+n•-��.ti......+....., ....�.. rsw.+-..5.--.+...�+..-w.ti .. ...�. - • -,. - ' .. .. _♦ Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding . 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved.Additives Contamination from Raw Ingredients 1 S 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* Require Reporting by Food Employees and Contamination from the Environment 7-102.11 1 Common Name-Working Containers* 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* F Employee r An * 590.003(F) Responsibility of A Foodo 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 PP P * 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils ( ) 9 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ' ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective titnoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS i 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )ro) 3-201.17 Game Animals* Good Hygienic Practices 1 T Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165'F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (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 ( ) g Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the * 3-403.11E Remaining 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction*. Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 5-205.11 Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention* Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Forrnbackfi-2doc *Denotes critical item in the federal 1999 Food.Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. F IME r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: g, % I / Date: Page: of OFFICE HOURS tv PUBLIC HEALTH DIVISION 8:00-930A.M. &,R �r�E. 200 MAIN STREET s:3o-a3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION /PLAN OF CORRECTION Date Verified MASS. g MON.-FRI. ,639•e 0 HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item P A P INT LEARL FOOD ESTABLISHMENT INSP CT ON REPORT /' Name Date ape of Ins pection j O s outin /. 1VA r Address Risk o Servi nspectio Level �RetailPrevious I n'Telephone sldential Kitchen Date: Mobile Pre-oper io ea A Owner HACCP Y/N Temporary Suspect I n ss Caterer General Complaint y' ` ^- Person in Charge(PIC) Time Bed&Breakfast HACCP A NI htiT I Other Inspector ut: Each violation checked requires an explanation on the narrativ age(s)and a citation of specific provision(s)violated. 14 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 i 9 AT ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities I IV EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives /111 Ali lk ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals v AL FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 1714.Food and Water from Approved Source ❑ 16.Cooking Temperatures. ❑ 5.Receiving/Condition ❑ 17.Reheating �® ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding 46 PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control J v ❑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 ViolatioVIWO 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,t e it ms F] Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4non-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 scored automatically 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 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non Critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) g violation,4 to 8 non-critical vi ations• C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: I ec Si to Print: i 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N r " #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI ature Print: Self Service- Wait Service Provided Grease Trap Size Variance Letter Posted Y N e C� �� 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* $ Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-102.11 Common Name-Working Containers* 590.004(F) P g * 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 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(D) Exclusions and Restrictions*590.003(E) Removal of Exclusions and Disposition of Adulterated 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Re or of Food*Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP Restrictions ted or Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* Eff cave uuzovi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-1 155 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats- 55°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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( )-(D) Violations of Section 590.009(A)-(D)in cater-. * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing g' P � Game and Mid 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* * Other 590.009 violations relating to good retail ( ) * 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 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 * (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 fvodborne * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g 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 ( ) 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* 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �p THE Tpk, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Cq QJ Cho(q H-6" Date: 7/Ml (l Page: �i[ q OFFICE HOURS BARNSTABLE.O.n PUBLIC 2 0 MAN STREET 3:30 4:30 P.M. DIVISION - - - : 0-9:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified - �A M639,s�0g HYANNIS,MA 02601 M-8 -46 No Reference R-Red Item PLEASE PRINT CLEARLY rF0 MP'� 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Ca �.�`a�-t Date Type Tyue of of Ins ection _ m���� a`-� Operation(s) outine J Risk Food Service � pection _ Address Ib eO FQ1 M� �d orv. 1lt Level F ail Previous Inspection Telephone _ ential Kitchen Date: �GV S _ ` 0 Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness t (`4 _ QO Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other _ Inspector Q Q gU(n3 Out: V1 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) ❑ f L owl I��rs 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 ❑ S.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 A I 19 ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories b�16-r7) 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 B=One critical violation and less than 4non-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 lack of no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9non-critical: If no critical ' water,sewage back-up,infestation of rodents or insects,or la 28.Poisonous or Toxic Materials;. (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,"7 to 8 non-critical violations. If 1 critical refrigeration. y 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N """ ""CCCJJJ 6EE JJJ V / V� #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's SignalAlre Print: Self Service Wait Service Provided Grease Trap Size Variance_ Letter Posted Y N Dumpster Screen? Y N vL U l Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk-Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 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-s _ 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* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140'F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130'F* 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* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR. 3-306.14(A)(B)Resumed Food and 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 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(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System * gg Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* effe c"°e 1°12001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009 A ( )-(D)' Chemical ( )-(D) Violations of Section 590.009 A m cater- Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Mid Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 1650F 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) 3-202.15 Package Integrity (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 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140'F to 70°F 3-203.12 Shellstock Identification Maintained * Conveniently Located and Accessible Within 2 Hours and From 70'F to 41'F/45'F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices - 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials 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* 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. r Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. ratiLEI = Paul J.Canniff,D.M.D. n F.P. Thomas Lee Alternate *6)97 ]k 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: 286 Issue Date: 01/01/2021 DBA: CAPE COD CHOCOLATIER OWNER: ROBERT J. & CAROL A. CRONIN Location of Establishment: 1600 FALMOUTH ROAD, UNIT 12 CENTERVILLE„ MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: In r i doo Seat n 0 OutdoorSeatin 0 Total Seating: 0 g g g I 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: Variance wsa granted for one toilet. Town of Barnstable Office Oce Use Only: Initials: ��tMETpN,� Date Paid 4 (P Z Amt Pd$2SD— ,sTAB�� : Inspectional Services v Masa Check# � � � 1639. s,. Public Health Division ATfO MA't Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 i APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE IL-(TZ0 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: e (—®$ C` `6C-O 6- I e r— ADDRESS OF FOOD ESTABLISHMENT: a 000 RA , �✓\i 4 l� , ��� v� lle- j/ MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: l n` �l� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( - TOTAL NUMBER OF BATHROOMS:/ WELL WATER: YES NO / ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: vl 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? p 06- IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q\Application FormsTOODAPP 2020.doc ! s OWNER INFORMATION- FULL NAME OF APPLICANT 1 ►b -e—,r + �_� �e9 e'1 i(1 0 SOLE OWNERS NO D.O.B OWNER PHONE# ADDRESS_JAB k 7— U0,0 Lk, Va Z A,A- e2 S3-7 VKI CORPORATE OWNER: eajae CA C,koco to--fl6r- VZ C tX CORPORATE ADDRESS: C) �(� 6Li �-- PERSON IN CHARGE OF DAILY OPERATIONS: Oa/Lo (20 6 Cro A 11-`) 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 9 4ggS i 1.0 ro 1 Cf-of\%x A 9- /r D)31. �� ► l OA S6�� � / 'R625 r 1 Z l /S / 2OZO SIGN' ATUR" F APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/aI)plications.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 FortnsTOODAPP REV3-2019.doe rti Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli, M.D. � �+RNSTAOM. John T.Norman 1619�- F.P. Thomas Lee Alternate {, �� 200 Main Street, Hyannis, MA 02601 aca 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: 286 Issue Date: 12/20/18 DBA: CAPE COD CHOCOLATIER OWNER: ROBERTJ. & CAROL A. CRONIN Location of Establishment: 1600 FALMOUTH ROAD, UNITS 7 & 8 CENTERVILLE MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 _ FEES - _. FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - - --------- --- MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Variance wsa granted for one toilet. FINE Tp� Initials: Town of Barnstable i = Date Paid 1 AmLPd$ 9BARNgrABLE, Inspectional Services , i639. Check S� �rFD►+�'�p Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 /IAPP�JLIC�A�TION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 6 SIa 6/0 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT; �Q. O `rG YVl U t)4I �_ Pt_ C d �tjV qlj l MAILING ADDRESS(IF DIFFERENT FROM ABOVE): V o t' /Z D 2 E-MAIL ADDRESS: 6VD oi-n a d r co M TELEPHONE NUMBER OF FOOD ESTABLISHMENT: !%� `1 ! q TOTAL NUMBER OF BATHROOMS: I WELL WATER: YES NOV ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V SEASONAL: DATES OF OPERATION: / / TO I NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD 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:\Application Forms\FOODAPPREV2018.doc e PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES NO , OD..�O.B l Ia W-OWN�E�R�(PHONE # ( bl ✓ rl`9 q,36 / ADDRESS Q l'l�+° r� V 1(J-e/`rl f(t a Qa s3 / CORPORATE OWNER: FEDERAL ID NO. : p�(� �il Z ItG CORPORATE ADDRESS: n PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Xlkuyen Awareness Expiration Date 1. 0,-0- 9, oa a6d31. ! D9 / 310 2. f;a kf+ C "�M i�/ i�0)3 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 openinS!! 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.asl). 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 Pen-nit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec. 3l't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q\Application FormsT00DAPPREV2018.doc • 1 E i io j Menu: The Cape Cod Chocolatier proposed food product okferings; Chocolate Shop(current offering in Sandwich&W. Yarmouth locations) (These items are made on premises) Assorted chocolates&truffles Fudge Nut Brittles I (Other candy items are purchased and re-sold); Taffy,hard candies,jams&jellies,jelly beans, licorice etc. *Coffee&beverage Hot&iced Coffee Frozen fruit drinks (from Vita mix Blender) Espresso drinks i Hot&iced tea Cold bottled drinks (re-sale items) *Dry Baked goods(re-sale) Bagels (w/Cream cheese) Muffins Scones ' Croissants Short bread cookies *Ice Cream/scooped -Cones -IC dishes -sundaes i -frap drinks - i i We have been in the"Chocolate Shop/candy making"business since 2002. We anticipate that these areas will continue to be our primary area of business and the reason we would need a"candy kitchen"in this location. *The coffee,baked goods, and ice cream product offerings are new areas of business that we are proposing for the Bell Tower Mall Location in Centerville. As such we do not have a.formal menu at this time. Although we will be handlings"serving"these items to our customers,we do not plan to make or bake off these items on the premises and will offer counter service only. i i { t l YOU WISH TO �OPEN A BUSINESS? you DATE: Fill in please: BUSINESS YOUR HOME ADORESS: /�l NAME OF CORPORATION: C-0 d- ' When starting a new business there are several thin,gs you must do in order to be in compliance with the rules and 1-egUlations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GOTO2OOK8ain St. - (corner nfYa,mnvxh *d & Main Street) to n,akc sure YOU have the appropriate permits and |ionnxns rcqui,nd to |rgaUyoparatn yovr hupincns in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BO8RD OF HEALTH This individual h..— 1, n inf rn . f t e p f6tjUire ents that pertain to this type of business. Authorized gnature* COMMENTS: � CONSUMERAFFAIR LICEIINIGAUTHORITY) This individual he med of the lic rl�c � /]v�J/~ / [�/ � ~' ~" / /� °""..m.ze �y//uvu/e u V v COMME »~ � Town of Barnstable Barnstable �AABLE. 1 MASS. Board of Health 0gq. �ro 0 39. 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul Canniff,D.M.D. August 21, 2013 Ms. Carol Cronin 12 Westerly Drive East Sandwich, MA RE: Variance to" .-,. perate with`one Restrooh! Facility- Cape Cod C'hocolatie'r Dear Ms. Cronin, You are granted a variance to utilize the existing toilet facility for the operation of a food establishment at Cape Cod Chocolatier, 1600 Falmouth Road, Unit# 12, Centerville. The variance granted is as follows: Section 322-4 Toilet Facilities To utilize one restroom in lieu of the requirement to two provide separate male and female toilet facilities for male and female patrons and employees. The variance is granted with the following conditions: (1) Seating is not authorized. Dining room chairs shall not be installed onsite at any time. (2) This variance decision letter shall be posted on the wall adjacent to the food permit in an area which is easily accessible to be read by a health inspector anytime routine inspections are conducted. (3) This variance is not transferable to anyone other than the applicant. In the event that this business is sold or transferred, both the owner of the building and the licensee have the duty to inform any and all potential purchasers of the existence of these variances and the fact the Board has explicitly made them non-transferable. Sincerely yours, Wayne Miller, M.D. Chairman Board of Health Town of Barnstable Q:\WPFILES\CapeCodChocolatiersVariance20l3.doc 1 To: Town of Barnstable Regulatory Services Ap7l 24, 2008 Public Health Division I am writing in regard to NSF certification of our chocolate/candy equipment. Our equipment does not have NSF approval, In fact,to my knowledge there is no chocolate/candy equipment manufacturer that has NSF approval. The reasons for this include; 4 1] The inherent nature of chocolate; low moisture (less that 1 %) &high sugar. These conditions do not support microbial growth. Other products such as fudge and hard candy that are mostly sugar and have low water activity. 2] Because of the specialized equipment due to the small size of the retail candy making industry; manufacturer of equipment do not seek NSF approval. After my search of the NSF web site came up short on any information regarding chocolate/candy equipment or any guidelines for such equipment, I called the NSF and spoke to them regarding this. They supported the above reasons for the lack of NSF approved chocolate/candy equipment or guidelines for them. They provided me with these suggestions; 1] Select equipment that has food contact surfaces that are approved for food use. 2] Equipment should be should be easily disassembled, cleaned, sanitized. i I 3] Areas outside the food contact.zones should also be designed to be kept clean. 4] If necessary,have the manufacturer provide a list of materials in the food contact zone and/or allow for inspection of equipment prior to use. The equipment that we use is selected with the public safety and our reputation in mind. The Chocolate equipment we currently use is made by the leader in of chocolate equipment of this size(Hilliard's Chocolate Systems). The food contact zones are made of stainless, aluminum and food grade nylon. This equipment is easily disassembled, cleaned and sanitized. In addition they have cover sets that protect from dust or other physical contamination to the chocolate. Please let me know if additional information is needed in regard to our chocolate/candy equipment. i M i 1 i i i i { 1 5 t 3 ' 1 i i Miscellaneous items from check list Prepared by Rob Cronin 1 Cut sheets on all food equipment The coffee/beverage,baked goods and ice cream parts of this pFoposal represent new business segments to us. For this reason we are in the process df selecting equipment to be used in these areas of our business. Although we have made'decisions on the major pieces of food equipment(cut sheets included)we are still evaluating the smaller equipment and hand tools. We understand that NSF certification will be required on all food equipment that is selected for these segments of our business. ServSafe.Certification i We clearly understand the importance of the supervision of a food service by a Servsafe Certified professional. I currently am ServSafe Certified and am present during the hours of operation. My wife is signed up for the May-Hyannis ServSaafe course and should be Certified prior to opening. fl I i i i 9 i 1 9 i d I j i 1 1 i 1 l i i I l ' dumpster 13 e h.1 n d P l►t-c-A 509 09Y - deltvery exit entrance Hot water _ __. Storage/papei goods Heater ,--v Employee Mop s' Lockers a Office Toxic&Poisonous material storage--� Hood stainless steel table b - stoves Dry storage CAND4 ChocolatemeltersLAQ Dry storage � r� 4- Chocolate�enrober Cooling tunnel - t ........-... Walk-in -� Cooler stainless table Coffee --Coffee Grinder S i n Freezer Bre er _ f Utility Fre , ice cream red fudge Hands free I Sink �,. dipping cabinet area fixtures -^----baked. ® en spresso:goods {N Cd Restrooms- ! handicap accessible U C) 0 Olf-i 6 ..... ( L�`g — ( . x .� ' .. )C) 0'UO5�"A C _: L-J L P A� �_. -...g. counter seatui counter seating A rn� kou.,�P-r tIALt v i 5 7d'g ( `�-0_ 9_vVN_6JL4 C O-A u CI Application Fee: $1.00.00 plus Permit Fee- $250.00 or $200.00 - $285 Supermarkets • Name of Business: 12 F— L DATE Address: e V L) Owner: _c.(`c� a n `i► YYl #Seats and Standing Capacity: Indoors: *.')L ? Outdoors: RESTAURANTS FOR STAFF USE Approved Denied Menu t/ Floor. Plans— Recei.ved, 4/4 Staff Meeting Review Date: Appliation form `l� , ✓ hi-ground Grease Trap or GRD with a variance. � _ d� re co 2t� t.✓ Sewage Upgraded or Town Sewer ` 1 ' Water Supply- Approved Source, if w 11, annual testing& licensed Operator tl\-j� ✓ Handwash Sinks—location, number, design and signs v Touchless fixtures I �J Three Compartment Sink and Dishwasher (high or low temp?) Visual or audible device. Test strips, Log Book - Low sanitizer - Type of Sanitizer: Quats, Iodine, or Bleach? (Show storage Location on Plan) v Mop Sint:—Mops to be hung properly and dried tl' Frozen Dessert Machine (Daily) Yes No ✓ v Drain Boards air dry utensils and equipment Ventilation. Systems for Hood n SQI� Ue&-^ _Number of Bathrooms Proposed: , _ 1. Touchless.Fixtures Y 2. Ventilation Systems y 3. Self-closing door(if located off the kitchen) n(/q 4. Soap Dispensers—Mounted 5. Paper Towels Mounted Y t� 6. Handwashing Sign Y 7. Women's Room— y • Covered trash bin or sanitary napkin dispenser Y Floors, Walls, Ceilings (Smooth easily cleanable surfaces) j FINISH SCHEDULE [SEE ADDENDUM ATTACHED] y `� Lighting—Sufficient/lighting shielded Refuse containers Covered (suff cient number and size, durable easily cleaned, insect & rodent.resistant) .Dumpster impervious ground and blocked.from public view. kT Ar Touchless sensor-operated faucets at restroom sinks. 2'y Touchless sensor-operated faucets in handwash sinks in food preparation areas. a� 0M Fton 01�� -1`FS� Dry storage room location shown on floor plan Lockers for employees in designated area. Poisonous or Toxic Materials (storage located.marked on plan, labeled containers) y . Cut Sheets (for all food equipment) U Screens for Windows and Doors • Plan approval shall be granted or denied within 30 days. • This list is not inclusive of all Federal, State and Local requirements Revised 04/17/2007 Q:wpfiles/Reskitl0.doc THE C RMET March 20, 1996 Mr. Peter T. Doyle, Supervisor Town of Barnstable Water Pollution Control Division 617 Bearse's Way Hyannis, MA 02601 RE: Grease Trap (Your Letter of March 15) Dear Mr. Doyle: Thank you for your letter advising me that the records at WPC indicate an urgent need to pump the grease trap that we utilize at Bell Tower Mall. We last pumped the grease trap on August 24, 1995.(copy of work order enclosed). After that , Bell Tower Corporation assumed responsibility for regular pumping because the grease trap is a shared facility with other tenants. I have forwarded your letter to Bell Tower Corporation at 80 First Street in Bridgewater, MA 02324. Additionally, I have placed a call to Mr. Callahan at Bell Tower Corporation and will follow-up with him to ensure that a regular pumping schedule is adhered to. Sincerely yours, David E. Chase CC: John Callahan_ LToh1M Keon- 1600 Falmouth Road Unit 10 Bell Tower Mall Centerville, MA 02632 • 775-4946 TOWN Or BARNSTABLR DEPARTMENT Or PUBLIC WORKS WATER POLLUTION CONTROL DIVISION 617 BEARSE'S WAY HYANNIS, MA 02601 (508) 790-6335 Date: March 15, 1996 To: Casual Gourmet 1600 Falmouth Road Centerville,MA Subject: Grease trap The Town of Barnstable requires.all restaurants to have a grease trap installed so that grease does not enter the sewer system. The purpose of a grease trap is to prevent the grease from blocking the piping. Blockages cause flooding of buildings and roadways with sewage. The grease trap needs to be pumped out on a regular basis. To ensure the effectiveness of the grease trap, the Town of Barnstable Board of Health and the Department of Public Works, Water Pollution Control Division(WPCD)monitor and enforce the attached regulation. Regulation, #310 CMR(Commonwealth of Massachusetts Regulation)Paragraph 15.351.2, sets the minimum standard for cleaning grease traps. WPCD monitors grease trap pumping and semiannually forwards a copy of this letter to the Board of Health. Our records indicate that your facility has not pumped its grease trap in the past year. When you apply for your seasonal restaurant license this year at the Health Department they will have our list indicating that your grease trap hasn't been pumped. They will require you to pump your grease trap before issuing the seasonal license. If you have questions call the above phone number. Your participation is essential and your cooperation appreciated. a Sincerely, r II ' Peter T. yle, Supervisor,WPCD enc. PD/eje v tv �ahrc: utrr�K�t�NI'OF ENVIRONtiIEN'I'AL PROTECTION i 5 340. continued �I (4) The Department shall maintain a list of all approved System Inspectors. The list shall be available for inspection or examination by any person. (5) The Department may revoke or suspend the approval and/or listing of a Systems Inspector after opportunity for a hearing conducted pursuant to M.G.L. c. 30A when it determines that the inspector has falsified or fraudulently altered a system inspection report or misrepresented the results of an inspection performed by the Inspector. (6) It shall be a violation of 310 CMR 15.000 for any person to falsify, Misrepresent fraudulently alter a system inspection report or the results of an inspection. or (7) System Inspectors shall submit the results of their inspection on a System Inspecti Report form approved by the Department to the approving authority toeethcr with the signed on statement at the bottom of the form certifying that the inspection has ban performed and any recommendations regarding upgrade, repair, or maintenance of the system made by the inspector in the form were made consistent with the Inspector's training and experience in the maintenance and proper functioning of on-site systems. (8) System Inspectors may perform system inspections required by 310 0MR 15.301 while acting as an agent of an approving authority (a fee may be assessed pursuant to M.G.L. c. 40, § 22F), or as an independent Pe agent of the system owner. . 15.350: Other Maintenance Requirements 15.351: Svstcm PumDine and Routine Maintenanc z; (1) Every septic tank or cesspool shall be pumped whenever necessary to ensure proper functioning of the system. Pumping is required whenever the top of the sludge or solids layer is within 12 inches or less of the bottom of the oudet tee or the top of the scum layer is ' within two inches of the top of the outlet tee or inches of the bottom of the outlet tee. the bottom of the scum layer is within two Pumping frequency is a function of use, although Pumping is typically necessary at least once every three years and recommended on an annual basis for a system with a domestic garbage grinder. Without limiting the foregoing, a septic tank or cesspool shall be pumped when the owner or operator is required to do so by the local approving authority or the Department_ Whenever a septic tank or cesspool is pumped, its condition shall be noted on a system pumping form approved by the Department, and the results shall be submitted to the local approving authority. Such notation of the system's condition on the system pumping form shall not constitute a System. Inspection Report submitted to the local approving authority in accordance with 310 C—,,,IR 15.340. (2) Grease traps shall be inspected monthly and shall be cleaned by a licensed septage hauler whenever the level of grease is:25% of the effective depth of the trap, or•at least every three months, whichever is sooner. 15.352: Increases in Desien Flow to System No person shall increase the actual or design flow to any cesspool or to any other sysum above the existing approved capacity, unless the system is upgraded. Upgrades to accept increased design flow shall be performed in full compliance with the requirements applicable to new construction unless a variance is allowed pursuant to 310 CIv1R 15.414. is 15.353: Emcrecncv Rcoair (1) Emergency repair or replacement of systems shall be limited to the following: (a) pumping of a septic tank or cesspool as frequently as necessary to prevent backup or breakout; and 4� 3P?4/95 (Effective 3/31/95) 310CMR - 550 Z0'd IN101 A i N- 9 { 1 q ; I .l •.I I �i � I P =GT00 ( B'ORTO.I,OTTI CONSTRUCTION$' INC. j ! 765 Wakeby Road i MIRSTONS MILLS, MA 02648 ! $6 I ! (508) 771.9399 . • . '. ' i i i (508) 428-8926 RATS OFORDCR i •I iCU6TOM3FrV ORDER No. PHONE MECHANIC H"F1 6TARTINC:DATE � QPpGR TAKEN BY ; ' ADDPE881 � I ' a a ' 1 ❑ DAY WORK ❑ CONTRACT, j 1 i ElWXTRA• l 1 ( JO&HAMt AND I OCATIQN ! • I ' ' . . � JDe vHONe. i ;• j 1 1 j { DescRIPTiON OF wWIIt 1 � 1 • • ..1 _ ! 1. I 1 .. 1. •f •I I I it 1 t , i . t • , I I I 1 I I I TOTAL UATMIAU • 7pTALu►etJR ' 1 DA I gmLEr RK ORD ,+ iIVA TOT AIV�OUNT. : t�: Q.4, ' o tine ❑ Total amount tar Sbna>!u for above works or be rr19tlad'afta!t' 1 ( sir► oomple16 1 Thereby admowfedge the saNtlActory oomplotlovi Of work ` i of the above desur boo work. ' i TOWN OF BARNSTABLE �OF TH E Taw ��Q,�♦� OFFICE OF s Bsaa9TeeL i BOARD OF HEALTH �' ■nee. �, °o i639- ��� 367 MAIN STREET 0 MAY k HYANNIS, MASS. 02601 June 23, 1995 David Chase and Olive Chase Casual Gourmet, Inc. Bell Tower Mall 1600 Falmouth Road Unit 10 Centerville, MA 02632 " RE: Casual Gourmet Restaurant Dear Mr. and Mrs. Chaser You are granted a variance from Regulation 14, of the Town of Barnstable Health Regulations for outside dining with the following conditions: (1) This dining area must strictly conform to the original submitted plan. All outdoor tables and chairs shall be located against the"planter wall"area. No tables and chairs are authorized against the building. (2) You are granted this variance on a trial basis. This variance is subject to revocation in the event violations affecting health or safety are observed. (3) You must receive approval of the licensing authority for a change of description of your premises which includes your outside dining area. (4) This variance is not transferable. (5) This variance letter shall be posted on the wall adjacent to your food service permit in an easily accessible location for viewing by an agent of the Board of Health anytime inspections are conducted. Sincerely yours, =R'S. , Chairman Board of health Town of Barnstable SGR/bcs bell TOWPOF BARNSTABLE Bpi THE TO w OFFICE OF Z HAH39TS33L i BOARD OF HEALTH MAO& p 00 i639, 367 MAIN STREET 'FO MpY k' HYANNIS, MASS.02601 May 22, 1995 David Chase and Olive Chase Casual Gourmet, Inc. Bell Tower Mall 1600 Falmouth Road Unit 10 Centerville, MA 02632 Dear Mr. and Mrs. Chase: You are granted a variance from Regulation 14, of the Town of Barnstable Health Regulations for outside dining with the following conditions: (1) This dining area must strictly conform to paragraph A, of the Board of Health minimum criteria for consideration of variances for outside dining Paragraph A designates a ten foot setback from a property line, sidewalk, or public access way. (2) You are granted this variance on a trial basis. This variance is subject to revocation in the event violations affecting health or safety are observed. (3) You must receive approval of the licensing authority for a change of description of your premises which includes your outside dining area. (4) This variance expires May 15, 1996 and must be renewed annually. (5) This variance is not transferable. 0 (6) This variance letter shall be posted on the wall adjacent to your food service permit in an easily accessible location for viewing by an agent of the Board of health anytime inspections are conducted. Sincerely yours, Ousan G. Ra3 , R.S. Chairman Board of Health Town of Barnstable SGR/bcs L r� Casual Gourmet - Floor/Equipment Plan 2/21/95 501011 7 1/4 IT1/2" 12' 1/4" l ADDRESS: Men's Bell Tower Mall N 1600 Falmouth Road Office/Store Room OfficeUnits 7&8(Assessors 10&11) Lathe's N Prep/Storage Centerville,MA 02632 375sf = is was er Hoodnsu s em Assessors Map209 Parcel14 N Charbroile � iv i M ! ! ZONING: HB _-_-____ - Kitchen UNIT SIZE:3,300sf ---------------- I Prep Tables w 0 in 600sf o Walk-In Refridgerator � PARKING REQUIRED: 13 300sf I 311/2 U _ Prep Sink inI Counter PARKING PROVIDED: 16.5 _o APPLICANT: � �231/4 Casual Gourmet, Inc. (0 Walk-In Freezer o PO Box 1116 11 Office Office Centerville,MA 02632 ii [e�7-,rr I I II PHONE: (508)775-4946 II ! ! IL--------��------------- Handl-Cep I�___ EXISTING SEPTIC: U U ! ! HendS Rotisserie Sa^�^u Men s 2,000 gal grease trap ------a In, ; ; 1,500 gal septic tank ------- , cooler 1,000 gal.leach pit Handl-Cap II Counter!i CafieeMachine Pastry Case 9yey Ladie's i jl og`` II II 0 I, Q -- - Remove Existing Wall b---� ___= l- -- -- -- -- -- -- -- ---- -- -- -- -- -- -_ --- Construct New Wall b ❑ 0 0 0 0 dining Room ° c❑o c❑o 000 0 0 00 000 0000000 Casual Gourmet - Floor/Equipment Plan 2/21/95 . 501011 — t 7 1/4 - 13' 1/2" 12' 1/4" I ADDRESS: Men's Bell Tower Mail N 1600 Falmouth Road Office/Store Room office � Unitsl&8(ASSeSSOrS 10&11) Ladle's � Centerville,MA 02632 PA Prep/Storage 375sf 1 1-100cl&AnSyls e kosors Wp 2W,Parcel 14 aJ fn r. i ZONING:HB hC� �� w Kitchen UNIT SIZE:3,300sf In 600Sf Prep Tables o o Walk-In Refridprator PARKING REQUIRED: 13 300sf 3„/2 PROWS : .r, Prep Sink �, counter PARKING, ..�.,&,0 .6., 0 1 � � APPLICANT: 231/4 Casual Gourmet,Inc. (0 Walk-In Freezer o �', ornoe ornca PO Box 1116 Centerville,MA 02632 PHONE: (508)775-4946 i c EXISTING SEPTIC: � Men'S / � Rotiasede '� 2,000 gal grease trap i 1,500 gal septic tank Cooler 1,000 gal leach pit Counter CaRaelediM PafSyCeSe �" Lad'ei �j Dining Room be remevecl 00 ,� ❑ O 0 0 q v 6 e c)S ee c h I-C-0 M 0 CL]o cE10 OLIO I- pave Ott/ SINUS �1-10 00 000 0000000 -/ 0 1 1 1 FRo,uT of I�oUSE �� lJ�O��5"?-e�I'� 0PTr l Ce (,rq 1 S /N.rU1A/C.Cj l� GBH c�a f 90ll11h* y /Qa�ks col/�Hcr S�ie/v�:, s��alal J J �Y /Opp pia<.Mao W�.. •t N 1Gw flgi/N � Mtrr BItR«y _ A•oF arp../6 4,e�f eoo��a,:'<<� \ _ < ;i P•/_< I.. --.... . y it .. .-.��. .. PiP7r/ a.- - � G,,O/ /-.cOrJoi �_ .r'-.w.. - a.t.s<� I �4�flti.�.4. ¢..ate '•U _ .?-'.}'' •P /.. a t °,<a a i.�ii, M:.P G09,PCL/4 \ l: 'y/ xr �� / / •'sG1 ,�a ZA `Y�]V rC Le !300 \' � � -/ ' ' r1►a-=o!•a'O�IPi a 15 C /3 Y/Q �•`/�VT'N MIN LOT•IQocoar I• I r2^y Z Cw .l - MIN.WIDTN./GO' I �j° I / /iy� r �O�P.s-.rt• O+Ttp P lfe HK" T9 a3E RI. f / / /�� °j • y\�"�' •r ' Sy / n+UBG f A:aP.i / am re r..... P...a cIr,ee n / /, { �(r° .'/� ./ ��,,/J+?P f / ,. \' <• (e i+= pr ir.: N o •NBT<o..,s �� , / >{ P�/{� ��� of r°/' -\ �, �/ ,v�t _ .. � _ n>. / 5 . '/ © �C�.•.M is ti n �< zcuoa co.<tawarr D_.rc0 wr.;..ef i�.•s<wa aq+ae•f r-.s a<_,,, :aarP<..,ca•_ {� r /' 'tea 1 '/:. `{I 4Z 16 ti P�•ve••P r...•w to t q/n/•, r<r. </rL•. • / P / / / / \�` h p Ce...w►le,ri A-aa 2'4&Ma{ P°ova•.a, as�Ti...o..•v �i \ \ - Pa // j .�<<♦ \ %4— Cer<.e.. 24.77. eN sr,•-•..<^,rr p..a,V- / %: r � PROPOSES PARKI — � i / _.� ,�:•di } b./ � ..R'•GVLPR ly.ao•L._ zae z 4 '/ �• '� r' -c ,' DRAINAGE PLAN { // \�\ /� r• a•�o <• OF PROPOSED BELL TOWER t J + ,a. SHOPPING CENTER LEGEND \\ \ / �': `={ / ��� v / IN BARNSTABLE (CENTERVILLEI MASS. / � '•-� / f t a: ea N/.._', v{i� FOR LEBEL-SOLLOWS DEV. CORP /aROPoaCka t'cewraa a//2��_ ` an t.P t•,t .. a REFERENCE BARN.REG. OF DEEDS PR es•oacp w.VT<R Mww �y�-„- -e: `\ 6dtDz• !�• - / BOOK 393 PAGE 78 -:: r,<oae Loc aro✓ T ltopoalD P / REVISIONS: SCALE: I'-30' DATE� 3/18�86 �- AYrc—rm a//a/V_i /..-wa./�••,- .-..n,.<../x nt e. _ _ _ I ..o... 3 t-'�"� MAACA O DG. / <'/�`c— BY CRAIG R. SHORT, P.E. w:a....vr•y(.•.�'"1- (wu.1) / 131 OLD ROUTE 132 �'P.a•.e. Roos orw<.,.r•,►Q_.._ / HYANNIS,MASS. 02661 o.<I�o<...a ce..,.<„t<a<o<vart ii/•PR e,r..< A° t OWN.BY cRa SHEET E-11 OF 4 FILE NO. I-555 I � II� r» t PaC Q-. � 1 R N L D o Rot �dy1��6"P 1/ /• � �Gt,f Vl����� y t9U'`5�6� bS��J � O �L QcaS��mil. • Q 1 i • ��Q U-C-' S��,�J 1�`f` 1, I ' I� f �ppip v f 5 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. `• BARNMBLK Paul J.Canniff,D.M.D. tb$4 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate gD" ► 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: 286 Issue Date: 12/10/2019 DBA: CAPE COD CHOCOLATIER OWNER: ROBERT J. & CAROL A. CRONIN Location of Establishment: 1600 FALMOUTH ROAD, UNIT 12 CENTERVILLE, MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Variance wsa granted for one toilet. ec ..1 For Office Use Only: Initials: Town of Barnstable Date Paid AmLU$� 5�.1 MANSTAeLE. * Inspectional Services 13 M 41W p'A MAC Check# Public Health Division �EDMA�s . Thomas McKean, Director �C ( I�Ct 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE FOOD ESTABLISHMENT u DATE NEW OWNERSHIP RENEWAL V NAME OF FOOD ESTABLISHMENT: is � ® � lif"t O u l a-li / -TrN e" 26 ADDRESS OF FOOD ESTABLISHMENT: I b b b Ta l m o� 1 r�- '" Cu uyrO L-✓ A4 Ar 0 �Z. MAILING ADDRESS(IF DIFFERENT FROM ABOVE): U to I.,-� l 2- E-MAIL ADDRESS: ( awd ypn i n @ aD 1 ,c.0yn TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: i WELL WATER:YES NO V---... (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) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q\Application FormsTOODAPP 2020.doc ti OWNER INFORMATION: FULL NAME OF APPLICANT L, C(ft"C� A SOLE OWNER: YES/00 D.O.B 1�1( 7,OWNER PHONE # 50 ADDRESS ►' I.J`ivc i �} CORPORATE OWNER: U �of "�" C.b1� PAW ���`[ l�l CORPORATE ADDRESS: (n 6 �(� M U J l.Piy� PERSON IN CHARGE OF DAILY OPERATIONS: t�ayb I wJ 20 kr+ b� 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.�� 0 1 C ry n abd31, i L '96J1 2. R6 + di-0k1 h i aa. 120,�3 0��� 1_( ,,� 1 2/ 1 2 6/q 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 ovenine!! 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/heaIthdivision/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 I st to Dec.3 Vt each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:\Apphcation FormsTOODAPP REV3-2019.doc r - . k • �►'. ` yogi. o` TOWN OF f3AfiNSTABLE Mw UATE t OFFICE OF FEE VANymn ost = B0AHD OF HEALTH RECEIVED AY i6j7. �r 367 MAIN STREET 11YANNIS„MASS.02601 VARIANCE REQUEST FORH ALT, VARIANCES MUST BE SU13MTTTED FIFTEEN (51 DAIS PRIOR TO THE' SCHEDULED I30AIU) OF IIEALTI1 MEETING. NAME OF APPLICANT CaSUO( 600rolat' /hC. • TEL. NO. 775" Y1V� ADDRESS OF APPLICANT Q 'ou)er, Mall - 1600,F(w,ot,4A ��,�Q-III►,fi l� Cek7lervI/le, Ml+ ®2 61+- NAME OF OWNER OF PROPERTY1 SUBDIVISION NAME DATE APPROVED ASSESSORS MAP AND PARCEL NUMBER /Ka �OQ LOCATION OF REQUEST Isav►� ol. SIZE OF LOT q Ltc t SQ.FT WETLANDS WITHIN 200 FT.YES VARIANCE FROM REGULATION\(/List Regulation) NO /�1✓q V A 6 (a (� — V r r v1 t r0 �o y3+6'0 REASON FOR VARIANCE(May attach if more space is needed) lJ v�G�d0F' 5,eA T vi IC& r PLAN - FOUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED ' NOT APPROVED REAS DISAPPROVAL 9 ' BRIAN R. GRADY, R.S. , CHAIRMAN "Y SUSAN G. RASKr R.S. JOSEPH C. SNOW, M.D. + BOARD OF HEALTH TOWN OF BARNSTABLE E -44 '10 .R m Y�o v sue• p � c � 49 � ., � ' oa moo+� �-���..�� ��R• 0 \ .` •� \ CPO*- cu r 9• of \\ 1,9 . 3„ LIQUID CAPACITY = 1 500 GAL. ', PR •` 3 DI o PRECAST CONCRETE SEPTIC TANK (SUITABLE FOR H 20 LIVE LOAD) F I , �2 30' 30, 15' 15' 90 I T.H, i T.H.2 EX/5 T. O I/E,�kEA WIRES 30 et- PROP. RESERVE AREA (TYP. ) PROP LEACHING PIT (TYP) ic) PROP. DIST: BOX ;o to Z ONNING PROP. SEPTIC TANK h CHANGE LINE-_ _ _ I 70 - F-1 51 — --- _ 5 �i 10 7 PROP.) 7000 Sq. Ft[ OFFICE BI ILDING I � OR (DRY GOODS STORE. II I FIRST FLOOR LEV. = 52.00 I I 0 o i ., LO I i c� I I I I 140 ( +10E N BENCH MARK: el` eY�i�l�j V ST Top West Hydrant PLAN - Head bolt Elev.= 54.80 SCALE I" = 20 e; I No. ....... -- _....... Fps............._............ THE COMMONWEALTH OF MASSACHUSETTS .," BOARD OF HEALTH PAor'ev ....................OF.....,1��12a1 ..------•-----%'�3.....--......._..........••-- Appliratiou for Disposal Works Tonstru.rtiou Prrmit Application is hereby made for a Permit to Construct ( teror Repair ( ) ,an Individual Sewage Disposal System at: 8 L D Gi ................__ .............. .. ..... ... ... ,�. ��L �Aere�� �.# or Lot No:• ---...•-•----••--------- -----------•-------------.....-•••_---•-- ......- Owner Address a (Q.... .......... .........`......... ....... Installer Address % 11ee�� ... dType of Building OFA 7 CIF - fjlG Is G7 Size Lot_______________� ... feet U Dwelling—N _ _ ___________________Expansio Ic Garbage Grier--E--r Other—Type of Building ________________________• #ge>=sere____________________--- SYuxerrt_ •�_Ga#PteraE�T ) yes ---7---•• -' 4 6- a W Design Flow............................'_____________gallons per person per day. Total daily flow........... ...............gallons. 04 Septic Tank—Liquid capacity_16O®_gallons Length./d _ _._ Width_ .___g_ Diameter_-.- Depth_ '- .. W Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area._.___...._�..._..sq. ft. Seepage Pit No---------I.......... Diameter..../Pe4J Depth below inlet_.__............ Total leaching area._-3.6-_8.sq. ft. Z Other Distribution box.( Dosing tanl�� aPercolation Test Results Performed by.... .�:._.M_ _ ..�.. C Z�13S ate__..,.... ____- -- ,� Test Pit No.�_..—__ -minutes per inch Depth of Test Pit---- Test Depth to ground water.._..._...... ____.._.. Pit No. 6__.E�_.�_minutes per inch Depth of Test Pit..._ _Z_�_____ Depth to ground water----J_Z_'.__. ...... ------------•-••-----------------^--••----.._._....-------•---..__........_.._.l__...._...._..__................� D Description of Soil.......... ._ t312r.�------�-�-----��' '��� N - --... W -•-----•--•-••---------------•-----•--••------•-•-•----•-•-•--.._...-•--•-•-•-----•----.._..._._._-----••-__..._.._._.-------•--...--------•---•-------------------...--•---•-•---------•------•---_.... UNature of Repairs or Alterations—Answer when applicable. •----------------------------•-•----........-•-•--•---••-----------•--------------..._.............---••---•----•-••--•-----•--••--------•--------•••--------•---------•--...-----•-----••-----...----•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitar Code—The undersigne rtl:er agrees not to place the system in operation until a Certificate of Compliance has a iss a by the board alth. Signed---__---- •-------------- �./.:.... = ---------_-_-- -•---------_----•_---••__.... Date Application Approved By............... --- _ - . ......................... - 7-Dat Application Disapproved for the f of ing reasons---------------••-----------•--••-•-•--------•----------------•-----•----------•----------•••--••----••••----•- -----------------•--••-----.....-•••-----------•......------.._.......------••---•-.............------•-----._.._...--------•-•----•---•---•---------•-------•--••-----------•-••-----••--..._...-•-•-- Date PermitNo......................................................... Issued_....................................................... Date --- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �n• .............. ............OF.....� .! .--� .J:... .. ........ (9rdifiratr of dr— ToutpliFaatrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( e�'or Repaired ( ) by............................ -•�---....----------------------------•----------------------------------------------------•-----•-----•-------•------_-_----� ......._......._--•---��� /n Installer � k� ! ) � .-��:-, S'hv ... �'--•- � L � � �r�`�cam'''�/. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code a§ descr•bed in the application for Disposal Works Construction Permit No..... __'Q4A................ dated....... ........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................................•----•-----....._--•------............._. Inspector..................................................-=--.......:....... ............. No...•••-••-•••-•---....... Fins.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7-c) V-V......oF.....L'Z=?i2./V-S 7'-,-7,�3 L.� Appliration for 14sposal Works Tonitrnrtion umi# Application is hereby m ade-ffor,a Permit to Construct ( V) or Repair ( ) an Individual Sewage Disposal System at It �� .7..... ..........................• ...,. � ........ ----.--•-•-----------. ...............•. t -..........._.. L cat on-Addres � f��---- or Lot N. -----------------•-�------- A�J 1� L - ........... .-_ ---- - Owner Add----------------------------------••--------•--......-- -•-----.----•---•------------•---------•--•--- ..reessss........-•-------••••-•...-•-.......... CI 2 4�I W Installer Address G V Type of Building Q�'ri cc �c i /G G7 Size Lot............................Sq. feet Dwelling—No-of ro'c�oms:.._.__.____��.............................Expansion Attic ( ) Garbage Grinner(""'"j '4 Other—Type of Buildiii P.I YP g�-----�;---�--.-.-�,;-- No, ofp�r's-o�s.-----,�. � Shovers )� --'•iC-`af�'t�'r'ra'�) rs, I a i s — j a 6 0 A s - 3 Other-fixtures -•-----•-••••-••-•------•--•--•-••-------------•--••-•-----••-----•-••...-• •--•--•-•---•................... ...... W Design Flow..............................."'^....._gallons per person per day. Total daily flow.._........'J.'� ............... to s. WSeptic Tank—LiquiTd capacity.!.`....�dgallons Length_................ Width W 61 idth..s.....`..._ Diameter..... ...._. Depth. �_. x; Disposal Trench—No..................... Width.................... Total Length.:..... .......... area Total leaching area__' '.sq. ft. Z. Other Distribution box Dosing tank Percolation Test Results Performed by....... ..._M G � W/ C Z/�a SC .ate. / / . .............••-•---...---•-•-•----....----•••-- :.----- .. Test Pit No.�1_.._ . .minutes per inch Depth of Test Pit...../. ...... Depth to ground water........................ 11. Test Pit No. ]�e' .._-:.._---.minutes;per inch Depth of Test Pit-----___________.... Depth to ground water........................ -------------------------•--------... - D Description of Soil.........-C --..r�.Z S�.---•--T c� �. /✓G......�r:}/✓I�...�T/__ k .....�.Z----- U •-•••-••-•--••...•••---•-••--•-•••-•-•..............•-----•-•••---•----------......------....--••-----•-••-•-•••--•----••--•--•-•-•--••......•_.. W x ••-•••-•••-••---------•------•--••-------••••-••---•--•••----•••-•••--•-•---•--•••••--•.....-••-••••-••--•••--••-----•--••......-•••------- ............................................................ U Nature of Repairs or Alterations—Answer when applicable.......................................................................................0........ ...-••----------------------------------------••-------------------•-•--------------------------......_._......--•. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code—The undersigne rther agrees not to place the system in operation until a Certificate of Compliance has b� n 'ss a by Voard ltth._ Je Sig ed t`a = -"` ' .......... 3 2 446------ Application Approved By................. ......................................................... .. Date Application Disapproved for the following reasons:.......................................................................................................... ..............••---------•-•--------•-------•---•---••-•----•-•--...........--•-••------.......------•-----•----•------•--•-----'••-------•----•--•-•-•--•----•••••-••••--•-••-..........•---.........•. Date PermitNo.........................•-•'••..........._.........••... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 0,1V1V /Z.N-5,� O F. "" .......................................... ..................... ............................................................ Trr#ifirtttr of TompliaurrTHIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) x by-'---•--•:•--------••-.....-----•-•...................••--•'--------•-----•-------•-••-•------------;-----•-•-•---•--•-•---•-.............-•----...............-----..............--..........•••. at l3/_D(' -)�`'-- ✓�j)V,�� 6,r� erg .Si�v�1er��r� � �.•.....,/2"L �7 e•, � c��� PC- //�- 'has been installed in~accordance with the provisions of TI �f,The State Sanitary.Code as de` ribed i the ob application for Disposal Works Construction Permit No......................................... dated__............._ .. .g_... b_.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE TH T THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector............................................................ ...................... THE COMMONWEALTH OF MASSACHU'SETTS P BOARD OF HEALTH _ )J V✓i ..OF.........--��, .�?'c� rT .................................. . ............... FEE........................ Disposal �� (� G . to rni#n t e Permissioyis eieby granted.............................................._ -. _ -----. e�.�... to Constructr ir an In iuidual Sewage Disp sal S stem e at No................ i �.-, TZ 2`0 Z 4 L' a�--✓, //P ....---•••• --•-•------------ ---------••-----------•--••------•-••--••-•-•-...... ••••.........---••--............ •_ ...... r1;lY, S eet as shown on the application for Disposal Works Construction Per t N 4 :.----•-..-___ ated.......................................... . --- .- -------- - Board of FIealth DATE-----------------------------------------------------•-•---•----..............•• FORM 12'S!5 HOBBS & WARREN. INC.. PUBLISHERS No......................... Fxs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... '® vYN..OF. Appliration for Disposal Vorkfi Touts rurtiun Prrutit Application is hereby made for a Permit to Construct (V5'or Repair ( ) an Individual Sewage Disposal System at: -B:,,/5 L L -T'o ~Asa s "'o Tom.. C AW—V!. Location-Address or Lot No. v WV S /• fA.L TL�lf J /3 1 �o �A> Z TG /3 Z /may.�}r✓nr.cs .._. ..... - -----•-•----•-------- -- ..............•---•--•-•--......_......._..................--- Owner Address ------ ------l c-I`� �_........��-..-�., �-:.................... .....�:�.T- �.. .%.L. _.OF :�...................................... Installer Address UType of Building // Size Lot..9e...9._.9 C.....Sf. feet Dwelling—No. of Bedrooms.............r!'��...___._......Expansion Attic ( ) Garbage Grinder—(- � `4 Other—Type T e of Buildin Meta F l p p �--C (�--- pa yp g _______________�`__.__...__.Nyl. of ersons._._.__...___________...._.. Showers afeteria 04 Other fixtures ....� .... l..... W Design Flow............................................gallons per person per dal. Total p flow.__•..-._�.G.¢.._._.__._...._gallons. WSeptic Tank—Liquid*capacitv..__-O4gallons Length_ '0---. .. Width................ Diameter__._____•____.•. Depth-4.._.....R. x Disposal Trench—No..................... Width....... Total Length------------ _..... Total leaching area....................sq. ft. Seepage Pit No-----------I........ Diameter.....1_.'¢....... Depth below inlet......G........... Total leaching area..#Z-e...sq. ft. Z Other Distribution box ( of Dosin to `4 Percolation Test Results Performed by..�..S12 ,_.__!�_t.__!!�!_�.GH�/� w� c Z Date..A/V ��--.......• ------••.. 04 Test Pit No.?.....'' ..minutes per inch Depth of Test Pit--__�.2_�._...._ Depth to ground water......N�:�_._... fs, Test Pit No.S... ...minutes per inch Depth of Test Pit....1.z!..._.. Depth to ground water____"' a ---•-------•-••-----•••----•••-•.............•••---------...-•••------.....-•--•----........._-----.P-.-...,3 q. .p..4 D Description of Soil......... Sn13� / -�2 )-✓ 'L x U •---------------•••......--------------......--••-----------•-------------.....-•••--------------------...---•-------------•-•••-------•--••---•------•••-............................................ w M. -----•--•-••................••-----•---•---••-•----------•----••-•----•--•--------•-----------•--•••--•------•--------------•---••••----------•------•-•--•----------.................................. U Nature of Repairs or Alterations—Answer when applicable..._............................................................................................ -------------------------------------------•--•-----•---------------------------•--•---------....... ---•------------------------•-•------•-•-•----•----•------•-•••-••---•-•......------.......-------• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board cd health. /l Signed. XAA te•b :�.-• ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons--------------------------------•----•-------•-----------------••----------------•-----------------...-•---.._... •-•------••----------•--------------------------•-••---------...----------•---•-----•--------•------•------------------------------•------••---------•-•-•----•---•------------•--••-------••------_._.. Date PermitNo......................................................... Issued_....................................................... Date ....................................................................................................... ................. THE COMMONWEALTH OF MASSACHUSETTS j� BOARD OF HEALTH ............ ..............O N/'^/............OF...�/.t\/..................................................... ... Trdifiratr of Tuutplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( <Or Repaired ( ) ,� cITS ............0 ©A/.S 1' by +Y • •-•---•------------------------•----•-----._..............-••-----------------•---•--•-•----•-.........-•-----••-•-----.._.._. Installer at.- L[ o ✓v rL......... ` C Z Z$ r�.v r�lL�/'d [►Gam`' -- ............................................................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......................................... dated..........................-........_............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... ..... --------------- -- No......................... FEB.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH e Applirotion for Disposal Works Tonotrurtion Prrmit Application is hereby made for a Permit to Construct (V' or Repair ( ) an Individual Sewage Disposal System at: /a, ,M 4� 1Z / r '�,,'. r ,t7. ii' r 4— J "a ..^^s'- d e' �^ .: / 4w. ...... ........__._._ ... ..... .. •....------------------.--.-----• •- ------.------------------ --------•---- ............- ...... ... .. Location-Address or Lot No. - — -... •-•------------------ ............ .................. f Owner Address .......................................................... ----------- ....................................t�'.!..L. Installer Address QType of Building Size Lot.3_3......S�......Sq.--feet U �' :...................Ex Expansion Attic Garbage Grinder—(-- Other )Dwelling—No. of Bedrooms________________�....._ p ( ) g'� —Type e of Building L G E f o ;! p ( ) ( )— yp g '_'}�:._..__�.�..__.___ No. of ersons____________________________ Showers ,,_----�—=- Cafeteria --' Other fixtures ......... ... d W Design Flow............................................gallons per person per day. Total daily flow.......... ..._..............gallons. WSeptic Tank—Liquid capacity) q.gallons Length./.�L_..Lr Width_, ......... Diameter________________ Depth......: .`, x Disposal Trench—No..................... Width----................ Total Length.................... Total leaching area................_...sq. ft. Seepage Pit No-----------I......... Diameter.....t...4........ Depth below inlet..... ............ Total leaching area...42 R....sq. ft. Z Other Distribution box ( Dosing tank (-n-') 0-4 Percolation Test Results Performed by.�.-.0.......?.._._':LL �:a �.' N A.-`:........ Date_—5/1-r----.may------.-----_. a Test Pit No. ..... _ ...minutes per inch Depth of Test Pit---}_ ......... Depth to ground water......V'4_.1__.._.. . (i Test Pit No, :---- .__.._minutes per inch Depth of Test Pit..../.24,1....... Depth to ground water._.'" ........... ---•-----------•-------------------------------------------------------•-------•----•-----------.. '...fa_la--- .......... O Description of Soil...... f c ' ,U ? '- ` ' A;+ t,` V -•--•-----•----------------------•---•----•---•-•---....------•-----------•--........_........... W ----------------------------------------------------------------------------------------------------------------------------------------------------•-••----•-•---...-------••-----....---•--------_.... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.IJ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed. ,............. 'f ¢{{r p/ ApplicationApproved By--•-------•-•••-----•--•--•--•---------------------------------------••---....---...-•----------• ........................................ Date Application Disapproved for the following reasons--------------------------------•---•------------------•---•-------------------------------••......--••--..._.._ ......................................................-........................................._........................................................................................................ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH 7 .......I...........� v`i`."'..... ......OF.. :. r' r. `!..:.................................................... .... CwrxfifirFate of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (P__J'_or Repaired ( ) by------•............ .::............. =--------•------••--•-- .-•--------•---•-------••--------------------------•--•------........................---------- t Installer -------------- -------- -----------•------- ---------------------- TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................................•--.........................._.....••---- Inspector...........................................................................-........ THE COMMONWEALTH OF MASSACHUSETTS "�� � BOARD OF HEALTH .73......... ...............O F...................... ........................................... ........... No......................... FEE........................ Disposal Works Twonotrion Upamit Permission is hereby granted........ r r -r = ' C Q '`lk/__. ._�--•= to Construct or Repair ( ) an Individual Sewage Disposal System at -----...... ------ ----------------••-. ----_. ..---------. --• -------- --•-••--- ... ...................................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... .......-•---•---•-------•------••----••------•---------------------------------•--•--.._....._......•---- Board of Health DATE. FORM 1255 A. M. SULKIN, INC., BOSTON 'k ' .TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.-- LEACHING FACILITY:(type)NO. OF BEDROOMS ---� PRIVATE WELL, O PUBLIC WATER. _ BUILDER OR OWNFR__ �� ------_ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED_, VARIANCE GRANTED: Yes '� a� �-�° � o, o '�, -�- � - o JQQ �r ,. e11 Tower tMall it Septic T�s � Pld B i2la ? 87 l 65•5 �- �° 36 Cs a 38� a.s' B� e BAN. C `: i '�' �. =.t- _ -------- -- - - -- Goody's Grill - Floor/Equip(nment Plan 12/18/06 509 0" STORAGE ROOJW OFFICE STO1fGtGf 'P7M __ , .:. .:..:: . . ::.,ADDRESS Bell Tower Mall ROOD G^ �� 1600 Falmouth Road 00❑❑ Units 7&8 (Assessors 10&11) 3 75sf BROILER . TABLE.OVEN,TAHLE Centerville, MA 02632 Assessors Map 209, Parcel 14 PREP. TABLE ZONING:HB 8AY SINK UNIT SIZE: 3,300 sf Li J O c> _ 0 PARKING REQUIRED : 13 PARKING PROVIDED: 16.5 WALUNG COOLER "— APPLICANT: ti I sMPtr wrNDow _� � ,_ Goody"s Grill International, Inc� �•� NAND SINKWINNOW , I „� - - � -�DBA Goody's Grill 9 Whitman Drive r--- '0'' ---� Sandwich , MA 02563 ❑ ; C ASTRY ul CcUNtEP� ° -j 0 fir' - .• _ r OL-10 0E10 !0 0 0 0 ROOM El - live .. CD 0 0 o= o F-100 10L�7j �- Yl• 1 i ' Floor/Equi mGoody s Grill Ient Plan 12/18/06 p , 50.9 0" STORAGE ROOM OFFICE ,::,: :: ..ADDRESS STORAGE Bell Tower Mali ROOM G 1600 Falmouth Road Units 7&8 (Assessors 10&11) 3 75sf BROILER a TABLE,oyEN,TArLE Centerville, MA 02632 Assessors Map 209, Parcel 14 PREP. TABLE ZONING:HB Ll SAX sty P �� � p UNIT SIZE: 3,300 sf s � o _ _ J PARKING REQUIRED : 13 PARKING PROVIDED: 16.5 WALUNC COOLER LA, A SLWPLY WINDOW Goody"s Grill International, Inc a-.+> DBA Goody's Grill� NAND SINK � 9 Whitman Drive Sandwich , MA 02563 El STRi� u LF n COV N11:IZ� ° _ . .. C� O p toa�n NIG � ❑ � 0 ❑ [❑ 0 0 0 O O0 0 F-101" O CD 30 a — ----------------- PROJECT TITLE r J F� 'A rr� 1 r •yL f �,��J� ' e PREPARED FOR 0(,� U e Central Construction Company, , Steve Devlin •President - L 261 Bladdhom Drive•mmstons Mils,MA 02648.508 4201340 - SCALE — k * KDAT DWG NO / DRAWN �'") U`:J- r _ . -- SHEF �v � � � � 7 ........ . ...... . . . ............... ........... ' o�i' a qu ipm Casual Gou et floo 'E ent Pla 2/2,0/95 50, 01, Lq 71/4 13' Unro 12' ign ADDRESS: Men% Bell Tower Mall { 16.0Q Falmouth Road Offte/Store Room C)M Unl��&8 Mae N%Wqv M91} Ladie►'s Coed rile, MA t4 Prep/Storage 76sf 31 314 Ass %pZ09rlamel14 ZONI G-�HB QOsf itcheC ' r I N T W Walk-in Ret geftr 600 f CARIfG REQUIRE D: 13 PARSING PROUCD[D- t6.5 +� APPIJj T: j•, 2311/4 Ca�a�l o arrnet lnc. aIk•In F7aezer o Bi. V, 111 CHNOA,&on Div®� Cents ICe SIP► 2 PH Mews 0 C Ming Room � tier �- COO c 00150 1 . a i owNFR 13UlLT Pi- AN 01= -SEPT -1: C, s y s -rEM + a 5 z �f',R,N 5T TATE !-ila i Fo R F- IN 0, � HrTjQINLi 9 \ , I - - c� c.� T Cc • °L. �- 4' �", V, . 6 Q CENTERVII F , A A S � E SC A L �. - .1►� �+. < E � J G( 1`17" k'-v LL i N k MA RK ', a n S,E, Car, t G• B, : f i, 'S 7! 3000 &AL - p i � TANK - F . - r . _ 1 Zr — \ 1500 Gr4 . GrREASE TRAP olu 4-51 ,t p T �b `�. a •. _ n� 4 FIST: BOX h Inv. Y� + NOTES : Irtv, C' ut i) ALL PIPES ARF, 4 � P. i a) NO ! . R J3 A Cw� I) IS POSR L. IS - AU-0WE ,0- S9.0 1 80 •. 1 oGt tC� or1 �p.�" �S 5�©act t ���L1�l. Tn' • ' ��• - -. / � � _ _ R.C. you-f �, w ,r , L. S. . 7 ,f Y A i `- ! I C E Tom- F � THAT T H E S F IVA Gr E .� Y1 Tt.lr1 S H OWN HAS 8FF- N CJN-5TRUC-"E0 IN A �L0R0ANCE WITH - !HE ,�',De �" � 2 c.o �• ..�`}• �> �" �.� rG S t rye. � _. � RU �.Es T N o R E G U L-ATIO NS OF THE [3 A R. IA S T � � �. ��,� o +� I< �-. � fF• � .- 7 # BOARD JF HEALTH ASS. TITLE E. X • � : jrE a Z 2 A E �, C. S,l . 1 t, C K 1° C, L, s ' GrA LL F- y -- w T r 7 X••, "Y.,+tip & , I AS J3 Ul L T- PLAN OF E pT` C= - .5-rEM 7"O_ -E ----_N---0,_.. k IN r- A a a� ��:� �i STATE. 111�OWA R 0 y T"E �.. 3; C F- N T E R V I I J ` A _--- c t "-"T `r I L k- � ,�� �� M :..:.To Q SC A L E- 1 - - -J' -- - --- / 5 U J '�.E 1) A --- ) q g+ Ufa..' � 'j• . Gr LTG vI � L � ; if; . . .� N G H /M A K K } � 5000 GiA L . Jr P ► TANK , �_ d� = - �Cat;r f i L Inv, Let 4-9 . 38 1S0 Gr L . GrREAS E TPA P --,,, ,�1 r Inv Ln ,D3 j 7a �d( y PIT I i 1' �, . pI BOX , ri W i.� ALL FIB'S AIRE 4 SC4E� �-0 Pvc. a: 0 R �AGcFl Q TS POSA I, .15 ALLOWEO. 10(114 +IC4 /'3 -4 S 5- i 0 U,; f,� ni-o o Tel G E Y'- —FF—/il H "V%fit'l 8 F-F- N C DN.�TkUC,TE a IN A L""-' CDR )DANCE WITH T-H _ o. . f RU L-FS AND R E Gc ) L,ATIO NS OF TN E 5 A k " 6 -T k\ ? fore r,,t.. s+ b v r _.• �0,5;\` "`"`" `' t BOA R O OF H �A NTH A N p AA4 SS. TITLE E. DATE R.0 SOTCK Aoll y P17' PIT /QV - - !< S� - �,�► ' ,A `t-- T; 50 .��'�t�S � _ _��`{ � ,� .'"� ---- "'. �.,-r_ �: 1SGO q>�/• fir=--���� �� :;�,,�;� � jj 14/ _)CA �' � ht_a L� t `-.L � �— �— f-{ �` � CC car 1� � � � � 3 ' ! � { iv owl v 09 � /Q� �-.r �G°LT"T~t•=�<�,^ � D=t? � T � � ��` �•--� � 1; r\ t �rt�. t/Ve/��� 1� / � � � . _a, .>~`G;�"1.4G. S � _ �® �' � . 9 a/! � �� i I'�►,r T,Y1 t '�� ��•E�t/ � }. '�+ V . - `_ O � / I''G°G.t�.S f'� ` l IZS •• '�''� � � 1 h C C�. S`� car �t�. :z �. C"�.'�[ . �'G TAT ' �• � �--- nr' � ��' � �-- - �I't --_.__ ___----.'j-L - /�DL�..S /�JC • 1 � � D��r ��+J � -f�- �.� !r 3 , ` � j �1 � f ) �? �( / yam, .(�•,ff-�' "- ,/�:. --; ,,e�1%�� lot'* �r �• `•'7 / i .�'r � N 1' f' ..5 ��'P P -/'� -{ ram.V l/ /�/�L.�.✓/t+ I,,,.. N'c r,. �.r Gr- (_-+ • , I C../if �1`Y •- l..t } t `t/f f /�� .✓4•-,=f/ T �'/4� ".-r- ______--_ �.�•` - J� `- `'r*..' /� �T� L�. Ali+ -1 3 f. l4 x /4'< _4- �- sz`7x 2,5 : /3/8 � � A/_ z0 �c fig. I x /¢ 4l x / 44 z /78e) / be/op_.. �vt�d' w/.�.Cee 7- U/�_1,'>2," / v�j�c'G�tJ/V,[� e�•� . z� Y c3c�� l�[�er SS /a A,;o, 3. M-A ,`"i .f w//` % .-_/! L.i'���'' �/L..�...+• ....,_..,,••/ '�` . .-' � f•'ti' f-f� �/ ,..r`�L� r� �. ..1� i- ,L._.,.W .._ � � —_`""_,"''; �,f"`'-.-- �, �► ¢ G .� "'t�= �' - f `V`A f.:%' / 4 p .��� ! X 4 r Ell I #/ it IV, ci, 47-o J�' -' f l` c� A, �I L. J ' /! �/r4-f r _ 1'.r i V, f. �� �7� —,Zrvt y�� C/. g 'j• 5 O � 7; R.P'�Y c�J� a / �r`3 �v" Ifi7 UGI� � •, r<'t'"v/Ti'- j/� f:'t`_�� d7 `. �• �� �.,,l r, t' �/`."(, , •� .... ,K:r «� �/� G'B�-7G', ,ti.��:Jr'��� G-f� h"7%.� �1C= /y : "!� :�f- ���'?.%/Q � �.�—' lr--xt•''.�•�" # '�!?'�` '{- 1'� � * ' (F ' ��," C. S iWICK ��/��G ✓T'�� ^r l�0/V U7"�,f�f,1�'Y 1�� C.�)ttsWcjjvg J:cigiaver 7R {/ ✓ r �f� irl ( . 7 G�, j <!_� L-.� 11 1�' f G t� - �a t y ' ri' C'I F?;14� ZP.a.ui ctv-n. s; �y 1 Y/�.l ✓/"i � /�/G '!� i 1 � •: i ;t� ic ,mot: 7 r 1A 44 cr+/4, c �G�L�n /� P! Ts , �„ R f LA J � F SEP1 1 � T� N� , -5 E N T F— R, V I L- F— H o YPIN -FA I I I H tV Ul -9- -- F, F- NTERVII L " Al A _ � ► - .. r �-t -.To ; - s 4. �.. �'t A SC A L I -- '` + - ---- --- /► 5 �? �A ' MARK : On S•F—/ VV rl In �• r I !-+►t ��• I • r.,i� 3000 �A l� 5E P �. TANK �._o r ' d L r ;_.._ r «.-- •'j PSOO Gr4 . Gr►REAS F, TPA P- doe LAa T_ � . T �. Ia _ prT— \ YJ� \` ` r pis ► E o X _ ,r 1 I Inv. Ir NOT F,S IP �) ALL FIFES ARE A ., SCHE10 40 PVC. __ �• w : , a) NO GGAR13AGcF, Ql:., POSAi, 15 AU-0WEiD . 4.Go 1 �ZT _ __ - - -- - *i +4 qs ss�,ot j , her*-oa 7 I Tel. rtr i I C E R T-i F. '� THAT i fE S FI A GE YE T -irlSH DWN HAS � i BF-F- N CoN.�TRUC TEC IN ACCoRIDANCE WITH -FH a ; _ U P S AND RFGW ATIDNS OF THE: J3 A k W J -T f- E5 L 41 '3OARQ of HEAL H NQ STD Ale Y r f D AT'E - / � � + me,µ; r l}y • f \ t \ ♦ I w • PLAN OF -SE T C- � S T`EM �� r.} S 5 �--'� A 5-FORE i�I O, �' U E I`� T L i� �i� I �.-.�.. � S H O YPIN TA-rE III Gx H 'A//� V R 0 u FE: CENT ER VI L. L � � d E ._.. , ._. _ �::: l (�`�/ ► A A ) 4 �..( -� r.•, l f..(o E �r ` �� ). -.:..� '�'�,/ �`J a- �l 1� ✓•. 7.�..( /� .c:' = SC A L E- i�i ; V A E� 1 � U �� E 0 / � `/ �. Z z— ! q g - ------- — -- i 8E: NCH MAP\K On 5.F, C o fr-, o� G.8. : r. S000 CjA L . SE P i I C.; TA N K - 1` `• _ ' 4 GrREASE TRAPTe � 41 PIS ; PIS _ � _x 1--�-- � • _ _ -- --- __.._ ��,�, � `�� • I �" Y. T vi 1•� A L.L Fl f E—.i APL 4 S T i 0 t id. L•. ` �Y `�" p'+ a,�` t NO GM R �AaF, P 0 A -T'7- A4 LA-0 w E C. os -4.017 1 role- I C E R T'.i r THAT i S FIVA G SST /�1 S '' .f�` HAS -� TRvGTE0 �N A �COR0ANC' WITH 1-H k u L, ti� A I V D PEG J � --A T IO Ns J t' THE- 5 A k Q J T � �- d # �- OAR � OF F � �, L H AW ) t SS. iTTL. E S. # - 0ATT 1?. C- SOU THWICK p . , L. S, } 1`� I (-i A L L- F- Y --,'