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HomeMy WebLinkAboutMC DONALDS - FOOD McDONAL 6.54 Iyannough Rd,Hy i • T,. Town of Barnstable BOARD OF HEALTH John T. Norman R Board of Health Donald A.Gaudagnoli,M.D. SST F.P.(Thomas)Lee,. "A&& Daniel Luczkow,M.D. Alt. 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 231 Issue Date: 01/01/2022 DBA: MCDONALD'S #1212 OWNER: MCBEE ENTERPRISES Location of Establishment: 654 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 80 OutdoorSeating: 0 Total Seating: 80 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2®22 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE-ICE CREAM: C�iA FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent i FOR ESTABLISHMENTS WITH SEATING: i PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Approved-Time as a control. Must discard food after 4 hours. For Office UsC_Q Ay• Initials: Town of Barnstable . Date Paid Amt Pd$ BAMSPABLE ; Inspectional Services MASS •``� Public Health Division I Check# o`� D MIS Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE_ /Z1/a1 �,, NEW OWNERSHIP ,RENEWAL 1/�] NAME OF FOOD ESTABLISHMENT: ► c f)"Ma�d s ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): D GI,UCV E-MAIL ADDRESS: 2LL�CpiYld►'�, YIL �(dV VY"�1��T1�,�Lll'Y� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (2Lb 77J - 45)6 v� TOTAL NUMBER OF BATHROOMS: _ WELL WATER:YES NO ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: I lLi_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV, ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?Nb TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) i OOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED.&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD V FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER YES/NO D.O.B OWNER PHONE# ,29' 3J al9D ADDRESS 0 LL11YV � I 40 W-1,8 A - ' CORPORATE OWNER: ftASP CORPORATE ADDRESS: 5� /�L ►�/�(� �! 71� YI�I. /��3y PERSON IN CHARGE OF DAILY OPERATIONS: Lo LS �' Rig— 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 Dol.� G� I. 2. DQ)Y'2a X roijo n SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments, including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townotbarnstable.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 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsT00DAPP REV3-2019.doc w t Town of Barnstable BOARD OF HEALTH I John T.Norman Board Of Health Donald A.Gaudagnoli,M.D. BARNSTA Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 231 Issue Date: 01/01/2021 DBA: MCDONALD'S OWNER: MCBEE ENTERPRISES Location of Establishment: 654 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 80 OutdoorSeating: 0 Total Seating: 80 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2®21 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: C / FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions`. Approved-Time as a control. Must discard food after 4 hours. l st �TNE Tp� For Office Use Only: Initials: Town of Barnstable 3& Date Paid � b AII1LPd$ : .,,a,,,grAB Inspectional Services 9� nil6A�SS, `0� b== A,Fo . Public Health Division V Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A- FOOD ESTABLISHMENT DATE !I—V"Q9 NEW OWNERSHIP RENEWAL t/ NAME OF FOOD ESTABLISHMENT: Q ( �,I ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: 6&0 l-/WP910 fY ee=22 k,-Cil'?/1/� IX TELEPHONE NUMBER OF FOOD ESTABLISHMENT: yr( D$')1-., ,Jl TOTAL NUMBER OF BATHROOMS:_ 2 WELL WATER: YES NO—Z.- (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:�� SEASONAL: DATES OF OPERATION: / /_ TO NUMBER OF SEATS: INSIDE: -�L OUTSIDE: 0 TOTAL: Qn SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?— TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) FOBILE FOOD ROZEN 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 INSiPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT MeAm SOLE OWNER• YE NO D.O.B OWNER PHONE # ADDRESS 6-n t 12.& Di23 SZP CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date Y 1. 10A 1UQ4A ' a laQo2 1. 2. 9 a1 a-1 a �a SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/apt)lications.asr). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. QAApplication FormsTOODAPP REV3-2019.doc * pF Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. RAWNWAUM Paul J.Canniff,D.M.D. MAW 200 Main Street, MA 02601 F.P. Thomas Lee Alternate � Hyannis, Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 231 Issue Date: 12/10/2019 DBA: MCDONALD'S OWNER: MCBEE ENTERPRISES Location of Establishment: 654 IYANNOUGH ROAD HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 80 OutdoorSeating: 0 Total Seating: 80 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: $30.00 Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Approved-Time as a control. Must discard food after 4 hours. V • Initials: Town of Barnstable Date Paid Aid$ ,E : Inspectional Services i639' A Public Health Division check# `3aa I s`.` Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Q ` Office: 508-862-4644 Fax: 508-790-6304 i APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 1 I-1-I q NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: /- ma1ol/S ADDRESS OF FOOD ESTABLISHMENT: SLI lt� a n nljt)'4 h MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �Z D Q1,Y r S4., Ske W-O N -&LD& pIL3SZ-v E-MAIL ADDRESS: �Li°Gl hUVI° �111 C//Y� V�L�pc`�EYL�• 0 en'14 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (SDb 771- TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: v SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) ✓ OOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) OBILE FOOD 7 FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED . PLEASE CALL 508-862-4644 Q:Wpplication FormsTOODAPP 2020.doc r OWNER INFORMATION: FULL NAME OF APPLICANT e et:s-rs SOLE OWNE . YES/NO D.O.B OWNER PHONE# 8' a 36 -a9 90 ADDRESS b— b Li INY' CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: 1)l4 Y-t1( A 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. DO I" ljrffl &Vy 1 /a� � 1. San1�,� SL� 3 2. -a-mCCe S IAL)a SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to ovenine!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http•//www townofbarnstable.us/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.31"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 rt Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. BA John T.Norman gas F.P. Thomas Lee Alternate +�sq 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 231 Issue Date: 12/20/18 DBA: MCDONALD'S OWNER: McBEE ENTERPRISES, LLC Location of Establishment: 654 IYANNOUGH ROAD HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 80 OutdoorSeating: 0 Total Seating: 80 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - - - -- - -- ---- — - - MOBILE- FOOD: MOBILE-ICE CREAM: CQ� FROZEN DESSERT: $30.00 Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE 1 Restrictions: Approved-Time as a control. q, Op THE r, For Office Use Only: Initials: Town of Barnstable % Date Paid 9 KAM. Inspectional Services 4�,,rsb3a s`0 Check# 0 1 �13 W FDMA+ Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 + Office: 508-862-4644 Fax: 508-790-6304 � j i•'+,i e Y APPLICATION FOR PERMIT TO OPERATE AFOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL V/ NAME OF FOOD ESTABLISHMENT: .emj(�I ADDRESS OF FOOD ESTABLISIIMENT: qq MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: Q-1)!!aMaV . r1 �Jy►gin P2 mL6e_eTJ,q`,r CAQ M TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (5 ,.f llj-- 2,51a TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO V ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: _ OUTSIDE: TOTAL: 6-6 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 ELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) OBILE 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 Y PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO D.O.B OWNER PHONE # ADDRESS_ :� �L.MN1Y' L!y)T/1 CORPORATE OWNER: FEDERAL ID NO. CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least(1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. 1. Tr�r, *-Jal Zq 1. D " .Dunn >l ��� Lakv 2. Int�mbag- ZZl 3 law SIGNATURE OF APPLICANT DATE *** *** FOOD POLICY INFORMATION SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/bealthdivision/api)lications.asi). 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.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q\Application FormsTOODAPPREV2018.doc f oFTHE TOWN OF BARNSTA_ BLE HEALTH INSPECTOR'S Establishment Name: \ 1LC - �� � Date: ��-t Page: of , 'pPy ~fie OFFICE HOURS HEALTHBARNSTABLE, ' PUBLIC 0 MAN STREEETSION -3: ' :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30--0-4:30 P.M. 'qp Me; I. HYANNIS,MA 02601 sos-s2 aRsa4 No Reference R-Red Item PLEASE PRINT CLEARLY ,FDMP,e. OOD ESTABLISHMENT INSPECTION REPORT Name Da � of ectionpT 1k O er tion s uti" Address N- Risk Food S Re-inspection h Level a ai Previous Inspection C Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP e In: Other Inspecto 't`+",, V> < Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. kv1 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) C X-AS 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 J� EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives r Y� ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) - ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) ` Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection to ay,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other.: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and less than 4non-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 g p,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up, ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 = � 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations C. 30.Other DATE OF RE-INSPECTION: Inspecto i tur rint:' r 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.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F * - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-102.11 Common Name-Working Containers 590.004(F)- * 2 590.003(C) Responsibility of the Person-in-Charge to - Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* _ - 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and AdulteReserrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated � ) _ Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* .,. 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk-Products* 4-501.112- Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made Fiom Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * Equipment 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* sff"ane 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g ry 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g• P arY 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements.practices should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 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. DoFaE ro�, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: �-sW� Date: ®"XZzy'-wage: of OFFICE HOURS -T PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ' 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified A nn MASS.q: 5088 -FRI. `0$ HYANNIS,MA 02601 - 62-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 'FDN1P�' FOOD ESTABLISHMENT INSPECTION REPORT Name Date i Type of Type lypeof Inspection Address Risk < Food Se Re-inspection Level Retail Previous Inspection I In Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other t C Inspector � Out: ` Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS \ ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories U_r) Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) a `1,2) a0 Corrective Action Required: No ❑ Yes fEj Non-critical(N)violations must be corrected immediately or Overall Rating o�oC 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. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address within 10 days of receipt of this order. violation,4 to 8 no critical violations=C. 29.Speci/Ruirements (590.009) y p30.Other DATE OF RE-INSPECTION: Inspector's u nn 31.Dum terscreened 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 11 Ct ! Print: Self Service Wait Service Provided Grease Trap Size, Variance Letter Posted Y N \��` Dumpster Screen? Y N c�J `V l Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) JDerronstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14. Protection from Unapproved Additives* 79 PHF Hot and Cold Holding Contamination from Raw Ingredients 75 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-102.11 Common Name-Working Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage*g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 590.004(11)3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions Variance Requirements 590.003(G) Reporting by Person in Charge - Contamination from the Consumer * 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.I1A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff crivc inrzoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 scc* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 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 * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* Blue Items 23-30) 3-202.11 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 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. TOWN OF BARNSTABLE HEALTHINSPECTOR's Establishment Name: nr\� Date: l 13 1.. Page: of q OFFICE HOURS A E PUBLIC HEALTH MAN STREEETSION 8:30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. �p MASS p�0� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE P NT CLEARLY lFn MAC 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT ..°- Name SZ Date l Type of a section Routine Address 5 Risk Food Service Re-Inspection l Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other ` _ Inspector Out: 1 Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities E EMPLOYEE HEALTH PROTECTION FROM CHEMICALS l ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) cc ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures J ❑ 5.Receiving/Condition ❑ 17.Reheating V ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding If 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 U5 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 i 1 ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations 9 if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage 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. within 10 days of receipt of this order. violation,4 to a non critical violations=C. 29.Spe ' I Requirements (590.009) _ - 30.Oth DATE OF RE-INSPECTION: Inspf ur 31.D pster 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 s Sigac�A- t Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N V 1 V ��N N �/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 7 5 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F*Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* ' Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* Requirements 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.004(11) Variance Re q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3_202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY * Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water 3-401.11A(1)(2) Eggs-155°F 15 sec 4-601.11(A) Clean Utensils and Food Contact Surfaces ofmen[ Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment*5 lOLl1 Drinking Water from an Approved System* * Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* q p 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg°"°e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Lu Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 ' 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F TagsiRecords:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11. Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oFT ror TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: J�► ., ate: age: Of P r tia 4W OFFICE HOURS PUBLIC HEALTH DIVISION 8.00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. .Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mAss. MON.-FRI. A ,679•A.O HYANNIS, MA 02601 No Reference R-Red Item PL E PRINT CLEARLY o 506-862-4644 A 'FD1A1" OOD ESTABLISHMENT INSP QTI N REPORT ? Name Date/ Type of ns c ion ✓ , Routi !� Address j ( Food Se inspectionV11L el PrevioAt WPI L-� Telephone Residential Kitchen Date:Mobile Pre-opk Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint - Person in Charge(PIC) ime Bed&Breakfast HACCP 4 Other Inspector y / l / R Each violation checked-requires an explanation on the narrative pa,e(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) ❑ r 1 r / Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities - n 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 I ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold'Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control 9 r� ❑ 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 U ❑ 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 r ( ) y ( ) (� � `©I Corrective Action Required: ❑ No d 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 i ems ❑ 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 4Aon-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 ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 n iola,tl'Gal violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 ,s 29.Special Requirements (590.009) within 10 days of receipt of this order. vio lion,4 to 8Aon-critical viola-gns= 30.Other DATE OF RE-INSPECTION: Ins ct is n ur _ Pr' 31.Dumpster screened from public view- �.�./ Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y IN r ,- #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter.Posted Y N Dumpster Screen? Y N uvl; �, C Violations related to Foodborne Illness - Violations Related to Foodborne Illness Interventions 4 Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives ::., ., Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) i Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 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�1°F/45°F 590.004(F) * - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each ( 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-1'02.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) � Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use - 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* -REQUIREMENTS FOR - 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria*^ HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food'and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* _ _ - 4-501.111 Manual Warewashing-Hot Water ^ 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* _ 4-561.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* _ _ gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff eeve 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) - Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 - Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 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 1 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 g' Por 15 sec* in mobile food,temporary and residential � Game and Wild Mushrooms Approved By - - * 3-40L11(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 * 11 Good Hygienic Practices practices should be debited under#29-Special 3-201.17 Game Animals 17 Reheating for Hot Holding Requirements. $ - Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* _. 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 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 fallowing sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* . 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 1 Specialized Processing Methods* 130. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteriax 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. lAl�p THE TpN, _ TOWN OF BARNSTABLE, - HEALTH INSPECTOR'S Establishment Name: i I Date: Page: of p 1 OFFICE HOURS `J BARNsrAB�E. PUBLIC 2 0 MAN STREET 3:3030-4:30 P.M. DIVISION :00- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MA55. HYANNIS,MA 02601 MON.-FRI.soa-862-4saa No Reference R-Red Item PLEASE PRINT CLEARLY .. 'RFD MP�� n FOOQ�E TABLISHMENT INSPE T N REPORT_ - Name Date vne of Tvoe of Inspection OOoeration(s) Routine lilt / Address Risk Food Service Re-inspection / f Level Retail Previous Inspection Telephone Residential Kitchen Date: J Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness d Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other' i Inspector Out: Each violation checked requires- n explanation on the narrative page(s)and a citation of specific provision(s)violated. ja r . y c--� Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ r� ` Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ / FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ® / ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities '�� It A EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Disease's by Food Employees and PIC ❑ 14.Approved Food or Color Additives r�R ,1 ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals > / / f FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLSON .(Potentially Hazardous Foods) (gam , , r: .❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures / ! A ❑ 5.Receiving/Condition ❑ 17.Reheating �,© C ❑ 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 t ,I / ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) All ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP / ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY Ot l%,� ( � � f, _ `• � / ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories i 4� Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations L1111WI V I CAI LX) Critical(C)violations marked must be corrected immediately. (blue 8,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 9 re ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non critical. If no critical water,sewa a back-u 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 9 p,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials` (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to.8 non-critical violations. If 1 critical refrigeration. 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: In spPtur Print: 31.Dumpster screened from public view - Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N /��� #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's S Print: I Self Service Wait Service Provided Grease Trap Size Variance Letter Posted. Y. N �� Dumpster Screen? Y N 4 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 Additive*s Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 1f 1 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F*- Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 590.003(F) ,_ Responsibility of A Food Employee or An 3-302.15... Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*. Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR- 3-306.14(A)(B)Returned FoofAdudand Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and - ( ) P 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Idiate Service 145°F sec* * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* gg Immediate ery Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 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 Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 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 Ratites-165°F 15 sec* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle;Intact Beef Steaks 145°F* kitchen operations should be debited under - Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 . Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* Requirements. 5 Receiving/Condition g� g g 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11E Remaining 3-101.11 Food Safe and Unadulterated ( ) g 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 Tags/Records:Fish Products 5-203.11 Numbers and Capacifies* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from.Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* ti 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 590.600. ;T.t, E South Coast Development, LT ,C. April 26, 2018 j Mr. Jeffery Lauzon Chief Local Building Inspector Town of Barnstable 200 Main Street Barnstable MA 02601 RE: Drive thru Only Re-Open Request McDonalds 654 Iyannough Road Hyannis MA Dear Mr. Lauzon South Coast Development LLC (General Contractor) and McDonalds Franchisee Mark McBee for the above referenced location feels to the best of our knowledge that there will no construction activity in the kitchen area only in the dining room area after your inspection of the temporary dust wall separating the dining room work from the kitchen. We feel this will allow the kitchen and drive thru window to re-open. Sincerely; seott Scott Schedin Project Manager/License CS # 050556 Mark McBee Franchisee/Operator _t April 24, 2012 Called at 6:30 am by Capt. Craig Farrenkopf of Hyannis Fire Dept. (508-775-1300) to McDonald's, Rt. 132, Hyannis Pitco friolators failed for some unknown reason. At 11:30 pm last night they were cleaning up and the friolators started bubbling up and then exploded causing the ansul system to go off. These friolators are located on right rear side where they use them for lunch and dinner. Therefore after breakfast this morning they will close until they have the friolators fixed and cleaned. The contaminated oil will have to be taken away by the bulk oil company, Restaurant Technologies, Inc. (1-888-796-4997) They are also overdue on the cleaning of the hoods above friolators. Last done on Dec. 14, 2011. They should be done every 90 days .They are dirty, greasy and long overdue. They will have to be done before they can reopen. Industrial Steam Cleaning, 1-978-703- 1280, is the company that cleans the hoods. The manager of the McDonald's on Route 132, Hyannis is Eugeniu, aWa"Eugene". His cell is 774-208-6118 and the store number is 508-771-1513 Eugene will be there all day along with his manager who is coming in from Bourne. He will call us to have a re-opening inspection. However, due to some language problems, might be best to not assume and do our follow-up. They most likely will be closed for lunch and dinner due to the amount of work to be done. Donna Z. Miorandi, R. S. Health Inspector I Town of Barnstable PROTECTIuri UNI1r.&_,ATES ENVIRONMENTAL Mr. Theodore Head Kay Chemical Company 8300 Capital Drive Greensboro,NC 27409 Subject: Kay SolidSense Sanitizer EPA Registration No.: 5389.-20 Amendment Date: October 25, 2010 JAN 2 6 2011 EPA Receipt Date: October 28, 2010 Dear Mr. Head, The followingamendment, submitted in connection with registration under the Federal g Insecticide, Fungicide, and Rodenticide Act(FIFRA), as amended, is acceptable subject to the conditions listed below. • Alternate Brand Name: Apex Solid Quat Broad Range Sanitizer • Increase the rate to 400 ppm as per 40 CFR 180-940(a) Conditions: 1. Revise the claim on page 2 to be in agreement with the increase in use rate as follows: "Kay SolidSense Sanitizer is an effective...in 60 seconds at 200-400 ppm active and up to..." 2. Make the following two revisions to bring this label into agreement with PR Notice 2000-5. Revise the directions for Restaurants and Bars and Wisconsin State Board of Health Directions for Eating Establishments by replacing the word "should" sections with the word. "must." General Comments A stamped copy of the accepted labeling is enclosed. Submit one (1)copy of your final printed labeling before distributing or selling the product bearing the revised labeling. Please contact Tracy Lantz at(703) 308-6415 with any questions. Sin erely, N�' Velma Noble Product Manager (31) Regulatory Management Branch I Antimicrobials Division(751OP) Enclosure: Stamped Label _ l7510P:T.L :1/26/11.5389- C8lieuRRENCES SYh180L .. .....f� f� .r.•...•......r• •.•...Nr...rN• •.Mr.r...••.•.•• ................. •r.Y ......... ...NNNM.N... SURNAME ..:,(. .. .. GATE t OFFICI FILE COPY EPA Form 1320-IA(1190) PriRwica Recycled Paper AL C f 10/25/2010 Page 1 of 4 KAYS SolldSenseTM SanitlZer ACTIVE INGREDIENTS: Alkyl(60%C1430%C165%C125%Clg)dimethyl benzyl ammonium chloride......................... 18.93% Alkyl(68%C1232%C 14)dimethyl ethylbenzyl ammonium chloride....................................18.93% INERT INGREDIENTS....................................................................................62,14% TOTAL:.................................................................................................,.....100.00% KEEP OUT OF REACH OF CHILDREN DANGER For Commercial Use (Outer Carton): See Side Panel for Precautionary Statements and First Aid (Inner Package): See Inside this Label for Complete Directions for Use,Precautionary Statements and First Aid ACCEPTED ` with COMMENTS in EPA 'Letter Dated: NET WEIGHT: 2 lb.Block t < JP Z 6 20111 Kay Chemical Company Jrder the JP Insecticide, 8300 Capital Drive - < Fu!lgidde,and RodenticideActas Greensboro,NC 27409,USA urzerded,for the pesticide, Iegistered under EPA Reg.No.1513 S 9- EPA REG.NO.: 5389-20 EPA EST.NO.: 5389-NC-1(G),1677-MN-1 (P) < Superscript refers to first letter of date code .L PRECAUTIONARY STATEMENTS HAZARDS TO HUMANS AND DOMESTIC ANIMALS DANGER KEEP OUT OF REACH OF CHILDREN. CORROSIVE. Causes irreversible eye damage and skin burns. Do not get in eyes,on skin or on clothing. Wear goggles or face shield,rubber gloves,and protective clothing. May be fatal if swallowed or absorbed through the skin. Remove contaminated clothing and wash before re-use. Wash thoroughly with soap and water after handling and before eating, drinking,chewing gum,using tobacco,or using the toilet. FIRST AID Have the product container or label with you when calling a poison control center or doctor,or going for treatment. IF IN EYES: Hold eye open and rinse slowly and gently with water for 15-20 minutes. Remove contact lenses,if present,after the first 5 minutes,then continue rinsing eye. Call a poison control center or doctor for treatment advice. IF ON SKIN OR CLOTHING: Take off contaminated clothing. Rinse skin with plenty of water for 15- 20 minutes. Call a poison control center or doctor for treatment advice. 10/25/2010 Page 2 of 4 IF SWALLOWED: Call a poison control center or doctor immediately for treatment advice. Have person sip a glass of water if able to swallow. Do not induce vomiting unless told to do so by the poison control center or doctor. Do not give anything by mouth to an unconscious person. IF INHALED: Move person to fresh air. If person is not breathing,call911 or an ambulance;then,give artificial respiration,preferably mouth-to-mouth,if possible. Call a poison control center or doctor for treatment advice. Have the product container or label with you when calling a poison control center or doctor,or going for treatment, For medical emergency information call(877)231-2615 or call collect 0(952)853-1713 NOTE TO PHYSICIAN Probable mucosal damage may contraindicate the use of gastric lavage. ENVIRONMENTAL HAZARDS(Required for product supplied in containers 50 lbs.or greater) This pesticide is toxic to fish. Do not discharge effluent containing this product into lakes,streams,ponds, estuaries,oceans or other waters unless in accordance with the requirements of a National Pollutant Discharge Elimination System(NPDES)permit and the permitting authority has been notified in writing prior to discharge. Do not discharge effluent containing this product to sewer systems without previously notifying the local sewage treatment plant authority. For guidance,contact your State Water Board or Regional Office of the EPA. STORAGE AND DISPOSAL DO NOT CONTAMINATE WATER,FOOD OR FEED BY STORAGE OR DISPOSAL PESTICIDE STORAGE: Keep product dry in tightly closed container when not in use. Store in.cool, dry,well ventilated area away from heat or open flame. PESTICIDE DISPOSAL: Pesticide wastes are acutely hazardous. Improper disposal of excess pesticide, spray mixture,or rinsate is a violation of Federal Law. If these wastes cannot be disposed of by use according to label instructions contact your State Pesticide or Environmental Control Agency,or Hazardous Waste representative at the nearest EPA Regional Office for guidance. CONTAINER DISPOSAL: (Block wrap)—Container is destroyed by removing the product. Discard completely empty packet in trash. (Carton) Offer carton for recycling,if available,or discard in trash (Note: The following is considered optional marketing language) Use KAYSolidSense Sanitizer in restaurants,bars,cafeterias,institutional kitchens,food preparation.and storage areas,and convenience stores where sanitization of food contact surfaces is of prime importance. This product will sanitize previously cleaned and rinsed nonporous food contact surfaces such as: countertops,stovetops,sinks,dishes,glassware, silverware,cutlery and other eating and cooking utensils, plastic and other nonporous cutting boards and chopping blocks,and other hard nonporous surfaces. KAYSolidSense Sanitizer is an effective sanitizer for use on food contact surfaces in 60 seconds at 200 ppm active and up to 500 ppm hard water against: Escherichia coli(ATCC 11229) Staphylococcus aureus(ATCC 6538) Regular,effective cleaning and sanitizing of equipment,utensils,and work or dining surfaces which could harbor hazardous microorganisms minimizes the potential for contaminating food during preparation, storage or service. Effective cleaning will remove soil and prevent the accumulation of food residues, which may decompose or support the rapid development of food poisoning organisms or toxins. Application of effective sanitizing procedures reduces the number of those disease-causing organisms y Y 4J 10/25/2010 Page 3 of 4 which may be present on equipment and utensils after cleaning,and reduces the potential for the transfer, either directly through tableware such as glasses, cups and flatware or indirectly through food. To prevent cross-contamination,kitchenware and equipment food-contact surfaces must be washed,rinsed with potable water and sanitized after each use and following any interruption of operation during which time contamination may have occurred, Where equipment and utensils are used for the preparation of foods on a continuous or production-line basis,utensils and the food-contact surfaces of equipment must be washed,rinsed with potable water and sanitized at intervals throughout the day on a schedule based on food temperature,type of food,and amount of food particle accumulation. This product is suitable for use on materials such as: Aluminum Brass Copper Chrome Corian® Glass Glazed ceramic Glazed enameled surfaces Glazed porcelain Iron Laminated surfaces Metal Plastic(such as nylon,polystyrene or polypropylene) Plexiglass Porcelain Rubber(such as EPDM or Viton) Sealed granite Sealed limestone Sealed marble Sealed slate Sealed stone Sealed terra cotta Sealed terrazzo Stainless steel Vinyl and plastic Vinyl graphics DIRECTIONS FOR USE It is a violation of Federal Law to use this product in a manner inconsistent with its labeling. SANITIZING PREVIOUSLY CLEANED STATIONARY EQUIPMENT AND OTHER HARD, NON-POROUS FOOD CONTACT SURFACES Mix sanitizing solution as shown below: DILUTION: Sanitization...... 0.07 oz-0.14 oz.per gallon of water(or equivalent)(200-400 ppm active quat) f r 10/25/2010 Page 4 of 4 Prior to application,remove gross food particles and soil by a pre-flush or pre-scrape and,when necessary, pre-soak. Thoroughly wash or flush objects with a good detergent or compatible cleaner,followed by a potable water rinse before application of the sanitizing solution. Apply a use-dilution of 0.07 oz-0.14 oz.of KAYSolidSense Sanitizer per gallon of water(or equivalent dilution)to the pre-cleaned hard surface,with a cloth,mop,sponge,sprayer or by immersion,thoroughly wetting surfaces. Surfaces must remain wet for at least one minute(60 seconds)followed by adequate j draining and air drying. Do not rinse. Prepare fresh solution daily or more often if the use solution becomes diluted or soiled, Apply to sinks,countertops,and other stationary surfaces by cloth,sponge,brush,or sprayer. Immerse pre-cleaned glassware,dishes,silverware,cooking utensils and other similar size food processing equipment in a solution of 0.07 oz -0.14 oz.of KAY SolidSense Sanitizer per gallon of water(or equivalent dilution)for at least 60 seconds. Drain thoroughly and allow to air dry before re-use. Do not rinse. FOR RESTAURANTS AND BARS: Equipment and utensils should be thoroughly preflushed or prescraped and when necessary presoaked to remove gross food particles and soil. Then thoroughly wash or flush objects with a good detergent or compatible cleaner followed by a potable water rinse before application of the sanitizing solution. For precleaned dishes,glassware,silverware,cooking utensils, immerse in a solution containing 0.07 oz. -0.14 oz per one(1)gallon of water(or equivalent use dilution) (200—400 ppm active quaternary)allow surface to remain wet for at least 60 seconds. Drain thoroughly before reuse. No rinse is required. WISCONSIN STATE BOARD OF HEALTH DIRECTIONS FOR EATING ESTABLISHMENTS 1. Scrape and pre-wash utensils and glasses whenever possible. 2. Wash with a good detergent or compatible cleaner. 3. Rinse with clean water. 4. Sanitize in a solution of 0.07 oz.—0.14 oz of KAY SolidSense Sanitizer.per gallon of water(or equivalent dilution). Immerse all utensils for at least two minutes or for contact time specified by governing sanitary code. 5. Place sanitized utensils on a rack or drain board to air dry. 6. Fresh sanitizing solution should be prepared at least daily or when visibly soiled or diluted. NOTE: A clean,potable water rinse following sanitization is not permitted under Section HFS 196.13 of the Wisconsin Administrative Code. °Ft►,�,otiti Town of Barnstable Barnstable Board of Health BARNSTABLE, 9_ MASS. $ 200 Main Street,Hyannis MA 02601 G� i63q. �0 2007 OFFICE: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul Canniff,D.M.D. BOARD OF HEALTH MEETING RESULTS Tuesday, July 14, 2009 at 3:00 PM Town Hall, Hearing Room 367 Main Street, Hyannis, MA I. George Heufelder— Performance of I/A systems. George Heufelder presented a Power Point Presentation. The presentation analyzed the current I/A systems in the Town of Barnstable and on the Cape. II. Hearing — Housing: CONTINUED UNTIL Jason Ethier, owner— 15 Highland Street, Hyannis, SEP 8, 2009 BOH ceiling height. MEETING The Board voted to Continue to the September 8, 2009 Board of Health meeting and Mr. Etheir will measure the ceiling boards to verify whether they can obtain a height of 68". III. Septic Variance (Cont.): WITHDREW A. Brian Yergatian, BSC Group, representing Timothy and Eila Desrocher, owners — 3072 Falmouth Road, Marstons Mills, Map/Parcel 099-029, 2.2 acre parcel, requesting variance from 310 CMR 15.203 (4) to vary the design flow rate for the daycare facility. IV. Septic Variance (New): APPROVED Darren Meyer representing Robert Hallett, owner— 20 Tree Top WITH Circle Marstons Mills, Map/Parcel 150-035, 0.91 acre parcel, CONDITIONS four setback to wetlands variances. The Building code does not allow the only entrance to a bedroom to be from the garage. (The septic has been repaired as it was an emergency repair.) The Board of Health voted to approve the variances with the following conditions: approval of the plan's entrance to the bedroom from garage must be received by the Building Commissioner. V. Variance — Food (New): GRANTED A. Karl Keppler, Keppler Mgt Co d/b/a McDonald's — (three Board of Health Minutes—July 14,2009 Page 1 of 2 LThe THOUT locations: Rte 132, 175 North St, Cape Cod Mall), Hyannis, NDITIONS temperature of foods. Board of Health voted to approve a variance from the federal 1999 Foode 3-501.19 adopted by the State of Mass setts. GRANTED A. Kenneth Foster representing Cape Cod Community Education WITH Foundation —temporary food application for July 17 annual MENU event with hamburgers and hot dogs at Cape Cod Community College. The Board of Health voted to approve the annual temporary food permit with the menu of hamburgers and hot dogs. VI. INFORMAL REVIEW: A. Robert Anderson, owner - 71 Midway Drive, Hyannis, Map/Parcel 252- 069, 0.26 acre parcel, installing a White Knight treatment system. Dr. Miller stated there are issues to be resolved: 1) need a septic system designed for four bedrooms provided they are not in a restricted zone, or if the property is limited to expansion, Mr. Anderson will have to convince the Board of Health historically that the bedrooms upstairs were put in with proper permits even though the size of the septic was an oversight by the town. With the small system, the owner is aware that he will most likely need to replace the whole system. The Board stated that Mr. Anderson will have to have his engineer look into the MA DEP's approvals for the White Knight System. The MA DEP must approve it before the product is permitted to be used in our town. B. John Whiteley - septic treatment products including digestase. John Whiteley has contracted with Athea to distribute their products. There are no chemicals, only enzymes. The Board stated the company's product must appear on the list of Mass DEP's list (currently of 64 additives approved to be used in this state). Mr. Whiteley will obtain the necessary paperwork. -VII. ADDITIONAL - DISCUSSION: Pio Lombardo, PE, Lombardo Associates, spoke on the Nitrex System. Mr. Lombardo said George Heufelder, Barnstable County Board of Health, tested the Nitrex for three years at his test center and results were very consistent. Board of Health Minutes—July 14,2009 Page 2 of 2 I y I'm lovin'M. February 12, 2007 To whom it may concern, At McDonald's food safety is our top priority. In our restaurants we have programs in place to assure the safety of food products that require refrigeration when used at the preparation table. All refrigerators maintain products below 40°F. Products are used directly out of the walk-in refrigerator. When products are removed from refrigeration and placed in our preparation table, our secondary shelf life program requires time monitoring to assure that the time they are placed out of refrigeration is controlled. If products are not used within 2 hours after they were removed from the walk-in refrigerator, they are discarded. FDA's 2005 Food Code, which represents the agreed on best practices for maintaining the safety of foods at retail, addresses time as a public health control (please see p. 86 in Chapter 3 of the Food Code at http://www.cfsan.fda.gov/—dms/fc05-toc.html). Potentially hazardous foods that are removed from refrigeration can be held for 4 hr without temperature control (6 h if the temperature of the food does not exceed 70°F). The justification for this is provided in an annex to the code on the public health reasons for various requirements (http://www.efsan.fda.gov/acrobat/fc05-a3.pdf). On p. 401 of the Food Code there is a position paper that lays out the science that FDA and USDA have agreed supports the provision of the Code. Therefore, given that potentially hazardous foods can be held without refrigeration for at least 4 hours, McDonald's practice of holding these products for<4 h (in practice, 2 h) does not present a public health hazard. Please contact me should you need additional information on our restaurant procedures or food safety programs. Sincerely, Alejandro Mazzotta, Ph.D. Director, Food Safety & Quality Systems McDonald's Corporation 2111 McDonald's Drive Oak Brook, IL 60523 630-623-7946 alejandro.mazzotta@us.mcd.com McCormick& Company, Inc. McCormick Flavor Division 226 Schilling Circle Hunt Valley, MD 21031 USA TEL. (410) 771-7500 March 1, 2005 To Whom It May Concern: Subject: Stability of McDonald's Sandwich Sauces This will serve to confirm the information with reference to the microbiological stability of, specifically, McDonald's Big Mac Sauce, McDonald's Tartar Sauce, and McDonald's Mayonnaise manufactured by McCormick& Company, Inc. These acidic products, although stored and distributed under refrigerated conditions, do not pose any public health hazards at room temperature because they are manufactured to a pH equal to or less than 4.1. The pH level equal to or less than 4.1 to control pathogenic organism has been documented in scientific literature. Specific regulations, 21 Code of Federal Regulations Part 114 for Acidified Foods, exempts dressings, condiments, and foods stored, distributed, and retailed under refrigeration from the coverage of this regulation. This information is the basis on which these products do not pose health hazards when held at ambient temperatures. If I may be of further assistance, please let me know. Sincerely, Bailey Jacobs Director Technical Services I - The Commonwealth of Massachusetts Executive Office of Health and Human Services ' Department of Public Health Bureau of Environmental Health " y Food Protection Program DEVAL L.PATRICK 305 South Street, Jamaica Plain, MA 02130-3597 GOVERNOR 617-983-6712 617-983-6770 - Fax TIMOTHY P.MURRAY LIEUTENANT GOVERNOR JUDYANN BIGBY,MD SECRETARY JOHN AUERBACH COMMISSIONER MEMORANDUM TO: Local Boards of Health FROM: Priscilla Neves, Director Food Protection Program DATE: October 19, 2007 RE: Time as a Public Health Control, Variance Requirement This memorandum is relative to retail food establishments, in particular fast-food-type chain restaurants, which hold potentially hazardous food items, such as processed pasteurized cheese, sliced ham, pizza, etc., at room temperature for a period of time. In Massachusetts, retail food establishments must obtain a variance from the board of health prior to using time as a public health control (TPHC)in accordance with 105 CMR 590.004(H)and the federal 1999 Food Code, section 3-501.19,which allows a four-hour time period. Documents pertaining to TPHC can be found on the FPP website at http://www.mass.gov/dph/fpp/retailfood. At this time, Massachusetts has not adopted the federal 2005 Food Code which has revised the definition of"Potentially Hazardous Food (PHF)"to"Potentially Hazardous Food (Time/Temperature Control for Safety Food)and section 3-501.19,which allows a four-hour and a six-hour time period for"TPHC. Some retail food establishments may be using the federal 2005 Food Code requirements for TPHC; however, the board of health should request a variance and verify that the proper procedures are being followed during an inspection regardless of which Food Code is being used by industry. During an inspection,the board of health should verify the following: o Written procedures using HACCP principles are approved, maintained in the food establishment and available for review. o Pre-requisites are met(i.e. compliance with 105 CMR 590.000;calibrated thermometers) o Using monitoring procedures(i.e. food is marked to indicate the time limit) o Food employees have knowledge of corrective actions o Evidence of employee training o Manager's records are available and accurate. If non-compliance with approved written procedures is found,the board of health should take corrective action by suspending TPHC operations immediately and, if needed, notify the Food Protection Program. If local boards of health have any questions or need assistance reviewing HACCP-based and/or risk-control plans,they should contact the Food Protection Program at 617-983-6712 or Diane Bernazzani, Food Vulnerability Assessment and Training Coordinator, at 617-983-6765. SAkGo�wE— NTOO May 18, 2006 To Whom It May Concern: The safety and wholesomeness of the food products that Sargento Foods, Inc.,provides to its customers is of paramount importance. We recognize that microbial hazards are a significant risk in the food industry and carefully consider proper storage and handling procedures. A suitable guideline with which to start is the Food and Drug Administration's Food Code, that among other things sets food temperature guidelines that apply to various stages of food preparation and serving of potentially hazardous foods. The Food Code sets for this type of food a limit of 4 hours at room temperature. The operational procedure of limiting product held at ambient temperature to 2 hours is a safe practice. The shredded Cheddar and Monterey Jack Cheese that we provide, UPC#4610032976-4, are safe when held as described above. These cheeses may be held for considerable periods of time at ambient temperature without risk. This type of natural cheese is manufactured from pasteurized milk using commercial lactic starters that aid in the microbial stability of the product. Sincerely, GAM Gary L. Pruitt Sr. Food Safety Principal '=- Sargento Foods, Inc. s o m CJ W SCHREI ER Schreiber Foods,Inc. 425 Pine Street PO Box 19010 Rick Katz Green Bay,WI 54307-9010 Manager,Quality Systems 920-437-7601 920-455-3576 www.sficorp.com March 4,2005 Ms Lisa Yee US Quality Systems McDonald's Corporation Oak Brook, IL 60521 Dear Lisa: Our understanding is that McDonald's will allow refrigerated packages of Pasteurized Process American Cheese to temper at room temperature(72°F or less)for up to 24 hours. We have completed a challenge study through the Food Research Institute,University of Wisconsin-Madison,to evaluate the ability of Schreiber process cheese to support the growth of Listeria monocytogenes, Staphylococcus aureus, Salmonella and Escherichia coli 0157:1-17 for 72 hours at 30°C(860F). As the attached Executive summary indicates,the formulations do not support the growth of these pathogens through 72 hours at 30°C(86T). As the times and temperatures outlined in McDonald's cheese handling protocol are much lower than that used in the challenge study,there does not appear to be a food safety risk associated with this procedure. Sincerely, Rick Katz Manager, Quality Systems cc: Chuck Hutchison, Schreiber Foods, Inc. March 9, 2005 Ms. Lisa Yee McDonald's Corporation 2111 McDonald's Drive Oak Brook, Illinois 60523 Results of the 1997 microbial challenge study conducted by the Food Research Institute (FRI)on McDonald's cheese slices demonstrate that counts of key inoculated pathogens including Listeria monocytogenes, Salmonella sp., Staphylococcus aureus,and E. coli 0157:H7, remain stable for up to 96 hours at 86°F. These results indicate that tempering cheese slices at room ambient temperatures for up to 24 hours will "not support growth of the pathogens tested." This microbiological study remains appropriate for the room ambient tempering of the McDonald's America cheese slices supplied by Kraft. If you have any questions, please don't hesitate to contact me at(847) 646-3879. Very truly yours, Kraft Foods, Inc. d. C Laura J. Prostko Kraft FS Quality Program Leader cc: Jamie Pudney—Kraft Foods Jim Gira —Kraft Foods Melanie Hamelton — Kraft Foods WCORMICK McCormick&Company,Inc. McCormick Flavor Division 226 Schilling Circle Hunt Valley,MD 21031 USA TEL. (410)771-7500 August 2,2005 To Whom It May Concern: Subject. Stability of McDonald s Mayonnaise Dressing This will serve to confirm the microbiological stability of, specifically,McDonald's Mayonnaise Dressing manufactured by McCormick&Company,Inc. This acidic product,although stored and distributed under refrigerated conditions,does not pose any public health hazards at room temperature because it is manufactured to a pH equal to or less than 4.1. The pH level equal to or less than 4.1 to control pathogenic organism has been documented in scientific literature. Specific regulations,21 Code of Federal Regulations Part 114 for Acidified Foods,exempts dressings,condiments,and foods stored,distributed,and retailed under refrigeration from the coverage of this regulation. This information is the basis on which this product does not pose health hazards when held at ambient temperatures. If I may be of further assistance,please let me know. Sincerely, Bailey Jacobs Director Technical Services 6 4r No.. 6-y/ ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 ........OF.... -vn4 --••----•...............•------- Appliratiun for Disposal Works Tonstrnrtiun runfit Application is hereby made for a Permit to Construct ( ) or Repair (kj an Individual Sewage Disposal System al;,__,_ .- . ........... -- -----•-- ----------•------••------• ........................................... ... e �� Lp�aticpi Address or Lot.No. • ...._....@_�.�....�'...�.� ... •............. .................................................................................................. Owner Address aW — ••-_-•......T......................... .•-•-••-•-•-----•-.............._........... .....--•.--•--............................. Ins ler O Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms............................................Ex Expansion Attic a g— p ( ) 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. W Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ xDisposal 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. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lr4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ' f .•-- ------------------------------------- ? pG terDescri Description of S � _O v _----------------- ' .......-------=St4�d-%�--o-ct .ma's ' ............... .......................... x -- -----...... - U Nature of Re it or Alterations—Answ r when applicab ___._ _ ��-G . .............. .. _.vy_ _�_...._..._.............F ` �,� Agreeme The undersigned agrees to install the aforedescribed Individual Sewage Disposal System{in accordance with the provisions of iITi LE 5 of the State Sanitary Code— The undersigned further agrees not to'place the system in operation until a Certificate of Compliance has bpeTbissued by the boaro of 46Z lth. agne r_. '. -•.-• . ...--................ �•� Dst 7 Application Approved BY-----.. �.................... Date Application Disapproved for the following reasons:...--• ........................................... .....................................................................................................................................•--------------••-----•--------•-•••----•------ -•-••---------•-- Date PermitNo......................................................... Issued_....................................................... Date a 14 No....-- ...--• .... FEE...., , "............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H `k �Appliration for Disposal ,ark, 'Tonstrurtinn Prrutit Application,is hereby made for a Permit to Construct, ( ) or Repair (41 an Individual Sewage Disposal S...ystem a . __ ' . :�`"" '' ......................................... ..__...... .--.---.......---........ a ddress or Lot No. a Ins r .' ........ .. . Owne Address - e Address d Type of Building ;. Size Lot................. Sq. feet Dwelling—No. of Bedrooms......... ............................... .Expansion Attic ( ) Garbage Grinder: (t . ) pP,,, Other—Type of Building ............................ No. of persons_;-.......................... Showers ( ) — Cafeteria dOther fixtures -----•--------------------------------------------•.......------ -. a. . ,........, .. --•------------------------------.....-------- W Design Flow........................................:.,,3:gallons per person per day. Total daily flow__._.__....._._.__._._._._...._.:.__.__.gallons. WSeptic Tank—Liquid capacity ..._gallons Length................ Width---------------- Diameter..._............ Depth................. Disposal Seepage Pit No-- o_____.. Diameter..Width Total't;ength Total leaching area..... sq. ft. eter .................. Depth below.inlet ................ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank '~ Percolation Test Results Performed Iiy. _« ..........:.:.............. Date....................................... Test Pit No. I................minutes per inch Dept of Test Pity...... .........._ depth to ground water-___..__-_-__-__..-- Gz, Test Pit No. 2................minutes per in&M Depth of Test Pit............},...... Depth to ground water........................ Descriptionof Soil............................................. .............. ................................. ......----••----••........................................... ..................................... .. ----- ® __• ____. ._.... .. _... ......_...____.. U Npre of Re it or Alterations nsw when apphcab 4-4� ----••-••---. AgreemenjF The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITHE, 5 of the State Sanitary Code,—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bjO I Vssued by the boar of h lth. ign u ; .,. /Date Application Approved By------' 1 rr = .............•..----- Application Disapproved for e following reasons:_......................:.: f th e � ate a ...................................................' --_ -------------- ---.............................................-___-...__ -.._._ __ '_........... r Date Permit No. - r Issued:._.-.` . ,<. .................................... }.... Date THE COMMONWEALTH OF MASSaCHUSEfi`P5 BOARD OF HEALTHV4— k ': 1 (Irdifiratr of Tv t lianrr THIS IS 0 RT That the In ,vidual Sewage Disposal System constructed ( j or Repaired ( . . kr " .. -_.�rx vy.by..!".... ..� ,. ....--- -- e ----------- Insal ' has been installed in accordance with the provisions of TIT, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit Ni "`��....��` :.............. dated....CP. ................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-.....-- '' 7� Inspector., / .L......L_. r_b ... ..................... rTHE COMMONWEALTH OF MASSACHUSETTS , -°-°=r BOARD OF.7...... HEALTH ::. v . .r .. .... ...OF. ' r`y' . . .. �+�'� No• � FEE..... .... w �Disposal nrk� .0� urtion Writ Permission is her granted.,...._._. .. . ....F ...........................................................� .... to Cons*.. ) o R air ( e!w dual ewag(e Dispos ystem ,.-. 1, r at No... , .+� ........ .. as shown on the application for Disposal Works Construction_P No __ _. Dated... `�'".� ......._. Board of Hea i/ lth'; DATE--- ,,, ` FORM 1255 HOBBS & WARREN, INC.,- PUBLISHERS 1. jt'Y - A & B CESSPOOL ERVICE� P Terrace '128 Bisho s � �. t� �� � f .� -'• �.. � ;,�, „ � HYANNIS MASS X2601 e s thy` 4 x x a <u r t kt .vr7 irJ x t pats/ m/d • � �. ra chS.-ifr s�, M `V,.x..,�,�.fy'��r ���'k'tia §.�� vx5.�� :�4 i .]` `r 1... � �Y�' - . r 1:.e.�3/.��f i rr✓• Q+E� .�AM Sf ,[�st.r.`.�y .y`,wt•':.- tv '01pp- E w+r'by ,1•� s }.. ► E•;,_^4�[ '3. 1 M. ,, f i w 1F: .. y. •. - .. .. o` $°z1i 4 ��z$•� � ,s"��`t sue"�- "'fi"i.�µ d,t*&t4tt r,.. �_ �':_^.x a+� � A.-• �.;.�,;s t +r d� 9: `�•b J�f'.� �{/�,� ,yrFt;A, Q7J� T F 37 ti :«., 11 Zr s+�' r l.' fs•t',s 3 § r i r'a t, •a./�. 3 W. 1 Q.g jt•f• 5,,. '} � '4 �J - a .a� Li-C{ 9 't'+3 .. o e.> `}♦+ + ��„�k� i.. 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T,ri•/G• 02�i L�1�,� • .p i i 4A`F ''4'"- s4 J s r .�' r i.�..,� t �� t""t w� t � � -s. :? v .,' 7 t•t^.n° �' .,t�� S� .. � -., y. , ., th_. + T''.. :.t,1 ,I . ,t *s ,�'.'a+.. �r r.c•,r .. a t,. l �" + � n + , 4 � r, Wit; +; rz F - ',J f"• r� d. " '14F 4, f .. :,`- :r*r;t i ` F 2� �y .f f' �'.t �. 4 S.v t ..;. � Z , r? •J 4 T'4 •.4 t t', I k` 'r�'t ^^' 4 a..• r:. -.,-s 7 y '�..✓ , `� f L :;a J 4 r.•` �- I �: � �' � r ..r , <i 7 4 `Vj;C, i .` .. 'i. , y "k ..._ It It ��• 4•. ,r a.. ,� , t �, , J .fir' _4 s I +Js 'is w.wr _ .r s a •`s .a.ti 'le �` �„ t ra �.µa: J^` t F a u „t • - ,. y '. ' 'Febtuary�.N16 , <'1983, _ ,e^ � ^. /. ,� •h 1~t,, a„;,.«�1 ..h{, �• t 1 ..�- t .ti � � '.,�� '. ,.1. t sr� 4 .. F y a •*Ar 41.1 11 rY *a, �.00, i " `"f � a f C. i r "� . ry. J3 t. yt ��+ Y '_ .. i- ,�" .I �� r ".•N � ,.,t � .'� t , � S 1R Y� Y aM1_`�T'a �,:. ,�v( 5 � t �,, � ++• � 7 $' t. rw "5 � •1�Iapager " ar ;`- J 4 .'k •�''+ ', 6.�,,. •'ar + - t.^ ie"� tir �,4 ` . f ` McDonald`:s "` a t �K, '�, ,r,' q` r, + 4 •" Route,`'l32 r Hyannis , MA 02601 ' ,�• 4 L� t - 1 •t y IJ. ,�;;4 YS "�. . B R IFp,y ��*. +?. S+ Dear." Sir/Ma�dam S ✓•t r," .". F4 `" +° ,. A P r: � e'is+. ��, 'I�F }Mtk' pR,1� .I �'�; 'M,;. a .4, ! � •a � •a}y.�'er� tTa, � " - "v``s` t+ The •,Town "of garnsta;ble: Sewer] P1.ant',contin.ues'r to=have problem$ F #• ' ,, w1ti' gr'ea e 'r. You are reminded that• all,'Food "S,e,rvice •Establish :, F ments 'w -th `small, ,insi,dbtl ease 't aps -mu"st ins.t`all- larger` outsi'd' ` = a grease interceptors'by Othe`n�"ext licensing period, '' in {accor'danc'e• r } ` ,;witht`Town` Health •.Regulations =In 'the intei5i'm; your inside, grease trap must•+.be cleaned- monthly.:: , ;tn61>osed ,are {i:nstructions bn bow, to :clean . a grease 'trap properly s: t Our 'notice`` datedr. December y, 1982:; .requir'es each food service ti . j establishment t6`,keep�maintenan'ce recards `of scheduled grease ,? }" trap cleaning �' �,�t' 4 v. b y .0 ti ..• ,�,,, . fit.✓i ± ct w i - .' you ,,.have :any •_questions,, please call' 1775-112Q; extension' 182 ..Very, truly yours', 'x�+S rak y. � a w,n„� •aT w`a r rt, }, by t f�+ `sti k ,t„v �' - t � f ''� John M O`Kel 'y ..ya." Director`,ofr3PubTi'c Health1, " r ` ; y +y.S +.�• �yw.. t. t1 r A.. �T'.;. r,., ;'�.. � � � � a r• 1 Ott­_ r s4 JMIC/mm r tir ' >,encl:.. 71 1 F ,, ' 1-" t ",,• 4 yr .r+ '. ` y i.. C� yeti 3 �' ,t aX,✓ { .�'+'+: -+. « t+,� * '. *„�," +S ,» ., � >.•. �tsa ,,+'a°i•t {x A'�.` w}",. '>~ � a ,r � vi ✓ -�. r w I ,i r �{`� tG, r - «f ..A review.= of_ our� ooiia°service records indicates 'your-'file is,"'♦ ' •t { � 'r ,'` not-domplete ��Pl`ease, fill in.ahe enclosed;applrication ' to{update' sour' flles 'A`self=addressed ,envelope "is `enclosed 'for" your K = -'.co'nven ence:{»h}�" F •I , r :. ', a• srr '� a: t { s �+far ,^ }yp } {s r, , :t A » `•�' e. •.,• j, fr � *. t \ •�to � k yi/ ° ~ �•.:iT'" "vS�>R "so....S... -.r;,r�fi�<..�'.sr.,t.. y,'.'t" ti �"a =:'!*;m.„r }• � 1 OLD OWNERS FILE IN ATTIC 6" INVERT TO BE CONFIRMED IN GENERAL NOTES = FIELD BY CONTRACTOR PRIOR NOTES: TO CONSTRUCTION AS REQUIRED , `� 1. LOCUS KNOWN AS LOT 86, MAP 311, AS IDENTIFIED ON THE TAX MAP OF THE TOWN AIRj m U APPROXIMATE LOCATION OF cc EXISTING 6" 41p:I= 52.E'? ` ; j OF BARNSTABLE, BARNSTABLE COUNTY, MASSACHUSETTS. v J;Y SEWER SERVICE. EXACT FIELD LOCATION I 'l'w 4S.1-6 \\ ; .!.� 1. McDONALD'S ROAD SIGN AND BASE ARE BY THE SIGN CONTRACTOR. AND INVERT TO BE DETERMINED IN FIELD ' 2. AREA = 46,457 S.F. OR 1.067 AC. ►- CONDUIT AND WIRING ARE BY THE GENERAL CONTRACTOR. BY CONTRACTOR PRIOR TO CONSTRUCTION. / CONTRACTOR TO REVIEW ANY DISCREPANCIES "" WITH OWNER'S REPRESENTATIVE AND ENGINEER -% � -° •" 3. LOCATION OF ALL UNDERGROUND UTILITIES ARE APPROXIMATE. ALL LOCATIONS AND SIZES ARE PLAN] Z �' BASED ON UTILITY IwtRK-OUTS, ABOVE GROUND STRUCTURES THAT WERE VISIBLE & ACCESSIBLE 2. BASES, ANCHOR BOLTS, CONDUIT, AND WIRING FOR ALL OTHER PRIOR TO ANY CHANGES �, ' fr °' IN THE FIELD, AND 7HE MAPS AS LISTED IN THE REFERENCES AVAILABLE AT THE TIME OF THE CAPETOWN SHOPPING CENTER SIGNS ARE BY THE GENERAL UONTRACTER. W SURVEY. AVAILABLE P3BUILT PLANS AND UTILITY MARKOUT DOES NOT ENSURE MAPPING OF ALL Z UNDERGROUND UTILWE:S AND STRUCTURES. BEFORE ANY EXCAVATION IS TO BEGIN, ALL p HYANNIS AIRPORT ¢ ~" -' 1 -' UNDERGROUND UTILII ES SHOULD BE VERIFIED AS TO THEIR LOCATION, SIZE AND TYPE BY SITE 3. 3/4" EMPTY CONDUIT TO LOCATIONS SHOWN AT THE LOT PERT- U N/F REPUTED OWNER ,� I� �° CONC. BOUND THE PROPER UTILITY COMPANIES METER FOR LOT LIGHTING IS BY THE GENERAL CONTRACTOR. LIGHT- TOWN OF BARNSTABLE ... j FOUND NEW SEWER MANHOLE/ ING FIXTURES, BASES, POLES, CONDUIT, AND WIRING ARE BY THE Z SAMPLING MANHOLE 4. THIS PLAN IS BASED 3N INFORMATION PROVIDED BY A SURVEY PREPARED IN THE FIELD BY CONTROL POINT AS`S 1CIATES, INC. AND OTHER REFERENCE MATERIAL AS LISTED HEREON. OWNER/OPERATOR. W W/ WATERTIGHT COVER w RIM= 53t THIS SURVEY WAS PREPARED WITHOUT THE BENEFIT OF A TITLE REPORT 132 a ;;;;Ala' 0_1 'v w '' % INV OUT= 49.27t (TO BE U t''' `I I CONFIRMED BY CONTRACTOR r 4. BASES FOR FLAGPOLES ARE BY THE GENERAL CONTRACTOR. ANCHOR U Q rJV- )9 i4_._ / 5. THIS PROPERTY MAY E&L SUBJECT TO RESTRICTIONS, COVENANTS AND/OR EASEMENTS, WRITTEN CAPE COD MALL � �" PRIOR TO CONSTRUCTION) OR IMPLIED BOLTS ARE BY THE FLAGPOLE SUPPLIER. W a ..... INV IN= 49.37 A 6. ELEVATIONS ARE BASE I) UPON NAVE 88, REFERENCE MASS. HIGHWAY BENCHMARK 8019, BARNSATBLE MUNICIPAL AIRPORT AERO LIGHT ? Q o wy MH RIM-53.87 5. PROPOSED UTILITIES ARE SHOWN IN SCHEMATIC ONLY. EXACT _� ? II INV A=48.42 ELEV. = 51.345 FEE" LOCATIONS SHALL BE DETERMINED TO ALLOW FOR THE MOST O W NEW CB 'B' INV 8=5$.42 . RIM=53.5 e) gOT=36.0± ECONOMICAL INSTALLATION. a M (TO BE REMOVED) 7. PROPERTY IS LOCATED IN FLOOD HAZARD ZONE C (AREAS OF MINIMAL FLOODING) AS PER z W W 1� ►mac: REF. #5. _ I -_-_ �n E o ° ° • -„' 6. THE CONTRACTOR SHALL COORDINATE WITH ALL UTILITY COMPANIES W f g''V 8. THIS SURVEY WAS PE' FORMED DURING A PERIOD WHEN THE GROUND WAS PARTIALLY SNOW R PON ----------- -- 33 ' p �\ H CONC, COVERED. ONLY VISIE' E UTILITY STRUCTURES AND ON SITE FEATURES HAVE BEEN LOCATED O TO DETERMINE EXACT POINT OF SERVICE CONNECTION AT EXISTING g $ ' INV A4. 10 0 AND IDENTIFIED AS D 'ICTED ON THIS SURVEY. N UTILITY. REFER TO THE BUILDING ELECTRICAL AND PLUMBING rn • ► r!.'� INV 6=50.80 DRAWINGS FOR UTILITY SERVICE ENTRANCE LOCATIONS, SIZES, AND W O O O BOT=4 3f w N (TO BE REMOVED) T v � p CIRCUITING. Q \ � 1B ti z a 2 N / J T EXIST. SEWER GRE SE /. ALL LLLVAIIUNJ JHUWN AML IN NLtLNLNUL. IU IHL bLNUHMANK ° TRAP AND SEWER PIPING j °�. P i p AND MUST BE VERIFIED BY THE GENERAL CONTRACTOR AT w �INV Al �0 136 „ w�/ " TO BE REMOVED S NEEDED �I�I �, ► ; ' �� MH/INLE4 REFERENCES: c pR m0 GROUNDBREAK. BOTB46.8 1 A/ RI -54.26 I' " e m //c�. IRIOMT j�30 t 1. TrHE OFFICIAL TAX MAP OF THE TOWN OF HYANNIS, BARNSTABLE COUNTY, MASSACHUSETTS. / (TO BE 46.8 D INV_ .31 �' TO BE REMOVED p' 8. FINISH WALK AND CURB ELEVATIONS SHALL BE 6" ABOVE FINISH BOT= rn BCONCC..BOUND ARK E3 (TO BE REMIO ! ` `1 ( ) 2. MAP ENTITLED "TOPOGIAPHIC AND PERIMETER SURVEY FOR MCDONALD'S CORP., IYANNOUGH V S' PAVEMENT. FOUND ROAD (ROUTE 132), HANNIS, MASS", PREPARED BY AYOUB ENGINEERING, INC., DATED: LIMI�E ►- p W ELEV.=53.59 \� I , o J �\ JAN. 14, 1985, PROJ. NO. 1 199.1 \O EL 9. ALL LANDSCAPE AREAS SHALL BE ROUGH GRADED TO 6" BELOW o \\ \ -- 3. MAP ENTITLED "SUBDIV�ION PLAN OF LAND IN BARNSTABLE", PREPARED BY WHITNEY & gVM M O`' TOP OF ALL WALKS AND CURBS. FINISH GRADING, LANDSCAPING, ) w ��\ "' 0 -� BASSETT, SURVEYORS, DATED: SEPTEMBER 1968, MAP NO. 25266D, FILED IN LAND QgN\ 9G� y� AND SPRINKLER SYSTEMS ARE BY THE OWNER/OPERATOR. REGISTRATION OFFICE .)CT. 23, 1968. MMH NL- T G R1 3. 7 19 INV 51.17 '15' OF 6" SDR 35 4. MAP ENTITLED "SUBDIVGION PLAN OF LAND IN BARNSTABLE", PREPARED BY BEARSE & 10. LOT LIGHITNG CONCRETE FOOTINGS TO CONFORM WITH THE SOILS , �\ BOT=49.2t L G PVC S-0.02 KELLOGG, CIVIL ENGINEERS, DATED: MAY 29, 1956, MAP NO. 25266B, FILED IN LAND REPORT RECOMMENDATIONS FOR THIS PARTICULAR SITE. � } RIM 5INEW �75 \0� �� (TO BE REMOVED) G EL�C�� REGISTRATION OFFICE .'LINE 7, 1956. - �. .' LOCUS PLAN 5. MAP ENTITLED "NATION/,.:_ FLOOD INSURANCE PROGRAM, FIRM, FLOOD INSURANCE RATE 11. REFER TO SHEETS SD-1 THRU SD-4 FOR ALL APPLICABLE NEW SEWER MA�Nk{OLE BARNSTABLE COUNTY", PANEL 5 OF 25, NOT TO SCALE SITE DETAILS. RIM= 55.15 MAP, TOWN OF BARNSTABLE, MASSACHUSETTS, 12" SCHD 40 PVC ° INV OUT= 50.98 COMMUNITY PANEL NUMBER 250001 0005 C, MAP REVISED: AUGUST 19, 1985. O 1 INV OU 50. 12. PROVIDE WEEPHOLES ON CURBS AT ALL LANDSCAPE AREAS LOCATIONS. TYPICAL COORDINATE WITH McDONALD'S PROJECT MANAGER. (n 10' OF 6" SDR 35 F- EXIST O/H WIRES TO O; PVC S=0.02 BE REMOVED �- NEW 1,500 GAL\\ Q = :\ INV=51.58 Z GREASE TRAP l J . Z � o \ z, INV=51.89 �O! INV OUT= 51.28 (n Q NEW 6 DIA. x 6 DEEP PRECAST CONC. DRYWELL IN ,> '' Om INV IN= 51.53 PAVING SPECIFICATION 15'x15' BED OF 3's" TO 1-1/2"WASHED STONE W/ FILTER \ -n 0 18' OF 6" SDR 35 (MINIMUM 3" TOTAL COMPACTED ASPHALT THICKNESS) RO FABRIC AT SOIL/STONE INTERFACE (TYP. 9 PLACES) '0 � W U PVC S=0.02 t�ZE�-� BOTTOM OF INFILTRATION SYSTEM TO BE SET A MIN. 70 �� New pavement shall consist of a 3" total thickness of W Q W 3 OF 2 ABOVE GROUND WATER ELEVATION. v EXTEND EXIST. GAS N�`'I'v'� � }' � 0 °• '`� z r` AASHTO Type 1 ore equivalent State Highway Sec. m _ O Q GROUND WATER ELEVATION AND PERC RATE TO c� SERVICE TO NEW l Gt 'v YP ( q 9 Y P Z BE CONFIRMED IN FIELD PRIOR TO CONSTRUCTION Q l BUILDING ;\ C�Ga � " p _ OF STORM WATER INFILTRATION SYSTEM. UPON bituminous concrete applied in two 1-1/2 courses over UE REVIEW SHOULD ACTUAL GROUNDWATER ELEVATION °%�` a 9" crushed aggregate base course. Compact the upper OR PERC RATE DIFFER FROM DATA USED IN DESIGN, \ 1 0 V. EXIST. 1 h P PP CL Z Ln OWNER'S ENGINEER IS TO MODIFY THE DESIGN ACCORDINGLY. 1 \ STORY BUILDING i O .' 12" of pavement subgrade, crushed aggregate base, W w \ f � 1 \ MAP 311 W 1 \ PARCEL 12 co pavement binder and surface courses to 95 percent MM Q v MH/ INLET LQ 5 1 W cS RIM=54.25 QN P ga N/F REPUTED OWNER p o O 1'"1'-l�(IFIT''�ll Cl�';Isi as determined for each material ., BOT=49.2f N1cv 8/ 1 NEW CB 'D' ' ch (,t�ArLES M. ROBINSON I NO PIPES ' SIBLE- �19 1 RIM=54.0 do (E M.D.M.A. REALTY r� LL (TO BE REMOVED 4� �p�NG S \ TRl I icES M. REALTY TRUST I I 'i '' t Q 1 7 8� ` - CENT. N0. 113844 Bv�SEp,Ts f r 55 ' ' pE. 931„ PG. 84 NOTE: McDONALD'S ENGINEER RESERVES THE RIGHT TO REQUEST A COMPACTION �" LU CL MAP 311 J/ r. Dw� l ` " A. .E 93 \ \ )v S,F- i \ TEST AND/OR A CORE SAMPLE. IF TESTS PROVE CORRECT, PER ABOVE Z �JSPECIFICATION, TESTS WILL BE AT THE EXPENSE OF McDONALD'S, N//F� REPUTED OWNER /� \^✓ _ TRACY, CONSTANCE M. W CERT. N0. 116647 ', ��/ ,\ o EXIST. WATER LINE TO BE 1 \;;: ".�.''.,:.•,..:, OTHERWISE, G.C. WILL BE CHARGED. Z . B 955 T \ EXTENDED TO NEW BLDG.\ ' 0 SHOULD FIELD VERIFICATION 1 - ET LOT LIGHTING RECOMMENDATION MH,OF EXISTING SERVICE 1 \' DEMONSTRATE INADEQUACY BOT=48.5f L- TO SERVICE THE NEW 1 (NO PIPES VISIBLE) \ AYOUB ENGINEERING, INC. EXPRESSLY DISCLAW ANY RE"ISEMI ® z0 BE� BLDG., A NEW SERVICE 1 (TO BE REMOVED) FOR MOMTORN(„ MISPECTWG, OBSERVING, OR SUPERVISING VVILL PROVIDED 1 OONSTIKTIDN SERNCES, OR THE MEANS, METHODS, SEQUENCES 1 AM TECHNIQUES OF CONSTRIIC110N OR FOR JOB SITE SAFETY AND t PROGRAMS FOR THE PROJECT DEFMFD BY THE PLANS FOR CH 0 0FA \ THIS aRIF07 ON IS AFFIXED. AYOUB HAS NOT Ba N RETAINED D N V) FOR NOR SHALL R HAVE ANY CONTROL OVER OR BE IN CHARGE APPROX. LOC. U.G. GAS o w l O �;',`:.` APPROX. LOC. U.G. WATER 1,,,-'LINE, PER UTILITY MARKOUT OF ACTS OR OMSSIONS OF ANY OONTRACTOR, SUBOONTRACTOR, IL OTHER AGENTS OR EMPLOYEES OR OF ANY OTHER PERSONS z z LINE, PER REF. #2 1 (SEE NOTE #3) 0 o z (NOT FIELD VERIFIED) 1 \\ PERFORMING PORTIONS OF THE 1W PARKING INFORMATION o w (SEE NOTE #3) 1 0 19 SPACES 9' X 20' ® 45° o \ c,\ 20 0 20 40 TOTAL ° r w �\ 20SPACES 9' X 20' @ 60 ` f° SPACES �.! \ � MAP 311 \ 1 3 SPACES 9' X 20' ® 90° p 0 D \ PARCEL 86 \ \ 3 N % REPUTED OWNER \ GRAPHIC SCALE C /� w W o MCDOONNALD'S CORPORATION a LN J L� 9 SPACES 9' X 20' ® 75° p = 3 \ Z CERT. N0. 105411 �;`\ FIFIRM �T n���nB. 861, PG. 51 lur lul\`vI HANDICAP: 3 SPACES 8' X 20' ® 75° ~ Uj W 0 UTILITY INFORMATION z & s \ \\ REFERENCE. w 0 W 1t S' PROPERTY LINES AND OTHER TOPOGRAPHIC INFORMATION SIZE TYPE LOCATION cai \ 1 \ SHOWN ON THIS DRAWING WERE: TAKEN FROM A PLAN ENTITLED: M BENCHMARK i` \ 1 "BOUNDARY & TOPOGRAPHICAL SURVEY- MCDONALD'S CORPORATION SANITARY SEWER w PK NAIL IN POLE \ 1 1 VANNOUGH ROAD (ROUTE 132)'"' DRAWN BY M.L.0; DATE: 318199; U) z ELEV.=56.60' \ 1 ��'\, SCALE: 1"=20'. WATER o z a CONC. BOUND - " \� 1 I \ STORM SEWER M FOUL z 99.92' _ \ Q.ELECTRIC :g z 0 (n N 60'13 00 W 1 GAS M U w o I 1 = 0� INLET LEGEND SURVEY INFORMATION ~ w o 0 INV56 =51.31 RIWIH56.38 I 12' CMP 10" AMP --- -G--- - G-----c -- -G---- ---- - -G ---- G-- --G'-- ---G----- G---=-_G-_ -G--1 - 133-- EXISTING CONTOUR PREPARED BY: MCDONALD'S CORPORATION N IYANNOUGH ROAD (ROUTE 132) j------ T-----T-----T-- --T-----T-----7i I T -T -T4 -T -T ---T----- T-----T--- T-q X1Z346 EXISTING SPOT ELEVATION TOWN OF BARNSTABLE (HYANNIS) �APPRGX. LOC. U.G. 'iEL. BARNSTABLE COUNTY, COMMONWEALTH OF MASSACHUSETTS GRT=55.17 R i= LINE, PER REF. #2 X 1C 12&45 EXIST. TOP (OF CURB ELEVATION E~ ,_ It INV.=51.11 T NOT FIELD VERIFIED; i X G 12195 EXIST. GUTTEER ELEVATION DATE: 3/8/99 ZO � cM Q. I NO PI NSIBLE�' SEE NOTE #3) -C7 HYDRANT Q (/) Q 00 I I 04 UTILITY VALW✓E O ~ Z LOC. U.G. GAS 0H- OVERHEAD WARES W ►--+ ROAD ; c, LINE, PER REF. SITE UTILITY PLAN z 0IYANN ® UGH I (NOT FIELD VERIFIED) - - APPROX. LO(C. UNDERGROUND GAS LINE � O Q G----- G----- --- G----- G ----G-----G1---- G-----cZAPPROX. LEE �VO E Z_G----- c----- c--� --W-- APPROX. LO(C. UNDERGROUND WATER LINE �, Q wa ►-� (A.K.A. MASSACH�ISETTS RO�1TE 132) a �' Z W (PUBLIC - 80' WIDE) I -T-- APPROX. LO(C. UNDERGROUND TEL. LINE -- }-- W-----W----- W-----W----- W----- ►�---- W----- - w----- W�----- W- ---W----- W----- W--� STREET ADDRESS Z APPROX. LOC, UNDERGROUND ELEC, LINE APPROX. LOC. U.G. WATER I Y A N N O U G H ROAD (ROUTE 13 2) LINE, PER REF. #2 t UTILITY POLE NOi FIELD VERIFIED) SEE NOTE 3 CITY STATE PROJECT N0. 1199 GRT=55.4, ° --- HYANNIS MASSAC H U S ETTS CAD FILE NO. 1199MP DRAWN BY. RCD - mm COUNTY SCALE: 1"=20' DA TE: 11117199 REGIONAL DWG. NO LOCATION CODE NUMBER DRAWING NUMBER F- Q� a S J O v CO2 �- FILL BOX A - - - - - - - UJ - I X H �-------- - w I PANEL I- — cv aJ�t i- 2' _211 I 41 1 - 1 I x I m 4-TIER ~ 1 H d X F- 4—TIER 1 11 o o I A �V, 2 -2 I 1 g 6' -411 i I § +4-TIER 21 -2" �, II - - 1 L - - - � b411 � I tK �{}� l < 18"X 4b 18"X 4W TIER 2' -21I I ( " ) 4-TIER 4-TIER 71 i 60 -4111 ' -TIER ' - - r - -- UNIV.PARTS i 2' -2°" - - - - - � I co CART CART W/ I b -4 BRUSH ------- ' ' GR I LL TOOL I 4-T I ER ' I I -I ( o CABINET " SHARPENER/ 8�i SCULLERY 5 I NK I I � � c.HORTEN I N6 TRA5H-L I NER�I i i 1 IL - _ _ - I F I W'` i�'s'p I NCOM I N6 REMOVAL CART m I I OFT. REG I RG. i ' -4" i i EXT ��a r °c ° HATER _ SODA SYSTEM � � � SERVICE W// II r - - - - - - - " 3NA5HER SHELF 1 (/ 1 i L SODA i 6, 2 X LOCK A I I �i MGFLURRY 1 I AA -'A MOP i I I Y5 5-TIER O 5T o I i EG2U I PMENT v A L Q f� HATER J HEATER SINKmowcB 0 i --- ICE ; � ------- OVERHEAD -- MEAT I '�lGOMBO J I ® Q FREEZER -®- . SHAKE/- IREEZ 1 15UNDAE i ^ N I �^ IL WORK TOP F YET LAND I N6 WORKTOP ii REFR I CG I L TABLE LCLAMJ L G BF?EAKER REFR I 6 I v }yI PANEL ( COFFEE I 1 CR I NDER — J X I t MON II T I i HOT GHOG j — 1 1 . � . - - - - - - - - � MUFFIN TOASTER/ I _ (CUP LID I I n G2' I N6 OVEN KY5 PREP TABLE �y - r HOLDER I I v u Q I = TABLE PRINTER F 1EATED RAILS _ UHG TABLE I I I v ^� (� PR I NTER1," - - - I - - - - �- �Y�� UHG UHG I I ' 1JAND I N6 ZONE- J J O —LNO 5 5 S N I OR I VE-THRU OVEN C RT 7 C I MON I TOR 5Y5TEM N 7- F- N � MUFF I RT I I SLANGY---- Z v T I S ^ TOASTERS TO E - - - - - - - vQ po ll. �v Q L - - - J JA - -- -a -1 - - - - - - - UIWOR v u .� ^� GREW A MANAGER'S TOP ARCH COFFEE BREWER J o Nam ~ KEY5T ION ROOM AREA FREEZER FRY 5-VAT FRY - - - - - - - - - - - - 77 - / F - - ^ F DRIVE-THRU n' ELECTRIC ' ` ISPENS STATION ICED TEA d MON I TOR I N 00 PANELS �� - Svc o KEYSTAT4 ON1 " Z w I I I IIIWT SYSTEM H6R _— 15cW o Y EN7T z 4 _ u T IO I I I I I , , 1/EN _ __ 000000 �� 4F- • -- - - ABOVE • uLU6 " TOMATO AUTO VI DEO 18 x 60 SABER B MONITOR L TV GOND I MENT ^ G COUNTER/ SYSTEM HOLDER DISPENSER � T- u- 1 43' -4" P�m m 1 K I TCHEN COVER SHEET SCALEs 1/4" = 1 ' -0" Q w 8 w W IT w m NOTESs A o 1 . ALL DIMENSIONS SHOWN ARE TAKEN TO FACE OF WALL FINISH. cv o Q ILU 0 O V x z o M Ca J 1 I M O 4-1 \ \ ^ ro aA ^ 8 o505TON > f<o A ITCHEN COVER 5HT