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HomeMy WebLinkAboutFOUR SEAS ICE CREAM - FOOD- OLD OWNERS `SOUR SEAS ICE CREAM �36O S. Main St. ,Cent pertT Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. eaMNrAa = F.P.(Thomas)Lee,. s .� 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. 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: 258 Issue Date: 01/01/2022 DBA: FOUR SEAS ICE CREAM OWNER: DOUG & PEGGY WARREN Location of Establishment: 360 SOUTH MAIN STREET CENTERVILLE„ MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 40 OutdoorSeating: 0 Total Seating: 40 FEES - FOODSERVICEESTABLISHMENT: $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: Q� FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent i FOR ESTABLISHMENTS WITH SEATING: j PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: RESTRICTED TO 40 SEATS PER HEALTH DEPT. Initials . ttte '• tea. Town of Barnstable i Date Paid Amt Pd$ MMWABU, : Inspectional`Services: . 1"9 ! - ' ' Cheek# ,•` - Public Health Division . {t: 5 a - - Thomas.McKean;-Director=*• = - - _ .. _200-Main Street;Hyannis;MA 02601 Office: 508-862-4644 Fax: 508-790-6.304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT t DATE I�25T1 " NEW OWNERSHIP - RENEWAL" ✓ - 4- t ' NAME OF FOOD ESTABLISHMENT: 176 LA v- .S-C�-S` 1 Sc-c `Cr lc ac vw% + ' i ADDRESS OF FOOD ESTABLISHMENT:'_3(D(O -Se, MAILING ADDRESS'(IF DIFFERENT FROMtABOVE): E-MAIL ADDRESS: e rn TELEPHONE'NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: Z ' WELL WATER:YES NO_I/ ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: ✓ DATES OF OPERATION: J_r 121 /22ro I/ 11 / I y NUMBER OF SEATS: INSIDE: OUTSIDE: Li 8 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. t ; . . IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? _ , IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOORS)? _ 2 TYPE OF ESTABLISHMENT: .(PLEASE CHECK ALL THAT APPLY BELOW) ✓FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST t_CONTINENTAL BREAKFAST • ,: ! COTTAGE FOOD INDUSTRY(formerly residential kitchen) + s , MOBILE FOOD 14]10ZEN DAIRY DESSERT MACHINES... (MONTHLY LAB ANALYSIS REQUIRED) ,CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: , FULL NAME OF APPLICANT 'V F �{i{i f �� y143 .4s.;.• + SOLE OWNER: YES/C4�. D.O.B OWNER PHONE# 56,9-3 t&- — 7 ADDRESS o I: CORPORATE OWNER el t{`O G CORPORATE ADDRESS: 117 L„-P-x i in :& n IJrTAv Qh n*( % . 1V1 '02Cdb I .t1ed 'l $."Fts§�kfii z4' 's� .iJi�.# 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 ,Certified Food Protection Manager PER'SHIFT: f "ATTACH COPIES OF CERTIFICATES" The Health Div.will NOT use past years' records.You must provide new copies and POST-THE CERTIFICATES-atyou'rfood establishment.' Certified-Food.Manaers H �,'. Ezeration Date Allergen Awareness•r,_4Ez iration Dat (7� 1. Wc�r �,r-, 23 2ty23 1. xn#7 _ _.. L . . y- 2. corir-e a /4:5 d'o °APPL ICANT DATE NA � t l+ � I $ �� "�a�ti,i t • i 1 r r i• " q} # a a ♦ y}' { r 1.1 Iyk ,.4 1 .► st 1x ..t .3 J # c.6t d.■ !.. . t 41 ,.'t C'. 1 I _ 1 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 5081862°4644 to schedule your in''speciion:-Please call of least(1)days in idvance.- 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 orr revocation of your Frozen Dessert' Permit until the above terms are met. M1 `rt a ft E e r ! :t r:8 t r :? CATERING POLICY: Anyone who caters:within the?Town of Barnstable must notify,theTown by fax or mail prior to_cater_ing event. You must complete a catering notice found at httn://www.townofbarnstable.us/henithdivision/agglications.asil. F 'tr.► , OUTDOOR COOKING: Outdoor cooking,,preparation;or display of any.food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31'each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES°BY-DEC 1st:>° .. �f t£}tS P. ..7« i` t 'i' .� #.4�;i DIY.«t. .!/. :a:��fT�+.g7,� 1,• , J•¢_trt .; 11 f' ��` .r: t fi.. �T .. �.i .j 1...xl l'l i.J itY 'i•Jx l .." I s � i�.[ A� . 1 J ft ! ,1.r:i 'r'u�.`a..t_._-�@ �i� r ..�1�� g. t .tV{ ,f�� ... f•.A �!1.�.....,it4 �..,i-� ���� ! # tr Q:\Application FonnsTOODAPP REV3-2019.doc °F. ► TOWN OF BARNSTABLE HEALTHINSFECTORs Establishment Name: Date: ,Page: of OFFICE HOURS °^ PUBLIC HEALTH DIVISION 800=9:30A.M. eAnNsrns�e. 200 MAIN STREET 3:30-4:30 F.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS, g, MON.-FRI. �p .639. HYANNIS,MA 02601 - -. 508-862-4644 No Reference R Red Item PLEASE PRINT CLEARLY .. FOOD ESTABLISHMENT INSPECTION REPORT Name Date �b Tvoeof T Inspection =Fo.d Routine'Address Risk rvice -Re--inspection - a Level Previous Inspection {� Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness ( -�:t j/1 Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP tV j Aq YL In: 3:)(� ey. other �✓� Inspector Out: 3; 30 Each violation checked reqliires 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) ❑ /hn Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ l S IJ � '- Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ tC 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 �j� ��� f ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals de _`p FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating Y"t 7� ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling �� C-e �u/�i> ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) �Py_,� e ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY V� , Ckv ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories 1 V et/Se l Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations L• � 2 (Jv� va&K_4 iS Of Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: o ❑ Ye 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 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials FC-7 590.008 be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. ( )( ) violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Si t Pri t: S C� v 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) i FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* S Cross-contamination 1q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from ' 3-202:12- Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * 2 Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F Applicants* 3-302.11(A) Food Protection* 20 7-201.11 Separation-Storage* 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 Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reared or of Food 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE,POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources F9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law*_ 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(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 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products 4-501.112 Mechanical Wazewashing-Hot Water Monitoring 3-202.13 Shell Eggs* _ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-I55°F 15 sec Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of i Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingW.aterfrom an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef IZpaSt 130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs " SPECIAL REQUIREMENTS' 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g, P �' 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) Critical and non-critical violations,which do not relate to the fvodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501;14 A CoolingCooked PHFs from 140°F to 70°F 3-203.18 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 * Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `pF*HE row TOWN OF BARNSTABLE - HEALTH INSPECTOR'S Establishment Name: Date:' _ Page.: r of ' OFFICE HOURS -.�1J5fSp PUBLIC HEALTH DIVISION a:oo-saoA.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified p e3q. `0$ HYANNIS, MA 02601 sos-s2 4Rsaa No Reference. R.,-Red Item FOOD ESTABLISHMENT INSP CTION REPORT ' PLEASE PRINT CLEARLY, Name �� Date." I I 1 ype of Type of Inspection O s Routine Address c:�- Risk ood Se Re-inspection J J Level etai Previous Inspection Telephone Residential Kitchen Mobile Pre-operation Owner HACCP Y/N Temporary c ness l StiIfs Caterer General Complaint Person in Charge(PIC) v/��('/�� Time tied&Breakfast HACCP 1 In: Other )aAAJ,i ^- J� C7 F Inspector f Out: Each violation checked re wires an explanation on the narrative page(s)and a citation of specific provision(s)violated. ` I. /' �C� Ito e. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ bya 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 Vyt j ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities 1 y EMPLOYEE HEALTH PROTECTION FROM CHEMICALS �7J✓� - ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives / ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals .(_ZJ lJJ(•(X^' `,, /) y_ ('K - l- _ I FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating 726 ❑ 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 J ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(H P) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSPei ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY J�(Jjr ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories r Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations I a','�Cl' d-welp- �?'A 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 S spension c C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 9 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and Jess than o 6 n critical violations 9 26.Water,Plumbingand Waste if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 t 8 on-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspecto' `Sig Pri 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's ure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y. N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) f FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination L14 Food or Color Additives - Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-]03.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) * EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Se oration-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.1 I Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 590.003(G) Reportin by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* g Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.1 l(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 Not Served 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate . Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* effe ce°e tiuzoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and a ide in cater- * Ratites-165°F 15 sec* in mobile food,tem or and residential Sources g, P 1p Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* When 3-401.11(2-301.14 Wh to Wash* A)( )O Other s- sec 1 b All Oth PHFs 145°F 15 * Other 590.009 violations relating to good retail practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 1 7 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* * 23. Mana ement and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 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: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 oFv+f Toy TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Z 2 Page: l of �Z c` yo OFFICE HOURS �• PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARN STABLE. ` ^ - •l M 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified -63s: 00 HYANNIS,MA 02601 MON.-FRI464 No Reference R-Red Item PLEASE PRINT CLEARLY �,ar fD MP,�° 508-8624644 ti FOOD ESTABLISHMENT INSPECTION REPORT r 'v f NameSeAS +j Cyr Date' lZ 1,j- T e o Tvoe of Inspection -r t'71®� f Routine J V Address Sa� n/6 jn 5��, - Risk Food Re-inspection n�� I'r�p 'v` Level Retail Previous Inspection c] Telephone Residential Kitchen D Mobile Pre-operation Owner HACCP Y/N Temporary spe Hess 13 d_ w G- Caterer General Complaint Person in Charge(PIC) Q �, Time Bed&Breakfast HACCP r/(I w n: V.1-5--►",r�m Other Inspector Out:Z:S-� J a SLWI Each violation checked/requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. / Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ l�l�L/ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ., FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands wa'�(4 VIl�Y ❑ 1.PIC Assigned/Knowledgeable/Duties �.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS t CI (<tTiT'KS S� u f�i�jf UVll tl 1 YI.�I ❑ 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 TIMEfTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ( � e ❑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 7/7 PROTECTION FROM CONTAMINATION a1T` ,ime As a Public Health Control ❑8 Se aration/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) .Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.ProperAdequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices .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 Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ® Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ® Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 6=One critical violation and less than 4Hon-critical violations 9 ( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9Hon-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials . (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) receipt within 10 days of recei t of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector' ignature Print: l 31.Dumpster screened from public view /" Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N G #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N -� A Dumpster Screen? Y N /,-- �(/U Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.1 I(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 590.004(F) 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* Time as a Public Health Control 20 590.003(F) Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Contra]* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria--Chemicals*3-306.14(A)(B)Returned Food and Reservice of Food* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 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 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Tem era[ures* Raw Seed Sprouts Not Served* p 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Fg five 1112001 590.006 B 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* ( ) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-20L14 Fish and Recreationally Cough[Molluscan Contact Surfaces 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* 10 Proper,Adequate Handwashing Ratites-165°F 15 sec* ing•mobile food,temporaryand residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 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 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,O erasion and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention P 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. 'I NE TOWN OF BARNSTABLE + HEALTH INSPECTOR'S Establishment Name: Date: Page: of 11 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. enaNsrna�e. = 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 9 �639. �0� HYANNIS, MA 02601 08-8MON -FRI. NO Reference R-Red Item PLEASE PRINT CLEARLY �pTFO MP,°' 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name ( Date a of Type of Inspection gaftrillftmW Routine 1 Address Risk k.d Service) Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date- Mobile re-operatio Owner HACCP YIN Temporary Caterer General Complaint e Person in Charge(PIC) Time Bed&Breakfast HACCP S In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items1 Anti-Choking 590.009(E) ❑ 4 (�� dc; Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ ' Q� Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating E]6.Tags/Records/Accuracy of Ingredient Statements ❑�, �18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans P16,Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and less than 4pon-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Si nature Print: 31.Dum ster screened from public view 'tt& P p _ i Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's S ure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B). Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 19 PHF Hot and Cold Holding g 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each * 590.004(F) 7-101.1 I 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 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 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(1 I) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food 7.204.14 Drying Agents,Criteria* 21 3-801.I 1(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.I I A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of 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* 3-401.1 l(A)(2) Comminuted Fish,Meats&Game Pathogens* eff-eye inrznw 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 4 703.1 I Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* f; g y 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11 C 3 Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wlld Mushrooms Approved By ( )( ) P 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. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food:140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-]01.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 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 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402. Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(4(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. i 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. + �OF THE rpm TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: 0P 1 Page:; of c� do PUBLIC HEALTH DIVISION OFFICE HOURSa:oo_s:3oA.M. BARNSTABLE. • 200 MAIN STREET 3:3o a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. i-FRI. ,639•a o HYANNIS,MA 02601 sos-ssz 4saa No Reference R-Red Item PLEASE P CL RLY s 'FDN1P` FOOD ESTABLISHMENT INSPAICT N REPOR Name e r Tvoe of Tvoe of Inspection O Routine Address3�0 sin Map� oo Servi Re-inspection vel Retail Prn* s on Telephone a'identi 'chenMobile rOwner HACCP Y/N Temporary Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspector u Each violation checked requires an explanation on the narrative p ge(s)and a citation of specific provisions)violated. d 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) ❑ AO Action as determined by the Board of Health. Allergen Awareness 590.009(1 ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands s� ❑ 1.PIC Assigned/Knowledgeable I Duties ❑ 13.Handwash Facilities f EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 9 ❑ 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 rill ❑ 5.Receiving/Condition ❑ 17.Reheating E36.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling f ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ` ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP l i ❑ 10.Proper Adequate Handwashing . . CONSUMER ADVISORY L - 11.Good Hygienic Practices _ ❑ yg ❑ 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) liq � Corrective Action Re71quired: ❑ No I❑ Yes Non-critical(N)violations must be corrected'immediately or within 90 days as determined b the Board of Health. Overall Rating Voluntary Compliance y y ❑ ry p [].Employee Restriction/Exclusion ❑ Re-inspection Scheduled F] Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no.more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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. vi n,4 to 8non-critical violati s=G 30.Other DATE OF RE-INSPECTION: s ctor' gnature int: 31.Dumpster screened from public view = �� Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed frozen Dessert Machines: Outside Dining Y N PIC's i ature Pri / Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N �G� W• �j(/�/L/L�^7`�.. Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk'Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41'F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods.for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-WorkingContainers* Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g * 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(1)) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical/ Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 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 Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg crave 1/I12001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - fide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and AutWIdhority Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the Foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashin 9 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 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 ■ 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. 1 Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced_Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical Rem in the federal 1999 Food Code or 105 CMR 590.000. r pfrrt BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BAMNS ABLE'+ Paul J.Canniff,D.M.D. IM A&kF.P. Thomas Lee Alternate ,ass• , 200 Main Street, Hyannis, MA 02601 arutR 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: 258 Issue Date: 04/27/2021 DBA: FOUR SEAS ICE CREAM OWNER: DOUG & PEGGY WARREN Location of Establishment: 360 SOUTH MAIN STREET CENTERVILLE, MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 40 OutdoorSeating: 0 Total Seating: 40 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: G�� _ FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: j PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE l Restrictions: RESTRICTED TO 40 SEATS PER HEALTH DEPT. ¢ Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. e Paul J.Canniff,D.M.D. � PAB1YSl'A018, " a 9. 200 Main Street,Hyannis,MA 02601 F.P.(Thomas)Lee,Alternate ' a Phone:(508)862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A,305B, 146, 189 and 189A;Chapter 111,Sections 5 and 127A,a permit is hereby granted to: Permit No: 258 Issue Date: 01/01/2021 DBA: FOUR SEAS ICE CREAM OWNER: DOUG &PEGGY WARREN - Location of Establishment: 360 SOUTH MAIN STREET CENTERVILLE, MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: C� IndoorSeating: 35 OutdoorSeating: 24 / Total Seating: 59 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: Q FROZEN DESSERT: $30.00 Thomas A. McKean, RS,CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE a Restrictions: For O Initials: Ob Town of Barnstable ( ~o� Date Paid L` Amt Pd$ BA WRMBLE, : Inspectional Services Q G n '°'9. Check# ,0-1 � `` Public Health Division iDlen►aa+a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 �A�P�PLICATION FOR PERMIT TO OPERATE A/FOOD ESTABLISHMENT DATE�_J_► �-1 �� NEW OWNERSHIP RENEWAL NAME OF FOOD EESTABLISHMENT: 'PO i.t l_ r' L?l� S �2 C��? �l 41r1 Cd'l •�U L,o ,Veil 10� 3 2 ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Lex I f 2L(l ^y E-MAIL ADDRESS: Reg �/ ' 1i I e Ci l.� �` TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ...(ANNUAL WATER ANALYSISQUIRED�� i 1. J&-y ANNUAL: SEASONAL: V DATES OF OPERATION: /_/_ TO NUMBER OF SEATS: INSIDE: .5 OUTSIDE: — _TOTAL: S q 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? IVO IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? ("J TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) /FOOD SERVICE z/ RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD 7�7FROZEN 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 �t OWNER INFORMATION: FULL NAME OF APPLICANT )QU (1 ' Reqitj 4t is SOLE OWNER: YES/(NNO) D.O.B I 4! OWNER PHONE# ,�j(� �j G,'fq�602 3� ADDRESS L1Z y `� (n i 1./1 /-� O CORPORATE OWNER: �J ►� u�' ��. CORPORATE ADDRESS: ) -Oclf,16 6j ')0 L , r PERSON IN CHARGE OF DAILY OPERATIONS: ) V ZGh 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 �j ``��U �v l 0ri'�+7 / �23 � y 1, cJ...e-e. us, 1°4 na�ar � 2. �c cll ✓ i�r�� iZ3 r2 3, �� �2,� WG N /14dO/ PLICANT 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 httt)://www.townofbarnstable.us/healthdivision/applications.ast). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPP REV3-2019.doc i IKE Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. RARNSLABM Paul J.Canniff,D.M.D. 6 , 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate owl° Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit Issue Date: 12 10 2019 No: 258 / / DBA: FOUR SEAS ICE CREAM OWNER: DOUG & PEGGY WARREN Location of Establishment: 360 SOUTH MAIN STREET CENTERVILLE, MA 02632 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 40 OutdoorSeating: 0 Total Seating: 40 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: G: FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: r c For Office Use Only: Initials: _ Town of Barnstable [10 r� 11 Date Paid �lol`ill`i Am Td$ asTAB , : Inspectional Services �— *� 703 Public Health Division check# �FDMP�a Thomas McKean,Director r ca 200 Main Street,Hyannis,MA 02601 � K1"i Office: 508-862-4644 Fax: 508-790-6304 r APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE ��. 1 NEW OWNERSHIP RENEWAL V NAME OF FOOD ESTABLISHMENT: Far St°a. ' �-e_- . ADDRESS OF FOOD ESTABLISHMENT: O ✓O a(n 5-F AAIA r a��a MAILING ADDRESS(IF DIFFERENT FROM ABOVE): l ,L k oX) r n n i S E-MAIL ADDRESS. Q�� Q L --��' 1� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: tOS-M,5 IJ 9 TOTAL NUMBER OF BATHROOMS: C79— WELL WATER:YES NO Z... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: 5/ 0_11a o NUMBER OF SEATS: INSIDE: $ OUTSIDE: _�_TOTAL: 3 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) / 'V 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 DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) ]?11ROZEN ATERING ... (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 i OWNER INFORMATION: FULL NAME OF APPLICANT—Do ►'�/�"6 SOLE OWNER: YES NO ` D.O.B OW R HONE# �`✓�� ADDRESS ( V1r Q,n h I^S A- o O CORPORATE OWNER: C— i I b Ilnn d CORPORATE ADDRESS: s-� L.`e..�C ✓1 G` c ilT I PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records.You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. ' I / 2323 i. 6PGVjOF PLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.31s`each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Application FormsTOODAPP REV3-2019.doc �_ I rtH ,q,� Town of Barnstable BOARD OF HEALTH 'i Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. *' DARNSTAB & = John T.Norman M A SMS 200 Main Street Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 258 , Issue Date: 12/20/18 DBA: FOUR SEAS ICE CREAM OWNER: DOUG & PEGGY WARREN Location of Establishment: 360 SOUTH MAIN STREET CENTERVILLE MA 02632 Type of Business Permit: FOOD SERVICE Annuial: YES Seasonal: IndoorSeating: 40 Outdoor5eating: 0 Total Seating: 40 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: C /� _ FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: I t� FI►E Tp� For Office Use Only-: Initials: Town of Barnstable Date P Amt Pd$off OU &MMST,BLE. Inspectional Services 1619. Public Health Division Check# Cash P�J Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 d4 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 1 �� NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: So [Y\a( �1 l e n�-e r- (���� A 0 5 Pe�jPy wow)�` MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �2,�(�.G T CJ�-1 V /G (� i 5 JUG x©Z(D co E-MAIL ADDRESS: 6f d -le Cre- Gp7'Y1 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( TOTAL NUMBER OF BATHROOMS: 02- WELL WATER: YES NO VI.. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: J DATES OF OPERATION:�-7 c , i TO r 7 NUMBER OF SEATS: INSIDE: lD OUTSIDE: O TOTAL: 3G 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? N(� IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?AA 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 FormsTOODAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT N-u � k j Q ' SOLE OWNER: YES/O D.O.B �j OWNER PHONE# q1�,5 ADDRESS i VVl i :l/l- CORPORATE OWNER:_ mP, FEDERAL ID NO. : O�— 3 5,6 1-9 3 CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: U 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 Aller en Awareness Expiration Date 1. as Vuym /23 12 1. a. tll of � e,( 1 2. P&,�O,(lWaf 1 / 23 /23 I T OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec.31s1 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC I st. ` �A hcation FormsTOODAPPREV2018.doc Q� PP Message Page 1 of 3 l =Miorandi, Donna From: Foley, Kim (DPH) [kim.foley@state.ma.us] Sent: Thursday, November 10, 2011 10:21 AM To: Miorandi, Donna Cc: Stanton, David; McKenzie, Marybeth; McKean, Thomas Subject: (Disarmed) RE: Four Seas Ice Cream and Cape Cod Creamery Donna I am ccing our dairy supervisor Ellen Fitzgibbons to also respond to your questions. We discussed yesterday and she was in agreement that the frozen dessert manufacturing license covers the firm to distribute their ice cream to retail or wholesale accounts. If they were offering other items that they did not produce, like frozen pops from another company, then they would need our license as a warehouse. But if they are only distributing their own produced ice cream, they can sell to anyone. Here is some info that Ellen forwarded yesterday after we spoke: Inserted please find information that may be helpful in regard to Giovanni's Gelato proposed establishment in Boston. Ellen Ellen A. Fitzgibbons Dairy Supervisor MDPH Bureau of Environmental Health Food Protection Program 305 South Street Jamaica Plain, MA 02130 Phone: 617-983-6751 Mobile: 617-438-6516 ellen.fitzgibbons(a�state.ma.us MailScanner has detected a possible fraud attempt from "email.state.ma.us" claiming to be http://www.mass.gov/dph/fpp The regulatory authority for inspection and licensing of frozen dessert establishments is stated in M.G.L. c.94, § 65G-U. The law states that frozen desserts manufacturers, both retail and wholesale, shall be licensed and inspected by local boards of health. Frozen desserts are further regulated in 105 CMR 561.000, Frozen Desserts, Frozen Dessert Mixes and Ice Cream. All wholesale or retail frozen dessert manufacturers require licensing by the local board of health. Please note that I have inserted DU-01 Licensing and Testing Requirements for Frozen Desserts for your review. Additionally, 105 CMR 561.000: Frozen Desserts, Frozen Dessert Mixes and Ice Cream can be accessed in its entirety at the website listed below. http://www.mass.aov/dph/fpp Ellen: please feel free to add further comments or clarification.Thanks very much. Kim 6/5/2012 Message Page 2 of 3 d � Kim K.Foley,R.S. Assistant Director MA Department of Public Health Bureau of Environmental Health Food Protection Program 305 South Street Jamaica Plain, MA 02130 (617)983-6747 FAX(617)983-6770 kim.foley@state.ma.us htti)://www.mass.gov/dr)h/fr)r) **This e-mail message is intended for the exclusive use of the recipient(s) named above. It may contain information that is protected, privileged, or confidential. If you are not the intended recipient, any dissemination, distribution, or copying is strictly prohibited. If you think you received this e-mail in error, please e-mail the sender immediately.** From: Miorandi, Donna [mailto:Donna.Miorandi@town.barnstable.ma.us] Sent: Thursday, November 10, 2011 10:11 AM To: Foley, Kim (DPH) Cc: Stanton, David; McKenzie, Marybeth; McKean,Thomas Subject: RE: Four Seas Ice Cream and Cape Cod Creamery Hi Kim, There seems to be different interpretations of your e-mail as to whether Four Seas needs a wholesale license from you or not. They have a food service permit with us as well as a frozen dessert permit. They are manufacturing ice cream. Right now they are making and selling quarts of ice cream out the door. They also distribute to other small grocery stores and some restaurants that also serve their ice cream. So do they need a wholesale permit with MDPH or not. It sounds a little ambiguous and the staff here doesn't seem to have a clear understanding at all. Please advise as I told the owner yesterday he needs a wholesale permit and he is wondering why as he states he has been distributing for years. Thanks for your help. Donna Miorandi -----Original Message----- From: Foley, Kim (DPH) [mailto:kim.foley@state.ma.us] Sent: Wednesday, November 09, 2011 9:53 AM To: Miorandi, Donna Subject: RE: Four Seas Ice Cream and Cape Cod Creamery Hello Donna Neither of these has wholesale licenses; Cape Cod Creamery submitted an app but as they are producing frozen desserts, the license comes from the local board of health by statute. I would assume if Four Seas Ice Cream is manufacturing the ice cream in addition to distributing, that they should be licensed by the local health dept also. Distribution activities associated with produced ice cream would be covered under their frozen dessert permit from the health department. Our inspectors do perform inspections of frozen dessert plants. If you need some help with Four Seas, please let me know. Kim Kim K.Foley,R.S. Assistant Director MA Department of Public Health Bureau of Environmental Health Food Protection Program 305 South Street Jamaica Plain, MA 02130 (617)983-6747 FAX(617)983-6770 6/5/2012 r Message Page 3 of 3 kim.foley-(a),state.ma.us htti)://www.mass.gov/di)h/fpp "This e-mail message is intended for the exclusive use of the recipient(s) named above. It may contain information that is protected, privileged, or confidential. If you are not the intended recipient, any dissemination, distribution, or copying is strictly prohibited. If you think you received this e-mail in error, please e-mail the sender immediately. From: Miorandi, Donna [mailto:Donna.Miorandi@town.barnstable.ma.us] Sent: Wednesday, November 09, 2011 8:51 AM To: Foley, Kim (DPH) Subject: Four Seas Ice Cream and Cape Cod Creamery Good Morning Kim: Can you tell me if these two places have wholesale licenses or not. Four Seas Ice Cream is located in Centerville and Cape Cod Creamery is located in Yarmouth. Both of these ice creams are found in supermarkets and small Mom & Pop retail stores. Thanks so much! Donna Miorandi, R.S. Town of Barnstable Health Inspector 6/5/2012 Four Seas Ice Cream and Cape Cod Creamery Page 1 of 1 Miorandi, Donna From: Foley, Kim (DPH) [kim.foley@state.ma.us] Sent: Wednesday, November 09, 2011 9:53 AM To: Miorandi, Donna Subject: RE: Four Seas Ice Cream and Cape Cod Creamery Hello Donna Neither of these has wholesale licenses; Cape Cod Creamery submitted an app but as they are producing frozen desserts, the license comes from the local board of health by statute. I would assume if Four Seas Ice Cream is manufacturing the ice cream in addition to distributing, that they should be licensed by the local health dept also. Distribution activities associated with produced ice cream would be covered under their frozen dessert permit from the health department. Our inspectors do perform inspections of frozen dessert plants. If you need some help with Four Seas, please let me know. Kim Kim K. Foley,R.S. Assistant Director MA Department of Public Health Bureau of Environmental Health Food Protection Program 305 South Street Jamaica Plain,MA 02130 (617)983-6747 FAX(617)983-6770 kim.folevna,state.ma.us http://www.mass.gov/dph/fpp "This e-mail message is intended for the exclusive use of the recipient(s) named above. It may contain information that is protected, privileged, or confidential. If you are not the intended recipient, any dissemination, distribution, or copying is strictly prohibited. If you think you received this e-mail in error, please e-mail the sender immediately.** From: Miorandi, Donna [mailto:Donna.Miorandi@town.barnstable.ma.us] Sent: Wednesday, November 09, 2011 8:51 AM To: Foley, Kim (DPH) Subject: Four Seas Ice Cream and Cape Cod Creamery Good Morning Kim: Can you tell me if these two places have wholesale licenses or not. Four Seas Ice Cream is located in Centerville and Cape Cod Creamery is located in Yarmouth. Both of these ice creams are found in supermarkets and small Mom & Pop retail stores. Thanks so much! Donna Miorandi, R.S. Town of Barnstable Health Inspector 6/5/2012 r Message Page 1 of 2 c � Miorandi, Donna From: Stanton, David Sent: Tuesday, June 05, 2012 8:28 AM To: Miorandi, Donna Subject: FW: Four Seas Ice Cream and Cape Cod Creamery -----Original Message----- From: Miorandi, Donna Sent: Thursday, November 10, 2011 10:11 AM To: 'Foley, Kim (DPH)' Cc: Stanton, David; McKenzie, Marybeth; McKean, Thomas Subject: RE: Four Seas Ice Cream and Cape Cod Creamery Hi Kim, There seems to be different interpretations of your e-mail as to whether Four Seas needs a wholesale license from you or not. They have a food service permit with us as well as a frozen dessert permit. They are manufacturing ice cream. Right now they are making and selling quarts of ice cream out the door. They also distribute to other small grocery stores and some restaurants that also serve their ice cream. So do they need a wholesale permit with MDPH or not. It sounds a little ambiguous and the staff here doesn't seem to have a clear understanding at all. Please advise as I told the owner yesterday he needs a wholesale permit and he is wondering why as he states he has been distributing for years. Thanks for your help. Donna Miorandi -----Original Message----- From: Foley, Kim (DPH) [mailto:kim.foley@state.ma.us] Sent: Wednesday, November 09, 2011 9:53 AM To: Miorandi, Donna Subject: RE: Four Seas Ice Cream and Cape Cod Creamery Hello Donna Neither of these has wholesale licenses; Cape Cod Creamery submitted an app but as they are producing frozen desserts, the license comes from the local board of health by statute. I would assume if Four Seas Ice Cream is manufacturing the ice cream in addition to distributing, that they should be licensed by the local health dept also. Distribution activities associated with produced ice cream would be covered under their frozen dessert permit from the health department. Our inspectors do perform inspections of frozen dessert plants. If you need some help with Four Seas, please let me know. Kim Kim K.Foley,R.S. Assistant Director MA Department of Public Health Bureau of Environmental Health Food Protection Program 305 South Street Jamaica Plain,MA 02130 (617)983-6747 FAX(617)983-6770 kim.folevAstate.ma.us http://www.mass.gov/di)h/fi)p "*This e-mail message is intended for the exclusive use of the recipient(s) named above. It may contain information that is protected, privileged, or confidential. If you are not the intended 6/5/2012 Message Page 2 of 2 recipient, any dissemination, distribution, or copying is strictly prohibited. If you think you received this e- mail in error, please e-mail the sender immediately.** From: Miorandi, Donna [mailto:Donna.Miorandi@town.barnstable.ma.us] Sent: Wednesday, November 09, 2011 8:51 AM To: Foley, Kim (DPH) Subject: Four Seas Ice Cream and Cape Cod Creamery Good Morning Kim: Can you tell me if these two places have wholesale licenses or not. Four Seas Ice Cream is located in Centerville and Cape Cod Creamery is located in Yarmouth. Both of these ice creams are found in supermarkets and small Mom & Pop retail stores. Thanks so much! Donna Miorandi, R.S. Town of Barnstable Health Inspector 6/5/2012 `ir ' WN OF, BARNSTABLE � LOCATION � � G SEWAGE #� y- VILLAGE ASSES-SOR'S MAP LOTZ6-•» G1 INSTALLER'S NAME & PHONE NO. ��- SEPTIC TANK CAPACITY -6 -0 G ,T LEACHING FACILITY:(type) L/ 4',4//- f (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER � 9, :w DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No (i •V7 �.ice• 0'4F d LOCATION SEWAGE PERMIT N0. 416— VILLAGE _ A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED v� a lie) -7 No.... — Fic ........... �.� $ ......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABL.E Applirativaa for Diipuual Workii Tumitraartwu Varait Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: Main St Centerville 4cs Ice Cream .............................•-----.........-•--•-------•-••-------------------.............--.... .-•----------•-------------•--•-----•---•-•---•-••••--..........--••--------•--...--••-----...•--- Location-Address or Lot No. Dick Warren .................•------••--............---------•-••---------------------••-••--•-•----•-•---. ---------•-------•---•--------•-------------------•--------••--•-••----•----•-------•---•----..... Owner Address a ..........W...E...... obinson_Septic___Service__..____ P.O. Box l 089 Centerville Installer Address UType of Building Size Lot............................Sq. feet .-t Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) pa., Other—Type of Building ............................ No. of persons.--.-..-..-..-..--.--------- Showers ( ) — Cafeteria ( ) A4 Other fixtures ------------------------------- - - w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width--------.------- Diameter_------------- Depth................ x Disposal Trench—No- -------------------- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter...........--------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by---------------------•-------•------•-------------••-•-•--••--------..... Date........................................ a Test Pit No. I----------------minutes per inch Depth of Test Pit......---_-_----_-- Depth to ground water........................ 40 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ---------------------------------------------------------------------------------------------------•-------------------------------------- . ................ O Description of Soil----------gravel............................................................................................... x w UNature of Repairs or Alterations—Answer when applicable------install---4---s.t-onepacke:d...gal,l.ies....... H2O / Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en ed by the board of health. Signed ... . L b --------------------------------------------- Date Application Approved By ...... ... _�.U...�.9. ..- Date Application Disapproved for the following reasons- ------------------------------------------------- --------------------------------------------------------------------- -------- .......... ------------------------------------- ---------------------------------- ---------------- -----------------------------------------_------------_------------------ ---------- ---------------------------------------- Permit No. --------91- -----.--q 3 ?--------------- Issued -------------------------------- -------------------........... Date —_--- ------------------------------ -7 No..__25 - 3 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Biopoottl Eorlui Ti nitrnrtion Errant Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: Main St Centerville Ocs Ice Cream ........-•----...-----•----•-•---•-••-•.................•-•-•----------•------------•--•••..--•--- --••--------.................................................................................... Dick WarrenLOCation-Address or Lot No. 1 Owner Address a W.E. Robinson Septic Service P.O. Box 1089 Centerville ------------------------------•-----...-•--•----------•---•------................................ Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons----_--_------_.-------- .. Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------- ----------------------------------------------------- .................................................... ---------------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width--------_------ Diameter.----........... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------.-_--------- Diameter-------------------- Depth below inlet---.---............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit---_-----..----_-- Depth to ground water---....--............... Li, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 9 ---------------------------------------------------------------•----------------•----------•-----........................................................... 0 Description of Soil.........gravel ------------------- --------------- ------------------------------------------- x U -----•---------•-----------•------•--•-----••---•-------------------••--•-------•-•-•----------------------•--------------------------•------------ ........................................... W -------------- H2(1 ---------•-----•-•------------.....................- ............•-•••----------•--------------------------•-----------•------•-------•------------------------...--•••-•--•- U Nature of Re� A, _l,- airs or Alterations—Answer when applicable----. ns-tol_ ..-4___s � ,n t.oPaake—d_._gal_1.�_Q- _____.. -------------•----•------•----------•---•--•------•--------•----------•--•-•---------------------•--•--••------.....------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been '.awed by the board of health. Signed .....K. I.... --- --. . ....................... ....... Dace Application,Approved BY ... ............... J y------------------------.---------. _------ ........3 — Date Application Disapproved for the following reasons- ----------------------------------- ---------------------------------------------------------------------------------------------- ------------------- --------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ........................................ Date Permit No. ........... .... Issued r Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE lL��ertifirate of V IImpli? nre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( x) b W.E.....Robinson SeAti.c....Service ---------- ------------------------------------------------------------ ------------------- h.,taue Main $t Centerville 4CS Ice Cream ------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ------ dated .... ..-.. . ,C---J:...._.. `'I^THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE - ..... ` i`*.-"�`--......., ------- Inspect'r•^.._- �� •--.. -'I .. __, -,_ -____ --_-__,_ .-,___._--_.-_-_-- _.-_.______/_,_,_,-_ Warren THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE NO.._.��.:...i/ �� FEE... 3_O_e OO....... Ropooal Workii Tono#rudion �ermi� W.E. Robinson Septic Service Permissionis hereby granted--------- - ----- ----------------------------------------------------------------------------------------•-----•---..-----•-----•- to Construct ( ) or Repair ( x) an Individual Sewage Disposal System atNo.....Main...S 1,dlle..--- ---------------------------------------------- --------------------------••-----------. Street e� as shown on the application for Disposal Works Construction Permit No.,__-Xi!_ �.`�. ........ � - Board of Health DATE-------------------------.3..------_--•--•-.....7/ FORM 36508 HOBBS R WARREN,INC..PUBLISHERS Q..No. ..... Loa Fes$..�.....a............ . . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........... D_vviv....---....OF�.......� Zs°7- ��.. ....... Appliration for DhipmFai Workii Corm rnrtinn Fmat Application is hereby made for a Permit to Construct ( ) or Repair (X an Individual Sewage Disposal System at: .. 0 S. ... ..//�1. . . ..�'��..r:t .. G C . -•............................... ..... -•--•-•---.....................----------- . Location-Address or Lot No. �C//��?� V`/i9�2/2 yv 1 •�2...............!� cam*i" `� ..... .........................................................., 1QN)'L'./L,0 - --- .................. Owner Address a 6__ s.SPQr� tom. :-.......................... ....................... Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) 04 Other—T e of Building No, of persons............................ Showers — Cafeteria Pa Other fixtures ------------------------------------•..._... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.............._..... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test.Pit.................... Depth to ground water........................ O Description of Soil-----.0� �' . x V ---••------------------------------•-----•---------------------•-----•----•-•-----•------------•----.....--------------------------------------....-----•--------------...---•-•---•-------.........--- W -------------------------------------------------------------------------------------------------------------------------------------------- ............................................. U Nature of Repairs or Alterations—Answer when a0plicable.1. ....57 ............................................ ik. ------.fir° Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ITLL 5 of the State Sanitary Code— The undersigned further agrees not o lace the system in operation until a Certificate of Compliance has bee>is cd by-thebo rd of....... ....... .............----- : . ...._.. .. ......�... D ApplicationApproved By . '•...-- -•---- ----- -- -----..................................................... --..�,1........... . ............. Date Application Disapproved t following reasons---------------------------------------------------------------•----------------•-----------------------.------ ------•---------------------•----•------------ ....----------------------------.......----------...---- Date PermitNo......................................................... Issued..----...---------------------------------------------- Date MW NJ� •�.--- 4 FEs..Z�..�°..... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................... ................oF........l ?.... ............T > ....................................... Appliration for Biopooal Iforkii Tonotrortion ramit Application is hereby made for a Permit to Construct ( ) or Repair (), an Individual Sewage Disposal System at: .... . - ......... Location-Address or Lot No. 1 _ i r:r!> vssr3n2 iiir 1'ur2. -�. ��� <, .244,, l f��•�i� ....--•--••-•-•------................................................................. ---------• .......--......----......... ................................................ owner Address iG: C uv�- �y,2c/i ci_ r� �Sr�ej�s /C�z.2: r�%h?� S ,-1 --------------•- ......... ......... ... .......--••-•..._...-- Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -----------------------•-••-••---------------- W Design Flow............................................gallons per person per day. Total daily flow.............._.............................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) •-' Percolation Test Results Performed by----------- ................................................0............. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ p1 --•---•---•---•---•--•--•---•--- ........................................................................................................................ O Description of Soil------.. V .............................................................................................................•.....................................................:.................................... W --•-----•-- .....-----•-----------------------------------------------------------------------------------------------------------•-. U Nature of Repairs or Alterations—Answer when applicable-1 57�� -L..._ _..........�....�L�.°"�.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE4 5 of the State Sanitary Code— The undersigned further-agrees not ttto place the system in operation until a Certificate of Compliance has been issued by the board of h lth i ••-- af"" /Application Approved By V ..••--•....................................................... ...... �/Dat a Application Disapproved f th ollowing reasons:-----•-••••-------••••••------•---------•--•-----••------............................... ..................... .....................................•• ----- ..............................................•................--••-•------------.........................................-............................. Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS --�- BOARD OF HEALTH ..........� O.V&�...........OF-...... Trrtifirate of Tompliantr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�Q by-.1 . :! ..r� Sr c�t-•- .��^,?r/r c:4:.....,___./. r3 J�.sryG.�s....................................................l .......vw{s-•............. Installer at 6 _S•_ ///3//+/S 7" C/�/+irlt:7 ' I LL, � v `5�'�S IGi: '`= =``' has been installed in accordance with the provisions of TITLE 5 of The r tate Sanitary Code a Ws �(�. m the application for Disposal Works Construction Permit No..._GS .` 1" 0 dated_.-..fr� .... ..._.__._.__ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................................��rl i�..................... Inspector... _' THE COMMONWEALTH OF MASSACHUSETTS -�-; BOARD OF HEALTH f1...v.. /!/............OF...... 1f9e�>�crC.................................. No... 3,�: G► FEE. Y! .0 0.... Roposol Workii Tonotrnrtion VarAft _ Permission is hereby grantedAm..-.c!- 711�.._.:,�✓� 1��. %........ fi r fK!.,2s. � :' ,'i2 to Construct ( ) or Repair (A an Individual Sewage Disposal System Street as shown on the ap •catio for Disposal Works Construction Permit No. atD ed�'f-.1... . .+�................. oard of Health DATE---.�/r....... -- ...�'�•---••---•--•-----------•-------------------- 'FORM 12� HOBBS & WARREN. INC.. PUBLISHERS I a ASS. A 1639. 2021 Outdoor License Renewal Transaction Details Number: F149E12T1 Date: 4/6/2021 10:06 AM Type of Outdoor Dining Renewal COVID Temporary Extension of $0.00 Premise Subtotal: $0.00 Order Total: $0.00 Name of Business Four Seas Ice Cream Place of Business Address 17 Lexington Dr, Hyannis, Massachusetts 02601 Owner's Name Owner's Cell Phone Douglas and Peggy Warren (508) 364-4167 Owner's Email peggy@fourseasicecream.com Manager's Name Manager's Cell Phone Douglas Warren (508) 364-4165 TOWN OF BARNSTABLE o B �;� LICENSING DEPARTMENT 1639 I639, 2021 COVID TEMPORARY OUTDOOR EXTENSION OF PREMISE 9�p , ,�m0 Ar�D M��� RENEWALS WITH NO CHANGES STAFF REVIEW & ROUTING FORM Business: . Four Seas Ice Cream Address: 1360 S. Main St. Centerville •�• TYPE OF OUTDOOR AGREEMENT ❑ Pre-COVID Outdoor Dining Agreement ✓❑ COVID Temporary Extension of Premise ✓❑ Requires Licensing Authority Consent Agenda Approval April 12, 2021 Date of Public Meeting ❖ VERIFICATION OF FORMS RECEIVED AND ATTACHED ✓❑ 2021 Renewal Application ❑ 2021 License Agreement (if applicable) ❑✓ Site plan ✓❑ Certificate of Liability ❑ Payment Received (if applicable) Reviewed by Date r e H EALTH: The Health Division approval is contingent upon restricting REVIEWED BY: DATE: the overall number of seats to 40 maximum . The property homas A.McKean;Dig M=Kiteeally signetl by Tftomes A. n April 26 2021 -0d'00' is located within a Saltwater Estuary Protection Zone; Date:2021.04.2616:45:01 � therefore the wastewater discharge flow is restricted. ® . a emu Signature Date Manager's Email dugger@fourseasicecream.com Are you planning on making any changes this year to the licensed area? No changes are planned for this year. Type of Outdoor Renewal Type of Outdoor Dining Renewal COVID Temporary Extension of Premise Upload of Documents Updated Certificate of Liability Insurance Scan0077.pdf The undersigned hereby attests that there are NO CHANGES IN THE OPERATION of his/her business as stated in prior renewal applications. This shall include business name, manager's name, floor plan, seating plan, number of units, mailing address, and business telephone number. Signature '.. •. 'm�rNr+.+:wwmmmiw.Mxmwnmmwr»x....w.ewm-. --�.naram,.wmw",..v>.»..-m......x...me,memmmmmmm. �v,mA,.m..v,mnmmmmmwam.m-.:r.e-.....m ..mom..�mw'was-.mvs,mnmaaee'..m.�++c,c�'e.nr.-m..rt.-.mnmrv�uaae u.mm�»am IRgei1C1 , a ¢ r Town Boundary �°�� '. Radroad Tracits r• / it!i v/. �C �-' 3r Big" Approx.Building t Buildings - ' Paint Lines bra` a Par ldng Lots Paced r ` Unpaved { Paved s >. Unpaved. I Roads Paved Road II Unpaved Road F rBridge : rs} u Paved Median R F - ;` Streams Marsh r water Bodies c•, x ` - v t 2 i t w _ f c liti qD vzz «w.''s-'ee'` -; "a�,Y! �,i�T+� �,y`a p.: - •h}y J. / t.. . —�• Ar Map printed on: 717/2020 This map is.for 17116stration purposes only.lt.is not Parcel lines shown on this map are only graphic , wn adcquawfovle�al boundary drternunation or representations of Assessor's tau parcels,They are To of Barnstable GLS Unit. Feet regulatory:interpretation T i map does not represent note ae.property boundaries and do not regresvii 36?Main Street.Hyannis,MA o2601. 0 42 83- an on-the-ground survey.It navy be generalized,way not accoratc relationships to physical objects on the map So$-862-4624 diti reileet current conons;and:maycontain sach,aYbutTdinglocations: Approx.Scale:i inch= 42 feet eartogruphieerrors oromissions. gLS@town'.barrv-tabie:lna.us } r • / a : V r I CH N SKETCH PLAN - FN Co 77'27' - 'SET SHOWING STAKES SET, BOUNDS FOUND, AND BOUNDS SET IN NOVEMBER.2005 - LoCATION : 360 SOUTH MAIN STREET CENTEMLLE, M_4 SHELLS', SCALE i" = 40' DATE : JANUARY 23. 2006. -. ._:.�..'�.—_- - - --- — `- •�._ —...__ _— ._ _ • DRIVEWAY I REFERENCE : ASSESSOR'S MAP 207 PARCELS BO FNO PREPARED FOR: Lu CB. RXGHARD . WARREN SET 23.47, ee' & SET FND Ice. ,a' Ar LOT.COR. : • • O ` f.- ^ UNDER DUMMER ,.. . I _ .. .... _ . . BOB ` - on a0e-3e2-4S+1 SHED • Ime s0e 381-9880 �60 down cape ai g&ewlpg. mc. EXIST. BLDQ CIVM ENGINEERS LOT LINE AREA IN QUESTION EXIST. I,1►ND SURVEYORS EILDC. r 93 main sL yannwA, ma 02675 so ---- DATE---- -- �RE'G LAND SURVEYOR'--- JOB 05-259 is _. ----- — ----- -- — — --- — -- _....... .. a --------------- Jr 5-77 51 e _— t � r --- ` - =- - _ . - __ ...- - - O ' k A ........... _..__ _ ;. _ ... ... _..._ ... ... ........ _ _... ._..._ --.... ......_.... ........... _...... .... '. ......_ -- ... _..... — _ _ . ....... I j 1: I I , I , 1 : I 1 I . 1 , r I i I I" I I ; I , i .I f I I r i , I , I .r r 1 + : : :....:. i , I I •' i. I I i � r I I r 1 r I r I V ' I 1 II i I I i I ! r , : i I I , I i I 1' I i f . .... I I r , j ......... ' I I I. , : I i ? .:. .. --... I i 7 i i f I ... I ....... r , � r I. 4I KKK I V"S i ! _ �,�,A1 �u I 1 , �, p' ��, 6� �.I� ° T 4/� �.C"• h.. ���.. 1 ��I v ' I �i J , I i t ,fit - ..q .,.. .... .. �. _.:.7 I. I I i I. t ii I , : I JJ .... '..., i .. .. �� _ nd, 1 r I I I � �P� I } f .. 1 I I 1 r�.. {W.P� '1T i I Ifflf m.{ ,{�I I rr�•� .mt 4, , : I.. . :...... .......... T 4}. I ' { 17. '. I ' I I ' I I� q4 .j.. ...'. : 1 ' 1 -• 1 ; t I ..__+ ..,. .. 1 Al I I i i , LA 1 I 1 •! �• I I I� '' � I 1 i I I i SI , / I LA I I 1 I ; I ! r r 1 r , i , , 1 i i I I I 1 i i I I i I 1 i I I I 1 j .. tA I I i I I 1 1 , I r ; I i , I � , . , ` 1 .. 1 . I i I _. 1 � i I !.. 1 Bellaire, Dianna From: Soto, Kathryn Sent: Monday, April 26, 20214:46 PM To: Bellaire, Dianna Subject: Four Seas Hi Dianna, Do you know how the seat count got changed on the permit for Four Seas? Since last year there were more seats added and outdoor seats added too. They are only supposed to have 40 total. The outdoor seating is only temporary. Let me know FYI I left the file on your desk and Tom is going to probably ask you about it too Thanks, Kathryn 6:Af Health Inspector Town of Barnstable 200 Main St Hyannis, MA 02601 508- 62-4639 ME The information contained in this electronictransmission("e-mail"),including any attachnient(the"Information"),may be confidential or otherwise exempt from disclosure.it is for the addressee only.This Information may be privileged and confidential work-prode.ct or a privileged and confidential communication.Tile Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only.The information may not be disclosed without the prior written consent of the Director of Public Health and/or the"own Attorney's Office of the Town of Barnstable.If you have received this e. mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it. Thank yo€ for your cooperation, 1 r 44,70 WN OF BARD STABLE. 1 Zr LO:ATION1 �j 1j % SEWAGE # VILLAGE Z�n ASSESSbR'S MAP & LoiZ6 , INSTALLER'S NAME & PHONE NO. �?c>A , ' 2•-- ' SEPTIC TANK CAPACITY G .7 6-0 LEACHING FACILITY:(type) u S (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER_ BUILDER OR OWNER DATE PERMIT ISSUED: 34-2 - DATE COMPLIANCE ISSUED: 41 VARIANCE GRANTED: Yes No �: ;r=�_ _-= p I C G1 ���� d � � �� ,. y_��, _ � S ` 7 ,� � �� . � '�- } ' s -o o 1� LOCATION SEWAGE PERMIT NO. VILLAGE 3loO /�� �'�, 5 j � i�•� I • 3� A &° B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 0 ..f L----- - --_I ! I ' !—i—� - ------ ---- ---------——------- ! 1—--- —---- --- �. --� ----I - --- -------I..-- ---- --- --- -- -� -�---- - ---- --- --- ---I -i- - - -;-- ,,-- - -- ,-- - D --. ----- � � I � I I I I I � ► f i I , -I- - I � ! ` �? iv -- - ------- - --- - - --- - -i----- -- - ----- -- -- ---- ---.� -- ------ �- ---- ! ►____I_____ ......� ______ -- ------ - -=------ I ! - - — -- - -- - - - I-- r x . ! - X/- + I I v I I LLI I---- ----!_ L.._... .---------- ------- ---- ----� ----�---------'--- -- ----�-------- I - ------------ --- ---i - -- ---- --- ---- ------------- ----___ ------—----—__-. I _ - - - - I- --1--- --- - -I --- -- - -- ---;---�-- - --- ------- -- -- --,-- ------- -- ---- --- -- --I----�- -- I----i - I-- �-- - -- fj t t ----- - - -- - - --- ---- --- -- -- --II- - ----- ----- -- ----=--- - - ---- - -----: ----� --�- -- — _- I 217 Thornton Drive,Hyannis,MA 626oi o8.77i. uo f. 775- 4 P•5 3 / 508. 28 8. MASS. HOME IMPROVEMENT CONTRACTOR REG. #100121 I ! I I---� ---_----- �--_---- ---I---�--- � --- I----� ----------- ------- - -- - - ---- ---I--I-- -1--- - I www.oceansideinc.com MASS.CONSTRUCTION SUPERVISOR REG. #000043 i.----- -- - ——- o - -T �-------- -- 4 3 3- 39 94 -- -- - - -- -- -- --- - -- -------I - -------}— — - — - --� --------�----I ----------� -� .I - �---- --- ----- ----i Lead Certifications NAT- 8 2 1, R-T-i8 8-io-o26 I � ' ---�-------�--- ------------------I-------I----I -----i---- --}----, ,---. 1 , -� Four Seas Ice Cream ---__ �___._ ___ -- - � -- --�---------- —! I-- —�-1—���_—. _--�— ------I Min n rvill ---1----I------�----,---�--!---I---1---�------- -;--------I-------�--�---- -- ----- Main�---�`------, ------------------ ----i----� _ .7_I__. ---- ---- _ __I-------__---- -------- _._ . ._ a St, Ce to e -- ---— -I--�---='---- -----�--------- ---- --__-------- -----_.---- ----�---------� New rear . access to second level i I�---_�- --�-- ----i--� ---I--- �� -i - ---- ---�--- - ---�- - - ---- -�- -! 4 L---'- -- ' !----- I - !-- -- - -- - �( --1--I — - - ------ ! - --- —— ----� I----- ------i — ----- — - — - —� Draft April 27 2012 i No`' I............... ':?...°.0....... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH .........OF....:.. ,. ApplirFation -for Bhiposal Works Tanstrurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: �/--------------- ...----------------•------•--.----------- Locati�- d1dcress /1 e or Lot Ivo. . ...• :_-.�C.tee..-_c- ------ * caner ............................•-------._......Address Install Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------ --------------------------- W Design Flow............................................gallons per person per day. Total daily flow......................................._.....gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter............._._ Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area..--._.._---.-......sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet____.._______-_----- Total leaching area........----------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results . Performed by------------- -------------------------••----------------•---------------- Date---•------.-..----------------------.--- ,� Test Pit No. 1................minutes per inch Depth of "Pest Pit-------------------- Depth to ground water-..--_-.-.__-..-._---_ r=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+ ---------•----- " . ......................................................................................-----•---------•--------- - — � >O Description of Soil------------ ----- x ; U --------•-•-----•-----------•-------------------------•---------•--•---------------•--------•---------------_------•l--•-----....----••---•--••------•---------......_---.......--•-_-•_-- W ------------ -•------ -- --- ---- --------------- U jNate of epairs or Alterations—A w when applicable...._ n _ "-f� -------------------------------------------------- -------­--i�y----------- -- ment: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued by e board of health igne �°'/J_:-••• t'�.= = ' "r'' cam^ �- 6 ��1 .-- Date / Application Approved By---••---- Date Application Disapproved for the following reasons:_..... -•-------•------------------------•---------•--•----- .................... -•--•--•..................•-------------------------------•--..........--•-•-- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH .........OF...... 4.......................... 1011rrtifirate of fhomplinnrr THIS IS TOZ RTIF�; That the Indivi al Sewage Disposal System constructed ( ) or Repaired (� by------- ( ------- --- ................. i - l Installer�T �� i ,f has been installed in accordance with the provisions of Artiel �XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.____ __ _.. 7 " PP P dated'.. �� - �.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATiSFACTOU. � � DATE.-----------�-----------3...a----------�G------------ Inspector .....� � __�.. .............. THE COMMONWEALTH OF MASSACHUSE S BOARD O !EALT � ............... / 3 .........i. ......t►-? ..... OF........ No...... -'' . FEE...+., .__.�-.... Bi-tivoiittl ork �( on rtio$arrmit Permission is hereby granted. =c / �- to Construc- or Repair ( an Indio Vital Sewage Disposal stetry `�; /� Street as shown on the application for Disposal Works Construction PerNo_____________ ______ D. 'S 4- / __....---- )3oard of Health �f DATE -- ----------------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS